Document:

EX-4.3

 Exhibit 4.3 

 
  

 
 Stryker Corporation

 and 
 U.S. Bank National Association, 
 as Trustee 

 
  

Fifth Supplemental Indenture 
 Dated as of March 25, 2013 
 to Senior Debt Indenture 

Dated as of January 15, 2010 
 Establishing a series of Securities designated 
 4.100% Notes due 2043 

 
  

 

 FIFTH SUPPLEMENTAL INDENTURE, dated as of March 25, 2013 (this “Fifth
Supplemental Indenture”) between Stryker Corporation, a corporation duly organized and existing under the laws of the State of Michigan (herein called the “Company”), having its principal office at 2825 Airview Boulevard, Kalamazoo,
Michigan, and U.S. Bank National Association, a nationally chartered banking association, as trustee (herein called the “Trustee”). 
 RECITALS OF THE COMPANY 
 WHEREAS, the Company and the Trustee have heretofore executed and delivered an Indenture, dated as of January 15, 2010 (the “Base Indenture” and, together with this Fifth Supplemental
Indenture, the “Indenture”), providing for the issuance from time to time of the Company’s debentures, notes or other evidences of indebtedness (herein and therein called the “Securities”), to be issued in one or more series
as provided in the Base Indenture; 
 WHEREAS, Section 901 of the Base Indenture permits the Company and the Trustee to
enter into a supplemental indenture to the Base Indenture to establish the form and terms of any series of Securities; 

WHEREAS, Section 201 of the Base Indenture permits the form of Securities of any series to be established in a supplemental
indenture to the Base Indenture; 
 WHEREAS, Section 301 of the Base Indenture permits certain terms of any series of
Securities to be established pursuant to a supplemental indenture to the Base Indenture; 
 WHEREAS, pursuant to Sections 201
and 301 of the Base Indenture, the Company desires to provide for the establishment of a new series of Securities in an aggregate principal amount of $400,000,000 to be designated the “4.100% Notes due 2043” (hereinafter called the
“Notes”) under the Base Indenture, the form and substance of such Notes and the terms, provisions and conditions thereof to be set forth as provided in the Base Indenture and this Fifth Supplemental Indenture; and 

WHEREAS, all things necessary to make this Fifth Supplemental Indenture a valid agreement of the Company, in accordance with its terms,
have been done; 
 NOW, THEREFORE, for and in consideration of the foregoing and the purchase of the Notes established by this
Fifth Supplemental Indenture by the holders thereof (the “Holders”), it is mutually agreed, for the equal and proportionate benefit of all such Holders, as follows: 
 ARTICLE I 
 DEFINITIONS AND INCORPORATION BY REFERENCE 

SECTION 1.01 Relation to Base Indenture. This Fifth Supplemental Indenture constitutes a part of the Base Indenture (the
provisions of which, as modified by this Fifth Supplemental Indenture, shall apply to the Notes) in respect of the Notes but shall not modify, amend or otherwise affect the Base Indenture insofar as it relates to any other series of Securities or
modify, amend or otherwise affect in any manner the terms and conditions of the Securities of any other series. 
 SECTION 1.02
Definitions. For all purposes of this Fifth Supplemental Indenture, the capitalized terms used herein (i) which are defined in this Section 1.02 have the respective meanings assigned hereto in this Section 1.02 and
(ii) which are defined in the Base Indenture (and which are not defined in this Section 1.02) have the respective meanings assigned thereto in the Base Indenture. For all purposes of this Fifth Supplemental Indenture: 

(a) Unless the context otherwise requires, any reference to an Article or Section refers to an Article or Section, as the case may be,
of this Fifth Supplemental Indenture; 

 (b) The words “herein,” “hereof” and “hereunder” and words
of similar import refer to this Fifth Supplemental Indenture as a whole and not to any particular Article, Section or other subdivision; 
 (c) Headings are for convenience or reference only and do not affect interpretations; and 
 (d) The terms defined in this Section 1.02(d) have the meanings assigned to them in this Section and include the plural as well as the singular: 

“Applicable Procedures” has the meaning set forth in Section 2.07(a). 

“Attributable Debt” in respect of a Sale and Leaseback Transaction means, at the time of determination, the present value
(discounted at the imputed rate of interest of such transaction as determined in good faith by the Company) of the obligation of the lessee for net rental payments during the remaining term of the lease included in such Sale and Leaseback
Transaction (including any period for which such lease has been extended or may, at the option of the lessor, be extended). The term “net rental payments” under any lease for any period means the sum of the rental and other payments
required to be paid in such period by the lessee thereunder, not including any amounts required to be paid by such lessee (whether or not designated as rental or additional rent) on account of maintenance and repairs, insurance, taxes, assessments,
water rates or similar charges required to be paid by such lessee thereunder or any amount required to be paid by lessee thereunder contingent upon the amount of maintenance and repairs, insurance, taxes, assessments, water rates or similar charges.
In the case of any lease that is terminable by the lessee upon the payment of a penalty, such net amount shall be the lesser of (x) the net amount determined assuming termination upon the first date such lease may be terminated (in which case
the net amount shall also include the amount of the penalty, but shall not include any rent that would be required to be paid under such lease subsequent to the first date upon which it may be so terminated) or (y) the net amount determined
assuming no such termination. 
 “Base Indenture” has the meaning given to such term in the recitals hereof.

 “Below Investment Grade Rating Event” means the Notes are rated below Investment Grade by each of the Rating
Agencies on any date during the period commencing upon the first public notice of the occurrence of a Change of Control or the Company’s intention to effect a Change of Control and ending 60 days following public notice of the occurrence of the
related Change of Control (which period shall be extended so long as the rating of the Notes is under publicly announced consideration for possible downgrade by any of the Rating Agencies); provided that a Below Investment Grade Rating Event
otherwise arising by virtue of a particular reduction in rating shall not be deemed to have occurred in respect of a particular Change of Control (and thus shall not be deemed a Below Investment Grade Rating Event for purposes of the definition of
Change of Control Repurchase Event hereunder) if the Rating Agencies making the reduction in rating to which this definition would otherwise apply do not announce or publicly confirm or inform the Trustee in writing at its request that the reduction
was the result, in whole or in part, of any event or circumstance comprised of or arising as a result of, or in respect of, the applicable Change of Control (whether or not the applicable Change of Control shall have occurred at the time of the
Below Investment Grade Rating Event). 
 “Business Day” means any day, other than a Saturday or Sunday, that is
neither a legal holiday nor a day on which the Trustee or banking institutions in The City of New York are authorized or required by law or regulation to close. 
 “Change of Control” means the occurrence of any of the following: 
 (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 Company’s assets and those of the
Company’s 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 the Company’s Subsidiaries; 

  
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 (2) the adoption of a plan relating to the Company’s liquidation or dissolution;

 (3) the first day on which a majority of the members of the Company’s Board of Directors are not Continuing
Directors; or 
 (4) the consummation of any transaction (including, without limitation, any merger or consolidation) the
result of which is that any “person” (as that term is used in Section 13(d)(3) of the Exchange Act), other than the Company or one or more of its Subsidiaries, becomes the beneficial owner (as defined in Rule 13d-3 of the Exchange
Act), directly or indirectly, of more than 50% of the then outstanding number of shares of the Company’s Voting Stock. 
 Notwithstanding
the foregoing, a transaction shall not be considered to be a Change of Control if (a) the Company becomes a direct or indirect wholly-owned subsidiary of a holding company and (b)(i) immediately following that transaction, the direct or
indirect holders of the Voting Stock of the holding company are substantially the same as the holders of the Company’s Voting Stock immediately prior to that transaction or (ii) immediately following that transaction, no person is the
beneficial owner, directly or indirectly, of more than 50% of the Voting Stock of such holding company. 
 “Change of
Control Repurchase Event” means the occurrence of both a Change of Control and a Below Investment Grade Rating Event. 

“Company” has the meaning given to such term in the preamble hereof. 

“Comparable Treasury Issue” means the United States Treasury security selected by a Reference Treasury Dealer as having a
maturity comparable to the remaining term (as measured from the date of redemption) 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 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, (2) if the Company can only obtain less
than four such Reference Treasury Dealer Quotations, the average of all such quotations or (3) if the Company can only obtain one Reference Treasury Dealer Quotation, such quotation. 

“Consolidated Net Tangible Assets” means the total amounts of assets (less depreciation and valuation reserves and other
reserves and items deductible from gross book value of specific asset accounts under generally accepted accounting principles) that under generally accepted accounting principles would be included on a consolidated balance sheet of the Company and
its consolidated Restricted Subsidiaries after deducting (1) all current liabilities, excluding current liabilities that could be classified as long-term debt under generally accepted accounting principles and current liabilities that are by
their terms extendable or renewable at the obligor’s option to a time more than 12 months after the time as of which the amount of current liabilities is being computed; (2) Investments in Unrestricted Subsidiaries; and (3) all trade
names, trademarks, licenses, patents, copyrights and goodwill, organizational and development costs, deferred charges, other than prepaid items such as insurance, taxes, interest, commissions, rents and similar items and tangible assets being
amortized, and amortized debt discount and expense, less unamortized premium. 
 “Continuing Directors” means, as of
any date of determination, any member of the Company’s Board of Directors who (1) was a member of such Board of Directors on the date of the issuance of the Notes; or (2) was nominated for election, elected or appointed 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, election or appointment (either by a specific vote or by approval of the Company’s proxy
statement in which such member was named as a nominee for election as a director). 

  
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 “Definitive Notes” means certificated Notes registered in the name of the Holder
thereof and issued in accordance with Section 2.02 hereof, substantially in the form of Exhibit A hereto, except that such Security shall not bear the Global Note Legend. 

“Depositary” means, with respect to Global Notes issued under this Fifth Supplemental Indenture, DTC. 

“Dollar” and “$” means the lawful currency of the United States of America. 

“DTC” means The Depository Trust Company, its nominees and their successors and assigns. 

“Exchange Act” means the Securities Exchange Act of 1934, as amended from time to time. 

“Exempted Debt” means the sum of the following items outstanding as of the date Exempted Debt is being determined
(1) Indebtedness of the Company and its Restricted Subsidiaries secured by a Mortgage and not permitted to exist under the Indenture and (2) Attributable Debt of the Company and its Restricted Subsidiaries in respect of all Sale and
Leaseback Transactions not permitted under the Indenture. 
 “Funded Debt” means Indebtedness that matures more than
one year from the date of creation, or that is extendable or renewable at the sole option of the obligor so that it may become payable more than one year from such date. Funded Debt does not include (1) obligations created pursuant to leases,
(2) any Indebtedness or portion thereof maturing by its terms within one year from the time of any computation of the amount of outstanding Funded Debt unless such Indebtedness shall be extendable or renewable at the sole option of the obligor
in such manner that it may become payable more than one year from such time, or (3) any Indebtedness for the payment or redemption of which money in the necessary amount shall have been deposited in trust either at or before the maturity date
thereof. 
 “Global Note” means a single permanent fully-registered global note in book-entry form, without coupons,
substantially in the form of Exhibit A attached hereto. 
 “Global Note Legend” means the legend set forth in
Section 202 of the Base Indenture. 
 “Holders” has the meaning given to such term in the recitals hereof.

 “Indebtedness” means any and all of the obligations of a Person for money borrowed that in accordance with
generally accepted accounting principles would be reflected on the balance sheet of such Person as a liability as of the date of which the Indebtedness is to be determined. 
 “Indenture” has the meaning given to such term in the recitals hereof. 

“Indirect Participant” means a Person who holds a beneficial interest in a Global Note through a Participant. 

“Interest Payment Date” has the meaning set forth in Section 2.03(c). 

“Investment” means any investment in stock, evidences of Indebtedness, loans or advances, however made or acquired, but does
not include the Company’s account receivable or the accounts receivable of any Restricted Subsidiary arising from transactions in the ordinary course of business, or any evidences of Indebtedness, loans or advance made in connection with the
sale to any Subsidiary of the Company’s accounts receivable or the accounts receivable of any Restricted Subsidiary arising from transactions in the ordinary course of business. 

“Investment Grade” means a rating of Baa3 or better by Moody’s (or its equivalent under any successor rating categories of
Moody’s) and a rating of BBB- or better by S&P (or its equivalent under any successor rating categories of S&P) or the equivalent investment grade credit rating from any additional Rating Agency or Rating Agencies selected by the
Company. 

  
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 “Maturity Date” has the meaning set forth in Section 2.03(b) hereof.

 “Moody’s” means Moody’s Investors Service Inc., a subsidiary of Moody’s Corporation, and its
successors. 
 “Mortgage” means any mortgage, security interest, pledge, lien or other encumbrance. 

“Notes” has the meaning given to such term in the recitals hereof. 

“Participant” means, with respect to the Depositary, a Person who has an account with the Depositary. 

“Permitted Mortgage” means (a) any purchase money mortgage on such Principal Property prior to, simultaneously with or
within 180 days after the later of (1) the acquisition or completion of construction or completion of substantial reconstruction, renovation, remodeling, expansion or improvement (each, a “substantial improvement”) of such Principal
Property or (2) the placing in operation of such property after the acquisition or completion of any such construction or substantial improvement; (b) Mortgages on a Principal Property existing at the time of acquisition, including
acquisition through merger or consolidation; (c) Mortgages existing on the date of the initial issuance of the Notes, Mortgages on assets of a corporation or other business entity existing on the date it becomes a Restricted Subsidiary or is
merged or consolidated with the Company or a Restricted Subsidiary or at the time the corporation or other business entity sells, leases or otherwise disposes of its property as an entirety or substantially as an entirety to the Company or a
Restricted Subsidiary or Mortgages on the assets of a Subsidiary that is newly designated as a Restricted Subsidiary if the Mortgage would have been permitted under the provisions of this paragraph if such Mortgage was created while the Subsidiary
was a Restricted Subsidiary; (d) Mortgages in favor of the Company or a Restricted Subsidiary; (e) Mortgages for taxes, assessments or governmental charges or levies that are not delinquent or that are being contested in good faith;
(f) carriers’, warehousemen’s, materialmen’s, repairmen’s, mechanic’s, landlords’ and other similar Mortgages arising in ordinary course of business that are not delinquent or remain payable without penalty or that
are being contested in good faith; (g) Mortgages (other than any Mortgage imposed by the Employee Retirement Income Security Act of 1974) consisting of pledges or deposits required in the ordinary course of business in connection with
workers’ compensation, unemployment insurance and other social security legislation; (h) easements, rights-of-way, restrictions, encroachments, imperfections and other similar encumbrances affecting real property that, in the aggregate,
are not substantial in amount and do not in any case materially detract from the value of the Principal Property subject thereto or materially interfere with the ordinary conduct of the Company and its Subsidiaries’ business, taken as a whole;
(i) Mortgages arising by reason of deposits with, or the giving of any form of security to, any governmental agency or any body created or approved by law or governmental regulation, including any zoning or similar law or right reserved to or
vested in any governmental office or agency to control or regulate the use of any real property; (j) Mortgages arising from filing Uniform Commercial Code financing statements relating solely to leases; and (k) Mortgages to secure
Indebtedness incurred to extend, renew, refinance or replace Indebtedness secured by any Mortgages referred to above, provided that the principal amount of the extended, renewed, refinanced or replaced Indebtedness does not exceed the principal
amount of Indebtedness so extended, renewed, refinanced or replaced, plus transaction costs and fees, and that any such Mortgage applies only to the same property or assets subject to the prior permitted Mortgage (and, in the case of
real property, improvements). 
 “Primary Treasury Dealer” means a primary U.S. government securities dealer in New
York City. 
 “Principal Property” means all real property and improvements thereon owned by the Company or a
Restricted Subsidiary, including, without limitation, any manufacturing, warehouse, distribution or research facility, and improvements therein, having a net book value in excess of 2% of Consolidated Net Tangible Assets that is located within the
United States, excluding its territories and possessions and Puerto 

  
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Rico. This term does not include any real property and improvements thereon that the Company’s Board of Directors declares by resolution not to be of material importance to the total
business conducted by the Company and its Restricted Subsidiaries taken as a whole. 
 “Rating Agency” means
(1) each of Moody’s and S&P; and (2) if any of Moody’s or S&P ceases to rate the Notes or fails to make a rating of the Notes publicly available for reasons outside of the Company’s control, a “nationally
recognized statistical rating organization” within the meaning of Rule 15c3-1(c)(2)(vi)(F) under the Exchange Act, selected by the Company as a replacement agency for Moody’s or S&P, or both of them, as the case may be.

 “Reference Treasury Dealer” means (1) each of Barclays Capital Inc., Goldman, Sachs & Co. and Merrill
Lynch, Pierce, Fenner & Smith Incorporated and their respective successors or their respective affiliates that are Primary Treasury Dealers; provided, however, that if any of the foregoing shall cease to be a Primary Treasury Dealer, the
Company shall substitute therefor another Primary Treasury Dealer, and (2) any other Primary Treasury Dealer(s) selected by the Company. 
 “Reference Treasury Dealer Quotation” means, with respect to each Reference Treasury Dealer and any Redemption Date, the average of the bid and asked prices for the Comparable Treasury Issue
(expressed in each case as a percentage of its principal amount) quoted in writing to the Company by such Reference Treasury Dealer at 5:00 p.m., New York City time, on the third Business Day preceding such Redemption Date. 

“Regular Record Date” has the meaning set forth in Section 2.03(c). 

“Redemption Date” means the Business Day on which Notes are redeemed by the Company pursuant to Section 3.01 hereof

 “Redemption Price” has the meaning set forth in Section 3.01(a). 

“Registered Securities” means any Securities which are registered in the Security Register. 

“Restricted Subsidiary” means a Subsidiary that owns a Principal Property. 

“S&P” means Standard & Poor’s Ratings Services, a division of The McGraw-Hill Companies, Inc. and its
successors. 
 “Sale and Leaseback Transaction” means an arrangement with any Person providing for the leasing by the
Company or any Restricted Subsidiary of any Principal Property owned or acquired thereafter that has been or is to be sold or transferred by the Company or such Restricted Subsidiary to such Person with the intention of taking back a lease of such
Principal Property. 
 “Securities” has the meaning given to such term in the recitals hereof. 

“Senior Funded Debt” means all Funded Debt (except Funded Debt, the payment of which is subordinated to the payment of the
Notes). 
 “Subsidiary” means a corporation, partnership or other legal entity of which, in the case of a corporation,
more than 50% of the outstanding voting stock is owned, directly or indirectly, by the Company or by one or more other Subsidiaries, or by the Company and one or more other Subsidiaries or, in the case of any partnership or other legal entity, more
than 50% of the ordinary capital interests is, at the time, directly or indirectly owned or controlled by the Company or by one or more other Subsidiaries. For the purposes of this definition, “voting stock” means the equity interest that
ordinarily has voting power for the election of directors, managers or trustees of an entity, or persons performing similar functions, whether at all times or only so long as no senior class of equity interest has such voting power by reason of any
contingency. 

  
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 “Treasury Rate” means, with respect to any Redemption Date, the rate per annum
equal to the semi-annual equivalent yield to maturity 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. 
 “Trustee” has the meaning given to such term in the preamble hereof. 

“Unrestricted Subsidiary” means any Subsidiary other than a Restricted Subsidiary. 

“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 II 

CREATION, FORMS, TERMS AND CONDITIONS OF THE SECURITIES 
 SECTION 2.01 Creation of the Notes. In accordance with Section 301 of the Base Indenture, the Company hereby creates the Notes as a separate series of its securities issued pursuant to the
Indenture. The Notes shall be issued initially in an aggregate principal amount of $400,000,000, except as permitted by Sections 304, 305 or 306 of the Base Indenture. 
 SECTION 2.02 Form of the Notes. The Notes shall each be issued in the form of a Global Note, duly executed by the Company and authenticated by the Trustee, which shall be deposited with the Trustee
as custodian for DTC and registered in the name of “Cede & Co.,” as the nominee of DTC. The Notes shall be substantially in the form of Exhibit A attached hereto (including the Global Note Legend thereon). Notes issued in
definitive certificated form in accordance with the terms of the Base Indenture and this Fifth Supplemental Indenture, if any, shall be substantially in the form of Exhibit A attached hereto (but without the Global Note Legend thereon). So long as
DTC, or its nominee, is the registered owner of a Global Note, DTC or its nominee, as the case may be, shall be considered the sole owner or Holder of the Notes represented by such Global Note for all purposes under the Indenture. Ownership of
beneficial interests in such Global Note shall be shown on, and transfers thereof shall be effected only through, records maintained by DTC (with respect to beneficial interests of participants) or by participants or Persons that hold interests
through participants (with respect to beneficial interests of beneficial owners). In addition, the following provisions of clauses (1), (2), and (3) below shall apply only to Global Notes: 

(1) Notwithstanding any other provision in the Indenture, no Global Note may be exchanged in whole or in part for Securities registered,
and no transfer of a Global Note in whole or in part may be registered, in the name of any Person other than the Depositary for such Global Note or a nominee thereof unless (A) such Depositary has notified the Company that it is unwilling or
unable or no longer permitted under applicable law to continue as Depositary for such Global Note and the Company has not appointed a successor Depositary within 90 days of receipt of such notice or has ceased to be a clearing agency registered
under the Exchange Act, (B) there shall have occurred and be continuing an Event of Default with respect to such Global Note or (C) the Company (subject to the procedures of the Depositary) so directs the Trustee by Company Order.
Beneficial interests in Global Notes may be exchanged for Definitive Notes of the same series upon request but only upon at least 30 days’ prior written notice given to the Trustee by or on behalf of the Depository in accordance with customary
procedures. 
 (2) Subject to clause (1) above, any exchange of a Global Note for other Securities may be made in whole or
in part, and all Securities issued in exchange for a Global Note or any portion thereof shall be registered in such names as the Depositary for such Global Note shall direct. 
 (3) Every Security authenticated and delivered upon registration of transfer of, or in exchange for or in lieu of, a Global Note or any portion thereof, shall be authenticated and delivered in the form
of, and shall be, a Global Note, unless such note is registered in the name of a Person other than the Depositary for such Global Note or a nominee thereof. 

  
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 SECTION 2.03 Terms and Conditions of the Notes. The Notes shall be governed by all
the terms and conditions of the Base Indenture, as supplemented by this Fifth Supplemental Indenture. In particular, the following provisions shall be terms of the Notes: 
 (a) Title and Aggregate Principal Amount. The title of the Notes shall be as specified in the Recitals of the Company; and the aggregate principal amount of the Notes shall be as specified in
Section 2.01 of this Article II, except as permitted by Sections 304, 305 or 306 of the Base Indenture. 
 (b) Stated
Maturity. The Notes shall mature, and the unpaid principal thereon shall be payable, on April 1, 2043 (the “Maturity Date”), subject to the provisions of the Base Indenture and Articles III and IV below. 

(c) Interest. The rate per annum at which interest shall be payable on the Notes shall be 4.100%. Interest on the Notes shall be
payable semi-annually in arrears on each April 1 and October 1, commencing on October 1, 2013 (each, an “Interest Payment Date”), to the Persons in whose names the applicable Notes are registered in the Security Register
applicable to the Notes at the close of business on the immediately preceding March 15 or September 15, respectively, prior to the applicable Interest Payment Date regardless of whether such day is a Business Day (each, a “Regular
Record Date”). Interest on the Notes shall be computed on the basis of a 360-day year consisting of twelve 30-day months. Interest on the Notes shall accrue from and including March 25, 2013. If an Interest Payment Date or the Maturity
Date falls on a day that is not a Business Day, the payment shall be made on the next Business Day as if it were made on the date the payment was due, and no interest shall accrue on the amount so payable for the period from and after that Interest
Payment Date or the Maturity Date, as the case may be, to the date the payment is made. Interest payments shall include accrued interest from and including the date of issue or from and including the last date in respect to which interest has been
paid, as the case may be, to, but excluding, the Interest Payment Date or the Maturity Date, as the case may be. 
 (d)
Registration and Form. The Notes shall be issuable as Registered Securities as provided in Section 2.02 of this Article II. The Notes shall be issued and may be transferred only in minimum denominations of $2,000 and integral multiples
of $1,000 above that amount. All payments of principal, Redemption Price and accrued unpaid interest in respect of the Notes shall be made by the Company in immediately available funds. 

(e) Defeasance and Covenant Defeasance. The provisions for defeasance in Section 1302 of the Base Indenture, and the
provisions for covenant defeasance in Section 1303 of the Base Indenture, shall be applicable to the Notes. 
 (f)
Further Issues. Notwithstanding anything to the contrary contained herein or in the Base Indenture, the Company may, from time to time, without notice to, or the consent of, the Holders, create and issue additional securities having the same
ranking and terms and conditions as the Notes in all respects, except for issue date, the public offering price and, in some cases, the first Interest Payment Date. Additional Notes issued in this manner shall be consolidated with and shall form a
single series with the previously outstanding Notes. Notice of any such issuance shall be given to the Trustee and a new supplemental indenture shall be executed in connection with the issuance of such additional Notes. 

(g) Other Terms and Conditions. The Notes shall have such other terms and conditions as provided in the form thereof attached as
Exhibit A. 
 SECTION 2.04 Ranking. The Notes shall be general unsecured obligations of the Company. The Notes shall rank
pari passu in right of payment with all unsecured and unsubordinated indebtedness, including, without limitation, any unsecured senior indebtedness, of the Company and senior in right of payment to all subordinated indebtedness of the
Company. 
 SECTION 2.05 Sinking Fund. The Notes shall not be entitled to any sinking fund. 

  
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 SECTION 2.06 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 in The City of New York, State of New York. 
 SECTION 2.07 Transfer and Exchange. 
 (a) The transfer and exchange of
beneficial interests in the Global Notes shall be effected through the Depositary, in accordance with the provisions of the Base Indenture, this Fifth Supplemental 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 or an Indirect Participant 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 Note 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 Notes are at such time permitted to be issued pursuant to this
Fifth Supplemental Indenture and the Base 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 Note 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 Note
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 Notes contained in the Base Indenture, this Fifth
Supplemental Indenture and the Notes or otherwise applicable under the Securities Act, the Security Registrar shall adjust the principal amount of the relevant Global Notes pursuant to Section 2.08 hereof. 

(b) Upon request by a Holder of Definitive Notes and such Holder’s compliance with the provisions of this Section 2.07(b), the
Security Registrar shall register the transfer or exchange of Definitive Notes. Prior to such registration of transfer or exchange, the requesting Holder shall present or surrender to the Trustee the Definitive Notes 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 Notes so surrendered, and the Company shall
execute and, upon receipt of a Company Order pursuant to Section 303 of the Base Indenture, the Trustee shall authenticate and deliver to the Person designated in the instructions a new Definitive Note in the appropriate principal amount. Any
Definitive Note issued pursuant to this Section 2.07(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 Notes to the Persons in whose names such Definitive Notes are so registered. In addition, the requesting Holder shall provide any
additional certifications, documents and information, as applicable, required pursuant to Section 305 of the Base Indenture. 
 SECTION 2.08 Cancellation and/or Adjustment of Global Notes. At such time as all beneficial interests in a particular Global Note have been exchanged for Definitive Notes or a particular Global
Note has been redeemed, repurchased or cancelled in whole and not in part, each such Global Note shall be returned to or retained and cancelled by the Trustee in accordance with Section 309 of the Base Indenture. At any time prior to such
cancellation, if any beneficial interest in a Global Note is exchanged for or transferred to a Person who will take delivery thereof in the form of a beneficial interest in another Global Note or for Definitive Notes, the principal amount of
Securities represented by such Global Note shall be reduced accordingly and an endorsement shall be made on such Global Note 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 Note, such other Global Note shall be increased accordingly and an endorsement shall be made on such
Global Note by the Security Registrar or by the Depositary at the direction of the Security Registrar to reflect such increase. 

  
 9 

 ARTICLE III 
 REDEMPTION OF THE NOTES 
 SECTION 3.01 Optional Redemption by
Company. 
 (a) The Company shall have the right to redeem the Notes at any time in whole or from time to time in part for
cash at a redemption price (the “Redemption Price”) equal to the greater of: 
 (i) 100% of the principal amount of
the Notes to be redeemed; and 
 (ii) unless the Notes are redeemed on or after October 1, 2042, the sum of the present
values of the remaining scheduled payments of principal and interest thereon (not including any portion of such payments of interest accrued as of the date of redemption), discounted to the date of redemption on a semi-annual basis (assuming a
360-day year consisting of twelve 30-day months) at the Treasury Rate, plus fifteen (15) basis points; 
 plus,
in each case, accrued and unpaid interest thereon to the date of redemption. 
 (b) Notwithstanding subsection (a) above,
installments of interest on the Notes that are due and payable on any Interest Payment Date falling on or prior to a Redemption Date shall be payable on such Interest Payment Date to the registered Holders as of the close of business on the relevant
Regular Record Date according to the terms of the Notes and the Indenture. Unless the Company defaults in payment of the Redemption Price, on and after the Redemption Date, interest shall cease to accrue on any Notes or portions thereof that are
called for redemption. 
 (c) Notices of redemption shall be mailed at least thirty (30) but not more than sixty
(60) days before the Redemption Date to each Holder of the Notes to be redeemed at its registered address. The Company shall calculate the Redemption Price and shall deliver an Officers’ Certificate to the Trustee setting forth the
Redemption Price no later than two Business Days prior to the Redemption Date. 
 (d) If less than all the Notes are to be
redeemed at any time, the Notes to be redeemed shall be selected by lot by DTC, in the case of Global Notes, or by the Trustee by a method the Trustee deems to be fair and appropriate, in the case of Notes that are not represented by a Global Note.

 ARTICLE IV 
 CHANGE OF CONTROL  
 SECTION 4.01 Repurchase at the Option of Holders
Upon Change of Control Repurchase Event. 
 (a) If a Change of Control Repurchase Event occurs, unless the Company has
exercised its right to redeem the Notes pursuant to the Indenture, the Company shall be required to make an offer to each Holder of the Notes to repurchase all or any part (in minimum denominations of $2,000 and integral multiples of $1,000 above
that amount) of that Holder’s Notes at a repurchase price in cash equal to 101% of the aggregate principal amount of the Notes repurchased plus any accrued and unpaid interest on the Notes repurchased to the date of such
repurchase. 
 (b) Within thirty (30) days following any Change of Control Repurchase Event or, at the option of the
Company, prior to any Change of Control, but after the public announcement of an impending Change of Control, the Company shall mail a notice to each Holder, with a copy to the Trustee, describing the transaction or transactions that constitute or
may constitute the Change of Control Repurchase Event and offering to repurchase the Notes on the payment date specified in the notice, which date shall be no earlier than thirty (30) days and no later than sixty (60) days from the date
such notice is mailed. The notice shall, if mailed prior to the date of consummation of the Change of Control, state that the offer to purchase is conditioned on a Change of Control Repurchase Event occurring on or prior to the payment date
specified in the notice. 

  
 10 

 (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 those laws and regulations are applicable in connection with the repurchase of the Notes as a result of a Change of Control Repurchase Event. To the extent that the provisions
of any securities laws or regulations conflict with the Change of Control Repurchase Event provisions of the Notes, the Company shall comply with the applicable securities laws and regulations and shall not be deemed to have breached its obligations
under the Change of Control Repurchase Event provisions of the Notes or the Indenture by virtue of such conflict. 
 (d) On the
Change of Control Repurchase Event payment date, the Company shall, to the extent lawful: 
 (i) accept for payment all the
Notes or portions of the Notes (in minimum denominations of $2,000 and integral multiples of $1,000 above that amount) properly tendered pursuant to its offer; 
 (ii) deposit with the Paying Agent an amount equal to the aggregate purchase price in respect of all the Notes or portions of the Notes properly tendered; and 

(iii) deliver or cause to be delivered to the Trustee for cancellation the Notes properly accepted, together with an Officers’
Certificate stating the aggregate principal amount of Notes being repurchased by the Company. 
 (e) The Paying Agent shall
promptly mail to each Holder of Notes properly tendered the purchase price for the Notes, and the Trustee shall promptly authenticate and mail (or, if a Global Note, to be adjusted on the Schedule of Exchanges attached thereto) to each Holder a new
Note equal in principal amount to any unpurchased portion of any Notes surrendered; provided, that each new Note shall be in a minimum principal amount of $2,000 or an integral multiple of $1,000 above that amount. 

(f) The Company shall not be required to make an offer to repurchase the Notes upon a Change of Control Repurchase Event if a third
party makes such an offer in the manner, at the times and otherwise in compliance with the requirements for an offer made by the Company and such third party purchases all Notes properly tendered and not withdrawn under its offer. 

ARTICLE V 

COVENANTS 

SECTION 5.01 Limitation on Liens. 
 (a) The Company shall not, and shall not permit any Restricted Subsidiary to, issue, assume or guarantee any Indebtedness secured by any Mortgage upon any Principal Property of the Company or any
Restricted Subsidiary without equally and ratably securing the Notes (and, if the Company so determines, any other Indebtedness ranking equally with the Notes) with such Indebtedness; provided, however, that the foregoing restrictions
shall not prevent the Company or any Restricted Subsidiary from issuing, assuming or guaranteeing any Indebtedness secured by a Permitted Mortgage. 
 (b) Notwithstanding the provisions of subsection (a) of this Section 5.01, the Company or any Restricted Subsidiary may, in addition to Mortgages permitted by subsection (a) of this
Section 5.01 and without equally and ratably securing the Notes, create or assume and renew, extend or replace Mortgages which would otherwise be subject to such subsection (a), provided that at the time of such creation, assumption, renewal,
extension or replacement, and after giving effect thereto, Exempted Debt does not exceed 15% of Consolidated Net Tangible Assets. 

  
 11 

 SECTION 5.02 Limitations on Sale and Leaseback Transactions. 

(a) The Company shall not, and shall not permit any Restricted Subsidiary to, enter into any Sale and Leaseback Transaction without
equally and ratably securing the Notes (and, if the Company so determines, any other Indebtedness ranking equally with the Notes) unless: 
 (i) within 180 days after the receipt of the proceeds of such sale or transfer, the Company or such Restricted Subsidiary applies an amount equal to the greater of the net proceeds of such sale or
transfer or the fair value of such Principal Property at the time of such sale or transfer to any (or a combination) of (1) the prepayment or retirement (other than any mandatory prepayment or retirement) of Senior Funded Debt of the Company or
(2) the purchase, construction, development, expansion or improvement of other comparable property, subject in each case to credits for voluntary retirements of Senior Funded Debt of the Company; or 

(ii) the Company or such Restricted Subsidiary would be entitled, at the effective date of such sale or transfer, to incur Indebtedness
secured by a Mortgage on such Principal Property, in an amount at least equal to the Attributable Debt in respect of the Sale and Leaseback Transaction, without equally and ratably securing the Notes pursuant to the provisions of Section 5.01
above. 
 The foregoing restriction shall not apply to any Sale and Leaseback Transaction (w) for a term of not more than
three years including renewals, (x) with respect to a Principal Property if a binding commitment is entered into with respect to such Sale and Leaseback Transaction within three years after the later of (1) March 25, 2013 or
(2) the date when the applicable Principal Property was acquired, (y) with respect to a Principal Property if a binding commitment with respect thereto is entered into within 180 days after the later of the date such property was acquired
and, if applicable, the date such property was first placed in operation, or (z) between the Company and any Restricted Subsidiary or between Restricted Subsidiaries. 
 (b) Notwithstanding the provisions of subsection (a) of this Section 5.02, the Company or any Restricted Subsidiary may, in addition to Sale and Leaseback Transactions permitted by subsection
(a) of this Section 5.02 and without equally and ratably securing the Notes, enter into any Sale and Leaseback Transaction without any obligation to retire any Senior Funded Debt of the Company or a Restricted Subsidiary, provided that, at
the time of entering into such Sale and Leaseback Transaction, and after giving effect thereto, Exempted Debt does not exceed 15% of Consolidated Net Tangible Assets. 
 ARTICLE VI 
 MISCELLANEOUS PROVISIONS  

SECTION 6.01 Ratification of Base Indenture. This Fifth Supplemental Indenture is executed and shall be construed as an indenture
supplemental to the Base Indenture, and as supplemented and modified hereby, the Base Indenture is in all respects ratified and confirmed, and the Base Indenture and this Fifth Supplemental Indenture shall be read, taken and construed as one and the
same instrument. 
 SECTION 6.02 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, which is required to be included in this Fifth 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. 
 SECTION 6.03 Effect of Headings. The Article and
Section headings herein are for convenience only and shall not affect the construction hereof. 
 SECTION 6.04 Successors and
Assigns. All covenants and agreements in this Fifth Supplemental Indenture by the Company shall bind its successors and assigns, whether so expressed or not. 

  
 12 

 SECTION 6.05 Separability Clause. In case any one or more of the provisions contained
in this Fifth Supplemental Indenture or in the Notes shall for any reason be held to be invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions shall not in any way be affected or
impaired thereby. 
 SECTION 6.06 Governing Law. THIS FIFTH SUPPLEMENTAL INDENTURE AND THE NOTES SHALL BE GOVERNED BY AND
CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK. 
 SECTION 6.07 Counterparts. This Fifth Supplemental
Indenture may be executed in any number of counterparts, and each of such counterparts shall for all purposes be deemed to be an original, but all such counterparts shall together constitute one and the same instrument. 

[Signature page follows] 

  
 13 

 IN WITNESS WHEREOF, the parties hereto have caused this Fifth Supplemental Indenture to be
duly executed, all as of the day and year first above written. 
  

					
	STRYKER CORPORATION
		
	By:	 	 /s/ Jeanne M. Blondia

		 	Name:	 	Jeanne M. Blondia
		 	Title:	 	Vice President and Treasurer
	
	U.S. BANK NATIONAL ASSOCIATION
		
	By:	 	 /s/ Jason Fry

		 	Name:	 	Jason Fry
		 	Title:	 	Vice President

 EXHIBIT A 
 [Form of Face of 2043 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 IN WHOLE OR IN PART FOR A SECURITY REGISTERED, AND NO TRANSFER OF THIS SECURITY IN WHOLE OR IN PART MAY BE
REGISTERED, IN THE NAME OF ANY PERSON OTHER THAN SUCH DEPOSITARY OR A NOMINEE THEREOF, EXCEPT IN THE LIMITED CIRCUMSTANCES DESCRIBED IN THE INDENTURE. 
 UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY, A NEW YORK CORPORATION (“DTC”), TO THE COMPANY OR ITS AGENT FOR REGISTRATION OF TRANSFER,
EXCHANGE, OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE & CO. OR IN SUCH OTHER NAME AS IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR TO SUCH OTHER ENTITY AS
IS REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC), ANY TRANSFER, PLEDGE, OR OTHER USE HEREOF FOR VALUE OR OTHERWISE BY OR TO ANY PERSON IS WRONGFUL INASMUCH AS THE REGISTERED OWNER HEREOF, CEDE & CO., HAS AN INTEREST HEREIN. 

STRYKER CORPORATION 
 4.100% Notes due 2043 
  

			
	No.	  	CUSIP NO.
		  	$            

 Stryker Corporation, a Michigan corporation (herein called the “Company”, which term includes any successor
Person under the Indenture hereinafter referred to), for value received, hereby promises to pay to Cede & Co., or registered assigns, the principal sum of
                     Dollars on April 1, 2043 and to pay interest thereon from March 25, 2013 or from the most recent Interest Payment Date
to which interest has been paid or duly provided for, semi-annually on April 1 and October 1 in each year, commencing October 1, 2013, at the rate of 4.100% per annum, until the principal hereof is paid or made available for
payment. The interest so payable, and punctually paid or duly provided for, on any Interest Payment Date will, as provided in such Indenture, be paid to the Person in whose name this Security is registered at the close of business on the Regular
Record Date for such interest, which shall be the March 15 or September 15 (whether or not a Business Day), as the case may be, next preceding such Interest Payment Date. Any such interest not so punctually paid or duly provided for will
forthwith cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security 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 any such interest on this Security will be made at the office or agency of the Company maintained for that purpose in The City of New York, State of
New York or at the office or agency of the Paying Agent in The City of New York, State of 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; provided,
however, that at the option of the Company payment of interest may be made by (i) check mailed to the address of the Person entitled thereto as such address shall appear in the Security Register or (ii) wire transfer in immediately
available funds to the place and account designated in writing by the Person entitled to such payment as specified in the Security Register; and provided further, that if this Security is a Global Note, payment may be made pursuant to the Applicable
Procedures of the Depositary as permitted in the Indenture. 

 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 hereof 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.

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

 

			
		 	STRYKER CORPORATION
		
	By:	 	  

		 	Name:
		 	Title:

  

	
	Attest:
	
	  

	Name:
	Title:

  
 F-2

 CERTIFICATE OF AUTHENTICATION 
 This is one of the Securities of the series designated therein referred to in the within-mentioned Indenture. 

 

			
		 	U.S. BANK NATIONAL ASSOCIATION
		 	As Trustee
		
	By:	 	  

		 	Authorized Signatory
		
		 	Dated:                    

  
 F-3

 [Form of Reverse of 2043 Note] 

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 January 15, 2010 (the “Base Indenture”), as supplemented by the Fifth Supplemental Indenture, dated as of March 25, 2013 (the “Supplemental Indenture” and,
together with the Base Indenture, the “Indenture”), between the Company and U.S. Bank National Association, a nationally chartered banking association, as Trustee (herein called the “Trustee”, which term includes any successor
trustee under the Indenture), and reference is hereby made to the Indenture for a statement of the respective rights, limitations of rights, duties and immunities thereunder of the Company, the Trustee and the Holders of the Securities and of the
terms upon which the Securities are, and are to be, authenticated and delivered. This Security is one of the series designated on the face hereof, initially limited in aggregate principal amount to $400,000,000, provided that the
Company may, without the consent of any Holder, at any time and from time to time increase the initial principal amount. 

The Securities of this series are subject to redemption as provided in Section 3.01 of the Supplemental Indenture and Article XI of
the Base Indenture. 
 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 of the rights and obligations of the Company and the rights of the Holders of the Securities of each series to be affected under the Indenture at any time by the Company and the Trustee with the consent of the Holders of a
majority in principal amount of the Securities at the time Outstanding of each series to be affected. The Indenture also contains provisions permitting the Holders of specified percentages in principal amount of the Securities of each series at the
time Outstanding, on behalf of the Holders of all Securities of such series, to waive compliance by the Company with certain provisions of the Indenture and certain past defaults under the Indenture and their consequences. Any such consent or waiver
by the Holder of this Security shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security issued upon the registration of transfer hereof or in exchange 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 principal amount of the Securities of this series at the time Outstanding shall have made written request to
the Trustee to institute proceedings in respect of such Event of Default as Trustee and offered the Trustee reasonable indemnity, and the Trustee shall not have received from the Holders of a majority in principal amount of Securities of this series
at the time Outstanding a direction inconsistent with such request, and shall have failed to institute any such proceeding, for 60 days after receipt of such notice, request and offer of indemnity. The foregoing shall not apply to any suit
instituted by the Holder of this Security for the enforcement of any payment of principal hereof or any 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. 

  
 R-1

 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 his 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 minimum denominations of $2,000 and integral
amounts of $1,000 above that amount. 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 may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall be affected by notice to the
contrary. 
 THE SECURITIES OF THIS SERIES SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW
YORK. 
 All terms used in this Security which are defined in the Indenture shall have the meanings assigned to them in the
Indenture. 

  
 R-2EX-10.23

 Exhibit 10.23 
 FIRST AMENDMENT TO CONSULTING AGREEMENT 
 THIS FIRST AMENDMENT TO
CONSULTING AGREEMENT (this “First Amendment”) is made as of March 1, 2013, by and between Aurora Diagnostics, LLC (the “Company”) and James C. New (“New”). 

WHEREAS, the Company and New are parties to that certain Consulting Agreement, dated July 6, 2011 (the “Consulting
Agreement”), pursuant to which New has provided professional consulting and transition services to the Company as an independent contractor; 
 WHEREAS, the parties desire for New to continue to provide the Consulting Services to the Company and serve on the Company’s Board of Managers; 

WHEREAS, the parties desire to amend the Consulting Agreement in light of the foregoing; and 

WHEREAS, capitalized terms used herein and not otherwise defined herein shall have the meaning ascribed such terms in the Consulting
Agreement; 
 NOW, THEREFORE, for and in consideration of the premises, the mutual covenants contained herein and other good and
valuable consideration, the receipt, adequacy and sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 
 1. Amendment. The parties hereby amend the Consulting Agreement to provide as follows: 
 (a) The Consulting Period, as defined in Section 3 of the Consulting Agreement, shall be extended and expire on the third (3rd) anniversary of the date of this First Amendment. 

(b) In lieu of a Final Consulting Payment or other payments contemplated under the Consulting Agreement, provided that New continues to
provide the Consulting Services in accordance with the terms of the Agreement and serve on the Company’s Board of Managers as requested, the Monthly Consulting Payments, as defined in Section 5 of the Consulting Agreement, shall be
increased from $5,667 per month to $12,500 per month beginning on the date of this First Amendment and continuing until the end of the Consulting Period, as extended hereby. In the event there occurs a Sale of Holdings LLC or a Sale of the Company
(as those terms are defined in the Second Amended and Restated Limited Liability Company Agreement of Aurora Diagnostics Holdings, LLC), the Consulting Agreement shall automatically terminate and New shall be entitled to a lump sum payment of the
Monthly Consulting Payments for each month remaining in Consulting Period as of the date of such termination. New acknowledges and agrees that the payments and rights provided to New under this paragraph are in full and complete satisfaction of any
and all compensation and other obligations due to New from the Company or any of its affiliates pursuant to the Consulting Agreement as of and after the date hereof, including without limitation any right New may have to a Final Consulting Payment
and the Company’s obligation to pay New $18,636 to cover the cost of a supplemental life insurance policy; provided, however, that New shall be entitled to continue to participate, at his cost, in the Company’s health and
welfare benefit plans under Section 6 of the Consulting Agreement and be reimbursed for expenses pursuant to Section 7 of the Consulting Agreement. 
 2. No Other Amendments; Entire Agreement. Except to the extent amended hereby, all of the definitions, terms, provisions and conditions set forth in the Consulting Agreement are hereby ratified and
confirmed and shall remain in full force and effect. The Consulting Agreement and this First Amendment shall be read and construed together as a single agreement. 

 3. Counterparts. This First Amendment may be executed and delivered by each party
hereto in separate counterparts (including by means of facsimile), each of which when so executed and delivered shall be deemed an original and both of which taken together shall constitute one and the same agreement. 

4. Choice of Law. This First Amendment shall be governed by and construed in accordance with the domestic laws of the State of
Florida, without giving effect to any choice of law or conflict of law provision or rule. 
 [Signatures on the Following Page]

  
 2 

 IN WITNESS WHEREOF, the undersigned have caused this First Amendment to Consulting Agreement
to be duly executed and delivered on the date and year first above written. 
  

			
	AURORA DIAGNOSTICS, LLC
		
	By:	 	 /s/ James C. New

	Name:	 	James C. New
	Title:	 	Board Member / Manager

  

	
	         /s/ James C. New

	James C. New

 [Signature Page to First Amendment to Consulting Agreement]

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