Document:

Stock Sale Plan Agreement

 Exhibit 4.2 
 EXECUTION COPY 
 STOCK SALE PLAN AGREEMENT 

This Stock Sale Plan Agreement (this “Agreement”) is entered into as of September 28, 2011, by and among
NuVasive, Inc., a Delaware corporation (“Acquiror”), the holders (the “Preferred Holders”) of Series A preferred stock and Series B preferred stock (collectively, the “Preferred
Stock”) of Impulse Monitoring, Inc., a Delaware corporation (“Target”), listed on Exhibit A hereto, and Robert W. Baird & Co. Incorporated (the “Broker”). Capitalized terms
not defined herein shall have the meanings set forth in the Merger Agreement (as defined below). 
 WHEREAS, pursuant to the
Agreement and Plan of Merger (the “Merger Agreement”), dated as of September 28, 2011, by and among Acquiror, Catamaran Acquisition Corporation, a Delaware corporation and wholly-owned subsidiary of Acquiror
(“Merger Sub”), Target and Tullis-Dickerson & Co., Inc., a Delaware corporation, in its capacity as stockholders’ agent, Merger Sub will merge with and into Target, with Target continuing as the surviving
corporation and wholly-owned subsidiary of Acquiror; 
 WHEREAS, pursuant to the terms of the Merger Agreement, the Merger
Consideration payable to the Preferred Holders for the shares of Preferred Stock held by such Preferred Holders shall be paid partially in cash and partially in shares of common stock, par value $0.001 per share (“Acquiror Common
Stock”), of Acquiror (the shares of Acquiror Common Stock issued to Preferred Holders as part of the Merger Consideration to be received by them pursuant to the Merger Agreement are referred to herein as the “Stock
Consideration”); 
 WHEREAS, Acquiror desires to place certain limitations on the sale of the Stock Consideration
as set forth herein, and the Preferred Holders have agreed to such limitations. 
 WHEREAS, as an integral part of the cash and
Stock Consideration to be received by Preferred Holders pursuant to the Merger Agreement, Acquiror has agreed to grant to the Preferred Holders certain contingent value rights relating to the Stock Consideration. 

NOW, THEREFORE, in consideration of the mutual covenants contained herein, the parties hereto agree as follows: 

Section 1. Appointment of Broker; Sale of Stock Consideration by Broker. 

(a) The Preferred Holders hereby appoint the Broker to sell on their behalf, pursuant to the terms of this Agreement, all of the Stock
Consideration that the Preferred Holders receive pursuant to the terms of the Merger Agreement and all of the True-Up Acquiror Common Stock, if any, received by the Preferred Holders pursuant to the terms of this Agreement. 

(b) Subject to the Volume Limitation contained in Section 2(a), the Broker shall sell all the Stock Consideration and True-Up
Acquiror Common Stock, if any, of the Preferred Holders during the Sell Down Period, at such prices and times, on such terms, to such counterparties and in such transactions as the Broker deems appropriate in its sole discretion and

  
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without any consultation with or advance notice to any of the Preferred Holders (subject in all cases to the Broker’s best execution obligations under applicable law and broker-dealer rules
and regulations). Acquiror and the Preferred Holders represent that the Broker’s obligation to sell any Stock Consideration and True-Up Acquiror Stock pursuant to this Agreement on behalf of the Preferred Holders shall be dependent on their
being an effective Shelf on file with the SEC allowing the Preferred Holders to sell the Stock Consideration and/or the True-Up Acquiror Common Stock, as the case may be, as contemplated by this Agreement, and as described in the Prospectus that has
been delivered to the Broker. Each sale of Stock Consideration and True-Up Acquiror Common Stock, if any, by the Broker shall (a) be made only pursuant to an effective Shelf on file with the SEC and (b) include each Preferred Holder’s
Pro Rata Share of the entire amount of Stock Consideration and True-Up Acquiror Common Stock, if any, included in such sale. A Preferred Holder’s “Pro Rata Share” shall equal the percentage obtained from a fraction, the
numerator of which is the number of shares of Acquiror Common Stock issued to such Preferred Holder as Stock Consideration, and the denominator of which is the aggregate number of shares of Acquiror Common Stock issued to all Preferred Holders as
Stock Consideration. The Pro Rata Share of each Preferred Holder is set forth on Exhibit A hereto. 

Section 2. Volume Limitation. 
 (a) On any trading day of Acquiror Common Stock on the NASDAQ Global Select Market (“NASDAQ”) following the Closing Date (each, a “Trading Day”), the Broker
shall not sell, on behalf of any Preferred Holder or, collectively, all of the Preferred Holders, Stock Consideration or True-Up Acquiror Common Stock, if any, totaling more than ten percent (10%) of the aggregate trading volume of Acquiror
Common Stock as traded on the NASDAQ on such Trading Day (the “Volume Limitation”) or such higher amount that may be approved by Acquiror in writing upon request by the Broker, on behalf of the Preferred Holders. 

(b) Until all Stock Consideration and True-Up Acquiror Common Stock, if any, has been sold pursuant to the terms of this Agreement, the
Broker shall provide a daily trade report to Acquiror and each Preferred Holder for each Trading Day in which a sale of any Stock Consideration and True-Up Acquiror Common Stock, if any, occurs and a weekly report of all Stock Consideration and
True-Up Acquiror Common Stock, if any, held by the Preferred Holders and summary of all sales of Stock Consideration and True-Up Acquiror Common Stock, if any, by the Broker on behalf of all Preferred Holders. 

Section 3. Adjustment Payment; Redemption. 

(a) Adjustment Payment. Subject to the proviso at the end of this paragraph (a), Acquiror shall make an Adjustment Payment (as
defined below, and with such payment being made pursuant to Section 3(a)(i) and 3(a)(ii), as applicable) to each Preferred Holder in an amount equal to (i) such Preferred Holder’s Pro Rata Share of the aggregate value of the Stock
Consideration (as valued at the closing price per share of the Acquiror Common Stock on the last full trading day on the NASDAQ Global Select Market prior the Closing pursuant to the terms set forth in Section 2.7(a) of the Merger Agreement)
multiplied by (x) the number of shares of Stock Consideration and True-Up Acquiror Common Stock, if any, sold by the Broker on behalf of such Preferred Holder during the applicable Sell Down Period (as defined below) divided by (y) the sum
of (I) the aggregate number of shares of Stock Consideration issued to such Preferred 

  
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Holder pursuant to the Merger Agreement and (II) True-Up Acquiror Common Stock issued to such Preferred Holder pursuant to this Agreement, less (ii) such Preferred Holder’s Net Proceeds
with respect to sales by the Broker on behalf of such Preferred Holder of Stock Consideration and True-Up Acquiror Common Stock, if any, during the applicable Sell Down Period; provided that in the event that such amount is a negative number,
then no Adjustment Payment shall be made to such Preferred Holder. The Broker shall provide a written certification to Acquiror and each Preferred Holder of any Adjustment Payment required to be made pursuant to this Section 3(a) within three
(3) Business Days after the applicable Adjustment Date and, unless Acquiror or any Preferred Holder raises any good faith objection(s) to the calculation of any Adjustment Payment(s) within three (3) Business Days after receipt of such
written certification, then Acquiror shall make the Adjustment Payment according to the terms set forth in Section 3(a)(i) or (ii), as applicable. The Broker shall not be responsible to any of the Preferred Holders for any shares of Acquiror
Common Stock comprising Stock Consideration or True-Up Acquiror Common Stock that the Broker was unable to sell pursuant to this Agreement due to the Volume Limitation, the limited duration of the Sell Down Period, market disruptions, legal,
regulatory or contractual restrictions or any other reason beyond the Broker’s reasonable control. 
 (i) In the event
that Acquiror elects to make any Adjustment Payments in cash, Acquiror shall, or shall cause the Paying Agent to, make such Adjustment Payments within three (3) Business Days after receipt of the written certification from the Broker of the
Adjustment Payment due and owing to each Preferred Holder pursuant to Section 3(a) and subject to any objection raised by Acquiror or any Preferred Holder as set forth in Section 3(a). 

(ii) In the event that Acquiror elects to make any Adjustment Payments in True-Up Acquiror Common Stock, Acquiror shall issue to each
Preferred Holder an amount of True-Up Acquiror Common Stock with a value as of the date of issuance equal to the Adjustment Payment for each such Preferred Holder. For these purposes, the shares of the True-up Acquiror Common Stock to be issued to
Preferred Holders shall be valued at the closing price per share (as published by Bloomberg) of Acquiror Common Stock on the last full Trading Day on the NASDAQ prior to the date of issuance thereof. Acquiror shall issue the True-Up Acquiror Common
Stock in book entry form to the Broker on behalf of each Preferred Holder within three (3) Business Days after receipt of the written certification from the Broker of the Adjustment Payment due and owing to each Preferred Holder pursuant to
Section 3(a), subject to any objection raised by Acquiror or any Preferred Holder as set forth in Section 3(a). In addition, the Sell-Down Period shall be extended for an additional thirty (30) Trading Days and the Volume Limitation
shall apply to sales by the Broker of such True-Up Acquiror Common Stock sold in this extended Sell-Down Period. If any further Adjustment Payments are required pursuant to Section 3(a) at the end of this extended Sell-Down Period and as it
applies to sales by the Broker on behalf of the Preferred Holders of the True-Up Acquiror Common Stock received by them, then Acquiror shall make such payments in cash within three (3) Business Days after receipt of the written certification
from the Broker of the additional Adjustment Payment due and owing to each Preferred Holder pursuant to Section 3(a), subject to any objection raised by Acquiror or any Preferred Holder as set forth in Section 3(a). 

(b) Redemption. In the event as of the Redemption Date a Shelf has been ineffective prior to the Redemption Date for more than the
number of Trading Days required for the Broker to sell the Stock Consideration and True-Up Acquiror Common Stock, if any, based 

  
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on the Volume Limitation, Acquiror agrees to purchase all of the unsold shares of Stock Consideration and True-Up Acquiror Common Stock, if any, held by or on behalf of Preferred Holders, if any,
on the Redemption Date, at the per share price equal to the Closing Acquiror Common Stock Price. 
 (c) Defined Terms

 (i) “Adjustment Date” shall mean the date that is thirty (30) Trading Days after the Shelf
Effective Date and, if applicable, the last day of any extended Sell Down Period under Section 3(a)(ii) or, if earlier in either case, when all the shares of Stock Consideration and True-Up Acquiror Common Stock, if any, have been sold by the
Broker pursuant hereto. 
 (ii) “Adjustment Payment” shall mean a payment made by Acquiror to the
Preferred Holders in the amount set forth in Section 3(a), which payment may be in the form of cash or additional shares of Acquiror Common Stock (“True-Up Acquiror Common Stock”), or any combination thereof, as
determined by Acquiror; provided, however, that any Adjustment Payment required to be made in connection with any extended Sell Down Period under Section 3(a)(ii) shall only be made in cash. 

(iii) “Net Proceeds” shall mean the cash proceeds payable to a Preferred Holder for sales of Stock Consideration
and True-Up Acquiror Common Stock during the Sell Down Period, net of the fees and commissions of the Broker set forth in Exhibit B hereto related to the sale of such Stock Consideration and True-Up Acquiror Common Stock by the Broker.

 (iv) “Redemption Date” shall mean the date that is ninety (90) days after the Closing.

 (v) “Sell Down Period” shall mean the period of time commencing on the Shelf Effective Date and
ending on the Adjustment Date. 
 (vi) “Shelf” shall mean the Registration Statement filed with the SEC
by Acquiror pursuant to Section 2.7 of the Merger Agreement. 
 (vii) “Shelf Effective Date” shall
mean the effective date of the Shelf. 
 (d) Dispute Resolution. The parties shall cooperate in good faith to resolve, as
promptly as practicable and in any event within ten (10) Business Days after such dispute or objection arises, any disputes or objections raised under Section 3(a) with respect to the amount of any Adjustment Payments required thereunder.

 Section 4. Broker’s Fees/Commissions. In exchange for its services hereunder, the Broker shall
be entitled to receive the amount set forth on Exhibit B hereto; provided, however, that no commissions shall be charged by the Broker for any redemptions made by Acquiror pursuant to the terms hereof. With respect to each Preferred Holder,
the Broker shall be entitled to withhold such amount from the proceeds received from sales of each share of Stock 

  
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Consideration and True-Up Acquiror Common Stock by the Broker on behalf of each such Preferred Holder. 
 Section 5. Stockholder Acknowledgment. Each Preferred Holder hereby acknowledges that Acquiror has not provided any advice, financial or otherwise, to such Preferred Holder with
respect to the matters set forth herein. 
 Section 6. Representations and Warranties. Each party represents
and warrants to the other parties as follows: 
 (a) It is duly organized and validly existing under the laws of its
jurisdiction of organization and has all requisite corporate or other power, as applicable, to own its properties and to carry on its business as it is now conducted. 
 (b) It has all requisite corporate or other power, as applicable, and authority to enter into this Agreement and to consummate the transactions contemplated by this Agreement. The execution and delivery
of this Agreement and the consummation of the transactions contemplated by this Agreement have been approved by all necessary actions and no other proceedings on its part are necessary to authorize the execution and delivery of this Agreement by it
and the consummation of the transactions contemplated by this Agreement. This Agreement has been duly executed and delivered by it and, assuming the due authorization, execution and delivery of this Agreement by the other parties hereto, constitutes
a valid and binding obligation of it, enforceable against it in accordance with its terms. 
 (c) The execution and delivery by
it of this Agreement and the consummation of the transactions contemplated by this Agreement do not and will not (a) conflict with or result in a breach of any provision of any of its organizational documents, (b) result in a violation or
breach of or constitute a default (or an event which, with or without notice or lapse of time or both, would constitute a default) under, or result in the termination, modification or cancellation of, or the loss of a benefit under or accelerate the
performance required by, or result in a right of termination, modification, cancellation or acceleration under the terms, conditions or provisions of any material contract or other material instrument of any kind to which it is now a party or by
which it may be bound or affected, or (c) violate any Legal Requirement applicable to it other than in the case of clauses (b) and (c) as would not prevent or delay the timely consummation of the transactions contemplated by this
Agreement. 
 (d) No declaration, filing or registration with, or notice to, or authorization, consent, order or approval of,
any Governmental Entity or other Person is required to be obtained or made in connection with or as a result of the execution and delivery of this Agreement by it or the consummation of its obligations under and in accordance with this Agreement
except for (i) applicable requirements, if any, of the Securities Act, the Exchange Act, or the rules and regulations of the NASDAQ or (ii) such other consents, authorizations, filings, approvals and registrations which, if not obtained or
made, would not prevent or delay the timely consummation of the transactions contemplated by this Agreement. 

  
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 Section 7. Additional Representations and Warranties of Preferred
Holders. 
 Each of the Preferred Holders makes the following representations and warranties to the Broker: 

(a) Such Preferred Holder is not as of the date hereof in possession of material, non-public information regarding Acquiror or any of its
Subsidiaries and is entering into this Agreement in good faith and not as part of any scheme or plan to evade compliance with securities laws. 
 (b) Such Preferred Holder is not as of the date hereof and will not be upon completion of the Merger an “affiliate” of Acquiror or have any Section 13 or Section 16 reporting
obligations with regard to any sales of the Stock Consideration. 
 (c) Such Preferred Holder will own his or its Pro Rata Share
of the Stock Consideration free and clear of any liens, pledges, security interests, encumbrances, claims or charges or any legal or contractual resale restrictions other than as set forth in this Agreement or under applicable law. 

(d) Such Preferred Holder will not have any authority, influence or control over any sales of the Stock Consideration by the Broker
pursuant to this Agreement (it being understood that nothing herein shall limit such Preferred Holder’s rights in the event of a breach of this Agreement by the Broker or Acquiror). 

Section 8. Additional Representations and Warranties of Acquiror. Until this Agreement is terminated in accordance
with Section 14, Acquiror represents and warrants to each Preferred Holder that it has, or will have, a sufficient amount of cash available to satisfy its obligations hereunder. 

Section 9. Characterization of Rights. 

(a) The parties agree that this Agreement, including each Preferred Holder’s right to receive payments hereunder, is an integral
part of the Merger Consideration paid in connection with the transactions contemplated by the Merger Agreement. 
 (b) The
rights contained in this Agreement are not be evidenced by any certificate or other instrument. 
 (c) This Agreement does not
grant or provide any voting or dividend rights with respect to any Acquiror Common Stock (it being understood, however, that this clause shall not affect the voting and dividend rights that are represented by the Stock Consideration or True-Up
Acquiror Common Stock held by or on behalf of the Preferred Holders). 
 (d) This Agreement does not represent or provide any
equity or ownership interest in Acquiror (it being understood, however, that this clause shall not affect the equity and ownership rights in Acquiror that are represented by the Stock Consideration or True-Up Acquiror Common Stock held by or on
behalf of the Preferred Holders). 

  
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 (e) No amount of interest shall accrue on amounts that may become payable under this
Agreement. 
 Section 10. Notices. All notices and other communications hereunder shall be in writing
and shall be deemed duly delivered: (i) upon receipt if delivered personally; (ii) two (2) Business Days after being sent by commercial overnight courier service; or (iii) upon transmission if sent via facsimile with confirmation
of receipt, in each case to the parties at the following address (or at such other address for a party as shall be specified upon like notice): 
  

			
	 If to Acquiror:

		
		 	 NuVasive, Inc.

		 	 7475 Lusk Boulevard

		 	 San Diego, CA 92121

		 	 Attention: General Counsel

		 	 Fax: (858) 909-2479

	
	 With a copy to:

		
		 	 DLA Piper LLP (US)
 4365
Executive Drive, Suite 1100

		 	 San Diego, CA 92121

		 	 Attn: Michael Kagnoff

		 	Fax: (858) 456-3075

 If to a Preferred Holder, at the address of such Preferred Holder (and with copies to such Persons as are
specified thereon, if any) as set forth on Exhibit A hereto under the heading entitled “Notice Information.” 
  

			
	 If to Broker:

		
		 	 Robert W. Baird & Co. Incorporated

		 	 777 East Wisconsin Avenue

		 	 Milwaukee, WI 53202

		 	 Attn: John Roesner

		 	 Fax: (414) 298-6120

	
	 With a copy to:

		
		 	 Robert W. Baird & Co. Incorporated

		 	777 East Wisconsin Avenue
		 	 Milwaukee, WI 53202

		 	 Attn: General Counsel

		 	 Fax: (414) 298-7800

 Section 11. Binding Effect. This Agreement shall be binding upon the respective
parties hereto and their heirs, executors, successors and assigns. 

  
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 Section 12. Modifications. This Agreement may not be altered or
modified without a writing signed by Acquiror and Preferred Holders holding two-thirds (2/3) of the Stock Consideration issued to the Preferred Holders at the Closing; provided, however, that no such alteration or amendment may
materially change the Broker’s rights and obligations hereunder without the prior written consent of the Broker, which will not be unreasonably withheld. Conduct or lack of conduct shall not constitute a waiver of any of the terms and
conditions of this Agreement, and no waiver shall be valid unless such waiver is specified in writing, and then only to the extent so specified. A waiver of any of the terms and conditions of this Agreement on one occasion shall not constitute a
waiver of the other terms of this Agreement, or of such terms and conditions on any other occasion. 

Section 13. Equitable Relief. Each of the parties hereto acknowledges and agrees that there would be
irreparable harm, damages would be difficult to determine and there would not be any adequate remedy at law in the event that any of the provisions of this Agreement were not performed by the parties in accordance with their specific terms or were
otherwise breached. Accordingly each of the parties agrees that the parties shall be entitled to an injunction or injunctions to prevent breaches of this Agreement and to enforce specifically the terms and provisions of this Agreement, this being in
addition to any other remedy to which the parties are entitled at law or in equity. 
 Section 14.
Termination. This Agreement shall terminate on the date on which Acquiror’s obligations hereunder have been fulfilled in full. 
 Section 15. Governing Law. This Agreement shall be governed by and construed in accordance with the laws of the State of Delaware without reference to such state’s
principles of conflicts of law. The parties hereto hereby irrevocably submit to the exclusive jurisdiction of the courts of the State of Delaware and the Federal courts of the United States of America located within the State of Delaware, in respect
of the interpretation and enforcement of the provisions of this Agreement, and in respect of the transactions contemplated hereby and thereby, and hereby waive, and agree not to assert, as a defense in any action, suit or proceeding for the
interpretation or enforcement hereof or thereof, that it is not subject thereto or that such action, suit or proceeding may not be brought or is not maintainable in said courts or that the venue thereof may not be appropriate or that this Agreement
or any such document may not be enforced in or by such courts, and the parties hereto irrevocably agree that all claims with respect to such action or proceeding shall be heard and determined in such a Delaware State or Federal court. The parties
hereby consent to and grant any such court jurisdiction over the person of such parties and over the subject matter of such dispute and agree that mailing of process or other papers in connection with any such action or proceeding in the manner
provided in Section 5 or in such other manner as may be permitted by applicable Legal Requirements, shall be valid and sufficient service thereof. With respect to any particular action, suit or proceeding, venue shall lie solely in the
State of Delaware. 
 Section 16. Counterparts. This Agreement may be executed in one or more
counterparts, all of which shall be considered one and the same agreement and shall become effective when one or more counterparts have been signed by each of the parties and delivered to the other parties, it being understood that all parties need
not sign the same counterpart and such counterparts may be delivered by the parties hereto via facsimile or electronic communication. 

  
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 Section 17. Severability. In the event that any provision of this
Agreement or the application thereof becomes or is declared by a court of competent jurisdiction to be illegal, void or unenforceable, the remainder of this Agreement will continue in full force and effect and the application of such provision to
other persons or circumstances will be interpreted so as reasonably to effect the intent of the parties hereto. The parties further agree to replace such void or unenforceable provision of this Agreement with a valid and enforceable provision that
will achieve, to the extent possible, the economic, business and other purposes of such void or unenforceable provision. 

Section 18. Entire Agreement. This Agreement constitutes the entire agreement between the parties hereto and
supersedes any prior agreement between the parties hereto (whether oral or written), in each case with respect to the subject matter hereof. 
 Section 19. Assignment; Parties in Interest. Neither this Agreement nor any rights or obligations hereunder may be assigned by any party without the prior written consent of the
other parties hereto, except by operation of law. Nothing under this Agreement shall be construed to give any rights or benefits in this Agreement to anyone other than the parties hereto (and their heirs, successors and permitted assigns), and
the duties and responsibilities undertaken pursuant to this Agreement shall be for the sole and exclusive benefit of the parties hereto (and their heirs, successors and permitted assigns). 

Section 20. Interpretation. 
 (a) When a reference is made in this Agreement to a Section hereof, such reference shall be to a Section of this Agreement unless otherwise indicated. 

(b) The headings contained in this Agreement are for reference purposes only and shall not affect in any way the meaning or
interpretation of this Agreement. 
 (c) The words “include,” “includes” or “including” shall be
deemed to be followed by the words “without limitation.” 
 (d) The words “hereof,” “herein” and
“hereunder” and words of similar import, when used in this Agreement, refer to this Agreement as a whole and not to any particular provision of this Agreement. 
 (e) All terms defined in this Agreement have their defined meanings when used in any certificate or other document made or delivered pursuant hereto, unless otherwise defined therein. 

(f) The definitions contained in this Agreement are applicable to the singular as well as the plural forms of such terms. 

(g) If any action is to be taken by any party hereto pursuant to this Agreement on a day that is not a Business Day, such action shall be
taken on the next Business Day following such day. 
 (h) References to a Person are also to its permitted successors and
assigns. 

  
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 (i) The use of “or” is not intended to be exclusive unless expressly indicated
otherwise. 
 Section 21. Effective Time and Exhibit A. This Agreement shall be conditioned on, and
shall take effect as of, the Closing. Exhibit A shall be completed by the parties as of the Closing. 
 [Remainder of Page
Intentionally Left Blank] 

  
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 IN WITNESS WHEREOF, the parties hereto have caused this Stock Sale Agreement to be executed
by their respective authorized persons, hereunto duly authorized, as of the day and year first above written. 
  

			
	 ACQUIROR:

	
	 NUVASIVE, INC.

		
	By:	 	 /s/ Alexis V. Lukianov

	Name:	 	Alexis V. Lukianov
	Title:	 	Chairman and Chief Executive Officer
	
	 BROKER:

	
	 ROBERT W. BAIRD & CO.
 INCORPORATED

		
	By:	 	 /s/ Travis R. Lacey

	Name:	 	Travis R. Lacey
	Title:	 	Vice President
	
	 SERIES A PREFERRED HOLDER:

	
	 ROGER A. CONLEY

		
	By:	 	 /s/ Roger A Conley

	Name:	 	Roger A. Conley
	
	 SERIES A PREFERRED HOLDER:

	
	 THOMAS E. CONLEY, M.D.

		
	By:	 	 Thomas E. Conley

	Name:	 	Thomas E. Conley, M.D.

 
			
	 SERIES A PREFERRED HOLDER:

 
 ERMA GRACE CONLEY
 REVOCABLE TRUST U/A 09-22-89

		
	By:	 	 /s/ John H. Conley

	Name:	 	 John H. Conley

	Title:	 	Trustee
	
	SERIES A PREFERRED HOLDER:
	
	RICHARD O’BRIEN, M.D.
		
	By:	 	 /s/ Richard O’Brien

	Name:	 	Richard O’Brien, M.D.
	
	SERIES A PREFERRED HOLDER:
	
	CARL CADWELL
		
	By:	 	 /s/ Carl Cadwell

	Name:	 	Carl Cadwell
	
	SERIES A PREFERRED HOLDER:
	
	ROBERT MORRIS REVOCABLE TRUST
		
	By:	 	 /s/ Robert Morris

	Name:	 	Robert Morris
	Title:	 	Trustee

 
			
	 SERIES A PREFERRED HOLDER:

	
	 GREGORY ENTERPRISES, LLC

		
	By:	 	 /s/ W. Grant Gregory

	Name:	 	W. Grant Gregory
	Title:	 	Manager
	
	 SERIES A PREFERRED HOLDER:

	
	 TULLIS-DICKERSON CAPITAL
 FOCUS III, L.P.

	  
 By: Tullis-Dickerson Partners III,
L.L.C.,
 its general partner

		
	By:	 	 /s/ James L.L. Tullis

	Name:	 	James L.L. Tullis
	 Title:
	 	Manager
	  
 SERIES B PREFERRED HOLDER:

	  
 TULLIS-DICKERSON CAPITAL

FOCUS III, L.P.

	  
 By: Tullis-Dickerson Partners III,
L.L.C.,
 its general partner

		
	By:	 	 /s/ James L.L. Tullis

	Name:	 	James L.L. Tullis
	 Title:
	 	Manager
	
	SERIES B PREFERRED HOLDER:
	
	 ASCENSION HEALTH, as Fiscal Agent
 and Nominee for Certain Wholly Owned
 Subsidiaries

		
	 By:
	 	 /s/ Anthony J. Speranzo

	 Name:
	 	Anthony J. Speranzo
	 Title:
	 	 Senior Vice President and Chief
 Financial Officer

 Exhibit A* 

Preferred Holders 
  

													
	 Preferred Holder
	  	Series
of
Target
Preferred
Stock	  	Number of Shares
of
Acquiror
Common Stock
Received as
Stock
Consideration	 	  	Pro Rata Share	 	 	 Notice Information**

	 Ascension Health, as

Fiscal Agent and Nominee

for Certain Wholly

Owned Subsidiaries
	  	B	  	 	471,477	  	  	 	20.181362897	% 	 	 Ascension Health Ventures, LLC
 4600 Edmundson Road
 11775 Borman Drive | Suite 310

St. Louis, MO 63146
 Attention: Matthew I.
Hermann
 Fax: (410) 740-1093
  

with a copy to:
  
 Goodwin Proctor
 Exchange Place
 53 State Street
 Boston, MA 02109
 Attention: Amber Dolman
 Fax: (617) 523-1231

					
	 Carl Cadwell
	  	A	  	 	51,067	  	  	 	2.185900180	% 	 	 Carl Cadwell, D.D.S.

Cadwell Laboratories, Inc.
 909 North Kellogg
Street
 Kennewick, WA 99336
 Fax: (509)
783-6503

					
	 Roger A. Conley
	  	A	  	 	257,461	  	  	 	11.020503382	% 	 	 Roger A. Conley
 5517
Chamberlin Avenue
 Chevy Chase, MD 20815

Fax: (301) 275-4659

											
	 Thomas E. Conley, M.D.
	  	A	  	 	287,443	  	  	12.303869532%	  	 Thomas E. Conley, M.D.
 111
Sendera Bonita
 Lakeway, TX 78734

					
	 Erma Grace Conley

Revocable Trust U/A 09-

22-89
	  	A	  	 	53,942	  	  	2.308963274%	  	 Erma Grace Conley Revocable Trust
 3900 Underwood Ave, Suite 100
 Omaha, NE 68114

Attention: John H. Conley

					
	 Richard O’Brien, M.D.
	  	A	  	 	10,530	  	  	0.450731958%	  	 Dr. Richard O’Brien
 820
Boxcar Drive
 Westminster, MD 21157

					
	 Gregory Enterprises, LLC
	  	A	  	 	48,617	  	  	2.081029021%	  	 Gregory Enterprises
 c/o
Gregory & Hoenemeyer, Inc.
 One Greenwich Office Park, North Building
 Greenwich, CT 06831

					
	 Robert Morris Revocable

Trust
	  	A	  	 	48,617	  	  	2.081029021%	  	 Olympus Partners
 One Station
Place
 Stamford, CT 06902
 Attention:
Robert Morris

					
	 Tullis-Dickerson Capital

Focus III, L.P.
	  	A and B	  	 	1,107,046	  	  	47.386610735%	  	 Tullis-Dickerson Capital Focus III, L.P.
 One Stamford Plaza
 263 Tresser Boulevard
 Stamford, CT 06901
 Attention: General Partner

Fax: (203) 323-5300

									
		  		  		  		  	 with a copy to:
  

Pepper Hamilton, LLP
 400 Berwyn Park

899 Cassatt Road
 Berwyn, PA 19312

Attention: Christopher A. Rossi
 Fax: (267)
200-0865

  

	*	To be completed at Closing. 

	**	Any notice delivered to a Preferred Holder shall also be copied to: 

 Clifford Chance US LLP 
 31 West 52nd Street 

New York, New York 10019 
 Attention: Benjamin K. Sibbett 
 Fax: (212) 878-8375 

 Exhibit B 
 Robert W. Baird & Co. Incorporated Fees & Commissions 
 $0.03 per
share of Stock Consideration and True-Up Acquiror Common Stock sold.Instrument of Resignation, Appointment and Acceptance

 Exhibit 10.1 
 THIS INSTRUMENT OF RESIGNATION, APPOINTMENT AND ACCEPTANCE (this “Instrument”), dated to be effective as of October 7, 2011 (the “Effective Date”), is by and among
TRAILER BRIDGE, INC. (the “Company”), a Delaware corporation, WELLS FARGO BANK, NATIONAL ASSOCIATION (the “Resigning Trustee”), a national banking association organized and existing under the laws of the United
States having its principal corporate trust office in Minneapolis, Minnesota, DEUTSCHE BANK TRUST COMPANY AMERICAS, as successor trustee (the “Successor Trustee”), a New York banking corporation, having its corporate trust office in
New York, NY, and CORPORATION SERVICE COMPANY®, a Delaware corporation, and its affiliates, including LexisNexisTM Document Solutions Inc. (collectively, the “Collateral Agent”). Capitalized terms used but not defined in
this Instrument have the meanings given in the Indenture (as defined below). 
 RECITALS 

WHEREAS, pursuant to an Indenture, dated as of December 1, 2004, between the Company and the Resigning Trustee,
the Company issued its 9 1/4% Senior Secured Notes
due 2011 (the “Notes”); 
 WHEREAS, the Company appointed the Resigning Trustee as the indenture trustee (the
“Trustee”), paying agent (the “Paying Agent”), and registrar (the “Registrar”) under the Indenture; 
 WHEREAS, there are presently issued and outstanding $82,500,000 in aggregate principal amount of the Notes; 
 WHEREAS, the Indenture provides that the Trustee may resign in writing at any time and be discharged from the trust created therein by so notifying the Company; 

WHEREAS, the Indenture further provides that, if the Trustee resigns, the Company shall promptly appoint a successor Trustee; 

WHEREAS, the Resigning Trustee desires to resign, and the Company desires to appoint the Successor Trustee as Trustee, Paying Agent, and
Registrar to succeed the Resigning Trustee in such capacities under the Indenture and in its respective capacities under the other documents executed by the Resigning Trustee in connection with or related to the Indenture (collectively, the
“Documents”); and 
 WHEREAS, the Successor Trustee is willing to accept the appointment as Trustee, Paying Agent, and
Registrar under the Indenture and the Documents. 
 NOW, THEREFORE, in consideration of the covenants set
forth herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 
 1. Acceptance of Resignation of Resigning Trustee and Appointment of Successor Trustee. The Company hereby accepts the resignation of the Resigning Trustee as Trustee, Paying Agent, and
Registrar under the Indenture and the Documents. Pursuant to Section 7.08 of the Indenture, the Company hereby appoints the Successor Trustee as Trustee, 

 
Paying Agent, and Registrar under the Indenture and the Documents, and vests and confirms to the Successor Trustee all the rights, powers, and duties of the Trustee under the Indenture and the
Documents. The Company and the Resigning Trustee shall execute and deliver such further instruments and shall do such other things as the Successor Trustee may reasonably request so as to more fully and certainly vest and confirm in the Successor
Trustee all the rights, powers, and duties assigned, transferred, delivered, and confirmed hereunder. 
 2. Company
Representations and Warranties. The Company hereby represents and warrants to the Successor Trustee that: 
  

	 	a.	It is duly organized and validly existing; 

  

	 	b.	It has full power, authority and right to execute, deliver and perform this Instrument, and has taken all action necessary to authorize the execution, delivery and
performance by it of this Instrument; 

  

	 	c.	This Instrument has been duly authorized, executed and delivered on behalf of the Company and constitutes a legal, valid and binding obligation enforceable against it
in accordance with its terms, except as such enforcement may be limited by bankruptcy, insolvency, reorganization, moratorium, liquidation, or other similar laws affecting the enforcement of creditors’ rights generally, and by general
principles of equity; 

  

	 	d.	It has not entered into any amendment or supplement to the Indenture or any of the Documents, and the Indenture and the Documents are in full force and effect;

  

	 	e.	Except as identified in Annex A, no Event of Default and no default exist under the Indenture or any of the Documents; 

 

	 	f.	Annex B represents a complete list of the Documents to which the Resigning Trustee is a party; 

 

	 	g.	No covenant or condition contained in the Indenture or the Documents has been waived by the Holders of the percentage in aggregate principal amount of the Notes
required by the Indenture to effect any such waiver; 

  

	 	h.	The Notes are validly issued securities of the Company; 

  

	 	i.	The Trustee has a valid and perfected first lien on, and security interest in, the Collateral for the benefit of the Holders of Notes; and 

 

	 	j.	The Company’s execution and delivery of this Instrument do not and will not conflict with, or result in a breach of, any of the terms or provisions of, or
constitute a default under, any (i) contract, agreement, indenture, or other instrument (including, without limitation, the Company’s certificate of incorporation and by-laws) to which the Company is a party or by which the Company or its
property is bound, or (ii) any judgment, decree, or order of any court or governmental agency or regulatory body or law, rule, or regulation applicable to the Company or its property. 

  
 - 2 -

 3. Resigning Trustee Representations and Warranties. The
Resigning Trustee hereby represents and warrants to the Successor Trustee that: 
  

	 	a.	This Instrument has been duly authorized, executed and delivered on behalf of the Resigning Trustee and constitutes a legal, valid and binding obligation enforceable
against it in accordance with its terms, except as such enforcement may be limited by bankruptcy, insolvency, reorganization, moratorium, liquidation, or other similar laws affecting the enforcement of creditors’ rights generally, and by
general principles of equity; 

  

	 	b.	It has not entered into any amendment or supplement to the Indenture or any of the Documents except as noted herein, and the Indenture and the Documents are in full
force and effect; 

  

	 	c.	No covenant or condition contained in the Indenture or the Documents has been waived by the Resigning Trustee or, to the best of the knowledge of the Resigning Trustee,
by the Holders of a percentage in aggregate principal amount of the Notes required by the Indenture to effect any such waiver; 

  

	 	d.	There is no action, suit, or proceeding pending or, to the best of the knowledge of the Resigning Trustee threatened, against the Resigning Trustee before any court or
governmental authority arising out of any action or omission by the Resigning Trustee as Trustee, Paying Agent, and Registrar under the Indenture or the Documents; 

 

	 	e.	It has made, or promptly will make, available to the Successor Trustee originals, if available, or copies in its possession, of the Indenture and the Documents relating
to the trusts (the “Trusts”) created by the Indenture and all written information in the possession of its corporate trust administration department relating to the administration and status of the Trusts and shall do such other things as
the Successor Trustee may reasonably request to more fully vest and confirm in the Successor Trustee all the rights, powers, and duties assigned hereby to the Successor Trustee; 

 

	 	f.	To the best of its knowledge, it has lawfully discharged its duties as Trustee, Paying Agent, and Registrar under the Indenture and the Documents; and

  

	 	g.	There are presently issued and outstanding $82,500,000 in aggregate principal amount of the Notes and interest has been paid through May 15, 2011.

 4. Successor Trustee Representation and Warranty. The Successor Trustee
represents and warrants to the Resigning Trustee and the Company that it is qualified and eligible to serve as Trustee, Paying Agent, and Registrar under the Indenture, the Documents, and the Trust Indenture Act of 1939, as amended. 

  
 - 3 -

 5. Acceptance by Successor Trustee. The Successor
Trustee hereby accepts its appointment, as of the Effective Date, as Trustee, Paying Agent, and Registrar under the Indenture and the Documents, and assumes all rights, powers, and duties of the Trustee, Paying Agent, and Registrar thereunder,
subject to the terms and conditions therein. 
 6. Assignment by Resigning Trustee. The
Resigning Trustee hereby confirms, assigns, transfers, delivers, and conveys, as of the Effective Date, to the Successor Trustee, as Trustee, Paying Agent, and Registrar under the Indenture and the Documents, all rights, powers, and duties, which
the Resigning Trustee, as Trustee, Paying Agent, and Registrar now holds under and by virtue of the Indenture and the Documents, and shall pay over to the Successor Trustee any and all property and moneys held by the Resigning Trustee under and by
virtue of the Indenture and the Documents, subject to the lien provided by Section 7.07 of the Indenture, which lien the Resigning Trustee expressly reserves to the fullest extent necessary to secure the Company’s obligations under said
Section to the Resigning Trustee and which lien shall also secure the Company’s obligations under said Section to the Successor Trustee. 
 7. Further Assurances by the Company. On or promptly after the Effective Date, the Company (with the cooperation of the Successor Trustee) shall make, or cause to be made, at its sole
expense, all necessary or reasonably requested filings and take all other actions necessary or reasonably requested to assign or transfer of record, or maintain the validity, perfection and priority of the Liens on the Collateral in favor of the
Successor Trustee. 
 8. Resigning Trustee’s Lien and Payment of Fees, Expenses and Indemnification.
Notwithstanding this Instrument and the resignation of the Resigning Trustee, the Resigning Trustee shall retain all rights and entitlements relating to its service as Trustee, Paying Agent, and Registrar under the Indenture arising or accruing on
or before the Effective Date, including without limitation, all entitlements to the payment of its fees and reimbursement of its expenses, regardless of when such amounts become payable or are paid. In the event and to the extent the Successor
Trustee shall exercise any lien upon the distributions to holders of the Notes for any reason at a time when the Resigning Trustee has not been fully paid, it shall do so for both its own fees and expenses and the outstanding fees and expenses of
the Resigning Trustee, incurred in connection with its duties under the Indenture and as permitted under the Indenture prior to the Effective Date, and any subsequent transitional services requested by the Successor Trustee from the Resigning
Trustee after the Effective Date. The Successor Trustee shall promptly pay over a pro rata portion of any and all such proceeds to the Resigning Trustee when and as received up to the amount then due the Resigning Trustee to the extent not directly
received from the Company. To the extent the Resigning Trustee receives funds from the Company, other than for payment of the Resigning Trustee’s fees and expenses as Trustee, it agrees to hold those funds as agent for the Successor Trustee and
promptly pay over such funds to the Successor Trustee. 
 9. Additional Documentation. The Company and the
Resigning Trustee, for the purposes of more fully and certainly vesting in and confirming to the Successor Trustee, as Trustee, Paying Agent, and Registrar, said rights, powers, and duties agree, upon reasonable request of the Successor Trustee, to
execute, acknowledge, and deliver such further instruments of conveyance and further assurance and to do such other things as may reasonably be required for more fully and certainly vesting and confirming to the Successor Trustee all rights, powers,
and duties which the Resigning Trustee now holds under and by virtue of the Indenture and the Documents, all at the cost of the Company. 

  
 - 4 -

 10. Acknowledgement of Collateral Agent. The Collateral Agent hereby
acknowledges the resignation of the Resigning Trustee and that, as of the Effective Date, it shall act as agent for the Successor Trustee as to any Collateral with respect to which a certificate of title has been issued. 

11. This Instrument and the resignation, appointment, and acceptance effected hereunder shall be effective as of the close of
business on the Effective Date; provided, however, that the resignation of the Resigning Trustee as Registrar and Paying Agent and appointment of the Successor Trustee as Registrar and Paying Agent shall be effective as of the close of
business 10 business days after the Effective Date. 
 12. The reasonable fees, costs and expenses incurred by
(A) the Successor Trustee and its counsel, and (B) the Resigning Trustee and its counsel, in connection with the negotiation, drafting, execution, and implementation of this Instrument shall be paid by the Company on or prior to the
Effective Date or as soon as practical thereafter. 
 13. The Successor Trustee is not assuming any obligation or
liability under the Indenture or the Documents for any act or omission occurring prior to the Effective Date. 
 14.
Pursuant to the requirements of Section 7.08 of the Indenture, on or promptly after the Effective Date, the Successor Trustee shall distribute a notice to the Holders of the Notes in the form attached hereto as Annex C. 

15. No amendment shall be made to this Instrument without the written consent of all parties hereto which may be provided in
counterparts. 
 16. The Company acknowledges that, in accordance with Section 326 of the USA Patriot Act, the
Successor Trustee, like all financial institutions, is required to obtain, verify, and record information that identifies each person or legal entity that establishes a relationship or opens an account with the Successor Trustee. The Company agrees
that it will provide Successor Trustee with such information as it may request in order for it to satisfy the requirements of the USA Patriot Act. 
 17. Governing Law. This Instrument shall be governed by and construed in accordance with the laws of the State of New York. 

18. Counterparts. This Instrument may be executed in any number of counterparts, each of which shall
be an original, but such counterparts shall together constitute one and the same instrument. Delivery of a counterpart hereof by facsimile transmission or by e-mail transmission of an Adobe portable document format file (also known as a
“PDF” file) shall be effective as delivery of a manually executed counterpart hereof. 

  
 - 5 -

 19. Notices. All notices, whether faxed or mailed will be deemed received when
sent pursuant to the following instructions: 
 TO THE RESIGNING TRUSTEE: 
 Wells Fargo Bank, N.A. 
 Attn: James R. Lewis 

45 Broadway - 12th Floor 
 New York, New York
10006 
 Telephone: (212) 515-5258 

Facsimile: (866) 524-4681 
 TO THE
SUCCESSOR TRUSTEE: 
 Deutsche Bank Trust Company Americas 
 Attn: Stanley Burg 
 60 Wall Street, MSNYC60-2720 

New York, NY 10005 
 Telephone:
(212) 250-5280 
 Facsimile: (212) 797-8610 
 TO THE COMPANY: 
 Trailer Bridge, Inc. 
 Attn: William G. Gotimer, Jr. 
 10405 New Berlin Rd. East 

Jacksonville, FL 32226 
 Telephone: 516-208-8138

 Facsimile: (904) 751-7444 
 TO
THE COLLATERAL AGENT: 
 Corporation Service Company 
 Attn: Janet Brown 
 801 Adlai Stevenson Drive 

Springfield, IL 62703 
 Telephone:
(217) 544-5900 x3754 
 Facsimile: (800) 611-0524 
 [Signatures to follow] 

  
 - 6 -

 IN WITNESSETH WHEREOF, the parties have executed this Instrument to be deemed
effective as of the day and year first above written. 
  

							
	Dated: October     , 2011	 		 	 TRAILER BRIDGE, INC.
  

 

		 		 	By:	 	
		 		 	Its:	 	
	  
 Dated: October     , 2011
	 		 	  
 WELLS FARGO BANK,

		 		 	 NATIONAL ASSOCIATION
  

 

		 		 	By:	 	James R. Lewis
		 		 	Its:	 	Vice President
	  
 Dated: October     , 2011
	 		 	  
 DEUTSCHE BANK TRUST
COMPANY

		 		 	 AMERICAS
  

 

		 		 	By:	 	Stanley Burg
		 		 	Its:	 	Vice President
		 		 	  
 and

 
  

		 		 	By:	 	Rodney Gaughan
		 		 	Its:	 	Vice President
	  
 Dated: October     , 2011
	 		 	  
 CORPORATION SERVICE COMPANY

 
  

		 		 	By:	 	Jackie Smetana
		 		 	Its:	 	Vice President

  

  
 - 7 -

 ANNEX A 

EVENTS OF DEFAULT AND DEFAULTS 

Section 4.04(a) of the Indenture requires the Company to deliver an Officer’s Certificate to the Trustee within 90 days after the end of each
fiscal year. As more fully set forth therein, the Officer’s Certificate must state that the Company conducted a review of its activities during the preceding fiscal year and that no Default or Event of Default occurred during such year, and
that no event has occurred which prohibits payment on account of the principal of or premium or interest on the Notes. The Company was required to deliver an Officer’s Certificate for the period ending December 31, 2010, on March 31,
2011, and it failed to do so. Such failure constitutes a Default under section 4.04(a) of the Indenture. Unless cured by October 30, 2011, such Default shall constitute an Event of Default under Section 6.01(e) of the Indenture.

 ANNEX B 

DOCUMENTS 
  

	1.	Indenture, dated as of December 1, 2004, between Trailer Bridge, Inc. and Wells Fargo Bank, National Association, as Trustee 

 

	2.	First Preferred Fleet Mortgage, dated as of December 1, 2004, between Trailer Bridge, Inc. and Wells Fargo Bank, Nation Association, as Trustee

  

	3.	Mortgage and Security Agreement, dated December 1, 2004, between Trailer Bridge, Inc. and Wells Fargo Bank, National Association, as Trustee

  

	4.	Security Agreement, dated as of December 1, 2004, between Trailer Bridge, Inc. and Wells Fargo Bank, National Association, as Trustee 

 

	5.	Assignment of Earnings, dated as of December 1, 2004, between Trailer Bridge, Inc. and Wells Fargo Bank, National Association, as Trustee 

 

	6.	Assignment of Insurances, dated as of December 1, 2004, between Trailer Bridge, Inc. and Wells Fargo Bank, National Association, as Trustee

  

	7.	Access Agreement, dated as of December 1, 2004, among Trailer Bridge, Inc., Wells Fargo Bank, National Association, as Trustee, and Congress Financial Corporation
(Florida) 

 ANNEX C 

FORM OF NOTICE TO HOLDERS OF
NOTES 
 [LETTERHEAD OF SUCCESSOR TRUSTEE] 

NOTICE 
 Cusip
Numbers*:              
 To the Holders of Trailer Bridge, Inc. 

9 1/4% Senior Secured Notes Due 2011 (the “Notes”) 

NOTICE IS HEREBY GIVEN, in the manner provided in Section 7.08 of the Indenture, dated as of December 1, 2004 (as amended, modified and
supplemented from time to time, the “Indenture”), by and between Trailer Bridge, Inc. (the “Company”) and Wells Fargo Bank, National Association, as Trustee, that Wells Fargo Bank, National Association has resigned
as Trustee under the Indenture. 
 The Company has appointed Deutsche Bank Trust Company Americas as successor Trustee,
Paying Agent and Registrar under the Indenture, which appointment has been accepted and become effective. The address of the Corporate Trust Office of Deutsche Bank Trust Company Americas is 60 Wall Street, 27th Floor, New York, New York 10005, Attention: Trust and Agency
Services – Corporate Team Deal Manager – Trailer Bridge Inc. 
 Dated: October     , 2011 

 

	
	Very Truly Yours,
	
	DEUTSCHE BANK TRUST COMPANY AMERICAS, as Successor Trustee

  
  

	*	Note: Cusip numbers appearing herein have been included solely for the convenience of the Holders. Deutsche Bank Trust Company Americas assumes no responsibility for
the selection or use of such numbers and makes no representation as to the correctness of the Cusip numbers listed above.

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