Document:

First Supplemental Indenture

 Exhibit 4.2 

EXECUTION VERSION 
 OWENS &
MINOR, INC., 
 as Issuer, 
 THE
GUARANTORS PARTY 
 HERETO 
 and

 U.S. BANK NATIONAL ASSOCIATION, 

as Trustee 
  

 
 FIRST
SUPPLEMENTAL INDENTURE 
 DATED AS OF SEPTEMBER 16, 2014 

TO INDENTURE 
 DATED AS OF
SEPTEMBER 16, 2014 
 ESTABLISHING TWO SERIES OF SECURITIES DESIGNATED 

3.875% SENIOR NOTES DUE 2021 

4.375% SENIOR NOTES DUE 2024 
  

 

 TABLE OF CONTENTS 

 

							
		  	 	Page	  
	 ARTICLE ONE INTERPRETATIONS AND AMENDMENTS
	  	 	1	  
	 SECTION 101.
	 	 First Supplemental Indenture.
	  	 	1	  
	 SECTION 102.
	 	 Definitions in First Supplemental Indenture.
	  	 	2	  
	 ARTICLE TWO THE NOTES
	  	 	2	  
	 SECTION 201.
	 	 2021 Notes.
	  	 	2	  
	 SECTION 202.
	 	 2024 Notes.
	  	 	2	  
	 SECTION 203.
	 	 Form of Notes; Incorporation of Terms.
	  	 	3	  
	 SECTION 204.
	 	 Place of Payment.
	  	 	3	  
	 SECTION 205.
	 	 Transfer and Exchange.
	  	 	3	  
	 SECTION 206.
	 	 Cancellation or Adjustment of Global Securities.
	  	 	5	  
	 ARTICLE THREE OPTIONAL REDEMPTION OF NOTES
	  	 	5	  
	 SECTION 301.
	 	 Redemption of 2021 Notes.
	  	 	5	  
	 SECTION 302.
	 	 Redemption of 2024 Notes.
	  	 	5	  
	 SECTION 303.
	 	 Notice of Redemption.
	  	 	6	  
	 SECTION 304.
	 	 Certain Additional Definitions Relating to Redemption of Notes.
	  	 	6	  
	 ARTICLE FOUR CHANGE OF CONTROL
	  	 	7	  
	 SECTION 401.
	 	 Repurchase Option Upon a Change of Control Triggering Event.
	  	 	7	  
	 SECTION 402.
	 	 Certain Additional Definitions Relating to Change of Control.
	  	 	8	  
	 ARTICLE FIVE GUARANTEES
	  	 	10	  
	 SECTION 501.
	 	 Guarantees.
	  	 	10	  
	 ARTICLE SIX GENERAL
	  	 	10	  
	 SECTION 601.
	 	 Execution as Supplemental Indenture.
	  	 	10	  
	 SECTION 602.
	 	 Conflict with Trust Indenture Act.
	  	 	10	  
	 SECTION 603.
	 	 Effect of Headings.
	  	 	11	  
	 SECTION 604.
	 	 Execution and Counterparts.
	  	 	11	  
	 SECTION 605.
	 	 Governing Law.
	  	 	11	  
	EXHIBIT A	 		  			
	EXHIBIT B	 		  			

 THIS FIRST SUPPLEMENTAL INDENTURE, dated as of September 16, 2014, is among Owens &
Minor, Inc., a Virginia corporation (the “Company”), the guarantors signatory hereto (the “Guarantors”) and U.S. Bank National Association, as trustee (the “Trustee”). 

WITNESSETH: 
 WHEREAS, the
Company and the Guarantors have heretofore executed and delivered to the Trustee an indenture, dated as of September 16, 2013 (herein called the “Base Indenture” and, together with this First Supplemental Indenture, the
“Indenture”), to provide for the issuance from time to time of its unsecured notes, debentures or other evidences of indebtedness (herein called a “Security” or the “Securities”), the form and terms
of which are to be established as set forth in Sections 2.01 and 3.01 of the Base Indenture; 
 WHEREAS, Section 9.01 of the Base
Indenture provides, among other things, that the Company and the Trustee may enter into indentures supplemental to the Base Indenture to, among other things, establish the form and terms of the Securities of any series as permitted in Sections 2.01
and 3.01 of the Base Indenture; 
 WHEREAS, the Company desires to create two series of Securities, consisting of one series in an aggregate
principal amount of $275,000,000 to be designated the “3.875% Senior Notes due 2021” (herein called the “2021 Notes”) and one series in an aggregate principal amount of $275,000,000 to be designated the “4.375% Senior
Notes due 2024” (herein called the “2024 Notes” and, together with the 2021 Notes, the “Notes”), and all action on the part of the Company necessary to authorize the issuance of the Notes under the Base
Indenture and this First Supplemental Indenture has been duly taken; 
 WHEREAS, the Company desires to issue the Notes in accordance with
this First Supplemental Indenture and treat the Notes as two series of Securities for all purposes, as amended or supplemented from time to time in accordance with the terms of this First Supplemental Indenture and the Base Indenture; and 

WHEREAS, all acts and things necessary to make the Notes, when executed by the Company and completed, authenticated and delivered by the
Trustee as provided in the Indenture, the valid and binding obligations of the Company and to constitute a valid and binding agreement according to its terms, have been done and performed. 

NOW, THEREFORE, THIS FIRST SUPPLEMENTAL INDENTURE WITNESSETH: 

That in consideration of the premises and of the acceptance and purchase of the Notes by the Holders thereof and of the acceptance of this
trust by the Trustee, the Company and the Guarantors covenant and agree with the Trustee, for the equal benefit of Holders of the 2021 Notes, and the equal benefit of Holders of the 2024 Notes, as applicable, as follows: 

ARTICLE ONE 

INTERPRETATIONS AND AMENDMENTS 

SECTION 101. First Supplemental Indenture. As used herein “First Supplemental Indenture”, “hereto”,
“herein”, “hereof”, “hereby”, “hereunder” and similar expressions refer to 

 
this First Supplemental Indenture and not to any particular Article, Section or other portion hereof and include any and every instrument supplemental or ancillary hereto or in implementation
hereof, and further include the terms of the Notes set forth in the forms of the 2021 Notes and the 2024 Notes attached hereto as Exhibit A and Exhibit B, respectively. 

SECTION 102. Definitions in First Supplemental Indenture. All terms contained in this First Supplemental Indenture that are defined in
the Base Indenture and not defined herein shall, for all purposes hereof, have the meanings given to such terms in the Base Indenture, unless the context otherwise specifies or requires; provided, however, that notwithstanding the
foregoing, the terms “Company” and “Trustee” shall have the respective meanings given to them in the Base Indenture. 

ARTICLE TWO 
 THE NOTES

 SECTION 201. 2021 Notes. A series of Securities, which shall be designated the “3.875% Senior Notes due 2021,” shall
be executed, authenticated and delivered in accordance with the provisions of, and shall in all respects be subject to, the terms, conditions and covenants of, the Base Indenture and this First Supplemental Indenture (including the form of 2021
Notes attached hereto as Exhibit A). The aggregate principal amount of 2021 Notes that may be authenticated and delivered under this First Supplemental Indenture shall not, except as permitted by the provisions of the Base Indenture,
initially exceed $275,000,000. The Company may from time to time or at any time, without notice to, or the consent of, any Holder of the 2021 Notes, create and issue additional 2021 Notes having the same terms as the initial 2021 Notes (except the
public offering price, issuance date and, if applicable, the initial Interest Payment Date), which additional 2021 Notes shall increase the aggregate principal amount of the 2021 Notes and, together with all other 2021 Notes, will constitute a
single series under the Indenture and vote together as one class on all matters with respect to the 2021 Notes; provided, however, that any additional 2021 Notes that are not fungible with existing 2021 Notes for U.S. federal income
tax purposes will have a separate CUSIP number than the existing 2021 Notes. 
 SECTION 202. 2024 Notes. A series of Securities,
which shall be designated the “4.375% Senior Notes due 2024,” shall be executed, authenticated and delivered in accordance with the provisions of, and shall in all respects be subject to, the terms, conditions and covenants of, the Base
Indenture and this First Supplemental Indenture (including the form of 2024 Notes attached hereto as Exhibit B). The aggregate principal amount of 2024 Notes that may be authenticated and delivered under this First Supplemental Indenture
shall not, except as permitted by the provisions of the Base Indenture, initially exceed $275,000,000. The Company may from time to time or at any time, without notice to, or the consent of, any Holder of the 2024 Notes, create and issue additional
2024 Notes having the same terms as the initial 2024 Notes (except the public offering price, issuance date and, if applicable, the initial Interest 

  
 2 

 
Payment Date), which additional 2024 Notes shall increase the aggregate principal amount of the 2024 Notes and, together with all other 2024 Notes, will constitute a single series under the
Indenture and vote together as one class on all matters with respect to the 2024 Notes; provided, however, that any additional 2024 Notes that are not fungible with existing 2024 Notes for U.S. federal income tax purposes will have a separate CUSIP
number than the existing 2024 Notes. 
 SECTION 203. Form of Notes; Incorporation of Terms. 

(a) The 2021 Notes and the 2024 Notes shall each be issued initially in the form of one or more Global Securities and, together with the
Trustee’s certificate of authentication thereon, shall be in substantially the form set forth in Exhibit A or Exhibit B attached hereto, respectively. The Notes may have such notations, legends or endorsements approved as to form
by the Company and required, as applicable, by law, stock exchange or depository rules and agreements to which the Company is subject. The terms of the 2021 Notes set forth in Exhibit A and the terms of the 2024 Notes set forth in Exhibit
B are herein incorporated by reference and are part of the terms of this First Supplemental Indenture. The Notes shall be issuable in definitive, fully registered form without coupons only in minimum denominations of $2,000 and any integral
multiples of $1,000 in excess thereof. 
 (b) The 2021 Notes and the 2024 Notes issued in global form shall be substantially in the form of
Exhibit A and Exhibit B attached hereto, respectively (including the Global Security legend thereon). The 2021 Notes and the 2024 Notes issued in definitive certificated form in accordance with the terms of the Base Indenture and this
First Supplemental Indenture, if any, shall be substantially in the form of Exhibit A and Exhibit B, respectively, attached hereto (but without the Global Security legend thereon). Each Global Security shall represent such of the
Outstanding Notes as shall be specified therein and each shall provide that it shall represent the aggregate principal amount of Outstanding Notes from time to time endorsed thereon and that the aggregate principal amount of Outstanding Notes
represented thereby may from time to time be reduced or increased, as appropriate, to reflect exchanges. Any endorsement of a Global Security to reflect the amount of any increase or decrease in the aggregate principal amount of Outstanding Notes
represented thereby shall be made by the Trustee in accordance with Section 206 hereof pursuant to instructions given by the Holder thereof as required by Section 205 hereof. 

SECTION 204. Place of Payment. The Place of Payment in respect of the Notes will be at the office or agency of the Company in The City
of New York, State of New York or at the office or agency of the Paying Agent. 
 SECTION 205. Transfer and Exchange. 

  
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 (a) The transfer and exchange of beneficial interests in the Global Securities shall be effected
through the Depositary, in accordance with the provisions of the Indenture and the then applicable procedures of the Depositary (the “Applicable Procedures”). In connection with all transfers and exchanges of beneficial interests,
the transferor of such beneficial interest must deliver to the Trustee either (A)(1) a written order from a Participant (as defined below) or an Indirect Participant (as defined below) given to the Depositary in accordance with the Applicable
Procedures directing the Depositary to credit or cause to be credited a beneficial interest in another Global Security in an amount equal to the beneficial interest to be transferred or exchanged and (2) instructions given in accordance with
the Applicable Procedures containing information regarding the Participant account to be credited with such increase or, if Definitive Securities are at such time permitted to be issued pursuant to the Indenture, (B)(1) a written order from a
Participant or an Indirect Participant given to the Depositary in accordance with the Applicable Procedures directing the Depositary to cause to be issued a Definitive Security in an amount equal to the beneficial interest to be transferred or
exchanged and (2) instructions given by the Depositary to the Security Registrar containing information regarding the Person in whose name such Definitive Security shall be registered to effect the transfer or exchange referred to in
(1) above. Upon satisfaction of all of the requirements for transfer or exchange of beneficial interests in Global Securities contained in the Indenture and the Notes or otherwise applicable under the Securities Act, the Security Registrar
shall adjust the principal amount of the relevant Global Securities pursuant to Section 206 hereof. “Participant” means, with respect to the Depositary, a Person who has an account with the Depositary. “Indirect
Participant” means a Person who holds a beneficial interest in a Global Security through a Participant. 
 (b) Upon request by a
Holder of Definitive Securities and such Holder’s compliance with the provisions of this Section 205(b), the Security Registrar shall register the transfer or exchange of Definitive Securities. Prior to such registration of transfer or
exchange, the requesting Holder shall present or surrender to the Trustee the Definitive Securities duly endorsed or accompanied by a written instruction of transfer in form satisfactory to the Security Registrar duly executed by such Holder or by
its attorney, duly authorized in writing. The Trustee shall cancel any such Definitive Securities so surrendered, and the Company shall execute and, upon receipt of a Company Order pursuant to Section 3.03 of the Base Indenture, the Trustee
shall authenticate and deliver to the Person designated in the instructions a new Definitive Security in the appropriate principal amount. Any Definitive Security issued pursuant to this Section 205(b) shall be registered in such name or names
and in such authorized denomination or denominations as the Holder of such beneficial interest shall instruct the Security Registrar through instructions from the Depositary and the Participant or Indirect Participant. The Trustee shall deliver such
Definitive Securities to the Persons in whose names such Definitive Securities are so registered. In addition, the requesting Holder shall provide any additional certifications, documents and information, as applicable, required pursuant to
Section 3.05 of the Base Indenture. 

  
 4 

 SECTION 206. Cancellation or Adjustment of Global Securities. At such time as all
beneficial interests in a particular Global Security have been exchanged for Definitive Securities or a particular Global Security has been redeemed, repurchased or cancelled in whole and not in part, each such Global Security shall be returned to
or retained and cancelled by the Trustee in accordance with Section 3.09 of the Base Indenture. At any time prior to such cancellation, if any beneficial interest in a Global Security is exchanged for or transferred to a Person who will take
delivery thereof in the form of a beneficial interest for Definitive Securities, the principal amount of Notes represented by such Global Security shall be reduced accordingly and an endorsement shall be made on such Global Security by the Trustee
or by the Depositary at the direction of the Trustee to reflect such reduction; and if the beneficial interest is being exchanged for or transferred to a Person who will take delivery thereof in the form of a beneficial interest in another Global
Security, such other Global Security shall be increased accordingly and an endorsement shall be made on such Global Security by the Security Registrar or by the Depositary at the direction of the Security Registrar to reflect such increase. 

ARTICLE THREE 
 OPTIONAL
REDEMPTION OF NOTES 
 SECTION 301. Redemption of 2021 Notes. The Company may redeem the 2021 Notes in whole or in part, at its
option at any time, at a Redemption Price equal to the greater of: 
 (i) 100% of the principal amount of such 2021 Notes to
be redeemed; or 
 (ii) the sum of the present values of the remaining scheduled payments of principal and interest thereon
(exclusive of interest accrued to the applicable Redemption Date) discounted to 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, accrued and unpaid interest thereon to, but excluding, the applicable Redemption Date. 

SECTION 302. Redemption of 2024 Notes. 

(a) Prior to September 15, 2024, the Company may redeem the 2024 Notes in whole or in part, at its option at any time, at a Redemption
Price equal to the greater of: 
 (i) 100% of the principal amount of such 2024 Notes to be redeemed; and 

  
 5 

 (ii) the sum of the present values of the remaining scheduled payments or
principal and interest thereon (exclusive of interest accrued to the applicable Redemption Date) discounted to the applicable 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, accrued and unpaid interest thereon to, but excluding, the applicable Redemption Date. 

(b) On and after September 15, 2024, the Company may redeem the 2024 Notes in whole or in part, at its option at any time, at a
Redemption Price equal to 100% of the principal amount of the 2024 Notes to be redeemed, plus accrued and unpaid interest thereon to, but excluding, the applicable Redemption Date. 

SECTION 303. Notice of Redemption. Notice of any redemption pursuant to this Article Three shall be given as provided in
Section 11.04 of the Base Indenture, except that any notice of such redemption shall not specify the related Redemption Price but only the manner of calculation thereof. The Trustee shall not be responsible for the calculation of such Optional
Redemption Price. The Company shall calculate such Optional Redemption Price and promptly notify the Trustee thereof. 
 SECTION 304.
Certain Additional Definitions Relating to Redemption of Notes. For the purposes of this First Supplemental Indenture, the following expressions shall have the following meanings: 

“Comparable Treasury Issue” means the United States Treasury security or securities selected by an Independent Investment
Banker as having an actual or interpolated maturity comparable to the remaining term of the Notes to be redeemed 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 a comparable maturity to the remaining term of such Notes. 
 “Comparable Treasury Price” means, with
respect to any Redemption Date, (1) the average of the Reference Treasury Dealer Quotations for such Redemption Date, after excluding the highest and lowest such Reference Treasury Dealer Quotations, or (2) if the trustee obtains fewer
than four such Reference Treasury Dealer Quotations, the average of all such quotations. 
 “Independent Investment Banker”
means one of the Reference Treasury Dealers appointed by the trustee after consultation with the Company. 
 “Reference Treasury
Dealer” means each of (1) J.P. Morgan Securities LLC, Merrill Lynch, Pierce, Fenner & Smith Incorporated and a Primary Treasury Dealer (as defined herein) selected by Wells Fargo Securities, LLC or their respective affiliates
which are primary U.S. 

  
 6 

 
Government securities dealers in the United States (a “Primary Treasury Dealer”), and their respective successors and (2) one other Primary Treasury Dealer; provided,
however, that if any of the foregoing or their affiliates shall cease to be a Primary Treasury Dealer, the Company shall substitute therefor another Primary Treasury Dealer. 

“Reference Treasury Dealer Quotations” means, with respect to each Reference Treasury Dealer and any Redemption Date, the
average, as determined by the trustee, 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 trustee by such Reference Treasury Dealer at 3:30 p.m. New
York time on the third business day preceding such Redemption Date. 
 “Treasury Rate” means, with respect to any
Redemption Date, the rate per year equal to the semiannual equivalent yield to maturity or interpolated (on a day count basis) of the Comparable Treasury Issue, assuming a price for the Comparable Treasury Issue (expressed as a percentage of its
principal amount) equal to the Comparable Treasury Price for such Redemption Date. 
 ARTICLE FOUR 

CHANGE OF CONTROL 
 SECTION
401. Repurchase Option Upon a Change of Control Triggering Event. With respect to each of the 2021 Notes and the 2044 Notes: 
 (a)
Upon the occurrence of a Change of Control Triggering Event with respect to a series of Notes, unless the Company has previously exercised its right to redeem such Notes pursuant to Section 301 or Section 302 hereof, as applicable, by
causing a notice of redemption to be delivered to the Holders of such Notes, the Company shall make an offer to each Holder of the applicable series of Notes to repurchase all or any part (equal to $2,000 or an integral multiple of $1,000 in excess
thereof) of each Holder’s Notes of such series (a “Change of Control Offer”) on the terms set forth herein at a purchase price in cash equal to 101% of the aggregate principal amount of the Notes repurchased plus accrued and
unpaid interest, if any, on the Notes repurchased, to, but excluding, the date of purchase (the “Change of Control Payment”). 

(b) Within 30 days following any Change of Control Triggering Event with respect to a series of Notes, the Company shall 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 on the date specified in the notice, which date will be no earlier than 30
days and no later than 60 days from the date such notice is mailed (the “Change of Control Payment Date”), pursuant to the procedures required by the Indenture and the Notes of the applicable series and described in such notice.

  
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 (c) The Company shall comply with the requirements of Rule 14e-1 under the Exchange Act and any
other securities laws and regulations thereunder to the extent such laws and regulations are applicable in connection with the repurchase of the Notes as a result of a Change of Control Triggering Event. To the extent that the provisions of any
securities laws or regulations conflict with this Section 401, the Company will comply with the applicable securities laws and regulations and will not be deemed to have breached its obligations under this Section 401 by virtue of such
conflict. 
 (d) On the Change of Control Payment Date, the Company shall, to the extent lawful, (1) accept for payment all Notes or
portions of Notes properly tendered pursuant to the Change of Control Offer, (2) deposit with the Paying Agent an amount equal to the Change of Control Payment in respect of all Notes or portions of Notes properly tendered and (3) deliver
or cause to be delivered to the Trustee the Notes properly accepted together with an Officers’ Certificate stating the aggregate principal amount of Notes or portions of Notes being purchased by the Company. The Paying Agent shall promptly mail
to each Holder of Notes properly tendered the Change of Control Payment for such Notes, and the Trustee shall promptly authenticate and mail (or cause to be transferred by book entry) to each Holder a new Note equal in the principal amount to any
unpurchased portion of the Notes surrendered, if any; provided that each new Note shall be in a principal amount of $2,000 or an integral multiple of $1,000 in excess thereof. 

The Company will not be required to make a Change of Control Offer upon a Change of Control Triggering Event if a third Person (1) makes
the Change of Control Offer in the manner, at the times and otherwise in compliance with the requirements set forth in this Section 401 applicable to a Change of Control Offer made by the Company and (2) purchases all Notes properly
tendered and not withdrawn under the Change of Control Offer. 
 SECTION 402. Certain Additional Definitions Relating to Change of
Control. For the purposes of this First Supplemental Indenture, the following expressions shall have the following meanings: 

“Below Investment Grade Rating Event” means with respect to a series of Notes, the Notes of such series are rated below an
Investment Grade Rating by each of the Rating Agencies on any date from the date of the public notice of an arrangement that could result in a Change of Control until the end of the 60-day period following public notice of the occurrence of the
Change of Control (which 60-day period shall be extended so long as the rating of the Notes of such series is under publicly announced consideration for possible downgrade by any of the Rating Agencies). 

“Change of Control” means the occurrence of any of the following: 

  
 8 

 (1) the 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 the Company or one of our Subsidiaries; 
 (2) the adoption of a plan
relating to the liquidation or dissolution of the Company (other than in a transaction that complies with Section 8.01 of the Base Indenture); 

(3) 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), becomes the “beneficial owner” (as defined in Rules 13d-3 and 13d-5 under the Exchange Act) directly or indirectly, of more than 50% of the
Company’s Voting Stock, measured by voting power rather than number of shares; 
 (4) the first day on which a majority
of the members of the Board of Directors of the Company are not Continuing Directors; or 
 (5) the Company consolidates
with, or merges with or into, any person (as that term is used in Section 13(d)(3) of the Exchange Act), or any person consolidates with, or merges with or into, the Company, in any such event pursuant to a transaction in which any of the
outstanding Voting Stock of the Company or such other person is converted into or exchanged for cash, securities or other property, other than any such transaction where the shares of the Voting Stock of the Company outstanding immediately prior to
such transaction constitute, or are converted into or exchanged for, a majority of the Voting Stock of the surviving person immediately after giving effect to such transaction. 

“Change of Control Triggering Event” means the occurrence of both a Change of Control and a Below Investment Grade Rating
Event. 
 “Continuing Director” means, as of any date of determination, any member of the Board of Directors of the Company
who: 
 (1) was a member of such Board of Directors on September 16, 2014; or 

(2) was nominated for election or elected to such Board of Directors with the approval of a majority of the Continuing
Directors who were members of such Board of Directors at the time of such nomination or election (either by specific vote or by approval of the Company’s proxy statement in which such member was named a nominee for election as a director,
without objection to such nomination). 

  
 9 

 “Fitch” means Fitch Ratings, Inc., a subsidiary of Hearst Corporation and
Fimalac S.A., and its successors. 
 “Investment Grade Rating” means a rating equal to or higher than Baa3 (or the
equivalent) by Moody’s and BBB- (or the equivalent) by S&P and by Fitch. 
 “Moody’s” means Moody’s
Investors Services, Inc., a subsidiary of Moody’s Corporation, and its successors. 
 “Rating Agency” means each of
S&P, Moody’s and Fitch, or if S&P, Moody’s or Fitch or all three shall not make a rating on the Notes of a given series publicly available, a “nationally recognized statistical rating organization” (within the meaning of
Section 3(a)(62) of the Exchange Act) selected by us (as certified by a resolution of our Board of Directors) which shall be substituted for S&P, Moody’s or Fitch, or all three, as the case may be. 

“S&P” means Standard & Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc., and its
successors. 
 “Voting Stock” of any specified Person as of any date means the Capital Stock of such Person that is at the
time entitled to vote generally in the election of the board of directors of such Person. 
 ARTICLE FIVE 

GUARANTEES 
 SECTION 501.
Guarantees. The provisions of Section 10.09 of the Base Indenture and Article Fourteen of the Base Indenture shall apply to the 2021 Notes and the 2024 Notes. The Guarantors hereto hereby agree to perform all of the obligations and
agreements of a Guarantor as defined in the Base Indenture. 
 ARTICLE SIX 

GENERAL 
 SECTION 601.
Execution as Supplemental Indenture. This First Supplemental Indenture is executed and shall be construed as an indenture supplemental to the Base Indenture and, as provided in the Base Indenture, this First Supplemental Indenture forms a
part thereof. 
 SECTION 602. Conflict with Trust Indenture Act. If any provision hereof limits, qualifies or conflicts with another
provision hereof, or with a provision of the Base Indenture, or with a provision of the Trust Indenture Act, which is required to be included in this First Supplemental Indenture, or in the Base Indenture, respectively, by any of the provisions of
the Trust Indenture Act, such required provision shall control to the extent it is applicable. If any 

  
 10 

 
provision hereof modifies or excludes any provision of the Trust Indenture Act which may be so modified or excluded, the latter provision shall be deemed to apply to this First Supplemental
Indenture as so modified or to be excluded, as the case may be. 
 SECTION 603. Effect of Headings. The Article and Section headings
herein are for convenience only and shall not affect the construction hereof. 
 SECTION 604. Execution and Counterparts. This First
Supplemental Indenture may be executed in any number of counterparts (which may be delivered by means of facsimile or e-mail), each of which shall be deemed to be an original, but all such counterparts shall together constitute but one and the same
instrument. 
 SECTION 605. Governing Law. This First Supplemental Indenture and the Notes shall be governed by and construed in
accordance with the laws of the State of New York. 
 [Signature Page to Follow] 

  
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 IN WITNESS WHEREOF, the parties hereto have executed and delivered this First Supplemental
Indenture as of the day and year first above written. 
  

			
	OWENS & MINOR, INC.
		
	By:	 	/s/ Richard A. Meier
	Name:	 	Richard A. Meier
	Title:	 	 Executive Vice President and
 Chief Financial
Officer

	
	U.S. BANK NATIONAL ASSOCIATION, as Trustee
		
	By:	 	/s/ Nancy H. Taylor
	Name:	 	Nancy H. Taylor
	Title:	 	Vice President
	
	GUARANTORS:
	
	OWENS & MINOR DISTRIBUTION, INC.
		
	By:	 	/s/ Richard A. Meier
	Name:	 	Richard A. Meier
	Title:	 	 Executive Vice President and
 Chief Financial
Officer

	
	OWENS & MINOR MEDICAL, INC.
		
	By:	 	/s/ Richard A. Meier
	Name:	 	Richard A. Meier
	Title:	 	 Executive Vice President and
 Chief Financial
Officer

  
 [Signature Page —
First Supplemental Indenture] 

 EXHIBIT A 

[Form of 2021 Note] 
 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 EXCHANGED OR TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF THE
DEPOSITARY OR BY THE DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. 

UNLESS THIS SECURITY IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITARY TO THE COMPANY OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR
PAYMENT, AND ANY SECURITY ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER NAME AS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITARY (AND ANY PAYMENT IS MADE TO CEDE & CO. OR TO SUCH OTHER ENTITY AS
REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITARY), 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. 

OWENS & MINOR, INC. 

3.875% SENIOR NOTES DUE 2021 
  

			
	 No. 1
	  	 $275,000,000

as revised by the Schedule of Increases and Decreases in Global Security attached hereto

 
 CUSIP NO. 690732AD4

ISIN NO. US690732AD40

 Owens & Minor, Inc., a corporation duly organized and existing under the laws of the Commonwealth of
Virginia (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
TWO HUNDRED SEVENTY-FIVE MILLION DOLLARS ($275,000,000), as revised by the Schedule of Increases and Decreases in Global Security attached hereto, on September 15, 2021, and to pay interest thereon from September 16, 2014 or from the most
recent Interest Payment Date to which interest has been paid or duly provided for, semi-annually on March 15 and September 15 in each year, commencing March 15, 2015, at the rate of 3.875% per annum, until the principal hereof is
paid or made available for payment. Interest will be computed on the basis of a 360-day year of twelve 30-day months. The interest so payable, and punctually paid or duly provided for (except 

  
 A-1 

 
for Defaulted Interest), 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 March 1 or September 1 (whether or not a Business Day), as the case may be, next preceding such Interest Payment Date even if Securities are
cancelled, repurchased or redeemed after the Regular Record Date and on or before the 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 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 said Indenture. 

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 New York, New York, 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, against surrender of this Security in the case of any payment due at
the Maturity of the principal hereof (other than any payment of interest that first becomes payable on a day other than an Interest Payment Date); provided, however, that 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. Payments in respect of Securities represented by a Global Security (including principal, premium, if any, and interest) will be made by the transfer
of immediately available funds to the accounts specified by DTC or any successor depository. 
 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. 

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 the Indenture or be valid or obligatory for any purpose. 

  
 A-2 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed. 

 

							
	 Dated:
	 		 	
		 		 	OWENS & MINOR, INC.
				
		 		 	By:	 	 
		 		 	Name:	 	
		 		 	Title:	 	

  
 [Global Note 2021] 

 CERTIFICATE OF AUTHENTICATION 

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

Dated:
                                        
 
  

			
	 U.S. Bank National Association,
 As
Trustee

		
	 By:
	 	
		 	  

		 	Authorized Signatory

  
 [2021 Global Note] 

 REVERSE OF 3.875% SENIOR NOTE DUE 2021 

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 an Indenture, dated as of September 16, 2014 (the “Base Indenture”), as supplemented by the First Supplemental Indenture, dated as of September 16, 2014 (the “First Supplemental
Indenture” and together with the Base Indenture, the “Indenture”, which term shall have the meaning assigned to it in such instrument), among the Company, the Guarantors and U.S. Bank National Association, as Trustee (herein called
the “Trustee”, which term includes any successor trustee under the Indenture), and reference is hereby made to the Indenture and all indentures supplemental thereto for a statement of the respective rights, limitations of rights, duties
and immunities thereunder of the Company, the Guarantors, 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 $275,000,000. 
 The Securities of this series are subject to redemption
prior to the Stated Maturity upon not less than 30 nor more than 60 days’ notice by mail, at any time, as a 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 Securities to be redeemed, or (ii) the sum of the present values of the remaining scheduled payments of principal and interest thereon (exclusive of interest accrued to the applicable Redemption Date) discounted to the applicable
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, accrued and unpaid interest thereon to, but excluding, the applicable Redemption Date.

 In the event of redemption of this Security 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. 
 In the event of a Change of
Control Triggering Event, unless the Company has exercised its right to redeem the Securities, the Company shall make an offer to each Holder to repurchase all or any part of each Holder’s Securities at a purchase price in cash equal to 101% of
the aggregate principal amount of Securities repurchased, plus accrued and unpaid interest, if any, on the Securities repurchased, to, but excluding the date of purchase. 

This Security will not be subject to any sinking fund. 

The Indenture contains provisions for defeasance at any time of the entire indebtedness of this Security or certain restrictive covenants and
Events of Default with respect to this Security, in each case upon compliance with certain conditions set forth in the Indenture. 
 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 Indenture permits, with certain exceptions as therein provided, the amendment thereof and the modification or waiver of the rights and
obligations of the Company 

  
 A-5 

 
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 more than 50% in
aggregate principal amount of the Securities at the time Outstanding of each series to be affected. The Indenture also contains provisions permitting the Holders of more than 50% in aggregate 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 with certain provisions of the Indenture and certain past Defaults (other than with respect to nonpayment or in respect of a provision that cannot be
amended without the written consent of each Holder affected) under the Indenture and their consequences. Any such consent or waiver by the Holder of this Security shall be conclusive and binding upon such Holder and upon all future Holders of this
Security and of any Security issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or waiver is made upon this Security. 

As provided in and subject to the provisions of the Indenture, the Holder of this Security shall not have the right to institute any
proceeding with respect to the Indenture or for the appointment of a receiver or trustee or for any other remedy thereunder, unless such Holder shall have previously given the Trustee written notice of a continuing Event of Default with respect to
the Securities of this series, the Holders of not less than 25% in aggregate principal amount of the Securities of this series at the time Outstanding shall have made written request to the Trustee to institute proceedings in respect of such Event
of Default as Trustee and offered the Trustee satisfactory indemnity, and the Trustee shall not have received from the Holders of a majority in aggregate principal amount of Securities of this series at the time Outstanding a direction inconsistent
with such request, and shall have failed to institute any such proceeding, for 60 days after receipt of such notice, request and offer of indemnity. The foregoing shall not apply to any suit instituted by the Holder of this Security for the
enforcement of any payment of principal hereof or any premium or interest hereon on or after the respective due dates expressed herein. 

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 its 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 integral multiples of
$1,000 in excess thereof. As provided in the Indenture and subject to certain limitations therein set forth, Securities of this series are 

  
 A-6 

 
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, but the Company may require payment of a sum sufficient to
cover any tax or other governmental charge payable in connection therewith. 
 Prior to due presentment of this Security for registration of
transfer, the Company, the Trustee and any agent of the Company or the Trustee shall treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company,
the Trustee nor any such agent shall be affected by notice to the contrary. 
 The Indenture and the Securities shall be governed by, and
construed in accordance with, the laws of the State of New York. 
 All terms used in this Security that are defined in the Indenture shall
have the meanings assigned to them in the Indenture. 

  
 A-7 

 SCHEDULE OF INCREASES AND DECREASES IN GLOBAL SECURITY 

The initial outstanding principal amount of this Global Security is TWO HUNDRED SEVENTY-FIVE MILLION DOLLARS ($275,000,000). The following
exchanges of a part of this Global Security for an interest in another Global Security or for a Definitive Security, or exchanges of a part of another Global Security or Definitive Security for an interest in this Global Security, have been made:

  

									
	 Date of Exchange
	 	 Amount of decrease in
Principal Amount of this
Global Security
	 	 Amount of increase in
Principal Amount of this
Global Security
	  	 Principal Amount of this
Global Security following
such decrease or
increase
	  	 Signature of authorized
signatory of Trustee,
Depositary or
Custodian

  
 A-8 

 EXHIBIT B 

[Form of 2024 Note] 
 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 EXCHANGED OR TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF THE
DEPOSITARY OR BY THE DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. 

UNLESS THIS SECURITY IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITARY TO THE COMPANY OR ITS AGENT FOR REGISTRATION OF TRANSFER, EXCHANGE OR
PAYMENT, AND ANY SECURITY ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER NAME AS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITARY (AND ANY PAYMENT IS MADE TO CEDE & CO. OR TO SUCH OTHER ENTITY AS
REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITARY), 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. 

OWENS & MINOR, INC. 

4.375% SENIOR NOTES DUE 2024 
  

					
	 No. 1
	  	 
  
 
 
  

 
  
	$275,000,000
 as revised by the Schedule of Increases and
Decreases in
Global Security attached
hereto
  
 CUSIP NO. 690732AE2

ISIN NO. US690732AE23
	  
   
  
  

 
   

  

 Owens & Minor, Inc., a corporation duly organized and existing under the laws of the Commonwealth of
Virginia (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
TWO HUNDRED SEVENTY-FIVE MILLION DOLLARS ($275,000,000), as revised by the Schedule of Increases and Decreases in Global Security attached hereto, on December 15, 2024, and to pay interest thereon from September 16, 2014 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, commencing December 15, 2014, at the rate of 4.375 % per annum, until the principal hereof
is paid or made available for payment. Interest will be computed on the basis of a 360-day year of twelve 30-day months. The interest so payable, and punctually paid or duly provided for (except 

  
 B-1 

 
for Defaulted Interest), 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 (whether or not a Business Day), as the case may be, next preceding such Interest Payment Date even if Securities are cancelled,
repurchased or redeemed after the Regular Record Date and on or before the 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 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 said Indenture. 

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 New York, New York, 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, against surrender of this Security in the case of any payment due at
the Maturity of the principal hereof (other than any payment of interest that first becomes payable on a day other than an Interest Payment Date); provided, however, that 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. Payments in respect of Securities represented by a Global Security (including principal, premium, if any, and interest) will be made by the transfer
of immediately available funds to the accounts specified by DTC or any successor depository. 
 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. 

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 the Indenture or be valid or obligatory for any purpose. 

  
 B-2 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed. 

 

							
	 Dated:
	 		 	
		 		 	OWENS & MINOR, INC.
				
		 		 	By:	 	 
		 		 	Name:	 	
		 		 	Title:	 	

  
 [Global Note 2024] 

 CERTIFICATE OF AUTHENTICATION 

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

Dated:
                                        
 
  

			
	 U.S. Bank National Association,
 As
Trustee

		
	 By:
	 	
		 	  

		 	Authorized Signatory

  
 [2024 Global Note] 

 REVERSE OF 4.375% SENIOR NOTE DUE 2024 

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 an Indenture, dated as of September 16, 2014 (the “Base Indenture”), as supplemented by the First Supplemental Indenture, dated as of September 16, 2014 (the “First Supplemental
Indenture” and together with the Base Indenture, the “Indenture”, which term shall have the meaning assigned to it in such instrument), among the Company, the Guarantors and U.S. Bank National Association, as Trustee (herein called
the “Trustee”, which term includes any successor trustee under the Indenture), and reference is hereby made to the Indenture and all indentures supplemental thereto for a statement of the respective rights, limitations of rights, duties
and immunities thereunder of the Company, the Guarantors, 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 $275,000,000. 
 The Securities of this series are subject to redemption
prior to the Stated Maturity upon not less than 30 nor more than 60 days’ notice by mail, at any time, as a whole or in part, at the election of the Company. Prior to September 15, 2024, the Securities of this series shall be redeemable at
a Redemption Price equal to the greater of: (i) 100% of the principal amount of the Securities to be redeemed, or (ii) the sum of the present values of the remaining scheduled payments of principal and interest thereon (exclusive of
interest accrued to the applicable Redemption Date) discounted to the applicable 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,
accrued and unpaid interest thereon to, but excluding, the applicable Redemption Date. On and after September 15, 2024, the Securities of this series shall be redeemable at a Redemption Price equal to 100% of the principal amount of the
Securities to be redeemed, plus accrued and unpaid interest thereon to, but excluding, the Redemption Date. 
 In the event of redemption of
this Security 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. 

In the event of a Change of Control Triggering Event, unless the Company has exercised its right to redeem the Securities, the Company shall
make an offer to each Holder to repurchase all or any part of each Holder’s Securities at a purchase price in cash equal to 101% of the aggregate principal amount of Securities repurchased, plus accrued and unpaid interest, if any, on the
Securities repurchased, to, but excluding the date of purchase. 
 This Security will not be subject to any sinking fund. 

The Indenture contains provisions for defeasance at any time of the entire indebtedness of this Security or certain restrictive covenants and
Events of Default with respect to this Security, in each case upon compliance with certain conditions set forth in the Indenture. 

  
 B-5 

 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 Indenture permits, with certain exceptions as therein provided, the amendment thereof and the modification or waiver 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 more than 50% in aggregate principal amount of
the Securities at the time Outstanding of each series to be affected. The Indenture also contains provisions permitting the Holders of more than 50% in aggregate 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 with certain provisions of the Indenture and certain past Defaults (other than with respect to nonpayment or in respect of a provision that cannot be amended without the written
consent of each Holder affected) under the Indenture and their consequences. Any such consent or waiver by the Holder of this Security shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security
issued upon the registration of transfer hereof or in exchange herefor or in lieu hereof, whether or not notation of such consent or waiver is made upon this Security. 

As provided in and subject to the provisions of the Indenture, the Holder of this Security shall not have the right to institute any
proceeding with respect to the Indenture or for the appointment of a receiver or trustee or for any other remedy thereunder, unless such Holder shall have previously given the Trustee written notice of a continuing Event of Default with respect to
the Securities of this series, the Holders of not less than 25% in aggregate principal amount of the Securities of this series at the time Outstanding shall have made written request to the Trustee to institute proceedings in respect of such Event
of Default as Trustee and offered the Trustee satisfactory indemnity, and the Trustee shall not have received from the Holders of a majority in aggregate principal amount of Securities of this series at the time Outstanding a direction inconsistent
with such request, and shall have failed to institute any such proceeding, for 60 days after receipt of such notice, request and offer of indemnity. The foregoing shall not apply to any suit instituted by the Holder of this Security for the
enforcement of any payment of principal hereof or any premium or interest hereon on or after the respective due dates expressed herein. 

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 its attorney duly authorized in writing, and thereupon one or more new Securities of this series and of like
tenor, of authorized 

  
 B-6 

 
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 integral multiples 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, but the Company may require payment of a sum sufficient to cover any tax or other governmental charge payable in connection therewith. 

Prior to due presentment of this Security for registration of transfer, the Company, the Trustee and any agent of the Company or the Trustee
shall treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the contrary. 

The Indenture and the Securities shall be governed by, and construed in accordance with, the laws of the State of New York. 

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

  
 B-7 

 SCHEDULE OF INCREASES AND DECREASES IN GLOBAL SECURITY 

The initial outstanding principal amount of this Global Security is TWO HUNDRED SEVENTY-FIVE MILLION DOLLARS ($275,000,000). The following
exchanges of a part of this Global Security for an interest in another Global Security or for a Definitive Security, or exchanges of a part of another Global Security or Definitive Security for an interest in this Global Security, have been made:

  

									
	 Date of Exchange
	 	 Amount of decrease in
Principal Amount of this
Global Security
	 	 Amount of increase in
Principal Amount of this
Global Security
	  	 Principal Amount of this
Global Security following
such decrease or
increase
	  	 Signature of authorized
signatory of Trustee,
Depositary or
Custodian

  
 B-8EX-4.2

 Exhibit 4.2 

SHARE ISSUE DEED 

AFFIMED THERAPEUTICS B.V. 
 On the
twelfth day of September two thousand and fourteen appear before me, Corstiaan Anne Voogt, notaris (civil-law notary) practising in Amsterdam: 
  

	a.	Janiek Johanna Meppelink, kandidaat-notaris (candidate civil-law notary), employed by De Brauw Blackstone Westbroek N.V., a limited liability company, with corporate seat in Amsterdam, the Netherlands, with address at:
1082 MD Amsterdam, the Netherlands, Claude Debussylaan 80, born in Rhenen, the Netherlands, on the seventh day of June nineteen hundred and eighty-seven, for the purpose hereof acting as attorney authorised in writing of: 

 

	 	1.	Affimed Therapeutics B.V., a private company with limited liability, with corporate seat in Amsterdam, the Netherlands, and with address at: Im Neuenheimer Feld 582, D-69120 Heidelberg, Germany, number Trade
Register 60673389 (the “Company”), and in that capacity is representing the Company; 

  

	 	2.	Dr Melvyn Little, residing at: Immenseeweg 17, 25826 Saint Peter-Ording, Germany, born in Manchester, United Kingdom, on the sixth day of January nineteen hundred and forty-five, holder of a British
passport with number: 519669637, having the British nationality, married (“Little”) and in that capacity is representing Little; 

  

	 	3.	SGR Sagittarius Holding AG, a company incorporated under the laws of Germany, with registered office and address at: Brügglistrasse 2, 8852 Altendorf, Switzerland, registered with the register of commerce of
the Canton of Schwyz, Switserland, under number: CHE-109.711.527 (“SGR”), and in that capacity is representing SGR; 

  

	 	4.	AGUTH Holding GmbH, a company incorporated under the laws of Germany, with registered office and address at: Schloß-Wolfsbrunnenweg 33, 69118 Heidelberg, Germany, registered with the Amtsgericht Mannheim
under number: HRB 337072 (“AGUTH”), and in that capacity is representing AGUTH; 

  

	 	5.	tbg Technologie-Beteiligungs-Gesellschaft mbH, a company incorporated under the laws of Germany, with registered office and address at: Ludwig-Erhard-Platz 1-3, 53179 Bonn, Germany, registered with the
Amtsgericht Bonn under number: HRB 4940 (“tbg”), and in that capacity is representing tbg; 

  

	 	6.	BioMed Invest I Ltd., a company incorporated under the laws of Guernsey, Channel Islands, with registered office and address at: Suite 7, Provident House, Havilland Street, St. Peter Port, Guernsey, GY1 2QE,
Channel Islands, registered with the Guernsey Registry under number: 51788 (“BMI”), and in that capacity is representing BMI; 

  

	 	7.	 OrbiMed Associates III, LP, a limited partnership organized under the laws of the state of Delaware, with registered office at: Corporation
Service Company, 2711 Centerville Road, Suite 400, Wilmington, Delaware, United States of America, 19808, and address at: 601 Lexington Avenue, 54th Floor, New York, NY 10022, 

	 	
United States of America, registered with the State of Delaware Department of State under number: 4141034 (“OrbiMed Associates”) and in that capacity is representing OrbiMed
Associates; 

  

	 	8.	OrbiMed Private Investments III, LP, a limited partnership organized under the laws of the state of Delaware, with registered office at: Corporation Service Company, 2711 Centerville Road, Suite 400, Wilmington,
Delaware, United States of America, 19808, and address at: 601 Lexington Avenue, 54th Floor, New York, NY 10022, United States of America, and registered with the State of Delaware Department of State under number: 4141039 (“OrbiMed Private
Investments”) and in that capacity is representing OrbiMed Private Investments, 

  

	 	9.	LSP III Omni Investment Coöperatief U.A., a cooperative with excluded liability incorporated under the laws of the Netherlands, with corporate seat in Amsterdam, the Netherlands, with address at: 1071 DV
Amsterdam, the Netherlands, Johannes Vermeerplein 9, registered with the Dutch trade register under number: 34259327 (“LSP”) and in that capacity is representing LSP; and 

 

	 	10.	Novo Nordisk A/S, a company incorporated under the laws of Denmark, with registered office and address at: Novo Allé, 2880 Bagsværd, Denmark, registered with the Danish Business Authority
(Erhvervsstyrelsen) under number: CVR 24256790 (“Novo Nordisk”) and in that capacity is representing Novo Nordisk; 

  

	b.	Eline Hedwig Viersen, kandidaat-notaris (candidate civil-law notary), employed by De Brauw Blackstone Westbroek N.V., a limited liability company, with corporate seat in Amsterdam, the Netherlands, with address at: 1082
MD Amsterdam, the Netherlands, Claude Debussylaan 80, born in The Hague on the nineteenth day of August nineteen hundred and eighty-seven, for the purpose hereof acting as attorney authorised in writing of KfW, a German public law
institution, with seat in Frankfurt am Main and a branch office with address at: Ludwig-Erhard-Platz 1-3, 53179 Bonn, Germany (“KfW”), and in that capacity is representing KfW; and 

 

	c.	Nathalia Christina Dymphna van Wiggen, kandidaat-notaris, (candidate civil-law notary), employed by De Brauw Blackstone Westbroek N.V., a limited liability company, with corporate seat in Amsterdam, the Netherlands,
with address at: 1082 MD Amsterdam, the Netherlands, Claude Debussylaan 80, born in Harderwijk on the twenty-fifth day of July nineteen hundred and eighty-nine, for the purpose hereof acting as attorney authorised in writing of Deutsches
Krebsforschungszentrum, a foundation under German public law, with registered office and address at: Im Neuenheimer Feld 280, D-69120 Heidelberg, Germany, registered within the foundation register (Stiftungsverzeichnis Teil II, Stiftungen,
des öffentlichten Rechts des Regierungspräsidiums Karlsruhe) under number: AZ: 14-0561.1 (12-21/9567.25) (“DKFZ”), and in that capacity is representing DKFZ, 

(the Company, Little, DKFZ, AGUTH, KfW, tbg, SGR, BMI, OrbiMed Associates, OrbiMed Private Investments, LSP, Novo Nordisk hereinafter together: the
“Parties”); 
 (Little, DKFZ, AGUTH, KfW, tbg, SGR, BMI, OrbiMed Associates, OrbiMed Private Investments, LSP, Novo Nordisk, each
hereinafter an “Investor”, and together: the “Investors”); and 
 (the Investors other than tbg hereinafter together: the
“Other Investors”). 
 The persons appearing 

  
 2 

 DECLARE THAT, 

WHEREAS: 
 Current shareholding. 

 

	(i)	prior to the execution of this deed the sole shareholder of the Company: Stichting Affimed Therapeutics, a foundation organised under the laws of the Netherlands, with corporate seat in Amsterdam, the Netherlands, and
address at: D-69120 Heidelberg, Germany, Im Neuenheimer Feld 582, number Trade Register 60669675 (the “Foundation”), holds one (1) share, with a nominal value of one eurocent (EUR 0.01), in the share capital of the Company
(the “Foundation Share”); 

 Restructuring. 

 

	(ii)	in connection with a contemplated initial public offering of common shares in the share capital of the Company on the NASDAQ Global Stock Market (the “IPO”), the Investors intend to exchange all their
shares in Affimed Therapeutics A.G., a company incorporated under the laws of Germany, with corporate seat in Heidelberg, Germany, and address at: D-69120 Heidelberg, Germany, Im Neuenheimer Feld 582 (“Affimed AG”), for shares in
the share capital of the Company, each share with a nominal value of one eurocent (EUR 0.01) (the “BV Shares”). As a result of such exchange, Affimed AG will become a wholly-owned subsidiary of the Company (the
“Reorganisation”); 

  

	(iii)	the current issued share capital of Affimed AG consists of common shares, series D preferred shares and series E preferred shares (such shares together the “AG Shares”). The shareholding of each
Investor in Affimed AG at the moment of execution of this deed is reflected in a schedule that is attached to this deed as Schedule A (the “Schedule A”); 

 

	(iv)	to effectuate the Reorganisation, the Investors wish to contribute their AG Shares in exchange for BV Shares (the “Share Exchange”). This Share Exchange will take into account the relevant provisions of
an investment agreement regarding pre-IPO financing between the Investors and Affimed AG, entered into on the twenty-fifth day of June two thousand and fourteen (the “Pre-IPO Investment Agreement”). The difference between the tbg
Exchange Ratio (as defined below) applicable for tbg and the Exchange Ratios (as defined below) applicable for the Other Investors is based on the understanding that tbg will waive any special rights it has in comparison to the rights of the Other
Investors with respect to the same classes of shares under Section H two (2) of the “Series C Investment and Shareholders’ Agreement with respect to Affimed Therapeutics AG in Heidelberg” dated eight April two thousand and ten
and as amended by paragraph seventeen (17) of the Pre-IPO Investment Agreement, a photocopy of both agreements will be attached to this deed; 

  

	(v)	to implement the Share Exchange, the Parties wish to agree that, in conformity with the Pre-IPO Investment Agreement, BV Shares will be issued in the following manner: 

 

	 	(i)	to tbg: for each series D preferred share in Affimed AG contributed by tbg fifteen point four six three seven nine four (15.463794) BV Shares will be issued (the “tbg Exchange Ratio”);

  

	 	(ii)	to the Other Investors: 

  

	 	(a)	for each common share in Affimed AG contributed by this Investor seven point five four three four three seven (7.543437) BV Shares will be issued; 

  
 3 

	 	(b)	for each series D preferred share in Affimed AG contributed by this Investor seven point five four three four three seven (7.543437) BV Shares will be issued; and 

 

	 	(c)	for each series E preferred share in Affimed AG contributed by this Investor thirteen point seven zero two six five four (13.702654) BV Shares will be issued, 

(the exchange ratios described under (a), (b), and (c) hereinafter: the “Exchange Ratios”), 

the number of BV Shares to be issued to an Investor based on the Exchange Ratios is reflected in a schedule that is attached to this deed as
Schedule B; 
 the number of BV Shares to be issued to tbg based on the tbg Exchange Ratio is reflected in a schedule that is attached to
this deed as Schedule C; 
 Share Issue. 
  

	(vi)	on the twelfth day of September two thousand and fourteen the general meeting of the Company resolved to (i) cancel the Foundation Share of the Foundation by the execution of this deed of issue, (ii) in
conformity with the Exchange Ratios, to issue: 

  

	 	(a)	to Little one hundred and fifty-one thousand and eighty (151,080) BV Shares, numbered 2 up to and including 151,081 (the “Little Shares”), against contribution of all AG Shares held by Little as
set forth in Schedule A (the “Contribution Shares Little”) (the “Contribution Little”); 

  

	 	(b)	to DKFZ twenty-eight thousand and one (28,001) BV Shares, numbered 151,082 up to and including 179,082 (the “DKFZ Shares”), against contribution of all AG shares held by DKFZ as set forth in
Schedule A (the “Contribution Shares DKFZ”) (the “Contribution DKFZ”); 

  

	 	(c)	to AGUTH five hundred and fifty-four thousand eight hundred and twelve (554,812) BV Shares, numbered 179,083 up to and including 733,894 (the “AGUTH Shares”), against contribution of all AG Shares
held by AGUTH as set forth in Schedule A (the “Contribution Shares AGUTH”) (the “Contribution AGUTH”); 

  

	 	(d)	to KfW three hundred and thirty-five thousand two hundred and seventy-six (335,276) BV Shares, numbered 733,895 up to and including 1,069,170 (the “KfW Shares”), against contribution of all AG
Shares held by KfW as set forth in Schedule A (the “Contribution Shares KfW”) (the “Contribution KfW”); 

  

	 	(e)	to SGR four million five hundred and forty-eight thousand six hundred and eighty-two (4,548,682) BV Shares, numbered 8,863,931 up to and including 13,412,612 (the “SGR Shares”), against
contribution of all AG Shares held by SGR as set forth in Schedule A (the “Contribution Shares SGR”) (the “Contribution SGR”); 

  

	 	(f)	to BMI one million four hundred and sixty one thousand five hundred and ninety-five (1,461,595) BV Shares, numbered 1,069,171 up to and including 2,530,765 (the “BMI Shares”), against contribution
of all AG Shares held by BMI as set forth in Schedule A (the “Contribution Shares BMI”) (the “Contribution BMI”); 

  

	 	(g)	to OrbiMed Associates forty-five thousand one hundred and forty-eight (45,148) BV Shares, numbered 7,357,380 up to and including 7,402,527 (the “OrbiMed Associates Shares”), against contribution of
all AG Shares held by OrbiMed Associates as set forth in Schedule A (the “Contribution Shares OrbiMed Associates”) (the “Contribution OrbiMed Associates”); 

  
 4 

	 	(h)	to OrbiMed Private Investments four million eight hundred and twenty-six thousand six hundred and fourteen (4,826,614) BV Shares, numbered 2,530,766 up to and including 7,357,379 (the “OrbiMed Private
Investments Shares”), against contribution of all AG Shares held by OrbiMed Private Investments as set forth in Schedule A (the “Contribution Shares OrbiMed Private Investments”) (the “Contribution OrbiMed Private
Investments”); 

  

	 	(i)	to LSP one million four hundred and sixty-one thousand four hundred and three (1.461.403) BV Shares, numbered 7,402,528 up to and including 8,863,930 (the “LSP Shares”), against contribution of all
AG Shares held by LSP as set forth in Schedule A (the “Contribution Shares LSP”) (the “Contribution LSP”); and 

  

	 	(j)	to Novo Nordisk two million two hundred and seventy one thousand one hundred and fifty-seven (2,271,157) BV Shares, numbered 13,412,613 up to and including 15,683,769 (the “Novo Nordisk Shares”),
against contribution of all AG Shares held by Novo Nordisk as set forth in Schedule A (the “Contribution Shares Novo Nordisk”) (the “Contribution Novo Nordisk”), 

and (iii) in conformity with the tbg Exchange Ratio, to issue to tbg three hundred thousand and four hundred (300,400) BV Shares,
numbered 15,683,770 up to and including 15,984,169 (the “tbg Shares”), against contribution of all AG Shares held by tbg as set forth in Schedule A (the “Contribution Shares tbg”) (the “Contribution
tbg”); 
 (the “Shareholder Resolution”); 

(the Little Shares, the DKFZ Shares, the AGUTH Shares, the KfW Shares, the tbg Shares, the SGR Shares, the BMI Shares, the OrbiMed Associates
Shares, the OrbiMed Private Investments Shares, the LSP Shares, and the Novo Nordisk Shares, hereinafter together: the “Shares”); 

(the Contribution Little, the Contribution DKFZ, the Contribution AGUTH, the Contribution KfW, the Contribution tbg, the Contribution SGR, the
Contribution BMI, the Contribution OrbiMed Associates, the Contribution OrbiMed Private Investments, the Contribution LSP, the Contribution Novo Nordisk, hereinafter together: the “Contributions”); 

Cancellation Foundation Share. 
  

	(vii)	pursuant to the Shareholder Resolution, the Foundation Share held by the Foundation is cancelled upon the execution of this deed; 

Description. 
  

	(viii)	the management board of the Company prepared a description referred to in section 2:204b in conjunction with section 2:204a Dutch Civil Code relating to the Contributions (the “Contribution
Description”), which Contribution Description is attached to this deed; 

 Approval contribution in kind. 

 

	(ix)	with respect to the issue of the BV Shares described under recital (vi) above, the general meeting of the Company resolved to approve the entering by the Company into the agreement contained in this deed and the
issue of the BV Shares contained in this deed in conformity with section 2:204 Dutch Civil Code, on the twelfth day of September two thousand and fourteen by way of the Shareholder Resolution; 

 

	(x)	pursuant to article 3.4 of the articles of association of the Company a shareholder has no pre-emptive rights upon an issue of shares, 

  
 5 

 IT IS HEREBY AGREED AND CONFIRMED AS FOLLOWS: 

Issue Little. 
 Article 1. 

 

	1.1.	Little hereby agrees to subscribe for, and the Company hereby agrees to issue to Little, the Little Shares. In consideration for the issue of the Little Shares and in order to fulfil his obligation to fully pay up the
Little Shares, Little hereby agrees to contribute and transfer the Contribution Shares Little to the Company. 

  

	1.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholder Resolution to issue the Shares and the agreement in article 1.1, the Company hereby issues to Little the Little Shares, under the
obligation for Little to make the Contribution Little to pay-up the Little Shares. 

  

	1.3.	Little accepts the Little Shares under the obligation referred to under 1.2. 

  

	1.4.	The value of the Contribution Little appears from the Contribution Description. The Little Shares will be fully paid up by way of the Contribution Little. To the extent the value of the Contribution Little exceeds the
aggregate nominal value of the Little Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	1.5.	The transfer of the Contribution Shares Little by Little to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares Little shall be for the account of the Company as
per the date hereof. 

 Issue DKFZ. 

Article 2. 
  

	2.1.	DKFZ hereby agrees to subscribe for, and the Company hereby agrees to issue to DKFZ, the DKFZ Shares. In consideration for the issue of the DKFZ Shares and in order to fulfil his obligation to fully pay up the DKFZ
Shares, DKFZ hereby agrees to contribute and transfer the Contribution Shares DKFZ to the Company. 

  

	2.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 2.1, the Company hereby issues to DKFZ the DKFZ Shares, under the
obligation for DKFZ to make the Contribution DKFZ to pay-up the DKFZ Shares. 

  

	2.3.	DKFZ accepts the DKFZ Shares under the obligation referred to under 2.2. 

  

	2.4.	The value of the Contribution DKFZ appears from the Contribution Description. The DKFZ Shares will be fully paid up by way of the Contribution DKFZ. To the extent the value of the Contribution DKFZ exceeds the aggregate
nominal value of the DKFZ Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	2.5.	The transfer of the Contribution Shares DKFZ by DKFZ to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares DKFZ shall be for the account of the Company as per
the date hereof. 

  
 6 

 Issue AGUTH. 

Article 3. 
  

	3.1.	AGUTH hereby agrees to subscribe for, and the Company hereby agrees to issue to AGUTH, the AGUTH Shares. In consideration for the issue of the AGUTH Shares and in order to fulfil his obligation to fully pay up the AGUTH
Shares, AGUTH hereby agrees to contribute and transfer the Contribution Shares AGUTH to the Company. 

  

	3.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 3.1, the Company hereby issues to AGUTH the AGUTH Shares, under the
obligation for AGUTH to make the Contribution AGUTH to pay-up the AGUTH Shares. 

  

	3.3.	AGUTH accepts the AGUTH Shares under the obligation referred to under 3.2. 

  

	3.4.	The value of the Contribution AGUTH appears from the Contribution Description. The AGUTH Shares will be fully paid up by way of the Contribution AGUTH. To the extent the value of the Contribution AGUTH exceeds the
aggregate nominal value of the AGUTH Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	3.5.	The transfer of the Contribution Shares AGUTH by AGUTH to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares AGUTH shall be for the account of the Company as
per the date hereof. 

 Issue KfW. 

Article 4. 
  

	4.1.	KfW hereby agrees to subscribe for, and the Company hereby agrees to issue to KfW, the KfW Shares. In consideration for the issue of the KfW Shares and in order to fulfil his obligation to fully pay up the KfW Shares,
KfW hereby agrees to contribute and transfer the Contribution Shares KfW to the Company. 

  

	4.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 4.1, the Company hereby issues to KfW the KfW Shares, under the
obligation for KfW to make the Contribution KfW to pay-up the KfW Shares. 

  

	4.3.	KfW accepts the KfW Shares under the obligation referred to under 4.2. 

  

	4.4.	The value of the Contribution KfW appears from the Contribution Description. The KfW Shares will be fully paid up by way of the Contribution KfW. To the extent the value of the Contribution KfW exceeds the aggregate
nominal value of the KfW Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	4.5.	The transfer of the Contribution Shares KfW by KfW to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares KfW shall be for the account of the Company as per the
date hereof. 

 Issue tbg. 

Article 5. 
  

	5.1.	tbg hereby agrees to subscribe for, and the Company hereby agrees to issue to tbg, the tbg Shares. In consideration for the issue of the tbg Shares and in order to fulfil his obligation to fully pay up the tbg Shares,
tbg hereby agrees to contribute and transfer the Contribution Shares tbg to the Company. 

  
 7 

	5.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 5.1, the Company hereby issues to tbg the tbg Shares, under the
obligation for tbg to make the Contribution tbg to pay-up the tbg Shares. 

  

	5.3.	tbg accepts the tbg Shares under the obligation referred to under 5.2. 

  

	5.4.	The value of the Contribution tbg appears from the Contribution Description. The tbg Shares will be fully paid up by way of the Contribution tbg. To the extent the value of the Contribution tbg exceeds the aggregate
nominal value of the tbg Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	5.5.	The transfer of the Contribution Shares tbg by tbg to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares tbg shall be for the account of the Company as per the
date hereof. 

 Issue SGR. 

Article 6. 
  

	6.1.	SGR hereby agrees to subscribe for, and the Company hereby agrees to issue to SGR, the SGR Shares. In consideration for the issue of the SGR Shares and in order to fulfil his obligation to fully pay up the SGR Shares,
SGR hereby agrees to contribute and transfer the Contribution Shares SGR to the Company. 

  

	6.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 6.1, the Company hereby issues to SGR the SGR Shares, under the
obligation for SGR to make the Contribution SGR to pay-up the SGR Shares. 

  

	6.3.	SGR accepts the SGR Shares under the obligation referred to under 6.2. 

  

	6.4.	The value of the Contribution SGR appears from the Contribution Description. The SGR Shares will be fully paid up by way of the Contribution SGR. To the extent the value of the Contribution SGR exceeds the aggregate
nominal value of the SGR Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	6.5.	The transfer of the Contribution Shares SGR by SGR to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares SGR shall be for the account of the Company as per the
date hereof. 

 Issue BMI. 

Article 7. 
  

	7.1.	BMI hereby agrees to subscribe for, and the Company hereby agrees to issue to BMI, the BMI Shares. In consideration for the issue of the BMI Shares and in order to fulfil his obligation to fully pay up the BMI Shares,
BMI hereby agrees to contribute and transfer the Contribution Shares BMI to the Company. 

  

	7.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 7.1, the Company hereby issues to BMI the BMI Shares, under the
obligation for BMI to make the Contribution BMI to pay-up the BMI Shares. 

  

	7.3.	BMI accepts the BMI Shares under the obligation referred to under 7.2. 

  
 8 

	7.4.	The value of the Contribution BMI appears from the Contribution Description. The BMI Shares will be fully paid up by way of the Contribution BMI. To the extent the value of the Contribution BMI exceeds the aggregate
nominal value of the BMI Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	7.5.	The transfer of the Contribution Shares BMI by BMI to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares BMI shall be for the account of the Company as per the
date hereof. 

 Issue OrbiMed Associates. 

Article 8. 
  

	8.1.	OrbiMed Associates hereby agrees to subscribe for, and the Company hereby agrees to issue to OrbiMed Associates, the OrbiMed Associates Shares. In consideration for the issue of the OrbiMed Associates Shares and in
order to fulfil his obligation to fully pay up the OrbiMed Associates Shares, OrbiMed Associates hereby agrees to contribute and transfer the Contribution Shares OrbiMed Associates to the Company. 

 

	8.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 8.1, the Company hereby issues to OrbiMed Associates the OrbiMed
Associates Shares, under the obligation for OrbiMed Associates to make the Contribution OrbiMed Associates to pay-up the OrbiMed Associates Shares. 

  

	8.3.	OrbiMed Associates accepts the OrbiMed Associates Shares under the obligation referred to under 8.2. 

  

	8.4.	The value of the Contribution OrbiMed Associates appears from the Contribution Description. The OrbiMed Associates Shares will be fully paid up by way of the Contribution OrbiMed Associates. To the extent the value of
the Contribution OrbiMed Associates exceeds the aggregate nominal value of the OrbiMed Associates Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

 

	8.5.	The transfer of the Contribution Shares Orbimed Associates by Orbimed Associates to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares Orbimed Associates shall
be for the account of the Company as per the date hereof. 

 Issue OrbiMed Private Investments. 

Article 9. 
  

	9.1.	Orbimed Private Investments hereby agrees to subscribe for, and the Company hereby agrees to issue to Orbimed Private Investments, the Orbimed Private Investments Shares. In consideration for the issue of the Orbimed
Private Investments Shares and in order to fulfil his obligation to fully pay up the Orbimed Private Investments Shares, Orbimed Private Investments hereby agrees to contribute and transfer the Contribution Shares Orbimed Private Investments to the
Company. 

  

	9.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 9.1, the Company hereby issues to Orbimed Private Investments the Orbimed
Private Investments Shares, under the obligation for Orbimed Private Investments to make the Contribution Orbimed Private Investments to pay-up the Orbimed Private Investments Shares. 

  
 9 

	9.3.	Orbimed Private Investments accepts the Orbimed Private Investments Shares under the obligation referred to under 9.2. 

  

	9.4.	The value of the Contribution Orbimed Private Investments appears from the Contribution Description. The Orbimed Private Investments Shares will be fully paid up by way of the Contribution Orbimed Private Investments.
To the extent the value of the Contribution Orbimed Private Investments exceeds the aggregate nominal value of the Orbimed Private Investments Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen
agio”). 

  

	9.5.	The transfer of the Contribution Shares Orbimed Private Investments by Orbimed Private Investments to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares Orbimed
Private Investments shall be for the account of the Company as per the date hereof. 

 Issue LSP. 

Article 10. 
  

	10.1.	LSP hereby agrees to subscribe for, and the Company hereby agrees to issue to LSP, the LSP Shares. In consideration for the issue of the LSP Shares and in order to fulfil his obligation to fully pay up the LSP Shares,
LSP hereby agrees to contribute and transfer the Contribution Shares LSP to the Company. 

  

	10.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 10.1, the Company hereby issues to LSP the LSP Shares, under the
obligation for LSP to make the Contribution LSP to pay-up the LSP Shares. 

  

	10.3.	LSP accepts the LSP Shares under the obligation referred to under 10.2. 

  

	10.4.	The value of the Contribution LSP appears from the Contribution Description. The LSP Shares will be fully paid up by way of the Contribution LSP. To the extent the value of the Contribution LSP exceeds the aggregate
nominal value of the LSP Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

  

	10.5.	The transfer of the Contribution Shares LSP by LSP to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares LSP shall be for the account of the Company as per the
date hereof. 

 Issue Novo Nordisk. 

Article 11. 
  

	11.1.	Novo Nordisk hereby agrees to subscribe for, and the Company hereby agrees to issue to Novo Nordisk, the Novo Nordisk Shares. In consideration for the issue of the Novo Nordisk Shares and in order to fulfil his
obligation to fully pay up the Novo Nordisk Shares, Novo Nordisk hereby agrees to contribute and transfer the Contribution Shares Novo Nordisk to the Company. 

  

	11.2.	In accordance with the provisions of section 2:196 Dutch Civil Code, the Shareholders Resolution to issue the Shares and the agreement in article 11.1, the Company hereby issues to Novo Nordisk the Novo Nordisk Shares,
under the obligation for Novo Nordisk to make the Contribution Novo Nordisk to pay-up the Novo Nordisk Shares. 

  
 10 

	11.3.	Novo Nordisk accepts the Novo Nordisk Shares under the obligation referred to under 11.2. 

  

	11.4.	The value of the Contribution Novo Nordisk appears from the Contribution Description. The Novo Nordisk Shares will be fully paid up by way of the Contribution Novo Nordisk. To the extent the value of the Contribution
Novo Nordisk exceeds the aggregate nominal value of the Novo Nordisk Shares, such excess value shall be regarded as (non-stipulated) share premium (“niet-bedongen agio”). 

 

	11.5.	The transfer of the Contribution Shares Novo Nordisk by Novo Nordisk to the Company shall be effectuated forthwith in accordance with the laws of Germany and the Contribution Shares Novo Nordisk shall be for the account
of the Company as per the date hereof. 

 Representations and Warranties. 

Article 12. 
  

	12.1.	The Company represents and warrants to each of the Investors as of the date of the execution of this deed as follows: 

  

	 	(a)	the Company is a private company with limited liability duly organised and validly existing under the laws of the Netherlands; 

  

	 	(b)	immediately prior to the execution of this deed, the issued share capital of the Company consists of the Foundation Share; 

  

	 	(c)	the Company has the full power and authority to enter into and perform this agreement contained in this deed and any other documents to be executed by the Company following the agreement contained in this deed, which,
when executed, will constitute valid and binding obligations on the Company, in accordance with their respective terms and conditions; 

  

	 	(d)	the Company has taken all corporate action required by it to authorise it to perform in accordance with the agreement contained in this deed and any other documents to be executed by it under the agreement contained in
this deed. 

  

	12.2.	Each Investor, save for Little in respect of (a) and (c) below, hereby represents and warrants to each of the Company and the other Investors as of the date of the execution of this deed that:

  

	 	(a)	the respective Investor validly exists and is a legal entity duly incorporated under the laws of its jurisdiction of incorporation; 

  

	 	(b)	the respective Investor has the full power and authority to enter into and perform the agreement contained in this deed and any other documents to be executed by the respective Investor under the agreement contained in
this deed, which, when executed, will constitute valid and binding obligations on the respective Investor, in accordance with their respective terms and conditions; 

 

	 	(c)	the respective Investor has taken all corporate action required by it to authorise it to perform in accordance with the agreement contained in this deed and any other documents to be executed by it under the agreement
contained in this deed; 

  

	 	(d)	the respective Investor is fully entitled to the AG Shares held by it, as set forth in Schedule A, such AG Shares are fully paid-up, they are encumbered neither with a right of pledge nor with a right of usufruct and
are not attached. 

  
 11 

 Miscellaneous. 

Article 13. 
  

	13.1.	The Company hereby agrees to forthwith register the issue of the Shares and the relevant details of the Investors in its register of shareholders and register the issue with the Dutch Trade Register
(handelsregister) at the Chamber of Commerce (Kamer van Koophandel). 

  

	13.2.	Each of the parties waives any right to dissolve the agreement contained in this deed. 

  

	13.3.	All costs and expenses connected with this deed will be for the account of the Company. 

  

	13.4.	The issuance of the Shares and the agreement contained in this deed are subject to the laws of the Netherlands. 

  

	13.5.	All disputes arising in connection with the agreement laid down in this deed, including disputes concerning the existence and validity thereof, shall be resolved by the courts in Amsterdam, the Netherlands.

  

	13.6.	With reference to the Rules of Professional Conduct (Verordening beroeps- en gedragsregels) of the Royal Dutch Organisation of Civil Law Notaries (Koninklijke Notariële Beroepsorganisatie) all Parties
expressly agree that (i) De Brauw Blackstone Westbroek N.V. acts as counsel to the Company in connection with, or acts as counsel for or on behalf of the Company in the event of any dispute relating to, this agreement or any related agreement,
and that (ii) a civil law notary (notaris) of De Brauw Blackstone Westbroek N.V. executes deeds connected with this agreement or any related agreement. 

Finally, the person appearing declares that through the execution of this deed (i) the condition precedent as included in the Shareholder Resolution,
being the execution of this deed of issue, is fulfilled by means of the execution of this deed, as a consequence of which the Foundation Share is cancelled, and (ii) the Shares are issued to the Investors. 

A photocopy of the Shareholder Resolution is attached to this deed. 

Sufficient proof of the existence of the powers of attorney has been given to me, notaris. 

The written powers of attorney to the persons appearing are evidenced by twelve (12) private instruments, (photo-)copies of which are attached to this
deed. 
 In witness whereof the original of this deed which will be retained by me, notaris, is executed in Amsterdam, on the date first mentioned in the
head of this deed. 
 Having conveyed the substance of the deed and given an explanation thereto and having pointed out the consequences arising from the
contents of the deed for the parties or one or more of them and following the statement of the persons appearing that they have taken note of the contents of the deed and agree with the partial reading thereof, this deed is signed, immediately after
reading those parts of the deed which the law requires to be read, by the persons appearing, who are known to me, notaris, and by me. 

  
 12

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