Document:

exv10w1

 

EXHIBIT 10.1

FORM OF PERFORMANCE UNIT AGREEMENT

     Crosstex Energy GP, LLC (“Company”) hereby agrees to award to the participant named below
(“Participant”) the number of common units representing limited partner interests of Crosstex
Energy, L.P. (the “Units”), in accordance with and subject to the terms, conditions and
restrictions of this Agreement. If the conditions described below are satisfied, such award will
be made under the terms of the Crosstex Energy GP, LLC Long Term Incentive Plan (the “Plan”) on the
Future Award Date.

     1. Definitions. Capitalized terms used herein and not otherwise defined herein shall
have the meaning ascribed to them in the Plan.

          (a) The basic terms of this Award include the following:

	 	 	 
	“Participant”

	 	_______
	“Target Number of Units”

	 	___ Units
	“Minimum Number of Units”

	 	___% of Target
	“Maximum Number of Units”

	 	___% of Target
	“Commencement Date”

	 	______, 20___
	“Grant Date”

	 	______, 20___
	“Future Award Date”

	 	______, 20___
	“Vesting Date”

	 	___, 20___
	“Target Growth Rate”

	 	___%
	“Minimum Growth Rate”

	 	___%
	“Maximum Growth Rate”

	 	___%

          (b) Other definitions include the following:

     “Cause” means (i) Participant has failed to perform the duties assigned to him and such
failure has continued for thirty (30) days following delivery by Company of written notice to
Participant of such failure, (ii) Participant has been convicted of a felony or misdemeanor
involving moral turpitude, (iii) Participant has engaged in acts or omissions against Company
constituting dishonesty, breach of fiduciary obligation, or intentional wrongdoing or misfeasance,
(iv) Participant has acted intentionally or in bad faith in a manner that results in a material
detriment to the assets, business or prospects of Company, or (v) Participant has breached any
obligation under this Agreement.

     “DCF/U” means the distributable cash flow per unit of Crosstex Energy, L.P. Any units that do
not require quarterly distributions are ignored for purposes of this calculation. The DCF/U for
each calendar quarter is determined by the Company and approved by the Board each quarter in
connection with the determination of quarterly earnings.

     “Disability” shall mean a physical or mental condition of Participant that, in the good faith
judgment of not less than a majority of the entire membership of the Board (excluding Participant,
if then a member of the Board), based upon certification by a licensed physician reasonably
acceptable to Participant and the Board, (i) prevents Participant from being able to perform the
services required under this Agreement, (ii) has continued for a period of at least 180 days during
any 12-month period, and (iii) is expected to continue.

 

 

     “Growth Rate” is the percentage increase (or decrease) in DCF/U during a particular calendar
year compared to DCF/U in the immediately preceding year. The “Average Growth Rate” is equal to the
sum of the annual Growth Rates divided by the number of years in the Measurement Period.

     “Good Reason” means any of the following: (i) the assignment to Participant of any duties
materially inconsistent with Participant’s position, authority, duties or responsibilities; (ii)
Company requiring Participant to be based at any office other than offices in the greater Dallas,
Texas area; or (iii) a breach or violation by Company of any material provision of any written
agreement with Participant, which breach or violation remains unremedied for more than 30 days
after written notice thereof is given to Company by Participant. For purposes of this definition,
no act or failure to act on Company’s part shall be considered a “Good Reason” unless Participant
has given Company written notice of such act or failure to act within 30 days thereof and Company
fails to remedy such act or failure to act within 30 days of its receipt of such notice.

     “Measurement Period” means the period beginning on the Commencement Date and ending on the
Future Award Date.

     “Qualifying Termination” means Participant’s employment or service with Company or its
Affiliates is terminated (i) by Company without Cause, (ii) by Participant for Good Reason, (iii)
due to Participant’s death, or (iv) due to Participant’s Disability.

     2. Award of Performance Units. An award of Restricted Units under the Plan will be
made to Participant effective as of the Future Award Date if Participant on such date is, and has
continuously been, employed by Company or an Affiliate since the Grant Date. Subject to the terms
hereof, no Units will be credited to Participant until such Future Award Date. After such future
award is made, the Units will be released from restrictions on the Vesting Date only upon the
satisfaction of all terms and conditions set forth in this Agreement.

     (a) The number of Units will be determined using the following formulas:

     If the Average Growth Rate is less than the Target Growth Rate, the formula is as
follows:

	 	 	 	 	 	 	 
	 

	 	T x (100% - (___% x
	 	B - A))
	 	 
	 

	 	 	 	C	 	 

     If the Average Growth Rate is more than the Target Growth Rate, the formula is as
follows:

	 	 	 	 	 	 	 
	 

	 	T x (100% + (___% x
	 	A - B))
	 	 
	 

	 	 	 	D	 	 

	 	 	 	 	 
	     Legend:

	 	A =
	 	Average Growth Rate (which will not be less than Minimum Growth Rate nor more than Maximum Growth Rate)
	 

	 	B =
	 	Target Growth Rate
	 

	 	C =
	 	Spread between Target Growth Rate and Minimum Growth Rate
	 

	 	D =
	 	Spread between Maximum Growth Rate and Target Growth Rate
	 

	 	T =
	 	Target Number of Units

     (b) Except as otherwise provided in this Section 2, provided Participant has continuously
been employed by Company or an Affiliate since the Grant Date, unrestricted ownership of the Units
will occur on the Vesting Date and the Units will be delivered to Participant shortly thereafter by
electronic transfer or the issuance of one or more certificates representing the Units.

 

 

     (c) If Participant ceases to be employed by Company or an Affiliate before the Vesting Date
for any reason other than a Qualifying Termination, this Agreement shall become null and void and
no awards or payments will be due to Participant.

     (d) If Participant’s employment is terminated due to a Qualifying Termination before the
Vesting Date, the terms of this subparagraph will apply. If the Qualifying Termination occurs
before the first April 1 following the Commencement Date, no award will be made and no payments
will be due under this Agreement. If the Qualifying Termination occurs at any time thereafter,
Participant or Participant’s estate will receive an award of the number of shares determined below
on the 90th day following the Qualifying Termination:

     (i) The Average Growth Rate that is achieved with respect to a short period ending on
the Qualifying Termination date will be based upon the Growth Rates of (x) each full
calendar year from the Commencement Date and (y) each short year during such period that
consists of at least one full calendar quarter (in which event, the Growth Rate for such
short year will be determined by annualizing the DCF/U for each of the full calendar
quarters during such short year).1

     (ii) The number of Units will be determined using the Average Growth Rate established
in subsection 2(d)(i) and the formula described in subsection 2(a). In the case of a
Qualifying Termination due to Participant’s death or Disability, Participant or
Participant’s estate will be entitled to the full number of Units without pro-ration. In
all other cases involving a Qualifying Termination, the number of Units will be pro-rated by
multiplying the full number of Units by a fraction with the numerator being the full number
of months Participant was employed by Company during the Measurement Period and the
denominator being the original number of months in the Measurement Period.

     (e) Until vesting, Participant shall have no rights with respect to the Units, including but
not limited to, rights to sell, vote, exchange, transfer, pledge, hypothecate or otherwise dispose
of the Units. This Award is not assignable or transferable by Participant.

     (f) During the period between the Grant Date and the Vesting Date, Participant will receive
quarterly cash payments, less all applicable taxes, equal to the distributions that would have been
paid on the Target number of Units Participant is entitled to hereunder, beginning with
distributions that are made in the second calendar quarter of the year that includes the
Commencement Date; provided, however, no cash distributions will be payable to or on behalf of
Participant with respect to any payment date occurring after Participant has forfeited a right to
receive the Units pursuant to the terms of this Agreement or the Plan.

     (g) Notwithstanding anything contained herein to the contrary, (i) the Committee shall have
the right to accelerate the Future Award Date and/or cancel all or any portion of any outstanding
restrictions prior to the termination of such restrictions with respect to any or all of the Units
on such

 

			
	1	 	An example of this calculation is as follows:
Assume that Participant’s employment is terminated in a Qualifying
Termination on July 15 in the year following the year of the Commencement Date
and that the DCF/U in year 0 was $2.50, in year 1 was $2.75, in the first
quarter of year 2 was $0.75, and in the second quarter of year 2 was $0.80.
The annualized DCF/U for year 2 would be $3.10 (total DCF/U for two quarters of
$1.55 multiplied by 2 to calculate an annualized total). The Growth Rate for
year 1 would be 10% ($0.25 growth over year 0 DCF/U of $2.50) and the Growth
Rate for year 2 would be 12.73% ($0.35 growth over year 1 DCF/U of $2.75). The
Average Growth Rate would be 11.36% (10% plus 12.73% divided by 2 years).

 

 

terms and conditions as the Committee may deem appropriate and (ii) in the event of a Change
in Control, the maximum award contemplated by this Agreement shall be made and automatically vested
in full as of the date of the Change in Control.

     (h) In the event that the number of Units, as a result of a split or unit distribution or
combination of units or any other change or exchange for other securities, by reclassification,
reorganization or otherwise, are increased or decreased or changed into or exchanged for a
different number or kind of units or other securities of Crosstex Energy, L.P. or of another
entity, the number of Units to be awarded under this Agreement shall be adjusted to reflect such
change in such manner as the Board or the Committee may deem appropriate. If any such adjustment
shall result in a fractional unit, such fraction shall be disregarded.

     3. Each notice relating to this award shall be in writing. All notices to Company shall be
addressed to the Secretary, at Company’s headquarters. All notices to Participant shall be
addressed to Participant in accordance with Company’s payroll records.

     4. Taxes. PARTICIPANT REPRESENTS THAT PARTICIPANT IS NOT RELYING ON COMPANY FOR ANY
TAX ADVICE IN CONNECTION WITH THIS AWARD. Participant will pay to Company, or make arrangements
satisfactory to the Committee regarding payment of, any federal, state or local taxes of any kind
required by law to be withheld with respect to (i) distributions received, and (ii) the termination
of restrictions with respect to the Units (in which case arrangements will be made no later than
the date of the termination of the restrictions). Participant shall, to the extent permitted by
law, have the right to deliver to Company or its Affiliates Units to which Participant shall be
entitled upon the vesting thereof (or other Units owned by Participant), valued at the fair market
value of such Units at the time of such delivery to Company or its Affiliates, to satisfy the
obligation of Participant under this Agreement. Any provision of this Agreement to the contrary
notwithstanding, if Participant does not otherwise satisfy the obligation of Participant under this
Section, then Company and its Affiliates shall, to the extent permitted by law, have the right to
deduct from any payments of any kind otherwise due from Company or its Affiliates to or with
respect to Participant, whether or not pursuant to this Agreement or the Plan and regardless of the
form of payment, any federal, state or local taxes of any kind required by law to be withheld with
respect to the ownership of the Units (with respect to which the restrictions set forth herein have
terminated).

     5. Entirety and Modification. This Agreement contains the entire agreement
between the parties hereto with respect to the subject matter hereof and supersedes any and all
prior agreements, whether written or oral, between such parties relating to such subject matter.
No modification, alteration, amendment or supplement to this Agreement shall be valid or effective
unless the same is in writing and signed by the party against whom it is sought to be enforced.

     6. Severability. If any provision of this Agreement is held to be unenforceable, this
Agreement shall be considered divisible, and such provision shall be deemed inoperative to the
extent it is unenforceable, and in all other respects this Agreement shall remain in full force and
effect; provided, however, that if any such provision may be made enforceable by limitation
thereof, then such provision shall be deemed to be so limited and shall be enforceable to the
maximum extent permitted by applicable law.

     7. This Agreement has been made in and shall be construed under and in accordance with
the laws of the State of Delaware.

 

 

	 	 	 	 	 	 	 	 	 
	 	 	CROSSTEX ENERGY GP, LLC	 	 
	 
	 	 	 	 	 	 	 	 
	 	 	 	 	 
	 

	 	By:	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 

	 	 	 	Title:	 	 	 	 
	 

	 	 	 	 	 	 

	 	 
	 
	 	 	 	 	 	 	 	 
	 	 	PARTICIPANT:exv4w1

 

EXHIBIT 4.1

EXECUTION COPY

      

UNITED SURGICAL PARTNERS INTERNATIONAL, INC.

and each of the Guarantors party hereto

87/8% SENIOR SUBORDINATED NOTES DUE 2017

and

91/4%/10% SENIOR SUBORDINATED TOGGLE NOTES DUE 2017

INDENTURE

Dated as of April 19, 2007

U.S. Bank National Association

Trustee

 

 

 

CROSS-REFERENCE TABLE*

	 	 	 	 	 
	Trust Indenture		 
	Act Section		Indenture Section
	310 	(a)(1) 	 		7.10

	 	(a)(2) 	 		7.10

	 	(a)(3) 	 		N.A.

	 	(a)(4) 	 		N.A.

	 	(a)(5) 	 		7.10

	 	(b)	 		7.10

	 	(c)	 		N.A.

	311 	(a)	 		7.11

	 	(b)	 		7.11

	 	(c)	 		N.A.

	312 	(a)	 		2.05

	 	(b)	 		13.03

	 	(c)	 		13.03

	313 	(a) 	 		7.06

	 	(b)(1) 	 		N.A.

	 	(b)(2) 	 		7.06; 7.07

	 	(c)	 		7.06; 13.02

	 	(d)	 		7.06

	314 	(a)	 		4.03; 4.04; 13.02; 13.05

	 	(b)	 		N.A.

	 	(c)(1) 	 		N.A.

	 	(c)(2) 	 		N.A.

	 	(c)(3) 	 		N.A.

	 	(d)	 		N.A.

	 	(e)	 		13.05

	 	(f)	 		N.A.

	315	(a)	 		7.01

	 	(b)	 		7.05

	 	(c)	 		7.01

	 	(d)	 		7.01

	 	(e)	 		6.11

	316 	(a)(last sentence) 	 		2.09

	 	(a)(1)(A) 	 		6.05

	 	(a)(1)(B) 	 		6.04

	 	(a)(2) 	 		N.A.

	 	(b)	 		6.07

	 	(c)	 		N.A.

	317 	(a)(1) 	 		6.08

	 	(a)(2) 	 		6.09

	 	(b)	 		2.04

	318 	(a)	 		13.01

	 	(b)	 		N.A.

	 	(c)	 		13.01

 

			
	 	 	N.A. means not applicable.
	 
	*	 	This Cross Reference Table is not part of this Indenture.

 

 

TABLE OF CONTENTS

	 	 	 	 	 	 	 
	 	 	 	 	Page
	ARTICLE 1.

	 
	 	 	 	 	 	 
	DEFINITIONS AND INCORPORATION BY REFERENCE

	 
	 	 	 	 	 	 
	SECTION 1.01

	 	Definitions.
	 	 	1	 
	SECTION 1.02

	 	Other Definitions.
	 	 	30	 
	SECTION 1.03

	 	Incorporation by Reference of Trust Indenture Act.
	 	 	31	 
	SECTION 1.04

	 	Rules of Construction and Calculation.
	 	 	31	 
	 
	 	 	 	 	 	 
	ARTICLE 2.

	 
	 	 	 	 	 	 
	THE NOTES

	 
	 	 	 	 	 	 
	SECTION 2.01

	 	Form and Dating.
	 	 	32	 
	SECTION 2.02

	 	Execution and Authentication.
	 	 	33	 
	SECTION 2.03

	 	Registrar and Paying Agent.
	 	 	34	 
	SECTION 2.04

	 	Paying Agent To Hold Money in Trust.
	 	 	34	 
	SECTION 2.05

	 	Holder Lists.
	 	 	35	 
	SECTION 2.06

	 	Transfer and Exchange.
	 	 	35	 
	SECTION 2.07

	 	Replacement Notes.
	 	 	46	 
	SECTION 2.08

	 	Outstanding Notes.
	 	 	46	 
	SECTION 2.09

	 	Treasury Notes.
	 	 	47	 
	SECTION 2.10

	 	Temporary Notes.
	 	 	47	 
	SECTION 2.11

	 	Cancellation.
	 	 	47	 
	SECTION 2.12

	 	Defaulted Interest.
	 	 	47	 
	SECTION 2.13

	 	CUSIP Numbers.
	 	 	47	 
	SECTION 2.14

	 	Issuance of Additional Notes.
	 	 	48	 
	 
	 	 	 	 	 	 
	ARTICLE 3.

	 
	 	 	 	 	 	 
	REDEMPTION AND PREPAYMENT

	 
	 	 	 	 	 	 
	SECTION 3.01

	 	Notices to Trustee.
	 	 	48	 
	SECTION 3.02

	 	Selection of Notes To Be Redeemed or Purchased.
	 	 	49	 
	SECTION 3.03

	 	Notice of Redemption.
	 	 	49	 
	SECTION 3.04

	 	Effect of Notice of Redemption.
	 	 	50	 
	SECTION 3.05

	 	Deposit of Redemption or Purchase Price.
	 	 	50	 
	SECTION 3.06

	 	Notes Redeemed or Purchased in Part.
	 	 	50	 
	SECTION 3.07

	 	Optional Redemption.
	 	 	51	 
	SECTION 3.08

	 	Mandatory Redemption
	 	 	51	 
	SECTION 3.09

	 	Offer To Purchase by Application of Excess Proceeds.
	 	 	51	 

-i-

 

	 	 	 	 	 	 	 
	 	 	 	 	Page
	ARTICLE 4.

	 
	 	 	 	 	 	 
	COVENANTS

	 
	 	 	 	 	 	 
	SECTION 4.01

	 	Payment of Notes.
	 	 	53	 
	SECTION 4.02

	 	Maintenance of Office or Agency.
	 	 	53	 
	SECTION 4.03

	 	Reports.
	 	 	54	 
	SECTION 4.04

	 	Compliance Certificate.
	 	 	54	 
	SECTION 4.05

	 	[Reserved].
	 	 	55	 
	SECTION 4.06

	 	Stay, Extension and Usury Laws.
	 	 	55	 
	SECTION 4.07

	 	Restricted Payments.
	 	 	55	 
	SECTION 4.08

	 	Dividend and Other Payment Restrictions Affecting Restricted Subsidiaries.
	 	 	60	 
	SECTION 4.09

	 	Incurrence of Indebtedness and Issuance of Disqualified Stock and Preferred Stock.
	 	 	62	 
	SECTION 4.10

	 	Asset Sales.
	 	 	66	 
	SECTION 4.11

	 	Transactions with Affiliates.
	 	 	68	 
	SECTION 4.12

	 	Liens.
	 	 	70	 
	SECTION 4.13

	 	Business Activities.
	 	 	70	 
	SECTION 4.14

	 	Corporate Existence.
	 	 	70	 
	SECTION 4.15

	 	Offer To Repurchase Upon Change of Control.
	 	 	70	 
	SECTION 4.16

	 	No Layering of Debt.
	 	 	72	 
	SECTION 4.17

	 	Designation of Restricted and Unrestricted Subsidiaries.
	 	 	72	 
	SECTION 4.18

	 	Payments for Consent.
	 	 	73	 
	SECTION 4.19

	 	Additional Subsidiary Guarantees.
	 	 	73	 
	SECTION 4.20

	 	Distributions by Qualified Restricted Subsidiaries.
	 	 	73	 
	 
	 	 	 	 	 	 
	ARTICLE 5.

	 
	 	 	 	 	 	 
	SUCCESSORS

	 
	 	 	 	 	 	 
	SECTION 5.01

	 	Merger, Consolidation, or Sale of Assets.
	 	 	74	 
	SECTION 5.02

	 	Successor Corporation Substituted.
	 	 	75	 
	 
	 	 	 	 	 	 
	ARTICLE 6.

	 
	 	 	 	 	 	 
	DEFAULTS AND REMEDIES

	 
	 	 	 	 	 	 
	SECTION 6.01

	 	Events of Default.
	 	 	75	 
	SECTION 6.02

	 	Acceleration.
	 	 	77	 
	SECTION 6.03

	 	Other Remedies.
	 	 	77	 
	SECTION 6.04

	 	Waiver of Past Defaults.
	 	 	78	 
	SECTION 6.05

	 	Control by Majority.
	 	 	78	 
	SECTION 6.06

	 	Limitation on Suits.
	 	 	78	 
	SECTION 6.07

	 	Rights of Holders To Receive Payment.
	 	 	78	 
	SECTION 6.08

	 	Collection Suit by Trustee.
	 	 	79	 
	SECTION 6.09

	 	Trustee May File Proofs of Claim.
	 	 	79	 
	SECTION 6.10

	 	Priorities.
	 	 	79	 
	SECTION 6.11

	 	Undertaking for Costs.
	 	 	80	 

-ii-

 

	 	 	 	 	 	 	 
	 	 	 	 	Page
	ARTICLE 7.

	 
	 	 	 	 	 	 
	TRUSTEE

	 
	 	 	 	 	 	 
	SECTION 7.01

	 	Duties of Trustee.
	 	 	80	 
	SECTION 7.02

	 	Rights of Trustee.
	 	 	81	 
	SECTION 7.03

	 	Individual Rights of Trustee.
	 	 	82	 
	SECTION 7.04

	 	Trustee’s Disclaimer.
	 	 	82	 
	SECTION 7.05

	 	Notice of Defaults.
	 	 	82	 
	SECTION 7.06

	 	Reports by Trustee to Holders of the Notes.
	 	 	82	 
	SECTION 7.07

	 	Compensation and Indemnity.
	 	 	83	 
	SECTION 7.08

	 	Replacement of Trustee.
	 	 	84	 
	SECTION 7.09

	 	Successor Trustee by Merger, etc.
	 	 	84	 
	SECTION 7.10

	 	Eligibility; Disqualification.
	 	 	85	 
	SECTION 7.11

	 	Preferential Collection of Claims Against Issuer.
	 	 	85	 
	 
	 	 	 	 	 	 
	ARTICLE 8.

	 
	 	 	 	 	 	 
	LEGAL DEFEASANCE AND COVENANT DEFEASANCE

	 
	 	 	 	 	 	 
	SECTION 8.01

	 	Option To Effect Legal Defeasance or Covenant Defeasance.
	 	 	85	 
	SECTION 8.02

	 	Legal Defeasance and Discharge.
	 	 	85	 
	SECTION 8.03

	 	Covenant Defeasance.
	 	 	86	 
	SECTION 8.04

	 	Conditions to Legal or Covenant Defeasance.
	 	 	86	 
	SECTION 8.05

	 	Deposited Money and Government Securities To Be Held in
Trust; Other Miscellaneous Provisions.
	 	 	87	 
	SECTION 8.06

	 	Repayment to Issuer.
	 	 	87	 
	SECTION 8.07

	 	Reinstatement.
	 	 	88	 
	 
	 	 	 	 	 	 
	ARTICLE 9.

	 
	 	 	 	 	 	 
	AMENDMENT, SUPPLEMENT AND WAIVER

	 
	 	 	 	 	 	 
	SECTION 9.01

	 	Without Consent of Holders.
	 	 	88	 
	SECTION 9.02

	 	With Consent of Holders.
	 	 	89	 
	SECTION 9.03

	 	Amendments regarding Subordination.
	 	 	90	 
	SECTION 9.04

	 	Compliance with Trust Indenture Act.
	 	 	90	 
	SECTION 9.05

	 	Revocation and Effect of Consents.
	 	 	90	 
	SECTION 9.06

	 	Notation on or Exchange of Notes.
	 	 	91	 
	SECTION 9.07

	 	Trustee To Sign Amendments, etc.
	 	 	91	 
	 
	 	 	 	 	 	 
	ARTICLE 10.

	 
	 	 	 	 	 	 
	SUBORDINATION

	 
	 	 	 	 	 	 
	SECTION 10.01

	 	Agreement to Subordinate.
	 	 	91	 
	SECTION 10.02

	 	Liquidation; Dissolution; Bankruptcy.
	 	 	91	 
	SECTION 10.03

	 	Default on Designated Senior Debt.
	 	 	92	 
	SECTION 10.04

	 	Acceleration of Notes.
	 	 	93	 
	SECTION 10.05

	 	When Distribution Must Be Paid Over.
	 	 	93	 

-iii-

 

	 	 	 	 	 	 	 
	 	 	 	 	Page
	SECTION 10.06

	 	Notice by Issuer.
	 	 	93	 
	SECTION 10.07

	 	Subrogation.
	 	 	93	 
	SECTION 10.08

	 	Relative Rights.
	 	 	93	 
	SECTION 10.09

	 	Subordination May Not Be Impaired by the Issuer.
	 	 	94	 
	SECTION 10.10

	 	Distribution or Notice to Representative.
	 	 	94	 
	SECTION 10.11

	 	Rights of Trustee and Paying Agent.
	 	 	94	 
	SECTION 10.12

	 	Authorization To Effect Subordination.
	 	 	94	 
	 
	 	 	 	 	 	 
	ARTICLE 11.

	 
	 	 	 	 	 	 
	SUBSIDIARY GUARANTEES

	 
	 	 	 	 	 	 
	SECTION 11.01

	 	Guarantee.
	 	 	95	 
	SECTION 11.02

	 	Subordination of Subsidiary Guarantee.
	 	 	96	 
	SECTION 11.03

	 	Limitation on Guarantor Liability.
	 	 	96	 
	SECTION 11.04

	 	Execution and Delivery of Subsidiary Guarantee.
	 	 	96	 
	SECTION 11.05

	 	Guarantors May Consolidate, etc., on Certain Terms.
	 	 	97	 
	SECTION 11.06

	 	Releases.
	 	 	97	 
	 
	 	 	 	 	 	 
	ARTICLE 12.

	 
	 	 	 	 	 	 
	SATISFACTION AND DISCHARGE

	 
	 	 	 	 	 	 
	SECTION 12.01

	 	Satisfaction and Discharge.
	 	 	98	 
	SECTION 12.02

	 	Application of Trust Money.
	 	 	99	 
	 
	 	 	 	 	 	 
	ARTICLE 13.

	 
	 	 	 	 	 	 
	MISCELLANEOUS

	 
	 	 	 	 	 	 
	SECTION 13.01

	 	Trust Indenture Act Controls.
	 	 	99	 
	SECTION 13.02

	 	Notices.
	 	 	99	 
	SECTION 13.03

	 	Communication by Holders with Other Holders.
	 	 	100	 
	SECTION 13.04

	 	Certificate and Opinion as to Conditions Precedent.
	 	 	100	 
	SECTION 13.05

	 	Statements Required in Certificate or Opinion.
	 	 	101	 
	SECTION 13.06

	 	Rules by Trustee and Agents.
	 	 	101	 
	SECTION 13.07

	 	No Personal Liability of Directors, Officers, Employees and Stockholders.
	 	 	101	 
	SECTION 13.08

	 	Governing Law.
	 	 	101	 
	SECTION 13.09

	 	No Adverse Interpretation of Other Agreements.
	 	 	102	 
	SECTION 13.10

	 	Successors.
	 	 	102	 
	SECTION 13.11

	 	Severability.
	 	 	102	 
	SECTION 13.12

	 	Counterpart Originals.
	 	 	102	 
	SECTION 13.13

	 	Table of Contents, Headings, etc.
	 	 	102	 

-iv-

 

EXHIBITS

	 	 	 
	Exhibit A1

	 	FORM OF CASH PAY NOTE
	Exhibit A2

	 	FORM OF TOGGLE NOTE
	Exhibit A3

	 	FORM OF REGULATION S TEMPORARY GLOBAL CASH PAY NOTE
	Exhibit A4

	 	FORM OF REGULATION S TEMPORARY GLOBAL TOGGLE NOTE
	Exhibit B

	 	FORM OF CERTIFICATE OF TRANSFER
	Exhibit C

	 	FORM OF CERTIFICATE OF EXCHANGE
	Exhibit D

	 	FORM OF NOTATION OF SUBSIDIARY GUARANTEE
	Exhibit E

	 	FORM OF SUPPLEMENTAL INDENTURE

-v-

 

     INDENTURE dated as of April 19, 2007 by and among UNITED SURGICAL PARTNERS INTERNATIONAL,
INC., a Delaware corporation (and successor by merger to UNCN Acquisition Corp.) (the “Issuer”),
the Guarantors (as defined), and U.S. BANK NATIONAL ASSOCIATION, a national banking association, as
trustee (the “Trustee”).

     The Issuer, the Guarantors and the Trustee agree as follows for the benefit of each other and
for the equal and ratable benefit of the Holders (as defined) of the 87/8% Senior Subordinated Notes
due 2017 (the “Cash Pay Notes”) and 91/4%/10% Senior Subordinated Toggle Notes due 2017 (the “Toggle
Notes” and, together with the Cash Pay Notes, the “Notes”):

ARTICLE 1.

DEFINITIONS AND INCORPORATION BY REFERENCE

SECTION 1.01 Definitions.

     “144A Global Note” means a Global Note substantially in the form of Exhibit A1 or
Exhibit A2 hereto bearing the Global Note Legend and the Private Placement Legend and
deposited with or on behalf of, and registered in the name of, the Depositary or its nominee,
issued in a denomination equal to the outstanding principal amount of the Notes sold in reliance on
Rule 144A.

     “Acquired Debt” means, with respect to any specified Person:

     (1) Indebtedness of any other Person existing at the time such other Person is merged
with or into or became a Restricted Subsidiary of such specified Person, whether or not such
Indebtedness is incurred in connection with, or in contemplation of, such other Person
merging with or into, or becoming a Restricted Subsidiary of, such specified Person; and

     (2) Indebtedness secured by a Lien encumbering any asset acquired by such specified
Person.

     “Additional Assets” means any property or assets (other than Indebtedness and Capital Stock)
to be used by the Issuer or a Restricted Subsidiary in a Permitted Business.

     “Additional Interest” means all additional interest then owing pursuant to the Registration
Rights Agreement.

     “Additional Notes” means any Notes (other than the Initial Notes), if any, issued under this
Indenture in accordance with Sections 2.02, 2.14 and 4.09.

     “Affiliate” of any specified Person means any other Person directly or indirectly controlling
or controlled by or under direct or indirect common control with such specified Person. For
purposes of this definition, “control,” as used with respect to any Person, means the possession,
directly or indirectly, of the power to direct or cause the direction of the management or policies
of such Person, whether through the ownership of voting securities, by agreement or otherwise;
provided that (except in the case of the use of the term “Affiliate” in the definition of
“Permitted Holders”) beneficial ownership of 10% or more of the Voting Stock of a Person will be
deemed to be control. For purposes of this definition, the terms “controlling,” “controlled by”
and “under common control with” have correlative meanings. No Person in whom a Receivables
Subsidiary makes an Investment in connection with a Qualified Receivables Transaction will be
deemed to be an Affiliate of the Issuer or any of its Subsidiaries solely by reason of such
Investment.

 

 

     “Agent” means any Registrar, co-registrar, Paying Agent or additional paying agent.

     “Agreement and Plan of Merger” means the Agreement and Plan of Merger among Holdings, UNCN
Acquisition Corp. and the Issuer, dated as of January 7, 2007.

     “Applicable Premium” means, with respect to any Note on any Make-Whole Redemption Date, the
greater of (i) 1.0% of the principal amount of such Note and (ii) the excess of (A) the present
value at such Make-Whole Redemption Date of (1) the redemption price of such Note at May 1, 2012
(exclusive of accrued interest), plus (2) all scheduled interest payments due on such Note from the
Make-Whole Redemption Date through May 1, 2012, computed using a discount rate equal to the
Treasury Rate at such Make-Whole Redemption Date, plus 50 basis points over (B) the principal
amount of such Note.

     “Applicable Procedures” means, with respect to any transfer or exchange of or for beneficial
interests in any Global Note, the rules and procedures of the Depositary that apply to such
transfer or exchange.

     “Asset Sale” means:

     (1) the sale, lease (other than operating leases), conveyance or other disposition of
any assets or rights outside of the ordinary course of business; provided that the sale,
lease, conveyance or other disposition of all or substantially all of the assets of the
Issuer and its Restricted Subsidiaries taken as a whole shall be governed by Sections 4.15
and 5.01 of this Indenture and not by Section 4.10 of this Indenture; and

     (2) the issuance of Equity Interests in any of the Issuer’s Restricted Subsidiaries or
the sale of Equity Interests in any of its Restricted Subsidiaries (other than directors’
qualifying Equity Interests or Equity Interests required by applicable law to be held by a
Person other than the Issuer or a Restricted Subsidiary).

     Notwithstanding the preceding, none of the following items shall be deemed to be an Asset
Sale:

     (1) any single transaction or series of related transactions that involves assets
having a Fair Market Value of less than $5.0 million;

     (2) a transfer of assets between or among the Issuer and its Restricted Subsidiaries;

     (3) an issuance of Equity Interests by a Restricted Subsidiary to the Issuer or to a
Restricted Subsidiary;

     (4) the sale or lease of products, services or accounts receivable (including at a
discount) in the ordinary course of business and any sale or other disposition of damaged,
worn-out, negligible, surplus or obsolete assets in the ordinary course of business;

     (5) the sale or other disposition of Cash Equivalents;

     (6) a Restricted Payment that does not violate Section 4.07 of this Indenture or is a
Permitted Investment;

     (7) a sale and leaseback transaction with respect to any assets within 180 days of the
acquisition of such assets;

-2-

 

     (8) any exchange of like-kind property of the type described in Section 1031 of the
Code for use in a Permitted Business;

     (9) the sale or disposition of any assets or property received as a result of a
foreclosure by the Issuer or any of its Restricted Subsidiaries on any secured Investment or
any other transfer of title with respect to any secured Investment in default;

     (10) the licensing of intellectual property in the ordinary course of business or in
accordance with industry practice;

     (11) the sale, lease, conveyance, disposition or other transfer of (a) the Capital
Stock of, or any Investment in, any Unrestricted Subsidiary or (b) Permitted Investments
made pursuant to clause (15) of the definition thereof;

     (12) surrender or waiver of contract rights or the settlement, release or surrender of
contract, tort or other claims of any kind;

     (13) leases or subleases to third persons in the ordinary course of business that do
not interfere in any material respect with the business of the Issuer or any of its
Restricted Subsidiaries;

     (14) sales of accounts receivable and related assets of the type specified in the
definition of Qualified Receivables Transaction to a Receivables Subsidiary for the Fair
Market Value thereof, less amounts required to be established as reserves and customary
discounts pursuant to contractual agreements with entities that are not Affiliates of the
Issuer entered into as part of a Qualified Receivables Transaction;

     (15) transfers of accounts receivable and related assets of the type specified in the
definition of Qualified Receivables Transaction (or a fractional undivided interest therein)
by a Receivables Subsidiary in a Qualified Receivables Transaction; and

     (16) for purposes of Section 4.10 only, the sale of Capital Stock in a Qualified
Restricted Subsidiary to a Strategic Investor in connection with the resyndication of such
Capital Stock within one (1) year of the purchase thereof from another Strategic Investor.

     “Bankruptcy Law” means Title 11, U.S. Code or any similar federal or state law for the relief
of debtors.

     “Beneficial Owner” has the meaning assigned to such term in Rule 13d-3 and Rule 13d-5 under
the Exchange Act, except that in calculating the beneficial ownership of any particular “person”
(as that term is used in Section 13(d)(3) of the Exchange Act), such “person” will be deemed to
have beneficial ownership of all securities that such “person” has the right to acquire by
conversion or exercise of other securities, whether such right is currently exercisable or is
exercisable only after the passage of time.

     “Board of Directors” means:

     (1) with respect to a corporation, the board of directors of the corporation or any
committee thereof duly authorized to act on behalf of such board;

     (2) with respect to a partnership, the board of directors or board of managers of the
general partner of the partnership;

-3-

 

     (3) with respect to a limited liability company, the managing member or members or any
controlling committee of managing members thereof; and

     (4) with respect to any other Person, the board or committee of such Person serving a
similar function.

     “Broker-Dealer” means any broker or dealer registered under the Exchange Act.

     “Business Day” means any day other than a Legal Holiday.

     “Capital Lease Obligation” means, at the time any determination is to be made, the amount of
the liability in respect of a capital lease that would at that time be required to be capitalized
on a balance sheet prepared in accordance with GAAP, and the Stated Maturity thereof shall be the
date of the last payment of rent or any other amount due under such lease prior to the first date
upon which such lease may be prepaid by the lessee without payment of a penalty.

     “Capital Stock” means:

     (1) in the case of a corporation, corporate stock;

     (2) in the case of an association or business entity, any and all shares, interests,
participations, rights or other equivalents (however designated) of corporate stock;

     (3) in the case of a partnership or limited liability company, partnership interests
(whether general or limited) or membership interests; and

     (4) any other interest or participation that confers on a Person the right to receive a
share of the profits and losses of, or distributions of assets of, the issuing Person, but
excluding from all of the foregoing any debt securities convertible into Capital Stock,
whether or not such debt securities include any right of participation with Capital Stock.

     “Captive Insurance Subsidiary” means a Subsidiary established by the Issuer or any of its
Subsidiaries for the sole purpose of insuring the business, facilities and/or employees of the
Issuer and its Subsidiaries.

     “Cash Equivalents” means:

     (1) United States dollars or, in the case of any Restricted Subsidiary which is not a
Domestic Subsidiary, any other currencies held from time to time in the ordinary course of
business;

     (2) securities issued or directly and fully guaranteed or insured by the United States
government or any agency or instrumentality of the United States government (provided that
the full faith and credit of the United States is pledged in support of those securities)
having maturities of not more than 12 months from the date of acquisition;

     (3) direct obligations issued by any state of the United States of America or any
political subdivision of any such state, or any public instrumentality thereof, in each case
having maturities of not more than 12 months from the date of acquisition;

-4-

 

     (4) certificates of deposit and eurodollar time deposits with maturities of 12 months
or less from the date of acquisition, bankers’ acceptances with maturities not exceeding 12
months and overnight bank deposits, in each case, with any lender party to the Credit
Agreement or with any domestic commercial bank that has capital and surplus of not less than
$500.0 million;

     (5) repurchase obligations with a term of not more than one year for underlying
securities of the types described in clauses (2) and (4) above entered into with any
financial institution meeting the qualifications specified in clause (4) above;

     (6) commercial paper having one of the two highest ratings obtainable from Moody’s
Investors Service, Inc. or Standard & Poor’s Rating Services and, in each case, maturing
within 12 months after the date of acquisition;

     (7) Indebtedness or preferred stock issued by Persons with a rating of “A” or higher
from Standard & Poor’s Rating Services or “A2” or higher from Moody’s Investors Service,
Inc. with maturities of 12 months or less from the date of acquisition; and

     (8) money market funds at least 95% of the assets of which constitute Cash Equivalents
of the kinds described in clauses (1) through (6) of this definition.

     “Cash Interest” has the meaning set forth in Exhibit A2 hereto.

     “Cash Pay Notes” has the meaning assigned to it in the preamble to this Indenture.

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

     (1) the direct or indirect sale, lease, 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 Issuer and its Subsidiaries
taken as a whole to any “person” (as that term is used in Section 13(d) of the Exchange Act)
other than Permitted Holders;

     (2) the adoption of a plan relating to the liquidation or dissolution of the Issuer;

     (3) the consummation of any transaction (including, without limitation, any merger or
consolidation), the result of which is that any “person” (as defined above), other than
Permitted Holders, becomes the Beneficial Owner, directly or indirectly, of more than 40% of
the Voting Stock of the Issuer, measured by voting power rather than number of shares,
unless the Permitted Holders are the Beneficial Owners of a greater percentage of the Voting
Stock of the Issuer; provided, however, for purposes of this clause (3), each Person will be
deemed to beneficially own any Voting Stock of another Person held by one or more of its
Subsidiaries; or

     (4) the first day on which a majority of the members of the Board of Directors of the
Issuer are not Continuing Directors.

     “Code” means the Internal Revenue Code of 1986, as amended from time to time and the rules and
regulations promulgated thereunder from time to time.

     “Consolidated Adjusted EBITDA” means, with respect to any specified Person for any period (the
“Measurement Period”), the Consolidated Net Income of such Person for such period plus, without
duplication

-5-

 

and to the extent deducted in determining such Consolidated Net Income, the amounts for
such period of:

     (1) the Fixed Charges of such Person and its Restricted Subsidiaries for the
Measurement Period; plus

     (2) the consolidated income tax expense of such Person and its Restricted Subsidiaries
for the Measurement Period; plus

     (3) the consolidated depreciation expense of such Person and its Restricted
Subsidiaries for the Measurement Period; plus

     (4) the consolidated amortization expense of such Person and its Restricted
Subsidiaries for the Measurement Period; plus

     (5) fees, costs and expenses paid or payable in cash by the Issuer or any of its
Subsidiaries during the Measurement Period in connection with the Transactions (including,
without limitation, retention payments paid as an incentive to retained employees in
connection with the Transactions); plus

     (6) other non-cash expenses and charges for the Measurement Period reducing
Consolidated Net Income (excluding any such non-cash item to the extent representing an
accrual or reserve for potential cash items in any future period or amortization of a
prepaid cash item that was paid in a prior period); plus

     (7) any non-recurring out-of-pocket expenses or charges for the Measurement Period
relating to any offering of Equity Interests by the Issuer, Holdings or any other direct or
indirect parent of the Issuer or merger, recapitalization or acquisition transactions made
by the Issuer or any of its Restricted Subsidiaries, or any Indebtedness incurred by the
Issuer or any of its Restricted Subsidiaries (in each case, whether or not successful); plus

     (8) all fees paid by the Issuer pursuant to clauses (8) and (15) of Section 4.11(b);
plus

     (9) the amount of any restructuring charges or reserves (which, for the avoidance of
doubt, shall include retention, severance, systems establishment cost, contract termination
costs, including future lease commitments, and costs to consolidate facilities and relocate
employees); minus

     (10) without duplication, other non-cash items (other than the accrual of revenue in
accordance with GAAP consistently applied in the ordinary course of business) increasing
Consolidated Net Income for the Measurement Period (excluding any such non-cash item to the
extent it represents the reversal of an accrual or reserve for potential cash item in any
prior period).

     “Consolidated Net Income” means, with respect to any specified Person for any period, the
aggregate of the Net Income of such specified Person and its Restricted Subsidiaries for such
period, on a consolidated basis, determined in accordance with GAAP; provided that:

     (1) the Net Income (but not loss) of any other Person that is not a Restricted
Subsidiary of such specified Person or that is accounted for by the equity method of
accounting will be excluded; provided that Consolidated Net Income of the Issuer will be
increased by the amount of

-6-

 

dividends or other distributions or other payments actually paid in cash (or to the
extent converted into cash) or Cash Equivalents to the Issuer or a Restricted Subsidiary
thereof in respect of such period, to the extent not already included therein;

     (2) solely for the purpose of determining the amount available for Restricted Payments
under clause (3)(A) of Section 4.07(a), the Net Income for such period of any Restricted
Subsidiary (other than any Guarantor) shall be excluded to the extent that the declaration
or payment of dividends or similar distributions by that Restricted Subsidiary of its Net
Income is not at the date of determination wholly permitted without any prior governmental
approval (which has not been obtained) or, directly or indirectly, by the operation of the
terms of its charter or any agreement, instrument, judgment, decree, order, statute, rule,
or governmental regulation applicable to that Restricted Subsidiary or its stockholders,
unless such restriction with respect to the payment of dividends or similar distributions
has been legally waived; provided that Consolidated Net Income of the Issuer will be
increased by the amount of dividends or other distributions or other payments actually paid
in cash (or to the extent converted into cash) or Cash Equivalents to the Issuer or a
Restricted Subsidiary thereof in respect of such period, to the extent not already included
therein;

     (3) the cumulative effect of a change in accounting principles will be excluded;

     (4) the amortization of any premiums, fees or expenses incurred in connection with the
Transactions or any amounts required or permitted by Accounting Principles Board Opinions
Nos. 16 (including non-cash write-ups and non-cash charges relating to inventory and fixed
assets, in each case arising in connection with the Transactions) and 17 (including non-cash
charges relating to intangibles and goodwill), in each case in connection with the
Transactions, will be excluded;

     (5) any gain or loss, together with any related provision for taxes on such gain or
loss, realized in connection with: (a) any sale of assets outside the ordinary course of
business; or (b) the disposition of any securities by such Person or any of its Restricted
Subsidiaries or the extinguishment of any Indebtedness of such Person or any of its
Restricted Subsidiaries will be excluded;

     (6) any extraordinary gain or loss, together with any related provision for taxes on
such extraordinary gain or loss will be excluded;

     (7) income or losses attributable to discontinued operations (including, without
limitation, operations disposed during such period whether or not such operations were
classified as discontinued) will be excluded;

     (8) any non-cash charges (i) attributable to applying the purchase method of accounting
in accordance with GAAP, (ii) resulting from the application of FAS 142 or FAS 144, and
(iii) relating to the amortization of intangibles resulting from the application of FAS 141,
will be excluded;

     (9) all non-cash charges relating to employee benefit or other management or stock
compensation plans of the Issuer or a Restricted Subsidiary (excluding any such non-cash
charge to the extent that it represents an accrual of or reserve for cash expenses in any
future period or amortization of a prepaid cash expense incurred in a prior period) will be
excluded to the extent that such non-cash charges are deducted in computing such
Consolidated Net Income; provided, further, that if the Issuer or any Restricted Subsidiary
makes a cash payment in respect of such

-7-

 

non-cash charge in any period, such cash payment will (without duplication) be deducted
from the Consolidated Net Income of the Issuer for such period; and

     (10) all unrealized gains and losses relating to hedging transactions and
mark-to-market of Indebtedness denominated in foreign currencies resulting from the
application of FAS 52 shall be excluded.

     “Continuing Directors” means, as of any date of determination, any member of the Board of
Directors of the Issuer who:

     (1) was a member of such Board of Directors on the Issue Date;

     (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; or

     (3) was designated or appointed with the approval of Permitted Holders holding a
majority of the Voting Stock of all of the Permitted Holders.

     “Corporate Trust Office of the Trustee” shall be at the address of the Trustee specified in
Section 13.02 or such other address as to which the Trustee may give notice to the Issuer.

     “Credit Agreement” means that certain Credit Agreement, dated as of the Issue Date, by and
among the Issuer, as borrower, Holdings, certain subsidiaries of the Issuer, Citibank, N.A., as
administrative agent and collateral agent, Citigroup Global Markets Inc. and Lehman Brothers Inc.
as joint lead arrangers and joint bookrunners, Bear, Stearns & Co. Inc. and UBS Securities LLC as
joint bookrunners, Lehman Brothers Inc., as syndication agent, Bear Stearns Corporate Lending Inc.,
SunTrust Bank, and UBS Securities LLC, as Co-Documentation Agents, and various lenders from time to
time party thereto providing for up to $530.0 million of term loans ($100.0 million of which will
be in the form of delayed draw term loans), $100.0 million of revolving credit borrowings and
$150.0 million of uncommitted incremental loan facilities, including any related notes, Guarantees,
collateral documents, instruments and agreements executed in connection therewith, and, in each
case, as amended, restated, modified, renewed, refunded, replaced (whether upon or after
termination or otherwise) or refinanced by any other Indebtedness (including by means of sales of
debt securities and including any amendment, restatement, modification, renewal, refunding,
replacement or refinancing that increases the amount borrowed thereunder or extends the maturity
thereof) in whole or in part from time to time.

     “Credit Facilities” means, one or more debt facilities (including, without limitation, the
Credit Agreement) or commercial paper facilities, in each case, with banks or other institutional
lenders providing for revolving credit loans, term loans, receivables financing (including through
the sale of receivables to such lenders or to special purpose entities formed to borrow from such
lenders against such receivables) or letters of credit or any other Indebtedness, in each case, as
amended, restated, modified, renewed, refunded, replaced (whether upon or after termination or
otherwise) or refinanced (including by means of sales of debt securities and including any
amendment, restatement, modification, renewal, refunding, replacement or refinancing that increases
the amount borrowed thereunder or extends the maturity thereof) in whole or in part from time to
time.

     “Custodian” means the Trustee, as custodian with respect to the Notes in global form, or any
successor entity thereto.

-8-

 

     “Default” means any event that is, or with the passage of time or the giving of notice or both
would be, an Event of Default.

     “Definitive Note” means a certificated Note registered in the name of the Holder thereof and
issued in accordance with Section 2.06, substantially in the form of Exhibit A1 or
Exhibit A2 hereto except that such Note shall not bear the Global Note Legend and shall not
have the “Schedule of Exchanges of Interests in the Global Note” attached thereto.

     “Depositary” means, with respect to the Notes issuable or issued in whole or in part in global
form, the Person specified in Section 2.03 as the Depositary with respect to the Notes, and any and
all successors thereto appointed as depositary hereunder and having become such pursuant to the
applicable provision of this Indenture.

     “Designated Noncash Consideration” means any non-cash consideration received by the Issuer or
a Restricted Subsidiary in connection with an Asset Sale that is designated as Designated Noncash
Consideration pursuant to an Officers’ Certificate.

     “Designated Senior Debt” means:

     (1) any Indebtedness outstanding under the Credit Agreement; and

     (2) any other Senior Debt permitted under this Indenture the principal amount of which
is $25.0 million or more and that has been designated by the Issuer as “Designated Senior
Debt.”

     “Disqualified Stock” means any Capital Stock that, by its terms (or by the terms of any
security into which it is convertible, or for which it is exchangeable, in each case, at the option
of the holder of the Capital Stock), or upon the happening of any event, matures or is mandatorily
redeemable, pursuant to a sinking fund obligation or otherwise, or redeemable at the option of the
holder of the Capital Stock, in whole or in part, on or prior to the date that is 90 days after the
date on which the Notes mature. Notwithstanding the preceding sentence, (x) any Capital Stock that
would constitute Disqualified Stock solely because the holders of the Capital Stock have the right
to require the Issuer or the Subsidiary that issued such Capital Stock to repurchase such Capital
Stock upon the occurrence of a change of control or an asset sale will not constitute Disqualified
Stock if the terms of such Capital Stock provide that the Issuer may not repurchase such Capital
Stock unless the Issuer would be permitted to do so in compliance with Section 4.07, (y) any
Capital Stock that would constitute Disqualified Stock solely as a result of any redemption feature
that is conditioned upon, and subject to, compliance with Section 4.07 shall not constitute
Disqualified Stock and (z) any Capital Stock issued to any plan for the benefit of employees will
not constitute Disqualified Stock solely because it may be required to be repurchased by the Issuer
or the Subsidiary that issued such Capital Stock in order to satisfy applicable statutory or
regulatory obligations. The amount of Disqualified Stock deemed to be outstanding at any time for
purposes of this Indenture will be the maximum amount that the Issuer and its Restricted
Subsidiaries may become obligated to pay upon the maturity of, or pursuant to any mandatory
redemption provisions of, such Disqualified Stock, exclusive of accrued dividends.

     “Domestic Subsidiary” means any Restricted Subsidiary that was formed under the laws of the
United States or any state of the United States.

     “Equity Interests” means Capital Stock and all warrants, options or other rights to acquire
Capital Stock (but excluding any debt security that is convertible into, or exchangeable for,
Capital Stock).

-9-

 

     “Equity Offering” means a public or private offering of Qualified Capital Stock of the Issuer,
Holdings or any other direct or indirect parent of the Issuer.

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

     “Exchange Notes” means the Notes issued in the Exchange Offer pursuant to the Registration
Rights Agreement.

     “Exchange Offer” means the “Registered Exchange Offer” as defined in the Registration Rights
Agreement.

     “Exchange Offer Registration Statement” has the meaning set forth in the Registration Rights
Agreement.

     “Excluded Contributions” means net cash proceeds, marketable securities or Qualified Proceeds
received by the Issuer from (i) contributions to its equity capital (other than Disqualified Stock)
or (ii) the sale (other than to a Subsidiary of the Issuer or to any management equity plan or
stock option plan or any other management or employee benefit plan or agreement of the Issuer) of
Equity Interests (other than Disqualified Stock) of the Issuer, in each case designated as Excluded
Contributions pursuant to an Officers’ Certificate on the date such capital contributions are made
or the date such Equity Interests are sold, as the case may be, that are excluded from the
calculation set forth in clause (3) of Section 4.07(a) hereof.

     “Existing Indebtedness” means Indebtedness, other than the Notes and Indebtedness under the
Credit Agreement and the U.K. Credit Facility, existing on the Issue Date after giving effect to
the Transactions.

     “Facility-Level EBITDA” means, for any period, the sum of (a) Consolidated Adjusted EBITDA of
the Issuer and its Restricted Subsidiaries plus (b) minority interest in income of consolidated
Subsidiaries, plus (c) corporate level general and administrative expenses, minus (d) equity in
unconsolidated Affiliates, in each case for such period on a consolidated basis determined in
accordance with GAAP.

     “Fair Market Value” means the value that would be paid by a willing buyer to an unaffiliated
willing seller in a transaction not involving distress or necessity of either party, determined in
good faith by the Board of Directors, chief executive officer or chief financial officer of the
Issuer (unless otherwise provided in this Indenture).

     “Fixed Charge Coverage Ratio” means with respect to any specified Person for any period, the
ratio of the Consolidated Adjusted EBITDA of such Person for such period to the Fixed Charges of
such Person for such period. In the event that the specified Person or any of its Restricted
Subsidiaries incurs, assumes, guarantees, repays, repurchases, redeems, defeases or otherwise
discharges any Indebtedness (other than ordinary working capital borrowings) or issues, repurchases
or redeems preferred stock or Disqualified Stock subsequent to the commencement of the period for
which the Fixed Charge Coverage Ratio is being calculated and on or prior to the date on which the
event for which the calculation of the Fixed Charge Coverage Ratio is made (the “Calculation
Date”), then the Fixed Charge Coverage Ratio will be calculated giving pro forma effect to such
incurrence, assumption, Guarantee, repayment, repurchase, redemption, defeasance or other discharge
of Indebtedness, or such issuance, repurchase or redemption of preferred stock or Disqualified
Stock, and the use of the proceeds therefrom, as if the same had occurred at the beginning of the
applicable four-quarter reference period.

-10-

 

     In addition, for purposes of calculating the Fixed Charge Coverage Ratio:

     (1) Investments, acquisitions, mergers, consolidations and dispositions that have been
made by the specified Person or any of its Restricted Subsidiaries, or any Person or any of
its Restricted Subsidiaries acquired by, merged or consolidated with the specified Person or
any of its Restricted Subsidiaries, and including any related financing transactions and
including increases in ownership of Restricted Subsidiaries, during the four-quarter
reference period or subsequent to such reference period and on or prior to the Calculation
Date will be given pro forma effect, including giving effect to Pro Forma Cost Savings, as
if they had occurred on the first day of the four-quarter reference period;

     (2) the Consolidated Adjusted EBITDA attributable to discontinued operations, as
determined in accordance with GAAP, and operations or businesses (and ownership interests
therein) disposed of prior to the Calculation Date, will be excluded;

     (3) the Fixed Charges attributable to discontinued operations, as determined in
accordance with GAAP, and operations or businesses (and ownership interests therein)
disposed of prior to the Calculation Date, will be excluded, but only to the extent that the
obligations giving rise to such Fixed Charges will not be obligations of the specified
Person or any of its Restricted Subsidiaries following the Calculation Date;

     (4) any Person that is a Restricted Subsidiary on the Calculation Date will be deemed
to have been a Restricted Subsidiary at all times during such four-quarter period;

     (5) any Person that is not a Restricted Subsidiary on the Calculation Date will be
deemed not to have been a Restricted Subsidiary at any time during such four-quarter period;
and

     (6) if any Indebtedness bears a floating rate of interest, the interest expense on such
Indebtedness will be calculated as if the rate in effect on the Calculation Date had been
the applicable rate for the entire period (taking into account any Hedging Obligation
applicable to such Indebtedness).

     For purposes of this definition, whenever pro forma effect is given to a transaction, the pro
forma calculations shall be made in good faith by a responsible financial or accounting officer of
the Issuer. For purposes of determining whether any Indebtedness constituting a Guarantee may be
incurred, the interest on the Indebtedness to be guaranteed shall be included in calculating the
Fixed Charge Coverage Ratio on a pro forma basis. Interest on a Capitalized Lease Obligation shall
be deemed to accrue at an interest rate reasonably determined by a responsible financial or
accounting officer of the Issuer to be the rate of interest implicit in such Capitalized Lease
Obligation in accordance with GAAP. For purposes of making the computation referred to above,
interest on any Indebtedness under a revolving credit facility computed on a pro forma basis shall
be computed based upon the average daily balance of such Indebtedness during the applicable period.
Interest on Indebtedness that may optionally be determined at an interest rate based upon a factor
of a prime or similar rate, a eurocurrency interbank offered rate, or other rate, shall be deemed
to have been based upon the rate actually chosen, or, if none, then based upon such optional rate
chosen as the Issuer may designate.

     “Fixed Charges” means, with respect to any specified Person for any period, the sum, without
duplication, of:

     (1) the consolidated interest expense of such Person and its Restricted Subsidiaries
for such period, net of interest income, whether paid or accrued, including, without
limitation,

-11-

 

original issue discount, non-cash interest payments, the interest component of any
deferred payment obligations, the interest component of all payments associated with Capital
Lease Obligations, commissions, discounts and other fees and charges incurred in respect of
letter of credit or bankers’ acceptance financings, and net of the effect of all cash
payments made or received pursuant to Hedging Obligations in respect of interest rates, and
excluding amortization of deferred financing costs; plus

     (2) any interest on Indebtedness of another Person that is guaranteed by such Person or
one of its Restricted Subsidiaries or secured by a Lien on assets of such Person or one of
its Restricted Subsidiaries, but only to the extent that such Guarantee or Lien is called
upon; plus

     (3) the product of (A) all cash dividends paid on any series of preferred stock of such
Person or any of its Restricted Subsidiaries (other than to the Issuer or a Restricted
Subsidiary), in each case, determined on a consolidated basis in accordance with GAAP
multiplied by (B) a fraction, the numerator of which is one and the denominator of which is
one minus the then current combined federal, state and local statutory tax rate of the
Issuer and its Restricted Subsidiaries expressed as a decimal.

     “Foreign Subsidiary” means any Subsidiary that is not incorporated under the laws of the
United States of America, any State thereof or the District of Columbia.

     “GAAP” means generally accepted accounting principles set forth in the opinions and
pronouncements of the Accounting Principles Board of the American Institute of Certified Public
Accountants and statements and pronouncements of the Financial Accounting Standards Board or in
such other statements by such other entity as have been approved by a significant segment of the
accounting profession, which are in effect on the Issue Date.

     “Global Note Legend” means the legend set forth in Section 2.06(g)(2), which is required to be
placed on all Global Notes issued under this Indenture.

     “Global Notes” means, individually and collectively, each of the Restricted Global Notes and
the Unrestricted Global Notes deposited with or on behalf of and registered in the name of the
Depository or its nominee, substantially in the form of Exhibits A1, A2, A3
and A4 hereto and that bears the Global Note Legend and that has the “Schedule of Exchanges
of Interests in the Global Note” attached thereto, issued in accordance with Section 2.01,
2.06(b)(3), 2.06(b)(4), 2.06(d)(2) or 2.06(f) hereof.

     “Government Securities” means direct obligations of, or obligations guaranteed by, the United
States of America (including any agency or instrumentality thereof) and the payment for which the
United States pledges its full faith and credit.

     “Guarantee” means a guarantee other than by endorsement of negotiable instruments for
collection in the ordinary course of business, direct or indirect, in any manner including, without
limitation, by way of a pledge of assets or through letters of credit or reimbursement agreements
in respect thereof, of all or any part of any Indebtedness (whether arising by virtue of
partnership arrangements, or by agreements to keep-well, to purchase assets, goods, securities or
services, to take or pay or to maintain financial statement conditions or otherwise).

     “Guarantors” means each Restricted Subsidiary that executes a Subsidiary Guarantee in
accordance with the provisions of this Indenture, and its successors and assigns, in each case,
until the Subsidiary Guarantee of such Person has been released in accordance with the provisions
of this Indenture.

-12-

 

     “Hedging Obligations” means, with respect to any specified Person, the obligations of such
Person under:

     (1) interest rate swap agreements (whether from fixed to floating or from floating to
fixed), interest rate cap agreements and interest rate collar agreements;

     (2) other agreements or arrangements designed to manage interest rates or interest rate
risk; and

     (3) other agreements or arrangements designed to protect such Person against
fluctuations in currency exchange rates or commodity prices.

     “Holder” means a Person in whose name a Note is registered.

     “Holdings” means USPI Holdings, Inc., a Delaware corporation.

     “Indebtedness” means, with respect to any specified Person, the principal and premium (if any)
of any indebtedness of such Person (excluding accrued expenses and trade payables), whether or not
contingent:

     (1) in respect of borrowed money;

     (2) evidenced by bonds, notes, debentures or similar instruments or letters of credit
(or reimbursement agreements in respect thereof) (other than letters of credit issued in
respect of trade payables);

     (3) in respect of banker’s acceptances;

     (4) representing Capital Lease Obligations;

     (5) representing the balance deferred and unpaid of the purchase price of any property
or services due more than twelve months after such property is acquired or such services are
completed (except any such balance that constitutes a trade payable or similar obligation to
a trade creditor); or

     (6) representing the net obligations under any Hedging Obligations,

if and to the extent any of the preceding items (other than letters of credit, and Hedging
Obligations) would appear as a liability upon a balance sheet of the specified Person prepared in
accordance with GAAP. In addition, the term “Indebtedness” includes all Indebtedness of others
secured by a Lien on any asset of the specified Person (whether or not such Indebtedness is assumed
by the specified Person) and, to the extent not otherwise included, the Guarantee by the specified
Person of any Indebtedness of any other Person.

     “Indenture” means this Indenture, as amended or supplemented from time to time.

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

     “Initial Notes” means the first $440.0 million aggregate principal amount of Notes issued
under this Indenture.

-13-

 

     “Initial Purchasers” means Citigroup Global Markets Inc., Lehman Brothers Inc., Bear, Stearns
& Co. Inc., UBS Securities LLC and SunTrust Robinson Humphrey, a division of SunTrust Capital
Markets, Inc.

     “Investment Affiliate” means, as to any Person, any other Person which directly or indirectly
is in control of, is controlled by, or is under common control with such Person and is organized by
such Person (or any Person controlling such Person) primarily for making equity or debt
Investments.

     “Investments” means, with respect to any Person, all direct or indirect investments by such
Person in other Persons (including Affiliates) in the forms of loans (including Guarantees or other
obligations), advances or capital contributions (excluding commission, travel, relocation and
similar advances to officers and employees made in the ordinary course of business), purchases or
other acquisitions for consideration of Indebtedness, Equity Interests or other securities,
together with all items that are or would be classified as investments on a balance sheet prepared
in accordance with GAAP. If the Issuer or any Restricted Subsidiary sells or otherwise disposes of
any Equity Interests of any direct or indirect Restricted Subsidiary such that, after giving effect
to any such sale or disposition, such Person is no longer a Subsidiary of the Issuer, the Issuer
will be deemed to have made an Investment on the date of any such sale or disposition equal to the
Fair Market Value of the Issuer’s Investments in such Subsidiary that were not sold or disposed of
in an amount determined as provided in Section 4.07(c). The acquisition by the Issuer or any
Restricted Subsidiary of a Person that holds an Investment in a third Person will be deemed to be
an Investment by the Issuer or such Restricted Subsidiary in such third Person in an amount equal
to the Fair Market Value of the Investments held by the acquired Person in such third Person in an
amount determined as provided in Section 4.07(c). The outstanding amount of any Investment shall
be the original cost thereof, reduced by all returns on such Investment (including dividends,
interest, distributions, returns of principal and profits on sale).

     “Issue Date” means April 19, 2007.

     “Issuer” means the party named as the “Issuer” in the first paragraph of this Indenture.

     “Legal Holiday” means a Saturday, a Sunday or a day on which banking institutions in the City
of New York or at a place of payment are authorized by law, regulation or executive order to remain
closed. If a payment date is a Legal Holiday at a place of payment, payment may be made at that
place on the next succeeding day that is not a Legal Holiday, and no interest shall accrue on such
payment for the intervening period.

     “Letter of Transmittal” means the letter of transmittal to be prepared by the Issuer and sent
to all Holders of the Notes for use by such Holders in connection with the Exchange Offer.

     “Lien” means, with respect to any asset, any mortgage, lien, pledge, charge, security interest
or encumbrance of any kind in respect of such asset, whether or not filed, recorded or otherwise
perfected under applicable law, including any conditional sale or other title retention agreement,
any lease in the nature thereof, any option or other agreement to sell or give a security interest
in and any filing of or agreement to give any financing statement under the Uniform Commercial Code
(or equivalent statutes) of any jurisdiction.

     “Make-Whole Cash Pay Notes Redemption Date” has the meaning set forth in Exhibit A1
hereto.

     “Make-Whole Redemption Date” means the date on which any Note is redeemed pursuant to Section
5(c) of the Notes.

-14-

 

     “Make-Whole Toggle Notes Redemption Date” has the meaning set forth in Exhibit A2
hereto.

     “Management Agreements” means the management, service or similar agreements pursuant to which
Parent or any of its Qualified Restricted Subsidiaries manages the assets and businesses of any of
its Restricted Subsidiaries.

     “Minority Interests” means the interests in income of the Issuer’s Restricted Subsidiaries
held by Persons other than the Issuer or a Restricted Subsidiary, as reflected on the Issuer’s
consolidated financial statements.

     “Net Income” means, with respect to any specified Person, the net income (loss) of such
Person, determined in accordance with GAAP and before any reduction in respect of preferred stock
dividends.

     “Net Proceeds” means the aggregate cash proceeds received by the Issuer or any of its
Restricted Subsidiaries in respect of any Asset Sale (including, without limitation, any cash
received upon the sale or other disposition of any non-cash consideration received in any Asset
Sale), net of the direct costs relating to such Asset Sale, including, without limitation, legal,
accounting and investment banking fees, payments made in order to obtain a necessary consent or
required by applicable law, and sales commissions, and any relocation expenses incurred as a result
of the Asset Sale, taxes paid or payable as a result of the Asset Sale, including taxes resulting
from the transfer of the proceeds of such Asset Sale to the Issuer, in each case, after taking into
account:

     (1) any available tax credits or deductions and any tax sharing arrangements;

     (2) amounts required to be applied to the repayment of Indebtedness secured by a Lien
on the asset or assets that were the subject of such Asset Sale;

     (3) any reserve for adjustment in respect of the sale price of such asset or assets
established in accordance with GAAP;

     (4) any reserve for adjustment in respect of any liabilities associated with the asset
disposed of in such transaction and retained by the Issuer or any Restricted Subsidiary
after such sale or other disposition thereof;

     (5) any distributions and other payments required to be made to minority interest
holders in Subsidiaries or joint ventures as a result of such Asset Sale; and

     (6) in the event that a Restricted Subsidiary consummates an Asset Sale and makes a pro
rata payment of dividends to all of its stockholders from any cash proceeds of such Asset
Sale, the amount of dividends paid to any stockholder other than the Issuer or any other
Restricted Subsidiary, provided that any net proceeds of an Asset Sale by a Non-Guarantor
Subsidiary that are subject to legal or contractual restrictions on repatriation to the
Issuer will not be considered Net Proceeds for so long as such proceeds are subject to such
restrictions, provided, however, that any such contractual restrictions on repatriation were
not entered into in contemplation of such Asset Sale.

     “Non-Guarantor Subsidiaries” means (v) any Unrestricted Subsidiary, (w) any Receivables
Subsidiary, (x) any Captive Insurance Subsidiary, (y) any Foreign Subsidiary and (z) any other
Subsidiary of the Issuer that does not guarantee the Issuer’s Obligations under the Credit
Agreement.

-15-

 

     “Non-Recourse Debt” means Indebtedness:

     (1) as to which neither the Issuer nor any of its Restricted Subsidiaries (a) provides
credit support of any kind (including any undertaking, agreement or instrument that would
constitute Indebtedness) or (b) is directly or indirectly liable as a guarantor or
otherwise; and

     (2) as to which the lenders have been notified in writing or have agreed in writing (in
the agreement relating thereto or otherwise) that they will not have any recourse to the
stock or assets of the Issuer or any of its Restricted Subsidiaries, except as permitted by
the definition of “Unrestricted Subsidiary.”

     “Non-U.S. Person” means a Person who is not a U.S. Person.

     “Notes” has the meaning assigned to it in the preamble to this Indenture.

     “Obligations” means any principal, interest, penalties, fees, indemnifications,
reimbursements, damages and other liabilities payable under the documentation governing any
Indebtedness.

     “Offering Memorandum” means the Issuer’s offering memorandum, dated April 11, 2007, related to
the issuance and sale of the Initial Notes.

     “Officer” means, with respect to any Person, the Chairman of the Board, the Chief Executive
Officer, the President, the Chief Operating Officer, the Chief Financial Officer, the Treasurer,
any Assistant Treasurer, the Controller, the Secretary or any Vice President of such Person.

     “Officers’ Certificate” means a certificate signed on behalf of the Issuer by one Officer of
the Issuer, who must be the principal executive officer, the principal financial officer, the
treasurer or the principal accounting officer of the Issuer, that meets the requirements of Section
13.05 hereof.

     “Opinion of Counsel” means an opinion from legal counsel that meets the requirements of
Section 13.05. The counsel may be an employee of or counsel to the Issuer or any Subsidiary of the
Issuer.

     “Partial PIK Interest” has the meaning set forth in Exhibit A2 hereto.

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

     “Permitted Business” means (i) any business engaged in by the Issuer or any of its Restricted
Subsidiaries on the Issue Date and (ii) any business or other activities that are reasonably
similar, ancillary, complementary or related to, or a reasonable extension, development or
expansion of, the businesses in which the Issuer and its Restricted Subsidiaries are engaged on the
Issue Date.

     “Permitted Holder” means (A) Welsh, Carson, Anderson & Stowe X, L.P., WCAS Capital Partners
IV, L.P., and their respective Investment Affiliates and (B) (i) any officer, director, employee,
member, partner or stockholder of the manager or general partner (or the general partner of the
general partner) of any of the Persons referred to in clause (A); (ii) each of the directors and
executive officers of the Issuer on the Issue Date; (iii) the spouses, ancestors, siblings,
descendants (including children or grandchildren by adoption) and the descendants of any of the
siblings of the Persons referred to in clause (i) or (ii); (iv) in the event of the incompetence or
death of any of the Persons described in any of clauses (i) through (iii), such Person’s estate,
executor, administrator, committee or other personal representative, in each case who at any
particular date shall be the Beneficial Owner or have the right to
acquire, directly or indirectly,

-16-

 

Capital Stock of the Issuer or Holdings (or any other direct or indirect parent
company of the Issuer); (v) any trust created for the benefit of the Persons described in any of
clauses (i) through (iv) or any trust for the benefit of any such trust; or (vi) any Person
controlled by any of the Persons described in any of the clauses (i) through (v). For purposes of
this definition, “control,” as used with respect to any Person, shall mean the possession, directly
or indirectly, of the power to direct or cause the direction of the management and policies of such
Person, whether through ownership of voting securities or by contract or otherwise.

     “Permitted Investments” means:

     (1) any Investment in the Issuer or in a Qualified Restricted Subsidiary;

     (2) any Investment in Cash Equivalents;

     (3) any Investment by the Issuer or any Qualified Restricted Subsidiary in a Person, if
as a result of such Investment:

     (a) such Person becomes a Qualified Restricted Subsidiary;

     (b) such Person, in one transaction or a series of transactions, is merged,
consolidated or amalgamated with or into, or transfers or conveys substantially all
of its assets to, or is liquidated into, the Issuer or a Qualified Restricted
Subsidiary; or

     (c) such Person becomes a Guarantor, provided, however, that such Person’s
primary business is a Permitted Business;

     (4) any Investment made as a result of the receipt of non-cash consideration from an
Asset Sale that was made pursuant to and in compliance with Section 4.10 hereof;

     (5) any Investment solely in exchange for the issuance of Equity Interests (other than
Disqualified Stock) of the Issuer;

     (6) any Investments received in compromise, settlement or resolution of (A) obligations
of trade debtors or customers that were incurred in the ordinary course of business of the
Issuer or any of its Restricted Subsidiaries, including pursuant to any plan of
reorganization or similar arrangement upon the bankruptcy or insolvency of any trade debtor
or customer, (B) litigation, arbitration or other disputes with Persons who are not
Affiliates or (C) as a result of a foreclosure by the Issuer or any Restricted Subsidiary
with respect to any secured Investment or other transfer of title with respect to any
secured Investment in default;

     (7) Investments represented by Hedging Obligations entered into to protect against
fluctuations in interest rates, exchange rates and commodity prices;

     (8) any Investment in payroll, travel and similar advances to cover business-related
travel expenses, moving expenses or other similar expenses, in each case incurred in the
ordinary course of business;

     (9) Investments in receivables owing to the Issuer or any Restricted Subsidiary if
created or acquired in the ordinary course of business and payable or dischargeable in
accordance with customary trade terms; provided, however, that such trade terms may include
such concessionary

-17-

 

trade terms as the Issuer or any such Restricted Subsidiary deems reasonable
under the circumstances;

     (10) Investments in prepaid expenses, negotiable instruments held for collection and
lease, utility and workers compensation, performance and similar deposits entered into as a
result of the operations of the business in the ordinary course of business;

     (11) obligations of one or more officers or other employees of the Issuer or any of its
Restricted Subsidiaries in connection with such officer’s or
employee’s acquisition of shares of Capital Stock of the Issuer or Capital Stock of Holdings (or any other direct or
indirect parent company of the Issuer) so long as no cash or other assets are paid by the
Issuer or any of its Restricted Subsidiaries to such officers or employees in connection
with the acquisition of any such obligations;

     (12) loans or advances to and guarantees provided for the benefit of employees made in
the ordinary course of business of the Issuer or the Restricted Subsidiary in an aggregate
principal amount not to exceed $5.0 million at any one time outstanding;

     (13) Investments existing on the Issue Date or an Investment consisting of any
extension, modification or renewal of any Investment existing as of the Issue Date
(excluding any such extension, modification or renewal involving additional advances,
contributions or other investments of cash or property or other increases thereof unless it
is a result of the accrual or accretion of interest or original issue discount or
payment-in-kind pursuant to the terms, as of the Issue Date, of the original Investment so
extended, modified or renewed);

     (14) repurchases of the Notes;

     (15) other Investments in any Person having an aggregate Fair Market Value (measured on
the date each such Investment was made and without giving effect to subsequent changes in
value), when taken together with all other Investments made pursuant to this clause (15)
that are at the time outstanding not to exceed $50.0 million; provided, however, that if any
Investment pursuant to this clause (15) is made in any Person that is not a Qualified
Restricted Subsidiary at the date of the making of such Investment and such Person becomes a
Qualified Restricted Subsidiary after such date, such Investment shall thereafter be deemed
to have been made pursuant to clause (1) above and shall cease to have been made pursuant to
this clause (15) for so long as such Person continues to be a Qualified Restricted
Subsidiary (it being understood that if such Person thereafter ceases to be a Qualified
Restricted Subsidiary, such Investment will again be deemed to have been made pursuant to
this clause (15));

     (16) the acquisition by a Receivables Subsidiary in connection with a Qualified
Receivables Transaction of Equity Interests of a trust or other Person established by such
Receivables Subsidiary to effect such Qualified Receivables Transaction; and any other
Investment by the Issuer or a Subsidiary of the Issuer in a Receivables Subsidiary or any
Investment by a Receivables Subsidiary in any other Person in connection with a Qualified
Receivables Transaction customary for such transactions;

     (17) payments to any Captive Insurance Subsidiary in an amount equal to (i) the capital
required under the applicable laws or regulations of the jurisdiction in which such Captive
Insurance Subsidiary is formed or determined by independent actuaries as prudent and
necessary capital to operate such Captive Insurance Subsidiary plus (ii) any reasonable
general corporate and overhead expenses of such Captive Insurance Subsidiary;

-18-

 

     (18) (A) Investments in joint ventures or Unrestricted Subsidiaries in an amount, taken
together with all other Restricted Payments made pursuant to this clause (A) not to exceed
15% of Total Assets outstanding at any time; provided that (i) substantially all of the
business activities of any such joint venture consists of owning or operating surgical
facilities and (ii) a majority of the Voting Stock of such Person is owned by the Issuer,
its Restricted Subsidiaries and/or other Persons that are not Affiliates of the Issuer; and
(B) sales of interests in joint ventures to Strategic Investors or contributions of the St.
Louis Investments to joint ventures with Strategic Investors; and

     (19) Guarantees of Indebtedness of the Issuer or a Restricted Subsidiary permitted
under Section 4.09 and performance guarantees in the ordinary course of business.

     “Permitted Junior Securities” means:

     (1) Equity Interests in the Issuer or any Guarantor; or

     (2) unsecured debt securities that are subordinated to all Senior Debt and any debt
securities issued in exchange for Senior Debt to substantially the same extent as, or to a
greater extent than, the Notes and the Subsidiary Guarantees are subordinated to Senior Debt
under this Indenture (including, in the case of Senior Debt under the Credit Facilities,
with respect to payment blockage and turnover), and the maturity and weighted average life
to maturity of which are at least six months greater than that of the Senior Debt and debt
securities issued in exchange for Senior Debt; provided that the term “Permitted Junior
Securities” shall not include any securities distributed pursuant to a plan of
reorganization if the Indebtedness under the Credit Agreement is treated as part of the same
class as the notes for purposes of such plan of reorganization; provided further that to the
extent that any Senior Debt of the Issuer or the Guarantors outstanding on the date of
consummation of any such plan of reorganization is not paid in full in cash on such date,
the holders of any such Senior Debt not so paid in full in cash have consented to the terms
of such plan of reorganization.

     “Permitted Liens” means:

     (1) Liens on assets of the Issuer or any of its Restricted Subsidiaries securing Senior
Debt that was permitted by the terms of this Indenture to be incurred;

     (2) Liens in favor of the Issuer or the Guarantors;

     (3) Liens on property or assets of a Person, plus renewals and extensions of such
Liens, existing at the time such Person is merged with or into, consolidated with or
acquired by the Issuer or any Restricted Subsidiary; provided that such Liens were in
existence prior to the contemplation of such merger, consolidation or acquisition and do not
extend to any assets other than those of the Person merged into, consolidated with or
acquired by the Issuer or such Subsidiary;

     (4) Liens on property (including Capital Stock) existing at the time of acquisition of
the property by the Issuer or any Restricted Subsidiary; provided that such Liens were in
existence prior to, such acquisition, and not incurred in contemplation of, such
acquisition;

     (5) Liens (including deposits and pledges) to secure the performance of public or
statutory obligations, progress payments, surety or appeal bonds, performance bonds or other
obligations of a like nature incurred in the ordinary course of business;

-19-

 

     (6) Liens to secure Indebtedness (including Capital Lease Obligations) permitted by
Section 4.09(b)(4) covering only the assets acquired, constructed or improved with or
financed by such Indebtedness;

     (7) Liens existing on the Issue Date, plus renewals and extensions of such Liens;

     (8) Liens for taxes, assessments or governmental charges or claims that are not yet
delinquent or that are being contested in good faith by appropriate proceedings promptly
instituted and diligently concluded; provided that any reserve or other appropriate
provision as is required in conformity with GAAP has been made therefor;

     (9) Liens imposed by law, such as carriers’, warehousemen’s, landlord’s, materialmen’s,
laborers’, employees’, suppliers’ and mechanics’ Liens, in each case, incurred in the
ordinary course of business;

     (10) survey exceptions, title defects, encumbrances, easements or reservations of, or
rights of others for, licenses, rights-of-way, sewers, electric lines, telegraph and
telephone lines and other similar purposes, or zoning or other restrictions as to the use of
real property that do not materially interfere with the ordinary conduct of the business of
the Issuer and its Subsidiaries, taken as a whole;

     (11) Liens created for the benefit of (or to secure) the Notes (or the Subsidiary
Guarantees);

     (12) Liens to secure any Permitted Refinancing Indebtedness permitted to be incurred
under this Indenture; provided, however, that:

     (a) the new Lien shall be limited to all or part of the same property and
assets that secured or, under the written agreements pursuant to which the original
Lien arose, could secure the original Indebtedness (plus improvements and accessions
to, such property or proceeds or distributions thereof); and

     (b) the Indebtedness secured by the new Lien is not increased to any amount
greater than the sum of (x) the outstanding principal amount, or, if greater,
committed amount, of the Permitted Refinancing Indebtedness and (y) an amount
necessary to pay any fees and expenses, including premiums, related to such renewal,
refunding, refinancing, replacement, defeasance or discharge;

     (13) Liens incurred in the ordinary course of business of the Issuer or any Subsidiary
of the Issuer with respect to obligations that do not exceed $10.0 million at any one time
outstanding;

     (14) Liens incurred in connection with a Qualified Receivables Transaction (which, in
the case of the Issuer and its Restricted Subsidiaries (other than Receivables Subsidiaries)
shall be limited to receivables and related assets referred to in the definition of
Qualified Receivables Transaction);

     (15) security for the payment of workers’ compensation, unemployment insurance, other
social security benefits or other insurance-related obligations (including, but not limited
to, in respect of deductibles, self-insured retention amounts and premiums and adjustments
thereto) entered into in the ordinary course of business;

-20-

 

     (16) deposits or pledges in connection with bids, tenders, leases and contracts (other
than contracts for the payment of money) entered into in the ordinary course of business;

     (17) zoning restrictions, easements, licenses, reservations, provisions, encroachments,
encumbrances, protrusion permits, servitudes, covenants, conditions, waivers, restrictions
on the use of property or minor irregularities of title (and with respect to leasehold
interests, mortgages, obligations, liens and other encumbrances incurred, created, assumed
or permitted to exist and arising by, through or under a landlord or owner of the leased
property, with or without consent of the lessee), in each case, not materially interfering
with the ordinary conduct of the business of the Issuer and its Subsidiaries, taken as a
whole;

     (18) leases, subleases, licenses or sublicenses to third parties entered into in the
ordinary course of business;

     (19) Liens securing Hedging Obligations entered into to protect against fluctuations in
interest rates, exchange rates and commodity prices;

     (20) Liens arising out of judgments, decrees, orders or awards in respect of which the
Issuer shall in good faith be prosecuting an appeal or proceedings for review which appeal
or proceedings shall not have been finally terminated, or if the period within which such
appeal or proceedings may be initiated shall not have expired;

     (21) Liens on Capital Stock of an Unrestricted Subsidiary that secure Indebtedness or
other obligation of such Unrestricted Subsidiary;

     (22) Liens on the assets of Non-Guarantor Subsidiaries securing Indebtedness of the
Issuer or the Restricted Subsidiaries that were permitted by the terms of this Indenture to
be incurred;

     (23) Liens arising from filing Uniform Commercial Code financing statements regarding
leases;

     (24) Liens (i) of a collection bank arising under Section 4-210 of the Uniform
Commercial Code on items in the course of collection and (ii) in favor of banking
institution encumbering deposits (including the right of set-off) and which are within the
general parameters customary in the banking industry; and

     (25) Liens encumbering reasonable customary initial deposits and margin deposits and
similar Liens attaching to brokerage accounts incurred in the ordinary course of business
and not for speculative purposes.

     “Permitted Payment Restriction” means any consensual encumbrance or restriction on the ability
of any Restricted Subsidiary to (a) pay dividends or make any other distributions on its Equity
Interests to the Issuer or a Restricted Subsidiary or pay any Indebtedness owed to the Issuer or a
Restricted Subsidiary or (b) make any loans or advances to the Issuer or a Restricted Subsidiary,
which restriction satisfies all of the following conditions: (i) (A) such restriction becomes
effective only upon the occurrence of (x) specified events under its charter or (y) a default by
such Restricted Subsidiary in the payment of principal of or interest, a bankruptcy default, a
default on any financial covenant or any other material default, in each case on Indebtedness that
was incurred by such Restricted Subsidiary under Section 4.09 or (B) such restriction is permitted
under the U.K. Credit Facility as in effect on the Issue Date (or under clause (20) of Section 4.08
with respect to such restriction), and (ii) such restriction would not materially

-21-

 

impair the Issuer’s ability to make scheduled payments of cash interest and to make required
principal payments on the notes, as determined in good faith by the Board of Directors whose
determination shall be conclusive.

     “Permitted Payments to Parent” means

     (1) payments, directly or indirectly, to Holdings or any other direct or indirect
parent company of the Issuer to be used by Holdings (or any other direct or indirect parent
company of the Issuer) to pay (x) consolidated, combined or similar Federal, state and local
taxes payable by Holdings (or such parent company) and directly attributable to (or arising
as a result of) the operations of the Issuer and its Subsidiaries and (y) franchise or
similar taxes and fees of Holdings (or such parent company) required to maintain Holdings’
(or such parent company’s) corporate or other existence and other taxes; provided that:

     (a) the amount of such dividends, distributions or advances paid shall not
exceed (x) the amount that would be due with respect to a consolidated, combined or
similar Federal, state or local tax return that included the Issuer and its
Subsidiaries if the Issuer was a corporation for Federal, state and local tax
purposes plus (y) the actual amount of such franchise or similar taxes and fees of
Holdings (or such parent company) required to maintain Holdings’ (or such parent
company’s) corporate or other existence and other taxes, each as applicable; and

     (b) such payments are used by Holdings (or such parent company) for such
purposes within 90 days of the receipt of such payments; and

     (2) payments, directly or indirectly, to Holdings or any other direct or indirect
parent company of the Issuer if the proceeds thereof are used to pay general corporate and
overhead expenses (including salaries and other compensation of employees) incurred in the
ordinary course of its business or of the business of Holdings or such other parent company
of the Issuer as a direct or indirect holding company for the Issuer or used to pay fees and
expenses (other than to Affiliates) relating to any unsuccessful debt or equity financing.

     “Permitted Refinancing Indebtedness” means any Indebtedness of the Issuer or any of its
Restricted Subsidiaries issued in exchange for, or the net proceeds of which are used to extend,
renew, refund, refinance, replace, defease or discharge other Indebtedness of the Issuer or any of
its Restricted Subsidiaries (other than intercompany Indebtedness); provided that:

     (1) the principal amount (or accreted value, if applicable) of such Permitted
Refinancing Indebtedness does not exceed the principal amount (or accreted value, if
applicable) of the Indebtedness extended, renewed, refunded, refinanced, replaced, defeased
or discharged (plus all accrued interest on the Indebtedness and the amount of all fees,
commissions, discounts and expenses, including premiums, incurred in connection therewith);

     (2) either (a) such Permitted Refinancing Indebtedness has a final maturity date later
than the final maturity date of, and has a Weighted Average Life to Maturity equal to or
greater than the Weighted Average Life to Maturity of, the Indebtedness being extended,
renewed, refunded, refinanced, replaced, defeased or discharged or (b) all scheduled
payments on or in respect of such Permitted Refinancing Indebtedness (other than interest
payments) shall be at least 91 days following the final scheduled maturity of the Notes;

-22-

 

     (3) if the Indebtedness being extended, renewed, refunded, refinanced, replaced,
defeased or discharged is subordinated in right of payment to the Notes, such Permitted
Refinancing Indebtedness is subordinated in right of payment to the Notes on terms at least
as favorable to the Holders as those contained in the documentation governing the
Indebtedness being extended, renewed, refunded, refinanced, replaced, defeased or
discharged; and

     (4) such Indebtedness is incurred

     (a) by the Issuer or by the Restricted Subsidiary who is the obligor on the
Indebtedness being renewed, refunded, refinanced, replaced, defeased or discharged;

     (b) by any Guarantor if the obligor on the Indebtedness being renewed,
refunded, refinanced, replaced, defeased or discharged is a Guarantor; or

     (c) by any Non-Guarantor Subsidiary if the obligor on the Indebtedness being
renewed, refunded, refinanced, replaced, defeased or discharged is a Non-Guarantor
Subsidiary.

     “Person” means any individual, corporation, partnership, joint venture, association,
joint-stock company, trust, unincorporated organization, limited liability company or government or
other entity.

     “PIK Interest” has the meaning set forth in Exhibit A2 hereto.

     “Private Placement Legend” means the legend set forth in Section 2.06(g)(1) to be placed on
all Notes issued under this Indenture except where otherwise permitted by the provisions of this
Indenture.

     “Pro Forma Cost Savings” means, with respect to any period, the reduction in net costs and
related adjustments that (i) were directly attributable to an acquisition, merger, consolidation or
disposition that occurred during the four-quarter reference period or subsequent to the
four-quarter reference period and on or prior to the Calculation Date and calculated on a basis
that is consistent with Regulation S-X under the Securities Act as in effect and applied as of the
Issue Date, (ii) were actually implemented by the business that was the subject of any such
acquisition, merger, consolidation or disposition within 12 months after the date of the
acquisition, merger, consolidation or disposition and prior to the Calculation Date that are
supportable and quantifiable by the underlying accounting records of such business or (iii) relate
to the business that is the subject of any such acquisition, merger, consolidation or disposition
and that the Issuer reasonably determines are probable based upon specifically identifiable actions
to be taken within 12 months of the date of the acquisition, merger, consolidation or disposition
and, in the case of each of (i), (ii) and (iii), are described, as provided below, in an Officers’
Certificate, as if all such reductions in costs had been effected as of the beginning of such
period.

     “QIB” means a “qualified institutional buyer” as defined in Rule 144A.

     “Qualified Capital Stock” means any Capital Stock that is not Disqualified Stock.

     “Qualified Proceeds” means any of the following or any combination of the following:

     (1) Cash Equivalents;

     (2) the Fair Market Value of assets that are used or useful in the Permitted Business;
and

-23-

 

     (3) the Fair Market Value of the Capital Stock of any Person engaged primarily in a
Permitted Business if, in connection with the receipt by the Issuer or any of its Restricted
Subsidiaries of such Capital Stock, such Person becomes a Restricted Subsidiary or such
Person is merged or consolidated into the Issuer or any of its Restricted Subsidiaries;

provided that (i) for purposes of clause (3) of Section 4.07(a), Qualified Proceeds shall not
include Excluded Contributions and (ii) the amount of Qualified Proceeds shall be reduced by the
amount of payments made in respect of the applicable transaction which are permitted under clause
(8) of Section 4.11(b).

     “Qualified Receivables Transaction” means any transaction or series of transactions entered
into by the Issuer or any of its Subsidiaries pursuant to which the Issuer or any of its
Subsidiaries sells, conveys or otherwise transfers, or grants a security interest, to:

     (1) a Receivables Subsidiary (in the case of a transfer by the Issuer or any of its
Subsidiaries, which transfer may be effected through the Issuer or one or more of its
Subsidiaries); and

     (2) if applicable, any other Person (in the case of a transfer by a Receivables
Subsidiary),

in each case, in any accounts receivable (including health care insurance receivables),
instruments, chattel paper, general intangibles and similar assets (whether now existing or arising
in the future, the “Receivables”) of the Issuer or any of its Subsidiaries, and any assets related
thereto, including, without limitation, all collateral securing such Receivables, all contracts,
contract rights and all guarantees or other obligations in respect of such Receivables, proceeds of
such Receivables and any other assets, which are customarily transferred or in respect of which
security interests are customarily granted in connection with receivables financings and asset
securitization transactions of such type, together with any related transactions customarily
entered into in a receivables financings and asset securitizations, including servicing
arrangements.

     “Qualified Restricted Subsidiary” means any other Restricted Subsidiary of the Issuer that
satisfies all of the following requirements:

     (1) except for Permitted Payment Restrictions, there are no restrictions, directly or
indirectly, on the ability of such Restricted Subsidiary to pay dividends or make
distributions to the holders of its Capital Stock;

     (2) except to the extent restricted pursuant to a Permitted Payment Restriction, such
Restricted Subsidiary customarily declares and pays regular monthly, quarterly or
semi-annual dividends or distributions to the holders of its Capital Stock in an amount
equal to substantially all of the available cash flow of such Restricted Subsidiary for such
period, as determined in good faith by the board of directors, board of governors or such
other individuals performing similar functions, subject to such ordinary and customary
reserves and other amounts as, in the good faith judgment of such individuals, may be
necessary so that the business of such Restricted Subsidiary may be properly and
advantageously conducted at all times, and the Issuer intends to cause such Restricted
Subsidiary to continue to declare and pay such regular dividends or distributions in the
manner set forth above;

-24-

 

     (3) the Capital Stock of such Restricted Subsidiary consists solely of (A) Capital
Stock owned by the Issuer and its Qualified Restricted Subsidiaries, (B) Capital Stock owned
by Strategic Investors and (C) directors’ qualifying shares; and

     (4) the primary business of such Restricted Subsidiary is a Permitted Business.

     “Receivables Fees” means distributions or payments made directly or by means of discounts with
respect to any participation interest issued or sold in connection with, and other fees paid to a
Person that is not a Restricted Subsidiary in connection with, any Qualified Receivables
Transaction.

     “Receivables Subsidiary” means a Subsidiary of the Issuer which engages in no activities other
than in connection with the financing of accounts receivable and in businesses related or ancillary
thereto and that is designated by the Board of Directors of the Issuer (as provided below) as a
Receivables Subsidiary

     (A) no portion of the Indebtedness or any other Obligations (contingent or otherwise)
of which:

     (1) is guaranteed by the Issuer or any Subsidiary of the Issuer (excluding
guarantees of Obligations (other than the principal of, and interest on,
Indebtedness) pursuant to representations, warranties, covenants and indemnities
entered into in the ordinary course of business in connection with a Qualified
Receivables Transaction);

     (2) is recourse to or obligates the Issuer or any Subsidiary of the Issuer in
any way other than pursuant to representations, warranties, covenants and
indemnities customarily entered into in connection with a Qualified Receivables
Transaction; or

     (3) subjects any property or asset of the Issuer or any Subsidiary of the
Issuer (other than accounts receivable and related assets as provided in the
definition of Qualified Receivables Transaction), directly or indirectly,
contingently or otherwise, to the satisfaction thereof, other than pursuant to
representations, warranties, covenants and indemnities customarily entered into in
connection with a Qualified Receivables Transaction; and

     (B) with which neither the Issuer nor any Subsidiary of the Issuer has any material
contract, agreement, arrangement or understanding other than on terms no less favorable to
the Issuer or such Subsidiary than those that might be obtained at the time from Persons who
are not Affiliates of the Issuer, other than as may be customary in a Qualified Receivables
Transaction including for fees payable in the ordinary course of business in connection with
servicing accounts receivable; and (C) with which neither the Issuer nor any Subsidiary of
the Issuer has any obligation to maintain or preserve such Subsidiary’s financial condition
or cause such Subsidiary to achieve certain levels of operating results. Any such
designation by the Board of Directors of the Issuer will be evidenced to the Trustee by
filing with the Trustee a certified copy of the resolution of the Board of Directors of the
Issuer giving effect to such designation and an Officers’ Certificate certifying that such
designation complied with the foregoing conditions.

     “Registration Rights Agreement” means (i) the Registration Rights Agreement, dated as of April
19, 2007 among the Issuer, the Guarantors and the Initial Purchasers, as such agreement may be
amended, modified or supplemented from time to time and (ii) with respect to any Additional Notes,
one or more registration rights agreements among the Issuer and the other parties thereto, as such
agreement(s) may be

-25-

 

amended, modified or supplemented from time to time, relating to rights given by the Issuer to
the purchasers of Additional Notes to register such Additional Notes under the Securities Act.

     “Regulation S” means Regulation S promulgated under the Securities Act.

     “Regulation S Global Note” means a Regulation S Temporary Global Note or Regulation S
Permanent Global Note, as appropriate.

     “Regulation S Permanent Global Note” means a permanent Global Note in the form of Exhibit
A1 or Exhibit A2 hereto bearing the Global Note Legend and the Private Placement Legend
and deposited with or on behalf of and registered in the name of the Depositary or its nominee,
issued in a denomination equal to the outstanding principal amount of the Regulation S Temporary
Global Note upon expiration of the Restricted Period.

     “Regulation S Temporary Global Note” means a temporary Global Note in the form of Exhibit
A3 or Exhibit A4 hereto bearing the legend set forth in Section 2.06(g)(3) deposited
with or on behalf of and registered in the name of the Depositary or its nominee, issued in a
denomination equal to the outstanding principal amount of the Notes initially sold in reliance on
Rule 903 of Regulation S.

     “Replacement Preferred Stock” means any Disqualified Stock of the Issuer or any of its
Restricted Subsidiaries issued in exchange for, or the net proceeds of which are used to renew,
refund, refinance, replace or discharge any Disqualified Stock of the Issuer or any of its
Restricted Subsidiaries (other than intercompany Disqualified Stock); provided that such
Replacement Preferred Stock (i) is issued by the Issuer or by the Restricted Subsidiary who is the
issuer of the Disqualified Stock being redeemed, refunded, refinanced, replaced or discharged, and
(ii) does not have an initial liquidation preference in excess of the liquidation preference plus
accrued and unpaid dividends on the Disqualified Stock being redeemed, refunded, refinanced,
replaced or discharged.

     “Representative” means any trustee, agent or representative for any Senior Debt.

     “Responsible Officer,” when used with respect to the Trustee, means any officer within the
Corporate Trust Office of the Trustee (or any successor group of the Trustee) or any other officer
of the Trustee customarily performing functions similar to those performed by any of the above
designated officers and also means, with respect to a particular corporate trust matter, any other
officer to whom such matter is referred because of his knowledge of and familiarity with the
particular subject and who shall have responsibility for the administration of this Indenture.

     “Restricted Definitive Note” means a Definitive Note bearing the Private Placement Legend.

     “Restricted Global Note” means a Global Note bearing the Private Placement Legend.

     “Restricted Investment” means an Investment other than a Permitted Investment.

     “Restricted Period” means the 40-day distribution compliance period as defined in Regulation
S.

     “Restricted Subsidiary” of a Person means any Subsidiary of the referent Person that is not an
Unrestricted Subsidiary. Unless otherwise specified, all references to “Restricted Subsidiaries”
or “Restricted Subsidiary” are to Restricted Subsidiaries of the Issuer.

     “Rule 144” means Rule 144 promulgated under the Securities Act.

-26-

 

     “Rule 144A” means Rule 144A promulgated under the Securities Act.

     “Rule 903” means Rule 903 promulgated under the Securities Act.

     “Rule 904” means Rule 904 promulgated under the Securities Act.

     “SEC” means the Securities and Exchange Commission.

     “Securities Act” means the Securities Act of 1933, as amended.

     “Senior Debt” means:

     (1) all Indebtedness of the Issuer or any Guarantor outstanding under the Credit
Agreement or under any other Credit Facilities (including interest accruing on or after the
filing of any petition in bankruptcy or similar proceeding or for reorganization of the
Issuer or any Guarantor (at the rate provided for in the documentation with respect thereto,
regardless of whether or not a claim for post-filing interest is allowed in such
proceedings)), and any and all other fees, expense reimbursement obligations,
indemnification amounts, penalties, and other amounts (whether existing on the Issue Date or
thereafter created or incurred) and all obligations of the Issuer or any Guarantor to
reimburse any bank or other Person in respect of amounts paid under letters of credit,
acceptances or other similar instruments;

     (2) all Hedging Obligations and Treasury Management Obligations (and guarantees
thereof) owing to a Lender (as defined in the Credit Agreement) or any Affiliate of such
Lender (or any Person that was a Lender or an Affiliate of such Lender at the time the
applicable agreement giving rise to such Hedging Obligation or Treasury Management
Obligation was entered into); provided that such Hedging Obligations and Treasury Management
Obligations are permitted to be incurred under the terms of the indenture;

     (3) any other Indebtedness of the Issuer or any Guarantor permitted to be incurred
under the terms of this Indenture, unless the instrument under which such Indebtedness is
incurred expressly provides that it is on a parity with or subordinated in right of payment
to the Notes or any Subsidiary Guarantee; and

     (4) all Obligations with respect to the items listed in the preceding clauses (1), (2)
and (3).

     Notwithstanding anything to the contrary in the preceding, Senior Debt will not include:

     (1) any liability for federal, state, local or other taxes owed or owing by the Issuer
or the Guarantors;

     (2) any intercompany Indebtedness of the Issuer or any of its Subsidiaries to the
Issuer or any of its Affiliates;

     (3) any trade payables;

     (4) the portion of any Indebtedness that is incurred in violation of this Indenture
(but only to the extent so incurred); provided that Indebtedness outstanding under Credit
Facilities will not cease to be Senior Debt as a result of this clause (4) if the lenders or
agents thereunder obtained

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a representation from the Issuer or any of its Subsidiaries on the date such
Indebtedness was incurred to the effect that such Indebtedness was not prohibited by this
Indenture;

     (5) Indebtedness which is classified as non-recourse in accordance with GAAP or any
unsecured claim arising in respect thereof by reason of the application of Section
1111(b)(1) of the Bankruptcy Code; or

     (6) Disqualified Stock.

     “Shelf Registration Statement” means the Shelf Registration Statement as defined in the
Registration Rights Agreement.

     “Significant Subsidiary” means any Subsidiary that would be a “significant subsidiary” as
defined in Article 1, Rule 1-02 of Regulation S-X, promulgated pursuant to the Securities Act, as
such Regulation is in effect on the Issue Date. For purposes of determining whether an Event of
Default has occurred, if any group of Restricted Subsidiaries as to which a particular event has
occurred and is continuing at any time would be, taken as a whole, a “Significant Subsidiary” then
such event shall be deemed to have occurred with respect to a Significant Subsidiary.

     “Stated Maturity” means, with respect to any installment of interest or principal on any
series of Indebtedness, the date on which the payment of interest or principal was scheduled to be
paid in the documentation governing such Indebtedness as of the Issue Date, and will not include
any contingent obligations to repay, redeem or repurchase any such interest or principal prior to
the date originally scheduled for the payment thereof.

     “St. Louis Investments” means assets relating to (x) those certain ambulatory surgery centers
located in St. Louis, Missouri (or Investments in Persons owning such assets) that are owned by the
Issuer or a Restricted Subsidiary on the Issue Date or (y) one additional surgery center located in
St. Louis, Missouri (or Investments in Persons owning such assets) to be acquired by the Issuer or
a Restricted Subsidiary after the Issue Date.

     “Strategic Investors” means physicians, hospitals, health systems, other healthcare providers,
other healthcare companies and other similar strategic joint venture partners which joint venture
partners are actively involved in the day-to-day operations of providing surgical care and
surgery-related services, or, in the case of physicians, that have retired therefrom, individuals
who are former owners or employees of surgical care facilities purchased by the Issuer, any of its
Restricted Subsidiaries, and consulting firms that receive common stock solely as consideration for
consulting services performed.

     “Subsidiary” means, with respect to any specified Person at any date, any corporation, limited
liability company, partnership, association or other entity the accounts of which would be
consolidated with those of the parent in the parent’s consolidated financial statements if such
financial statements were prepared in accordance with GAAP as of such date.

     “Subsidiary Guarantee” means the Guarantee by each Guarantor of the Issuer’s Obligations under
this Indenture and the Notes, executed pursuant to the provisions of this Indenture.

     “TIA” means the Trust Indenture Act of 1939 (15 U.S.C. Sections 77aaa-77bbbb) as in effect on
the date on which this Indenture is qualified thereunder.

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     “Toggle Notes” has the meaning assigned to it in the preamble to this Indenture.

     “Total Assets” means the total consolidated assets of the Issuer and its Restricted
Subsidiaries as set forth on the most recent consolidated balance sheet of the Issuer and its
Restricted Subsidiaries.

     “Transactions” means the transactions contemplated by the Agreement and Plan of Merger,
including the borrowings under the Credit Agreement, the offering of the Notes and the other
related transactions described under the heading “The Transactions” in the Offering Memorandum.

     “Treasury Management Obligations” means obligations under any agreement governing the
provision of treasury or cash management services, including deposit accounts, funds transfer,
automated clearinghouse, zero balance accounts, returned check concentration, controlled
disbursement, lockbox, account reconciliation and reporting and trade finance services. Treasury
Management Obligations shall not constitute Indebtedness.

     “Treasury Rate” means, with respect to any Make-Whole Redemption Date, the yield to maturity
at the time of computation of United States Treasury securities with a constant maturity (as
compiled and published in the most recent Federal Reserve Statistical Release H.15(519) that has
become publicly available at least two business days prior to such Make-Whole Redemption Date (or,
if such Statistical Release is no longer published, any publicly available source of similar market
data)) most nearly equal to the period from such Make-Whole Redemption Date to May 1, 2012;
provided, however, that if the period from such Make-Whole Redemption Date to May 1, 2012 is not
equal to the constant maturity of a United States Treasury security for which a weekly average
yield is given, the Treasury Rate shall be obtained by linear interpolation (calculated to the
nearest one-twelfth of a year) from the weekly average yields of United States Treasury securities
for which such yields are given, except that if the period from such Make-Whole Redemption Date to
May 1, 2012 is less than one year, the weekly average yield on actually traded United States
Treasury securities adjusted to a constant maturity of one year shall be used.

     “Trustee” means the party named as such in the preamble to this Indenture until a successor
replaces it in accordance with the applicable provisions of this Indenture and thereafter means the
successor serving hereunder.

     “U.K. Credit Facility” means that certain Credit Agreement, dated as of April [ ], 2007, by
and between certain of the subsidiaries of the Issuer existing in the United Kingdom and The
Governor and Company of the Bank of Scotland, as amended, restated, modified, renewed, refunded,
replaced or refinanced (including by means of sales of debt securities and including any amendment,
restatement, modification, renewal, refunding, replacement or refinancing that increases the amount
borrowed thereunder or extends the maturity thereof) from time to time.

     “Unrestricted Global Note” means a Global Note that does not bear and is not required to bear
the Private Placement Legend.

     “Unrestricted Definitive Note” means a Definitive Note that does not bear and is not required
to bear the Private Placement Legend.

     “Unrestricted Subsidiary” means any Subsidiary of the Issuer that is designated by the Board
of Directors of the Issuer as an Unrestricted Subsidiary pursuant to a resolution of the Board of
Directors and any Subsidiary of an Unrestricted Subsidiary, but only to the extent that such
Subsidiary:

     (1) has no Indebtedness other than Non-Recourse Debt; provided that this clause (1)
shall be deemed to be satisfied for so long as the total amount of Indebtedness of all
Unrestricted

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Subsidiaries that is not Non-Recourse Debt does not exceed, measured as of the date of
incurrence thereof, 1% of Total Assets;

     (2) except with respect to any Indebtedness permitted by clause (1) above, is not party
to any agreement, contract, arrangement or understanding with the Issuer or any Restricted
Subsidiary unless the terms of any such agreement, contract, arrangement or understanding
are no less favorable to the Issuer or such Restricted Subsidiary than those permitted under
Section 4.11 hereof;

     (3) is a Person with respect to which neither the Issuer nor any of its Restricted
Subsidiaries has any direct or indirect obligation to maintain or preserve such Person’s
financial condition or to cause such Person to achieve any specified levels of operating
results; and

     (4) has not guaranteed or otherwise directly or indirectly provided credit support for
any Indebtedness of the Issuer or any of its Restricted Subsidiaries.

     “U.S. Person” means a U.S. Person as defined in Rule 902(k) promulgated under the Securities
Act.

     “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 in the election of the Board of Directors of such Person.

     “Weighted Average Life to Maturity” means, when applied to any Indebtedness at any date, the
number of years obtained by dividing:

     (1) the sum of the products obtained by multiplying (a) the amount of each then
remaining installment, sinking fund, serial maturity or other required payments of
principal, including payment at final maturity, in respect of the Indebtedness, by (b) the
number of years (calculated to the nearest one-twelfth) that will elapse between such date
and the making of such payment; by

     (2) the then outstanding principal amount of such Indebtedness.

     “Wholly Owned Subsidiary” of any specified Person means a Subsidiary of such Person all of the
outstanding Capital Stock or other ownership interest of which (other than directors’ qualifying
shares) will at that time be owned by such Person or by one or more Wholly Owned Subsidiaries of
such person.

SECTION 1.02 Other Definitions.

	 	 	 
	Term	 	Defined in Section
	“Affiliate Transaction”
	 	4.11

	“AHYDO Redemption Date”
	 	3.08(b)

	“Asset Sale Offer”
	 	3.09

	“Authentication Order”
	 	2.02

	“Calculation Date”
	 	1.01 (Definition of “Fixed Charge Coverage Ratio”)

	“Change of Control Offer”
	 	4.15

	“Change of Control Payment”
	 	4.15

	“Change of Control Payment Date”
	 	4.15

	“Covenant Defeasance”
	 	8.03

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	Term	 	Defined in Section
	“DTC”
	 	2.03

	“Event of Default”
	 	6.01

	“Excess Proceeds”
	 	4.10

	“incur”
	 	4.09

	“Legal Defeasance”
	 	8.02

	“Mandatory Principal Redemption”
	 	3.08(b)

	“Mandatory Principal Redemption Amount”
	 	3.08(b)

	“Offer Amount”
	 	3.09

	“Offer Period”
	 	3.09

	“Paying Agent”
	 	2.03

	“Permitted Debt”
	 	4.09

	“Payment Blockage Notice”
	 	10.03

	“Payment Default”
	 	6.01

	“PIK Notes”
	 	2.01(d)

	“PIK Payment”
	 	2.01(d)

	“Purchase Date”
	 	3.09

	“Registrar”
	 	2.03

	“Restricted Payments”
	 	4.07

	“Temporary Notes”
	 	2.10

SECTION 1.03 Incorporation by Reference of Trust Indenture Act.

     Whenever this Indenture refers to a provision of the TIA, the provision is incorporated by
reference in and made a part of this Indenture.

     The following TIA terms used in this Indenture have the following meanings:

     “indenture securities” means the Notes;

     “indenture security holder” means a Holder of a Note;

     “indenture to be qualified” means this Indenture;

     “indenture trustee” or “institutional trustee” means the Trustee; and

     “obligor” on the Notes and the Subsidiary Guarantees means the Issuer and the Guarantors,
respectively, and any successor obligor upon the Notes and the Subsidiary Guarantees, respectively.

     All other terms used in this Indenture that are defined by the TIA, defined by TIA reference
to another statute or defined by SEC rule under the TIA have the meanings so assigned to them.

SECTION 1.04 Rules of Construction and Calculation.

	 	(a)	 	Unless the context otherwise requires:

     (1) a term has the meaning assigned to it;

     (2) an accounting term not otherwise defined has the meaning assigned to it in
accordance with GAAP;

     (3) “or” is not exclusive;

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     (4) words in the singular include the plural, and in the plural include the singular;

     (5) “will” shall be interpreted to express a command;

     (6) provisions apply to successive events and transactions;

     (7) references to sections of or rules under the Securities Act will be deemed to
include substitute, replacement or successor sections or rules adopted by the SEC from time
to time;

     (8) “including” shall be interpreted to mean “including without limitation”; and

     (9) references to Sections, Articles and Exhibits shall refer to Sections, Articles and
Exhibits of this Indenture.

     (b) All financial calculations regarding the Issuer and its Subsidiaries for periods prior to
the Issue Date shall be based upon the consolidated financial statements of the Issuer and its
Subsidiaries.

ARTICLE 2.

THE NOTES

SECTION 2.01 Form and Dating.

     (a) General. The Notes and the Trustee’s certificate of authentication shall be
substantially in the form of Exhibits A1, A2, A3 or A4 attached
hereto. The Notes may have notations, legends or endorsements required by law, stock exchange rule
or usage (provided that any such notation, legend or endorsement required by usage is in a form
reasonably acceptable to the Issuer). Each Note shall be dated the date of its authentication.
The Notes shall be in denominations of $2,000 and integral multiples of $1,000 in excess thereof.

     The terms and provisions contained in the Notes shall constitute, and are hereby expressly
made, a part of this Indenture and the Issuer, the Guarantors and the Trustee, by their execution
and delivery of this Indenture, expressly agree to such terms and provisions and to be bound
thereby. However, to the extent any provision of any Note conflicts with the express provisions of
this Indenture, the provisions of this Indenture shall govern and be controlling.

     (b) Global Notes. Notes issued in global form shall be substantially in the form of
Exhibits A1 A2, A3 or A4 attached hereto (including the Global Note
Legend thereon and the “Schedule of Exchanges of Interests in the Global Note” attached thereto).
Notes issued in definitive form shall be substantially in the form of Exhibit A1 or
A2 attached hereto (but without the Global Note Legend thereon and without the “Schedule of
Exchanges of Interests in the Global Note” attached thereto). Each Global Note shall represent
such of the outstanding Notes as shall be specified therein and each shall provide that it
represents 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, repurchases, and redemptions.
Any endorsement of a Global Note 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 or the
Custodian, at the direction of the Trustee, in accordance with instructions given by the Holder
thereof as required by Section 2.06 and shall be made on the records of the Trustee and the
Depositary.

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     (c) Temporary Global Notes. Notes offered and sold in reliance on Regulation S shall
be issued initially in the form of the Regulation S Temporary Global Note, which shall be deposited
on behalf of the purchasers of the Notes represented thereby with the Trustee, as custodian for the
Depositary, and registered in the name of the Depositary or the nominee of the Depositary, duly
executed by the Issuer and authenticated by the Trustee as hereinafter provided. The Restricted
Period shall be terminated upon the receipt by the Trustee of:

     (1) a written certificate from the Depositary certifying that it has received
certification of non-United States beneficial ownership of 100% of the aggregate principal
amount of the Regulation S Temporary Global Note (except to the extent of any beneficial
owners thereof who acquired an interest therein during the Restricted Period pursuant to
another exemption from registration under the Securities Act and who shall take delivery of
a beneficial ownership interest in a 144A Global Note bearing a Private Placement Legend,
all as contemplated by Section 2.06(b)); and

     (2) an Officers’ Certificate from the Issuer.

     Following the termination of the Restricted Period, beneficial interests in the Regulation S
Temporary Global Note shall be exchanged for beneficial interests in the Regulation S Permanent
Global Note pursuant to the Applicable Procedures. Simultaneously with the authentication of the
Regulation S Permanent Global Note, the Trustee shall cancel the Regulation S Temporary Global
Note. The aggregate principal amount of the Regulation S Temporary Global Note and the Regulation
S Permanent Global Note may from time to time be increased or decreased by adjustments made on the
records of the Trustee and the Depositary or its nominee, as the case may be, in connection with
transfers of interest as hereinafter provided.

     (d) PIK Notes. In connection with the payment of PIK Interest or Partial PIK Interest
in respect of the Toggle Notes, the Issuer is entitled to, without the consent of the Holders and
without regard to Section 4.09, increase the outstanding principal amount of the Toggle Notes or
issue additional Toggle Notes (the “PIK Notes”) under this Indenture on the same terms and
conditions as the Toggle Notes offered hereby (in each case, the “PIK Payment”). The Cash Pay
Notes and the Toggle Notes are each a separate series of Notes but will be treated as a single
class of securities under this Indenture, except as otherwise stated herein. As a result, Holders
of each series of Notes will not have separate rights to, among other things, give notice of
Defaults or to direct the Trustee to exercise remedies during an Event of Default or otherwise.
Except as described under Article 9 hereof, the Notes offered by the Issuer, the PIK Notes and any
Additional Notes subsequently issued under this Indenture will be treated as a single class for all
purposes under this Indenture, including waivers, amendments, redemptions and offers to purchase.
Unless the context requires otherwise, references to “Notes” for all purposes of this Indenture
include any PIK Notes and Additional Notes that are actually issued, and references to “principal
amount” of the Notes includes any increase in the principal amount of the outstanding Notes as a
result of a PIK Payment.

SECTION 2.02 Execution and Authentication.

     At least one Officer must sign the Notes for the Issuer by manual or facsimile signature.

     If an Officer whose signature is on a Note no longer holds that office at the time a Note is
authenticated, the Note shall nevertheless be valid.

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     A Note shall not be valid until authenticated by the manual signature of the Trustee. The
signature of the Trustee shall be conclusive evidence that the Note has been duly authenticated
under this Indenture.

     The Trustee shall authenticate and deliver: (i) on the Issue Date, (A) an aggregate principal
amount of $240.0 million 87/8% Senior Subordinated Notes due 2017, and (B), an aggregate principal
amount of $200.0 million 91/4%/10% Senior Subordinated Toggle Notes due 2017, (ii) Additional Notes
for an original issue in an aggregate principal amount specified in an Authentication Order
pursuant to this Section 2.02, and (iii) Exchange Notes for issue only in an Exchange Offer
pursuant to the Registration Rights Agreement, for a like principal amount of Initial Notes or
Additional Notes, in each case upon a written order of the Issuer signed by one Officer (an
“Authentication Order”). Such Authentication Order shall specify the amount of the Notes to be
authenticated and the date on which the original issue of the Notes is to be authenticated.

     The Trustee may appoint an authenticating agent acceptable to the Issuer to authenticate
Notes. An authenticating agent may authenticate Notes whenever the Trustee may do so. Each
reference in this Indenture to authentication by the Trustee includes authentication by such agent.
An authenticating agent has the same rights as an Agent to deal with Holders or an Affiliate of
the Issuer.

SECTION 2.03 Registrar and Paying Agent.

     The Issuer shall maintain an office or agency where Notes may be presented for registration of
transfer or for exchange (“Registrar”) and an office or agency where Notes may be presented for
payment (“Paying Agent”). The Registrar shall keep a register of the Notes and of their transfer
and exchange. The Issuer may appoint one or more co-registrars and one or more additional paying
agents. The term “Registrar” includes any co-registrar and the term “Paying Agent” includes any
additional paying agent. The Issuer may change any Paying Agent or Registrar without notice to any
Holder. The Issuer shall notify the Trustee in writing of the name and address of any Agent not a
party to this Indenture. If the Issuer fails to appoint or maintain another entity as Registrar or
Paying Agent, the Trustee shall act as such. The Issuer or any of its Subsidiaries may act as
Paying Agent or Registrar.

     The Issuer initially appoints The Depository Trust Company (“DTC”) to act as Depositary with
respect to the Global Notes.

     The Issuer initially appoints the Trustee to act as the Registrar and Paying Agent and to act
as Custodian with respect to the Global Notes.

SECTION 2.04 Paying Agent To Hold Money in Trust.

     The Issuer shall require each Paying Agent other than the Trustee to agree in writing that the
Paying Agent shall hold in trust for the benefit of Holders or the Trustee all money held by the
Paying Agent for the payment of principal, premium or Additional Interest, if any, or interest on
the Notes, and shall notify the Trustee of any default by the Issuer in making any such payment.
While any such default continues, the Trustee may require in writing a Paying Agent to pay all
money held by it in trust to the Trustee. The Issuer at any time may require in writing a Paying
Agent to pay all money held by it in trust to the Trustee. Upon payment over to the Trustee, the
Paying Agent (if other than the Issuer or a Subsidiary) shall have no further liability for the
money. If the Issuer or a Subsidiary acts as Paying Agent, it shall segregate and hold in a
separate trust fund for the benefit of the Holders all money held by it as Paying Agent. Upon any
bankruptcy or reorganization proceedings relating to the Issuer, the Trustee shall serve as Paying
Agent for the Notes.

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SECTION 2.05 Holder Lists.

     The Trustee shall preserve in as current a form as is reasonably practicable the most recent
list available to it of the names and addresses of all Holders and shall otherwise comply with TIA
Section 312(a). If the Trustee is not the Registrar, the Issuer shall furnish to the Trustee at
least seven Business Days before each interest payment date and at such other times as the Trustee
may request in writing, a list in such form and as of such date as the Trustee may reasonably
require of the names and addresses of the Holders and the Issuer shall otherwise comply with TIA
Section 312(a).

SECTION 2.06 Transfer and Exchange.

     (a) Transfer and Exchange of Global Notes. A Global Note may not be transferred
except in whole (but not in part) by the Depositary to a nominee of the Depositary, by a nominee of
the Depositary to the Depositary or to another nominee of the Depositary, or by the Depositary or
any such nominee to a successor Depositary or a nominee of such successor Depositary. All Global
Notes shall be exchanged by the Issuer for Definitive Notes if:

     (1) the Depository (a) notifies the Issuer that it is unwilling or unable to continue
as Depositary for the Global Notes or (b) has ceased to be a clearing agency registered
under the Exchange Act and, in either case, a successor Depositary is not appointed by the
Issuer within 120 days after the date of such notice from the Depositary;

     (2) there has occurred and is continuing a Default or an Event of Default with respect
to the Notes.

     Upon the occurrence of any of the preceding events in (1) or (2) above, Definitive Notes shall
be issued in such names as the Depositary shall instruct the Trustee. Global Notes also may be
exchanged or replaced, in whole or in part, as provided in Sections 2.07 and 2.10. A Global Note
may not be exchanged for another Note other than as provided in this Section 2.06(a); however,
beneficial interests in a Global Note may be transferred and exchanged as provided in Section
2.06(b), (c) or (f).

     (b) Transfer and Exchange of Beneficial Interests in the Global Notes. The transfer
and exchange of beneficial interests in the Global Notes shall be effected through the Depositary,
in accordance with the provisions of this Indenture and the Applicable Procedures. Beneficial
interests in the Restricted Global Notes shall be subject to restrictions on transfer comparable to
those set forth herein to the extent required by the Securities Act. Transfers of beneficial
interests in the Global Notes also shall require compliance with either subparagraph (1) or (2)
below, as applicable, as well as one or more of the other following subparagraphs, as applicable:

     (1) Transfer of Beneficial Interests in the Same Global Note. Beneficial
interests in any Restricted Global Note may be transferred to Persons who take delivery
thereof in the form of a beneficial interest in the same Restricted Global Note in
accordance with the transfer restrictions set forth in the Private Placement Legend;
provided, however, that prior to the expiration of the Restricted Period, transfers of
beneficial interests in the Regulation S Temporary Global Note may not be made to a U.S.
Person or for the account or benefit of a U.S. Person (other than an Initial Purchaser).
Beneficial interests in any Unrestricted Global Note may be transferred to Persons who take
delivery thereof in the form of a beneficial interest in an Unrestricted Global Note. No
written orders or instructions shall be required to be delivered to the Registrar to effect
the transfers described in this Section 2.06(b)(1).

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     (2) All Other Transfers and Exchanges of Beneficial Interests in Global Notes.
In connection with all transfers and exchanges of beneficial interests that are not subject
to Section 2.06(b)(1) above, the transferor of such beneficial interest must deliver to the
Registrar either:

(A) both:

     (i) 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

     (ii) instructions given in accordance with the Applicable Procedures
containing information regarding the Participant account to be credited with
such increase; or

(B) both:

     (i) 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

     (ii) instructions given by the Depositary to the Registrar containing
information regarding the Person in whose name such Definitive Note shall be
registered to effect the transfer or exchange referred to in clause (i)
above; provided that in no event shall Definitive Notes be issued upon the
transfer or exchange of beneficial interests in the Regulation S Temporary
Global Note prior to (A) the expiration of the Restricted Period and (B) the
receipt by the Registrar of any certificates required pursuant to Rule 903
under the Securities Act.

     Upon consummation of an Exchange Offer by the Issuer in accordance with Section
2.06(f), the requirements of this Section 2.06(b)(2) shall be deemed to have been satisfied
upon receipt by the Registrar of the instructions contained in the Letter of Transmittal
delivered by the holder of such beneficial interests in the Restricted Global Notes.

     Upon satisfaction of all of the requirements for transfer or exchange of beneficial
interests in Global Notes contained in this Indenture and the Notes or otherwise applicable
under the Securities Act, the Trustee shall adjust the principal amount of the relevant
Global Note(s) pursuant to Section 2.06(h).

     (3) Transfer of Beneficial Interests to Another Restricted Global Note. A
beneficial interest in any Restricted Global Note may be transferred to a Person who takes
delivery thereof in the form of a beneficial interest in another Restricted Global Note if
the transfer complies with the requirements of Section 2.06(b)(2) above and the Registrar
receives the following:

     (A) if the transferee shall take delivery in the form of a beneficial interest
in the 144A Global Note, then the transferor must deliver a certificate in the form
of Exhibit B hereto, including the certifications in item (1) thereof; and

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     (B) if the transferee shall take delivery in the form of a beneficial interest
in the Regulation S Global Note then the transferor must deliver a certificate in
the form of Exhibit B hereto, including the certifications in item (2)
thereof.

     (4) Transfer and Exchange of Beneficial Interests in a Restricted Global Note for
Beneficial Interests in an Unrestricted Global Note. A beneficial interest in any
Restricted Global Note may be exchanged by any holder thereof for a beneficial interest in
an Unrestricted Global Note or transferred to a Person who takes delivery thereof in the
form of a beneficial interest in an Unrestricted Global Note if the exchange or transfer
complies with the requirements of Section 2.06(b)(2) above and:

     (A) such exchange or transfer is effected pursuant to the Exchange Offer in
accordance with the Registration Rights Agreement and the holder of the beneficial
interest to be transferred, in the case of an exchange, or the transferee, in the
case of a transfer, certifies in the applicable Letter of Transmittal that it is not
(i) a Broker-Dealer, (ii) a Person participating in the distribution of the Exchange
Notes or (iii) a Person who is an affiliate (as defined in Rule 144) of the Issuer;

     (B) such transfer is effected pursuant to the Shelf Registration Statement in
accordance with the Registration Rights Agreement;

     (C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer
Registration Statement in accordance with the Registration Rights Agreement; or

     (D) the Registrar receives the following:

     (i) if the holder of such beneficial interest in a Restricted Global
Note proposes to exchange such beneficial interest for a beneficial interest
in an Unrestricted Global Note, a certificate from such holder in the form
of Exhibit C hereto, including the certifications in item (1)(a)
thereof; or

     (ii) if the holder of such beneficial interest in a Restricted Global
Note proposes to transfer such beneficial interest to a Person who shall
take delivery thereof in the form of a beneficial interest in an
Unrestricted Global Note, a certificate from such holder in the form of
Exhibit B hereto, including the certifications in item (4) thereof;

and, in each such case set forth in this subparagraph (D), if the Registrar so
requests or if the Applicable Procedures so require, an Opinion of Counsel in form
reasonably acceptable to the Registrar to the effect that such exchange or transfer
is in compliance with the Securities Act and that the restrictions on transfer
contained herein and in the Private Placement Legend are no longer required in order
to maintain compliance with the Securities Act.

     If any such transfer is effected pursuant to subparagraph (B) or (D) above at a time
when an Unrestricted Global Note has not yet been issued, the Issuer shall issue and, upon
receipt of an Authentication Order in accordance with Section 2.02, the Trustee shall
authenticate one or more Unrestricted Global Notes in an aggregate principal amount equal to
the aggregate principal amount of beneficial interests transferred pursuant to subparagraph
(B) or (D) above.

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     Beneficial interests in an Unrestricted Global Note cannot be exchanged for, or transferred to
Persons who take delivery thereof in the form of, a beneficial interest in a Restricted Global
Note.

     (c) Transfer or Exchange of Beneficial Interests for Definitive Notes.

     (1) Beneficial Interests in Restricted Global Notes to Restricted Definitive Notes.
If any holder of a beneficial interest in a Restricted Global Note proposes to exchange such
beneficial interest for a Restricted Definitive Note or to transfer such beneficial interest to a
Person who takes delivery thereof in the form of a Restricted Definitive Note, then, upon receipt
by the Registrar of the following documentation:

     (A) if the holder of such beneficial interest in a Restricted Global Note proposes to
exchange such beneficial interest for a Restricted Definitive Note, a certificate from such
holder in the form of Exhibit C hereto, including the certifications in item (2)(a)
thereof;

     (B) if such beneficial interest is being transferred to a QIB in accordance with Rule
144A, a certificate to the effect set forth in Exhibit B hereto, including the
certifications in item (1) thereof;

     (C) if such beneficial interest is being transferred to a Non-U.S. Person in an
offshore transaction in accordance with Rule 903 or Rule 904, a certificate to the effect
set forth in Exhibit B hereto, including the certifications in item (2) thereof;

     (D) if such beneficial interest is being transferred pursuant to an exemption from the
registration requirements of the Securities Act in accordance with Rule 144, a certificate
to the effect set forth in Exhibit B hereto, including the certifications in item
(3)(a) thereof;

     (E) if such beneficial interest is being transferred to the Issuer or any of its
Subsidiaries, a certificate to the effect set forth in Exhibit B hereto, including
the certifications in item (3)(b) thereof; or

     (F) if such beneficial interest is being transferred pursuant to an effective
registration statement under the Securities Act, a certificate to the effect set forth in
Exhibit B hereto, including the certifications in item (3)(c) thereof,

the Trustee shall cause the aggregate principal amount of the applicable Global Note to be reduced
accordingly pursuant to Section 2.06(h), and the Issuer shall execute and the Trustee shall
authenticate and deliver to the Person designated in the instructions a Definitive Note in the
appropriate principal amount. Any Definitive Note issued in exchange for a beneficial interest in
a Restricted Global Note pursuant to this Section 2.06(c) 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 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 Notes are so registered. Any Definitive Note issued in exchange for a beneficial
interest in a Restricted Global Note pursuant to this Section 2.06(c)(1) shall bear the Private
Placement Legend and shall be subject to all restrictions on transfer contained therein.

     (2) Beneficial Interests in Regulation S Temporary Global Note to Definitive Notes.
Notwithstanding Sections 2.06(c)(1)(A) and (C), a beneficial interest in the Regulation S Temporary
Global Note may not be exchanged for a Definitive Note or transferred to a Person who takes
delivery thereof in the form of a Definitive Note prior to (A) the expiration of the Restricted
Period and (B) the receipt by the Registrar of any certificates required pursuant to Rule
903(b)(3)(ii)(B) under the Securities Act, except in

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the case of a transfer pursuant to an exemption from the registration requirements of the
Securities Act other than Rule 903 or Rule 904.

     (3) Beneficial Interests in Restricted Global Notes to Unrestricted Definitive Notes.
A holder of a beneficial interest in a Restricted Global Note may exchange such beneficial interest
for an Unrestricted Definitive Note or may transfer such beneficial interest to a Person who takes
delivery thereof in the form of an Unrestricted Definitive Note only if:

     (A) such exchange or transfer is effected pursuant to the Exchange Offer in accordance
with the Registration Rights Agreement and the holder of such beneficial interest, in the
case of an exchange, or the transferee, in the case of a transfer, certifies in the
applicable Letter of Transmittal that it is not (i) a Broker-Dealer, (ii) a Person
participating in the distribution of the Exchange Notes or (iii) a Person who is an
affiliate (as defined in Rule 144) of the Issuer;

     (B) such transfer is effected pursuant to the Shelf Registration Statement in
accordance with the Registration Rights Agreement;

     (C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer
Registration Statement in accordance with the Registration Rights Agreement; or

     (D) the Registrar receives the following:

     (i) if the holder of such beneficial interest in a Restricted Global Note
proposes to exchange such beneficial interest for an Unrestricted Definitive Note, a
certificate from such holder in the form of Exhibit C hereto, including the
certifications in item (1)(b) thereof; or

     (ii) if the holder of such beneficial interest in a Restricted Global Note
proposes to transfer such beneficial interest to a Person who shall take delivery
thereof in the form of an Unrestricted Definitive Note, a certificate from such
holder in the form of Exhibit B hereto, including the certifications in item
(4) thereof;

and, in each such case set forth in this subparagraph (D), if the Registrar so requests or
if the Applicable Procedures so require, an Opinion of Counsel in form reasonably acceptable
to the Registrar to the effect that such exchange or transfer is in compliance with the
Securities Act and that the restrictions on transfer contained herein and in the Private
Placement Legend are no longer required in order to maintain compliance with the Securities
Act.

     (4) Beneficial Interests in Unrestricted Global Notes to Unrestricted Definitive
Notes. If any holder of a beneficial interest in an Unrestricted Global Note proposes to
exchange such beneficial interest for a Definitive Note or to transfer such beneficial interest to
a Person who takes delivery thereof in the form of a Definitive Note, then, upon satisfaction of
the conditions set forth in Section 2.06(b)(2), the Trustee shall cause the aggregate principal
amount of the applicable Global Note to be reduced accordingly pursuant to Section 2.06(h), and the
Issuer shall execute and the Trustee shall authenticate and deliver to the Person designated in the
instructions a Definitive Note in the appropriate principal amount. Any Definitive Note issued in
exchange for a beneficial interest pursuant to this Section 2.06(c)(4) shall be registered in such
name or names and in such authorized denomination or denominations as the holder of such beneficial
interest requests through instructions to the Registrar from or through the Depositary and the
Participant or Indirect Participant. The Trustee shall deliver such Definitive Notes to the
Persons in whose names such Notes are so registered. Any Definitive Note issued in exchange for a
beneficial interest pursuant to this Section 2.06(c)(4) shall not bear the Private Placement
Legend.

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     (d) Transfer and Exchange of Definitive Notes for Beneficial Interests.

     (1) Restricted Definitive Notes to Beneficial Interests in Restricted Global Notes.
If any Holder of a Restricted Definitive Note proposes to exchange such Note for a beneficial
interest in a Restricted Global Note or to transfer such Restricted Definitive Notes to a Person
who takes delivery thereof in the form of a beneficial interest in a Restricted Global Note, then,
upon receipt by the Registrar of the following documentation:

     (A) if the Holder of such Restricted Definitive Note proposes to exchange such Note for
a beneficial interest in a Restricted Global Note, a certificate from such Holder in the
form of Exhibit C hereto, including the certifications in item (2)(b) thereof;

     (B) if such Restricted Definitive Note is being transferred to a QIB in accordance with
Rule 144A, a certificate to the effect set forth in Exhibit B hereto, including the
certifications in item (1) thereof;

     (C) if such Restricted Definitive Note is being transferred to a Non-U.S. Person in an
offshore transaction in accordance with Rule 903 or Rule 904, a certificate to the effect
set forth in Exhibit B hereto, including the certifications in item (2) thereof;

     (D) if such Restricted Definitive Note is being transferred pursuant to an exemption
from the registration requirements of the Securities Act in accordance with Rule 144, a
certificate to the effect set forth in Exhibit B hereto, including the
certifications in item (3)(a) thereof;

     (E) if such Restricted Definitive Note is being transferred to the Issuer or any of its
Subsidiaries, a certificate to the effect set forth in Exhibit B hereto, including
the certifications in item (3)(b) thereof; or

     (F) if such Restricted Definitive Note is being transferred pursuant to an effective
registration statement under the Securities Act, a certificate to the effect set forth in
Exhibit B hereto, including the certifications in item (3)(c) thereof,

the Trustee shall cancel the Restricted Definitive Note and increase or cause to be increased the
aggregate principal amount of the applicable Global Note.

     (2) Restricted Definitive Notes to Beneficial Interests in Unrestricted Global Notes.
A Holder of a Restricted Definitive Note may exchange such Note for a beneficial interest in an
Unrestricted Global Note or transfer such Restricted Definitive Note to a Person who takes delivery
thereof in the form of a beneficial interest in an Unrestricted Global Note only if:

     (A) such exchange or transfer is effected pursuant to the Exchange Offer in accordance
with the Registration Rights Agreement and the Holder, in the case of an exchange, or the
transferee, in the case of a transfer, certifies in the applicable Letter of Transmittal
that it is not (i) a Broker-Dealer, (ii) a Person participating in the distribution of the
Exchange Notes or (iii) a Person who is an affiliate (as defined in Rule 144) of the Issuer;

     (B) such transfer is effected pursuant to the Shelf Registration Statement in
accordance with the Registration Rights Agreement;

     (C) such transfer is effected by a Broker-Dealer pursuant to the Exchange Offer
Registration Statement in accordance with the Registration Rights Agreement; or

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     (D) the Registrar receives the following:

     (i) if the Holder of such Definitive Notes proposes to exchange such Notes for
a beneficial interest in the Unrestricted Global Note, a certificate from such
Holder in the form of Exhibit C hereto, including the certifications in item
(1)(c) thereof; or

     (ii) if the Holder of such Definitive Notes proposes to transfer such Notes to
a Person who shall take delivery thereof in the form of a beneficial interest in the
Unrestricted Global Note, a certificate from such Holder in the form of Exhibit
B hereto, including the certifications in item (4) thereof;

and, in each such case set forth in this subparagraph (D), if the Registrar so
requests or if the Applicable Procedures so require, an Opinion of Counsel in form
reasonably acceptable to the Registrar to the effect that such exchange or transfer
is in compliance with the Securities Act and that the restrictions on transfer
contained herein and in the Private Placement Legend are no longer required in order
to maintain compliance with the Securities Act.

     Upon satisfaction of the conditions of any of the subparagraphs in this Section 2.06(d)(2),
the Trustee shall cancel the Definitive Notes and increase or cause to be increased the aggregate
principal amount of the Unrestricted Global Note.

     (3) Unrestricted Definitive Notes to Beneficial Interests in Unrestricted Global
Notes. A Holder of an Unrestricted Definitive Note may exchange such Note for a beneficial
interest in an Unrestricted Global Note or transfer such Definitive Notes to a Person who takes
delivery thereof in the form of a beneficial interest in an Unrestricted Global Note at any time.
Upon receipt of a request for such an exchange or transfer, the Trustee shall cancel the applicable
Unrestricted Definitive Note and increase or cause to be increased the aggregate principal amount
of one of the Unrestricted Global Notes.

     If any such exchange or transfer from a Definitive Note to a beneficial interest is effected
pursuant to subparagraphs (2)(B), (2)(D) or (3) above at a time when an Unrestricted Global Note
has not yet been issued, the Issuer shall issue and, upon receipt of an Authentication Order in
accordance with Section 2.02, the Trustee shall authenticate one or more Unrestricted Global Notes
in an aggregate principal amount equal to the principal amount of Definitive Notes transferred or
exchanged pursuant to subparagraph (2)(B), (2)(D) or (3) above.

     (e) Transfer and Exchange of Definitive Notes for Definitive Notes. Upon request by a
Holder of Definitive Notes and such Holder’s compliance with the provisions of this Section
2.06(e), the Registrar shall register the transfer or exchange of Definitive Notes. Prior to such
registration of transfer or exchange, the requesting Holder must present or surrender to the
Registrar the Definitive Notes duly endorsed or accompanied by a written instruction of transfer in
form satisfactory to the Registrar duly executed by such Holder or by its attorney, duly authorized
in writing. In addition, the requesting Holder must provide any additional certifications,
documents and information, as applicable, required pursuant to the following provisions of this
Section 2.06(e).

     (1) Restricted Definitive Notes to Restricted Definitive Notes. Any Restricted
Definitive Note may be transferred to and registered in the name of Persons who take
delivery thereof in the form of a Restricted Definitive Note if the Registrar receives the
following:

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     (A) if the transfer shall be made pursuant to Rule 144A, then the transferor
must deliver a certificate in the form of Exhibit B hereto, including the
certifications in item (1) thereof;

     (B) if the transfer shall be made pursuant to Rule 903 or Rule 904, then the
transferor must deliver a certificate in the form of Exhibit B hereto,
including the certifications in item (2) thereof; and

     (C) if the transfer shall be made pursuant to any other exemption from the
registration requirements of the Securities Act, then the transferor must deliver a
certificate in the form of Exhibit B hereto, including the certifications
required by item (3) thereof, if applicable.

     (2) Restricted Definitive Notes to Unrestricted Definitive Notes. Any
Restricted Definitive Note may be exchanged by the Holder thereof for an Unrestricted
Definitive Note or transferred to a Person or Persons who take delivery thereof in the form
of an Unrestricted Definitive Note if:

     (A) such exchange or transfer is effected pursuant to the Exchange Offer in
accordance with the Registration Rights Agreement and the Holder, in the case of an
exchange, or the transferee, in the case of a transfer, certifies in the applicable
Letter of Transmittal that it is not (i) a broker-dealer, (ii) a Person
participating in the distribution of the Exchange Notes or (iii) a Person who is an
affiliate (as defined in Rule 144) of the Issuer;

     (B) any such transfer is effected pursuant to the Shelf Registration Statement
in accordance with the Registration Rights Agreement;

     (C) any such transfer is effected by a Broker-Dealer pursuant to the Exchange
Offer Registration Statement in accordance with the Registration Rights Agreement;
or

     (D) the Registrar receives the following:

     (i) if the Holder of such Restricted Definitive Notes proposes to
transfer such Notes to a Person who shall take delivery thereof in the form
of an Unrestricted Definitive Note, a certificate from such Holder in the
form of Exhibit B hereto, including the certifications in item (4)
thereof;

     (ii) if the Holder of such Restricted Definitive Notes proposes to
transfer such Notes to a Person who shall take delivery thereof in the form
of an Unrestricted Definitive Note, a certificate from such Holder in the
form of Exhibit B hereto, including the certifications in item (4)
thereof;

and, in each such case set forth in this subparagraph (D), if the Registrar so
requests, an Opinion of Counsel in form reasonably acceptable to the Registrar to
the effect that such exchange or transfer is in compliance with the Securities Act
and that the restrictions on transfer contained herein and in the Private Placement
Legend are no longer required in order to maintain compliance with the Securities
Act.

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     (3) Unrestricted Definitive Notes to Unrestricted Definitive Notes. A Holder
of Unrestricted Definitive Notes may transfer such Notes to a Person who takes delivery
thereof in the form of an Unrestricted Definitive Note. Upon receipt of a request to
register such a transfer, the Registrar shall register the Unrestricted Definitive Notes
pursuant to the instructions from the Holder thereof.

     (f) Exchange Offer. Upon the occurrence of the Exchange Offer in accordance with the
Registration Rights Agreement, the Issuer shall issue and, upon receipt of an Authentication Order
in accordance with Section 2.02, the Trustee shall authenticate:

     (1) one or more Unrestricted Global Notes in an aggregate principal amount equal to the
principal amount of the beneficial interests in the Restricted Global Notes accepted for
exchange in the Exchange Offer by Persons that certify in the applicable Letters of
Transmittal that (A) they are not Broker-Dealers, (B) they are not participating in a
distribution of the Exchange Notes and (C) they are not affiliates (as defined in Rule 144)
of the Issuer; and

     (2) Unrestricted Definitive Notes in an aggregate principal amount equal to the
principal amount of the Restricted Definitive Notes accepted for exchange in the Exchange
Offer.

     Concurrently with the issuance of such Notes, the Trustee shall cause the aggregate principal
amount of the applicable Restricted Global Notes to be reduced accordingly, and the Issuer shall
execute and the Trustee shall authenticate and deliver to the Persons designated by the Holders of
Restricted Definitive Notes so accepted Unrestricted Definitive Notes in the appropriate principal
amount.

     (g) Legends. The following legends shall appear on the face of all Global Notes and
Definitive Notes issued under this Indenture unless specifically stated otherwise in the applicable
provisions of this Indenture.

     (1) Private Placement Legend.

     (A) Except as permitted by subparagraph (B) below, each Global Note and each Definitive
Note (and all Notes issued in exchange therefor or substitution thereof) shall bear the
legend in substantially the following form.

“THE NOTES EVIDENCED HEREBY HAVE NOT BEEN REGISTERED UNDER THE UNITED STATES
SECURITIES ACT OF 1933 (THE ‘SECURITIES ACT’) AND MAY NOT BE OFFERED, SOLD, PLEDGED
OR OTHERWISE TRANSFERRED EXCEPT (A) (1) TO A PERSON WHO THE SELLER REASONABLY
BELIEVES IS A QUALIFIED INSTITUTIONAL BUYER WITHIN THE MEANING OF RULE 144A UNDER
THE SECURITIES ACT PURCHASING FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT OF A QUALIFIED
INSTITUTIONAL BUYER IN A TRANSACTION MEETING THE REQUIREMENTS OF RULE 144A, (2) IN
AN OFFSHORE TRANSACTION COMPLYING WITH RULE 903 OR RULE 904 OF REGULATION S UNDER
THE SECURITIES ACT, (3) TO AN INSTITUTIONAL ACCREDITED INVESTOR IN A TRANSACTION
EXEMPT FROM THE REGISTRATION REQUIREMENTS OF THE SECURITIES ACT, (4) PURSUANT TO AN
EXEMPTION FROM REGISTRATION UNDER THE SECURITIES ACT PROVIDED BY RULE 144 THEREUNDER
(IF AVAILABLE) OR (5) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE
SECURITIES ACT AND (B) IN ACCORDANCE WITH ALL APPLICABLE SECURITIES LAWS OF THE
STATES OF THE UNITED STATES.”

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     (B) Notwithstanding the foregoing, any Global Note or Definitive Note issued pursuant
to subparagraphs (b)(4), (c)(3), (c)(4), (d)(2), (d)(3), (e)(2), (e)(3) or (f) of this
Section 2.06 (and all Notes issued in exchange therefor or substitution thereof) shall not
bear the Private Placement Legend.

     (2) Global Note Legend. Each Global Note shall bear a legend in substantially
the following form:

“THIS GLOBAL NOTE IS HELD BY THE DEPOSITARY (AS DEFINED IN THE INDENTURE GOVERNING
THIS NOTE) OR ITS NOMINEE IN CUSTODY FOR THE BENEFIT OF THE BENEFICIAL OWNERS
HEREOF, AND IS NOT TRANSFERABLE TO ANY PERSON UNDER ANY CIRCUMSTANCES EXCEPT THAT
(1) THE TRUSTEE MAY MAKE SUCH NOTATIONS HEREON AS MAY BE REQUIRED PURSUANT TO
SECTION 2.01 AND SECTION 2.06 OF THE INDENTURE, (2) THIS GLOBAL NOTE MAY BE
EXCHANGED IN WHOLE BUT NOT IN PART PURSUANT TO SECTION 2.06(a) OF THE INDENTURE, (3)
THIS GLOBAL NOTE MAY BE DELIVERED TO THE TRUSTEE FOR CANCELLATION PURSUANT TO
SECTION 2.11 OF THE INDENTURE AND (4) THIS GLOBAL NOTE MAY BE TRANSFERRED TO A
SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF THE ISSUERS.

UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR NOTES IN DEFINITIVE FORM,
THIS NOTE MAY NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF
THE DEPOSITARY OR BY A NOMINEE OF THE DEPOSITARY TO THE DEPOSITARY OR ANOTHER
NOMINEE OF THE DEPOSITARY OR BY THE DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR
DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY. UNLESS THIS CERTIFICATE IS
PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST COMPANY (55 WATER
STREET, NEW YORK, NEW YORK) (“DTC”), TO THE ISSUER OR ITS AGENT FOR REGISTRATION OF
TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME
OF CEDE & CO. OR SUCH OTHER NAME AS MAY BE REQUESTED BY AN AUTHORIZED
REPRESENTATIVE OF DTC (AND ANY PAYMENT IS MADE TO CEDE & CO. OR SUCH OTHER ENTITY AS
MAY BE 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.”

     (3) Regulation S Temporary Global Note Legend. Each Regulation S Temporary
Global Note shall bear a legend in substantially the following form.

“THE RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS
AND PROCEDURES GOVERNING ITS EXCHANGE FOR CERTIFICATED NOTES, ARE AS SPECIFIED IN
THE INDENTURE (AS DEFINED HEREIN). NEITHER THE HOLDER NOR THE BENEFICIAL OWNERS OF
THIS REGULATION S TEMPORARY GLOBAL NOTE SHALL BE ENTITLED TO RECEIVE PAYMENT OF
PRINCIPAL HEREOF OR INTEREST HEREON.”

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     (h) 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 canceled in whole and not in part, each such Global
Note shall be returned to or retained and canceled by the Trustee in accordance with Section 2.11.
At any time prior to such cancellation, if any beneficial interest in a Global Note is exchanged
for or transferred to a Person who shall take delivery thereof in the form of a beneficial interest
in another Global Note or for Definitive Notes, the principal amount of Notes 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 shall 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 Trustee or by
the Depositary at the direction of the Trustee to reflect such increase.

     (i) General Provisions Relating to Transfers and Exchanges.

     (1) To permit registrations of transfers and exchanges, the Issuer shall execute and the
Trustee shall authenticate Global Notes and Definitive Notes upon receipt of an Authentication
Order in accordance with Section 2.02 or at the Registrar’s request.

     (2) No service charge shall be made to a Holder of a beneficial interest in a Global Note or
to a Holder of a Definitive Note for any registration of transfer or exchange, but the Issuer may
require payment of a sum sufficient to cover any transfer tax or similar governmental charge
payable in connection therewith (other than any such transfer taxes or similar governmental charge
payable upon exchange or transfer pursuant to Sections 2.10, 3.06, 3.09, 4.10, 4.15 and 9.06).

     (3) The Registrar shall not be required to register the transfer of or exchange of any Note
selected for redemption in whole or in part, except the unredeemed portion of any Note being
redeemed in part.

     (4) All Global Notes and Definitive Notes issued upon any registration of transfer or exchange
of Global Notes or Definitive Notes shall be the valid obligations of the Issuer, evidencing the
same debt, and entitled to the same benefits under this Indenture, as the Global Notes or
Definitive Notes surrendered upon such registration of transfer or exchange.

     (5) The Issuer shall not be required:

     (A) to issue, to register the transfer of or to exchange any Notes during a period
beginning at the opening of business 15 days before the day of any selection of Notes for
redemption under Section 3.02 and ending at the close of business on the day of selection;

     (B) to register the transfer of or to exchange any Note selected for redemption in
whole or in part, except the unredeemed portion of any Note being redeemed in part; or

     (C) to register the transfer of or to exchange a Note between a record date and the
next succeeding interest payment date.

     (6) Prior to due presentment for the registration of a transfer of any Note, the Trustee, any
Agent and the Issuer may deem and treat the Person in whose name any Note is registered as the
absolute owner of such Note for the purpose of receiving payment of principal of and interest on
such Notes and for all other purposes, and none of the Trustee, any Agent or the Issuer shall be
affected by notice to the contrary.

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     (7) The Trustee shall authenticate Global Notes and Definitive Notes in accordance with the
provisions of Section 2.02.

     (8) All certifications, certificates and Opinions of Counsel required to be submitted to the
Registrar pursuant to this Section 2.06 to effect a registration of transfer or exchange may be
submitted by facsimile.

     (9) Neither the Trustee nor the Registrar shall be under any obligation or duty to determine
or inquire as to compliance with the Securities Act (including any rules or regulations promulgated
thereunder) or any state securities laws that may be applicable in connection with or with respect
to any transfer of any interest in any Note (including any transfers between or among beneficial
owners of interests in any Global Note) or to monitor, determine or inquire as to compliance with
any restriction on transfer imposed under this Indenture with respect to transfers of interests in
any security (including any transfers between or among beneficial owners of interests in any Global
Notes); except that the Trustee shall be under a duty to require delivery of such certificates and
other documentation, if any, as are expressly required in the applicable circumstance, and to do so
if and when expressly required by, the terms of this Indenture, and to examine the same to
determine substantial compliance on their face with the express requirements hereof. The Trustee
shall have no responsibility for (i) the actions or omissions of the Depositary, or for the
accuracy of the books or records of the Depositary and (ii) transfers, of which it has no
knowledge, between or among beneficial owners of interests in the same Global Note.

SECTION 2.07 Replacement Notes.

     If any mutilated Note is surrendered to the Trustee or the Registrar and the Trustee receives
evidence to its satisfaction of the destruction, loss or theft of any Note, the Issuer shall issue
and the Trustee, upon receipt of an Authentication Order, shall authenticate a replacement Note if
the Trustee’s requirements are met. If required by the Trustee or the Issuer, an indemnity bond
must be supplied by the Holder that is sufficient in the judgment of the Trustee and the Issuer to
protect the Issuer, the Trustee, any Agent and any authenticating agent from any loss that any of
them may suffer if a Note is replaced. The Issuer may charge for its expenses in replacing a Note.

     Every replacement Note is an additional obligation of the Issuer and shall be entitled to all
of the benefits of this Indenture equally and proportionately with all other Notes duly issued
hereunder.

SECTION 2.08 Outstanding Notes.

     The Notes outstanding at any time are all the Notes authenticated by the Trustee except for
those canceled by it, those delivered to it for cancellation, those reductions in the interest in a
Global Note effected by the Trustee in accordance with the provisions hereof, and those described
in this Section 2.08 as not outstanding. Subject to Section 2.09, a Note does not cease to be
outstanding because the Issuer or an Affiliate of the Issuer holds the Note.

     If a Note is replaced pursuant to Section 2.07, it ceases to be outstanding unless the Trustee
receives proof satisfactory to it that the replaced Note is held by a protected purchaser.

     If the principal amount of any Note is considered paid under Section 4.01, it ceases to be
outstanding and interest on it ceases to accrue.

     If the Paying Agent (other than the Issuer, a Subsidiary or an Affiliate of any thereof)
holds, on a redemption date or maturity date, money sufficient to pay Notes payable on that date,
then on and after that date such Notes shall be deemed to be no longer outstanding and shall cease
to accrue interest.

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SECTION 2.09 Treasury Notes.

     In determining whether the Holders of the required principal amount of Notes have concurred in
any direction, waiver or consent, Notes owned by the Issuer or any of its Subsidiaries, shall be
considered as though not outstanding, except that for the purposes of determining whether the
Trustee shall be protected in relying on any such direction, waiver or consent, only Notes that a
Responsible Officer of the Trustee actually knows are so owned shall be so disregarded.

SECTION 2.10 Temporary Notes.

     Until certificates representing Notes are ready for delivery, the Issuer may prepare and the
Trustee, upon receipt of an Authentication Order, shall authenticate temporary Notes (“Temporary
Notes”). Temporary Notes shall be substantially in the form of certificated Notes but may have
variations that the Issuer considers appropriate for Temporary Notes and as may be reasonably
acceptable to the Trustee. Without unreasonable delay, the Issuer shall prepare and the Trustee
shall authenticate Definitive Notes in exchange for Temporary Notes.

     Holders of Temporary Notes shall be entitled to all of the benefits of this Indenture.

SECTION 2.11 Cancellation.

     The Issuer at any time may deliver Notes to the Trustee for cancellation. The Registrar and
Paying Agent shall forward to the Trustee any Notes surrendered to them for registration of
transfer, exchange or payment. The Trustee and no one else shall cancel all Notes surrendered for
registration of transfer, exchange, payment, replacement or cancellation and shall dispose of such
canceled Notes (subject to the record retention requirement of the Exchange Act). Certification of
the disposal of all canceled Notes shall be delivered to the Issuer upon its request therefor. The
Issuer may not issue new Notes to replace Notes that it has paid or that have been delivered to the
Trustee for cancellation. If the Issuer shall acquire any of the Notes, such acquisition shall not
operate as a redemption or satisfaction of the Indebtedness represented by such Notes unless and
until the same are surrendered to the Trustee for cancellation pursuant to this Section 2.11.

SECTION 2.12 Defaulted Interest.

     If the Issuer defaults in a payment of interest on the Notes, it shall pay the defaulted
interest in any lawful manner plus, to the extent lawful, interest payable on the defaulted
interest, to the Persons who are Holders on a subsequent special record date, in each case at the
rate provided in the Notes and in Section 4.01. The Issuer shall notify the Trustee in writing of
the amount of defaulted interest proposed to be paid on each Note and the date of the proposed
payment. The Issuer shall fix or cause to be fixed each such special record date and payment date;
provided that no such special record date may be less than 10 days prior to the related payment
date for such defaulted interest. At least 15 days before the special record date, the Issuer (or,
upon the written request of the Issuer, the Trustee in the name and at the expense of the Issuer)
shall mail or cause to be mailed to Holders a notice that states the special record date, the
related payment date and the amount of such interest to be paid.

SECTION 2.13 CUSIP Numbers.

     The Issuer in issuing the Notes may use CUSIP numbers and corresponding ISIN numbers (if then
generally in use), and, if so, the Trustee will use CUSIP numbers in notices of redemption as a
convenience to Holders; provided that any such notice may state that no representation is made as
to the correctness of such numbers either as printed on the Notes or as contained in any notice of
a redemption and

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that reliance may be placed only on the other identification numbers printed on the Notes, and
any such redemption will not be affected by any defect in or omission of such numbers. The Issuer
will promptly notify the Trustee of any change in the CUSIP numbers.

SECTION 2.14 Issuance of Additional Notes.

     The Issuer will be entitled, from time to time, subject to its compliance with Section 4.09,
without consent of the Holders, to issue Additional Notes under this Indenture with identical terms
as the Initial Notes issued on the Issue Date other than with respect to (i) the date of issuance,
(ii) the issue price, (iii) the amount of interest payable on the first interest payment date and
(iv) any adjustments in order to conform to and ensure compliance with the Securities Act (or other
applicable securities laws). The Initial Notes issued on the Issue Date, any Additional Notes and
all Exchange Notes issued in exchange therefor will be treated as a single class for all purposes
under this Indenture.

     With respect to any Additional Notes, the Issuer will set forth in an Officer’s Certificate
pursuant to a resolution of the Board of Directors of the Issuer, copies of which will be delivered
to the Trustee, the following information:

     (1) the aggregate principal amount of such Additional Notes to be authenticated and
delivered pursuant to this Indenture;

     (2) the issue price, the issue date and the CUSIP number of such Additional Notes;
provided, however, that no Additional Notes may be issued at a price that would cause such
Additional Notes to have “original issue discount” within the meaning of Section 1273 of the
Code; and

     (3) whether such Additional Notes will be subject to transfer restrictions or will be
issued in the form of Exchange Notes.

ARTICLE 3.

REDEMPTION AND PREPAYMENT

SECTION 3.01 Notices to Trustee.

     If the Issuer elects to redeem Notes pursuant to the optional redemption provisions of Section
5 of the Notes, the Issuer shall furnish to the Trustee, at least 30 days but not more than 60 days
before the redemption date, an Officer’s Certificate setting forth:

     (1) the clause of this Indenture pursuant to which the redemption shall occur;

     (2) the redemption date;

     (3) the principal amount of the Cash Pay Notes and/or Toggle Notes, as the case may be,
to be redeemed; and

     (4) the redemption price.

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SECTION 3.02 Selection of Notes To Be Redeemed or Purchased.

     If less than all of the Cash Pay Notes and/or Toggle Notes, as the case may be, are to be
redeemed or purchased in an offer to purchase at any time, the Trustee shall select Notes for
redemption or purchase on a pro rata basis except:

     (1) if the Notes are listed on any national securities exchange, in compliance with the
requirements of the principal national securities exchange on which the Notes are listed; or

     (2) if otherwise required by law.

     In the event of partial redemption or purchase by lot, the particular Notes to be redeemed or
purchased shall be selected, unless otherwise provided herein, not less than 30 nor more than 60
days prior to the redemption or purchase date by the Trustee from the outstanding Notes not
previously called for redemption or purchase.

     The Trustee shall promptly notify the Issuer in writing of the Notes selected for redemption
or purchase and, in the case of any Note selected for partial redemption or purchase, the principal
amount thereof to be redeemed or purchased. Notes and portions of Notes selected shall be in
amounts of $2,000 or integral multiples of $1,000 in excess thereof; except that if all of the
Notes of a Holder are to be redeemed or purchased, the entire outstanding amount of Notes held by
such Holder, even if not a multiple of $1,000, shall be redeemed or purchased. Except as provided
in the preceding sentence, provisions of this Indenture that apply to Notes called for redemption
or purchase also apply to portions of Notes called for redemption or purchase.

SECTION 3.03 Notice of Redemption.

     Subject to the provisions of Section 3.09, at least 30 days but not more than 60 days before a
redemption date, the Issuer shall mail or cause to be mailed, by first class mail, a notice of
redemption to each Holder whose Notes are to be redeemed at its registered address, except that
redemption notices may be mailed more than 60 days prior to a redemption date if the notice is
issued in connection with a defeasance of the Notes or a satisfaction and discharge of this
Indenture pursuant to Articles 8 or 12 of this Indenture.

     The notice shall identify the Notes to be redeemed (including CUSIP Number(s)) and shall
state:

     (1) the redemption date;

     (2) the redemption price;

     (3) if any Note is being redeemed in part, the portion of the principal amount of such
Note to be redeemed and that, after the redemption date upon surrender of such Note, a new
Note or Notes in principal amount equal to the unredeemed portion shall be issued upon
cancellation of the original Note;

     (4) the name and address of the Paying Agent;

     (5) that Notes called for redemption must be surrendered to the Paying Agent to collect
the redemption price;

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     (6) that, unless the Issuer defaults in making such redemption payment, interest and
Additional Interest, if any, on Notes called for redemption ceases to accrue on and after
the redemption date;

     (7) the paragraph of the Notes and/or Section of this Indenture pursuant to which the
Notes called for redemption are being redeemed; and

     (8) that no representation is made as to the correctness or accuracy of the CUSIP
number, if any, listed in such notice or printed on the Notes.

     At the Issuer’s request, the Trustee shall give the notice of redemption in the Issuer’s name
and at its expense; provided, however, that the Issuer has delivered to the Trustee, at least 45
days prior to the redemption date (or such shorter period as to which the Trustee may agree), an
Officer’s Certificate requesting that the Trustee give such notice and setting forth the
information to be stated in such notice as provided in the preceding paragraph.

SECTION 3.04 Effect of Notice of Redemption.

     Once notice of redemption is mailed in accordance with Section 3.03, Notes called for
redemption become irrevocably due and payable on the redemption date at the redemption price. A
notice of redemption may not be conditional.

SECTION 3.05 Deposit of Redemption or Purchase Price.

     On the relevant redemption or purchase date, the Issuer shall deposit with the Trustee or with
the Paying Agent money sufficient to pay the redemption or purchase price of and accrued interest
and Additional Interest, if any, on all Notes to be redeemed or purchased on that date. The
Trustee or the Paying Agent shall promptly return to the Issuer any money deposited with the
Trustee or the Paying Agent by the Issuer in excess of the amounts necessary to pay the redemption
or purchase price of, and accrued interest and Additional Interest, if any, on, all Notes to be
redeemed or purchased.

     If the Issuer complies with the provisions of the preceding paragraph, on and after the
redemption or purchase date, interest and Additional Interest, if any, shall cease to accrue on the
Notes or the portions of Notes called for redemption or purchase. If a Note is redeemed or
purchased on or after an interest record date but on or prior to the related interest payment date,
then any accrued and unpaid interest shall be paid to the Person in whose name such Note was
registered at the close of business on such record date. If any Note called for redemption or
purchase is not so paid upon surrender for redemption or purchase because of the failure of the
Issuer to comply with the preceding paragraph, interest shall be paid on the unpaid principal, from
the redemption or purchase date until such principal is paid, and to the extent lawful on any
interest not paid on such unpaid principal, in each case at the rate provided in the Notes and in
Section 4.01.

SECTION 3.06 Notes Redeemed or Purchased in Part.

     Upon surrender of a Note that is redeemed or purchased in part, the Issuer shall issue and,
upon receipt of an Authentication Order, the Trustee shall authenticate for the Holder at the
expense of the Issuer a new Note equal in principal amount to the unredeemed or unpurchased portion
of the Note surrendered; provided that each new Note will be in denominations of $2,000 or an
integral multiple of $1,000 in excess thereof.

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SECTION 3.07 Optional Redemption.

     The Notes are subject to optional redemption as provided in Section 5 of each of the Notes.
Any redemption of the Notes pursuant to such Section shall be made pursuant to the provisions of
Sections 3.01 through 3.06.

SECTION 3.08 Mandatory Redemption

     (a) Except as set forth in Section 3.08(b), the Issuer is not required to make mandatory
redemption or sinking fund payments with respect to the Notes

     (b) If the Toggle Notes would otherwise constitute “applicable high yield discount
obligations” within the meaning of Section 163(i)(1) of the Code, at the end of the first accrual
period ending after the fifth anniversary of the Toggle Notes’ issuance (the “AHYDO Redemption
Date”), the Issuer will be required to redeem for cash a portion of each toggle note then
outstanding equal to the Mandatory Principal Redemption Amount (such redemption, a “Mandatory
Principal Redemption”). The redemption price for the portion of each toggle note redeemed pursuant
to a Mandatory Principal Redemption will be 100% of the principal amount of such portion plus any
accrued interest thereon on the date of redemption. The “Mandatory Principal Redemption Amount”
means the portion of a toggle note required to be redeemed to prevent such Toggle Note from being
treated as an “applicable high yield discount obligation” within the meaning of Section 163(i)(1)
of the Code. No partial redemption or repurchase of the Toggle Notes prior to the AHYDO Redemption
Date pursuant to any other provision of the indenture will alter the Issuer’s obligation to make
the Mandatory Principal Redemption with respect to any Toggle Notes that remain outstanding on the
AHYDO Redemption Date. It is intended that this provision prevent any Toggle Note from being
treated as an “applicable high yield debt obligation” within the meaning of Section 163(i)(1) of
the Code, and this provision shall be interpreted in accordance with such intent.

     Any redemption of the Notes pursuant to this Section 3.08 shall be made pursuant to the
provisions of Sections 3.01 through 3.06.

SECTION 3.09 Offer To Purchase by Application of Excess Proceeds.

     In the event that, pursuant to Section 4.10, the Issuer is required to commence an offer to
all Holders to purchase Notes (an “Asset Sale Offer”), it shall follow the procedures specified
below.

     The Asset Sale Offer shall be made to all Holders and if the Issuer elects (or is required by
the terms of other pari passu indebtedness), all holders of other Indebtedness that is pari passu
with the Notes. The Asset Sale Offer shall remain open for a period of at least 20 Business Days
following its commencement and not more than 30 Business Days, except to the extent that a longer
period is required by applicable law (the “Offer Period”). No later than five Business Days after
the termination of the Offer Period (the “Purchase Date”), the Issuer shall apply all Excess
Proceeds (the “Offer Amount”) to the purchase of Notes and such other pari passu Indebtedness, if
any, (on a pro rata basis, if applicable) or, if less than the Offer Amount has been tendered, all
Notes and other Indebtedness tendered in response to the Asset Sale Offer. Payment for any Notes
so purchased shall be made pursuant to Section 4.01.

     If the Purchase Date is on or after an interest record date and on or before the related
interest payment date, any accrued and unpaid interest and Additional Interest, if any, shall be
paid to the Person in whose name a Note is registered at the close of business on such record date,
and no additional interest shall be payable to Holders who tender Notes pursuant to the Asset Sale
Offer.

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     Upon the commencement of an Asset Sale Offer, the Issuer shall send, by first class mail, a
notice to the Trustee and each of the Holders, with a copy to the Trustee. The notice shall
contain all instructions and materials necessary to enable such Holders to tender Notes pursuant to
the Asset Sale Offer. The notice, which shall govern the terms of the Asset Sale Offer, shall
state:

     (1) that the Asset Sale Offer is being made pursuant to this Section 3.09 and Section
4.10 and the length of time the Asset Sale Offer shall remain open;

     (2) the Offer Amount, the purchase price and the Purchase Date;

     (3) that any Note not tendered or accepted for payment shall continue to accrue
interest;

     (4) that, unless the Issuer defaults in making such payment, any Note accepted for
payment pursuant to the Asset Sale Offer shall cease to accrue interest after the Purchase
Date;

     (5) that Holders electing to have a Note purchased pursuant to an Asset Sale Offer may
elect to have Notes purchased in a minimum amount of $2,000 or an integral multiple of
$1,000 in excess thereof only;

     (6) that Holders electing to have Notes purchased pursuant to any Asset Sale Offer
shall be required to surrender the Note, with the form entitled “Option of Holder to Elect
Purchase” attached to the Notes completed, or transfer by book-entry transfer, to the
Issuer, a Depositary, if appointed by the Issuer, or a Paying Agent at the address specified
in the notice at least three days before the Purchase Date;

     (7) that Holders shall be entitled to withdraw their election if the Issuer, the
Depositary or the Paying Agent, as the case may be, receives, not later than on the
expiration of the Offer Period, a telegram, telex, facsimile transmission or letter setting
forth the name of the Holder, the principal amount of the Note the Holder delivered for
purchase and a statement that such Holder is withdrawing his election to have such Note
purchased;

     (8) that, if the aggregate principal amount of Notes and other pari passu Indebtedness
surrendered by holders thereof exceeds the Offer Amount, the Issuer shall select the Notes
and other pari passu Indebtedness to be purchased on a pro rata basis based on the principal
amount of Notes and such other pari passu Indebtedness surrendered (with such adjustments as
may be deemed appropriate by the Issuer so that only Notes in denominations of $2,000, or
integral multiples of $1,000 in excess thereof, shall be purchased); and

     (9) that Holders whose Notes were purchased only in part shall be issued new Notes
equal in principal amount to the unpurchased portion of the Notes surrendered (or
transferred by book-entry transfer).

     On or before the Purchase Date, the Issuer shall, to the extent lawful, accept for payment, on
a pro rata basis to the extent necessary, the Offer Amount of Notes or portions thereof tendered
pursuant to the Asset Sale Offer, or if less than the Offer Amount has been tendered, all Notes
tendered, and shall deliver or cause to be delivered to the Trustee the Notes properly accepted
together with an Officer’s Certificate stating that such Notes or portions thereof were accepted
for payment by the Issuer in accordance with the terms of this Section 3.09. The Issuer, the
Depositary or the Paying Agent, as the case may be, shall promptly (but in any case not later than
five days after the Purchase Date) mail or deliver to each tendering Holder an amount equal to the
purchase price of the Notes tendered by such Holder and accepted by

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the Issuer for purchase, and the Issuer shall promptly issue a new Note, and the Trustee, upon
written request from the Issuer, shall authenticate and mail or deliver (or cause to be transferred
by book entry) such new Note to such Holder, in a principal amount equal to any unpurchased portion
of the Note surrendered. Any Note not so accepted shall be promptly mailed or delivered by the
Issuer to the Holder thereof. The Issuer shall publicly announce the results of the Asset Sale
Offer on the Purchase Date.

     Other than as specifically provided in this Section 3.09, any purchase pursuant to this
Section 3.09 shall be made pursuant to the provisions of Sections 3.01 through 3.06.

ARTICLE 4.

COVENANTS

SECTION 4.01 Payment of Notes.

     The Issuer shall pay or cause to be paid the principal of, premium, if any, and interest and
Additional Interest, if any, on the Notes on the dates and in the manner provided in the Notes.
Principal, premium, if any, and interest and Additional Interest, if any, shall be considered paid
on the date due if the Paying Agent, if other than the Issuer or a Subsidiary thereof, holds on the
due date money deposited by or on behalf of the Issuer in immediately available funds and
designated for and sufficient to pay all principal, premium, if any, and interest then due. The
Issuer shall pay all Additional Interest, if any, in the same manner on the dates and in the
amounts set forth in the Registration Rights Agreement.

     The Issuer shall pay interest (including post-petition interest in any proceeding under any
Bankruptcy Law) on overdue principal at the rate equal to 1% per annum in excess of the then
applicable interest rate on the Notes to the extent lawful; it shall pay interest (including
post-petition interest in any proceeding under any Bankruptcy Law) on overdue installments of
interest and Additional Interest (without regard to any applicable grace period) at the same rate
to the extent lawful. Interest on the Notes shall accrue from the date of original issuance or, if
interest has already been paid, from the date it was most recently paid. Interest shall be
computed on the basis of a 360-day year comprised of twelve 30-day months.

SECTION 4.02 Maintenance of Office or Agency.

     The Issuer shall maintain in the Borough of Manhattan, the City of New York, an office or
agency (which may be an office of the Trustee or an affiliate of the Trustee, Registrar or
co-registrar) where Notes may be surrendered for registration of transfer or for exchange and where
notices and demands to or upon the Issuer in respect of the Notes and this Indenture may be served.
The Issuer shall give prompt written notice to the Trustee of the location, and any change in the
location, of such office or agency. If at any time the Issuer fails to maintain any such required
office or agency or fails to furnish the Trustee with the address thereof, such presentations,
surrenders, notices and demands may be made or served at the Corporate Trust Office of the Trustee.

     The Issuer may also from time to time designate one or more other offices or agencies where
the Notes may be presented or surrendered for any or all such purposes and may from time to time
rescind such designations; provided, however, that no such designation or rescission shall in any
manner relieve the Issuer of its obligation to maintain an office or agency in the Borough of
Manhattan, the City of New York for such purposes. The Issuer shall give prompt written notice to
the Trustee of any such designation or rescission and of any change in the location of any such
other office or agency.

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SECTION 4.03 Reports.

     (a) Whether or not required by the rules and regulations of the SEC, so long as any Notes are
outstanding, the Issuer shall furnish to the Trustee and the Holders of the Notes:

     (1) all quarterly and annual financial information that would be required to be
contained in a filing with the SEC on Forms 10-Q and 10-K, if the Issuer was required to
file such Forms, including a “Management’s Discussion and Analysis of Financial Condition
and Results of Operations” that describes the Issuer’s consolidated financial condition and
results of operation and, with respect to the annual information only, a report thereon by
the Issuer’s independent registered public accountants, and

     (2) all current reports that would be required to be filed with the SEC on Form 8-K if
the Issuer was required to file such reports.

     (b) The Issuer may satisfy its obligation to furnish such information to the Trustee and the
Holders at any time by filing such information with the SEC. In addition, the Issuer agrees that,
for so long as any Notes remain outstanding, the Issuer will furnish to any Beneficial Owner of
Notes or to any prospective purchaser of Notes in connection with any sale thereof, upon their
request, the information required to be delivered pursuant to Rule 144A(d)(4) under the Securities
Act.

     (c) If at any time Holdings (or any other direct or indirect parent company of the Issuer)
becomes a Guarantor of the Notes (there being no obligation of Holdings or any other direct or
indirect parent company of the Issuer to do so), and Holdings (or such other parent company) holds
no material assets other than cash, Cash Equivalents and the Capital Stock of the Issuer, Holdings
or any other direct or indirect parent company of the Issuer (and performs the related incidental
activities associated with such ownership) and complies with the requirements of Rule 3-10 of
Regulation S-X promulgated by the SEC (or any successor provision), the reports, information and
other documents required to be furnished to the Trustee and the Holders or filed with the SEC
pursuant to this Section 4.03 may, at the option of the Issuer, be those of Holdings (or such other
parent company) rather than the Issuer.

     (d) Notwithstanding anything herein to the contrary, the Issuer will not be deemed to have
failed to comply with any of its obligations hereunder for purposes of section 6.01(4) until 120
days after the date any report hereunder is due..

     (e) Delivery of such reports, information and documents to the Trustee is for informational
purposes only and the Trustee’s receipt of such shall not constitute constructive notice of any
information contained therein or determinable from information contained therein, including the
Issuer’ compliance with any of their covenants hereunder (as to which the Trustee is entitled to
rely exclusively on Officer’s Certificates).

SECTION 4.04 Compliance Certificate.

     (a) The Issuer shall deliver to the Trustee, within 120 days after the end of each fiscal year
of the Issuer, an Officer’s Certificate stating that a review of the activities of the Issuer and
its Subsidiaries during the preceding fiscal year has been made under the supervision of the
signing Officers with a view to determining whether the Issuer has kept, observed, performed and
fulfilled its obligations under this Indenture, and further stating, as to each such Officer
signing such certificate, that to his or her knowledge the Issuer has kept, observed, performed and
fulfilled each and every covenant contained in this Indenture and is not in default in the
performance or observance of any of the terms, provisions and conditions of this Indenture (or, if
a Default or Event of Default has occurred, describing all such Defaults or Events of

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Default of which he or she may have knowledge and what action the Issuer is taking or proposes
to take with respect thereto).

     (b) So long as any of the Notes are outstanding, the Issuer shall deliver to the Trustee,
within 30 days upon any Officer becoming aware of any Default or Event of Default, an Officer’s
Certificate specifying such Default or Event of Default and what action the Issuer is taking or
proposes to take with respect thereto.

SECTION 4.05 [Reserved].

SECTION 4.06 Stay, Extension and Usury Laws.

     The Issuer and each of the Guarantors covenant (to the extent that they may lawfully do so)
that they shall not at any time insist upon, plead, or in any manner whatsoever claim or take the
benefit or advantage of, any stay, extension or usury law wherever enacted, now or at any time
hereafter in force, that may affect the covenants or the performance of this Indenture; and the
Issuer and each of the Guarantors (to the extent that they may lawfully do so) hereby expressly
waive all benefit or advantage of any such law, and covenant that they shall not, by resort to any
such law, hinder, delay or impede the execution of any power herein granted to the Trustee, but
shall suffer and permit the execution of every such power as though no such law has been enacted.

SECTION 4.07 Restricted Payments.

     (a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly
or indirectly:

     (A) declare or pay any dividend or make any other payment or distribution on account of
the Issuer’s or any of its Restricted Subsidiaries’ Equity Interests (including, without
limitation, any payment in connection with any merger or consolidation involving the Issuer
or any of its Restricted Subsidiaries) or to the direct or indirect holders of the Issuer’s
or any of its Restricted Subsidiaries’ Equity Interests in their capacity as such (other
than dividends or distributions payable in Equity Interests (other than Disqualified Stock)
of the Issuer); provided that the repurchase, redemption or other acquisition or retirement
for value of any Equity Interests of a Restricted Subsidiary shall not constitute a
Restricted Payment;

     (B) purchase, redeem or otherwise acquire or retire for value (including, without
limitation, in connection with any merger or consolidation involving the Issuer) any Equity
Interests of the Issuer, Holdings or any other direct or indirect parent of the Issuer;

     (C) make any payment on or with respect to, or purchase, repurchase, redeem, defease or
otherwise acquire or retire for value any Indebtedness of the Issuer or any Guarantor that
is contractually subordinated to the Notes or to any Subsidiary Guarantee (excluding any
intercompany Indebtedness between or among the Issuer and any of its Restricted
Subsidiaries), except (i) a payment of interest or principal at the Stated Maturity thereof
or (ii) the purchase, repurchase, redemption, defeasance or other acquisition or retirement
of any such subordinated Indebtedness purchased in anticipation of satisfying a sinking fund
obligation, principal installment or payment at final maturity, in each case within one year
of the date of such purchase, repurchase, redemption, defeasance or other acquisition or
retirement; or

     (D) make any Restricted Investment;

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(all such payments and other actions set forth in these clauses (A) through (D) above being
collectively referred to as “Restricted Payments”), unless, at the time of and after giving effect
to such Restricted Payment:

     (1) no Default or Event of Default has occurred and is continuing or would occur as a
consequence of such Restricted Payment;

     (2) the Issuer would, at the time of such Restricted Payment and after giving pro forma
effect thereto as if such Restricted Payment had been made at the beginning of the
applicable four-quarter period, have been permitted to incur at least $1.00 of additional
Indebtedness pursuant to the Fixed Charge Coverage Ratio test set forth in Section 4.09(a)
of this Indenture; and

     (3) such Restricted Payment, together with the aggregate amount of all other Restricted
Payments made by the Issuer and its Restricted Subsidiaries since the Issue Date (excluding
Restricted Payments permitted by clauses (2), (3), (4), (5), (6), (7), (8), (9), (10), (12),
(13), (15), (16), (17), (18) and (19) of Section 4.07(b)), is less than the sum, without
duplication, of:

     (A) 50% of the Consolidated Net Income of the Issuer for the period (taken as
one accounting period) from April 1, 2007 to the end of the Issuer’s most recently
ended fiscal quarter for which internal financial statements are available at the
time of such Restricted Payment (or, if such Consolidated Net Income for such period
is a deficit, less 100% of such deficit); plus

     (B) 100% of the aggregate Qualified Proceeds received by the Issuer since the
Issue Date as a contribution to its equity capital (other than Disqualified Stock)
or from the issue or sale of Equity Interests of the Issuer (other than Disqualified
Stock and Excluded Contributions) or from the issue or sale of convertible or
exchangeable Disqualified Stock or convertible or exchangeable debt securities of
the Issuer that have been converted into or exchanged for such Equity Interests
(other than Equity Interests (or Disqualified Stock or debt securities) sold to a
Subsidiary of the Issuer); plus

     (C) an amount equal to the net reduction in Investments by the Issuer and its
Restricted Subsidiaries resulting from (i) the sale or other disposition (other than
to the Issuer or a Restricted Subsidiary) of any Restricted Investment that was made
after the Issue Date and (ii) repurchases, redemptions and repayments of such
Restricted Investments and the receipt of any dividends or distributions from such
Restricted Investments; plus

     (D) to the extent that any Unrestricted Subsidiary of the Issuer designated as
such after the Issue Date is redesignated as a Restricted Subsidiary after the Issue
Date, an amount equal to the lesser of (i) the Fair Market Value of the Issuer’s
interest in such Subsidiary immediately prior to such redesignation and (ii) the
aggregate amount of the Issuer’s Investments in such Subsidiary that was previously
treated as a Restricted Payment; plus

     (E) in the event the Issuer and/or any Restricted Subsidiary makes any
Investment in a Person that, as a result of or in connection with such Investment,
becomes a Restricted Subsidiary, an amount equal to the existing Investment of the
Issuer and/or any of its Restricted Subsidiaries in such Person that was previously
treated as a Restricted Payment.

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     (b) The preceding Section 4.07(a) shall not prohibit:

     (1) the payment of any dividend or other distribution or the consummation of any
irrevocable redemption within 60 days after the date of declaration of the dividend or
giving of the redemption notice, as the case may be, if at the date of declaration or
notice, the dividend or redemption payment would have complied with the provisions of this
Indenture;

     (2) the making of any Restricted Payment in exchange for, or out of the net cash
proceeds of the substantially concurrent sale (other than to a Restricted Subsidiary) of,
Equity Interests of the Issuer (other than Disqualified Stock) or from the substantially
concurrent contribution of equity capital to the Issuer (other than Disqualified Stock);
provided that the amount of any such net cash proceeds that are utilized for any such
Restricted Payment shall be excluded from clause (3)(B) of Section 4.07(a);

     (3) the repurchase, redemption, defeasance or other acquisition or retirement for value
of Indebtedness of the Issuer or any Guarantor that is contractually subordinated to the
Notes or to any Subsidiary Guarantee with the net cash proceeds from a substantially
concurrent incurrence of Permitted Refinancing Indebtedness, or from the substantially
concurrent sale (other than to a Restricted Subsidiary) of, Equity Interests of the Issuer
(other than Disqualified Stock) or from the substantially concurrent contribution of equity
capital to the Issuer (other than Disqualified Stock); provided that the amount of any such
net cash proceeds that are utilized for any such Restricted Payment will be excluded from
clause (3)(B) of Section 4.07(a);

     (4) the declaration and payment of regularly scheduled or accrued dividends to holders
of any class or series of Disqualified Stock of the Issuer or any Restricted Subsidiary of
which Disqualified Stock was issued after the Issue Date in accordance with Section 4.09;

     (5) the repurchase, redemption or other acquisition or retirement for value of
Disqualified Stock of the Issuer or any Restricted Subsidiary made by exchange for, or out
of the proceeds of the substantially concurrent sale of Replacement Preferred Stock that is
permitted to be incurred pursuant to Section 4.09;

     (6) the payment of any dividend (or any similar distribution) by a Restricted
Subsidiary to the holders of its Equity Interests on a pro rata basis;

     (7) the purchase, redemption or other acquisition or retirement for value of shares of
Capital Stock of a Qualified Restricted Subsidiary owned by a Strategic Investor if such
purchase, redemption or other acquisition or retirement for value is made for consideration
not in excess of the Fair Market Value of such Capital Stock;

     (8) the repurchase, redemption or other acquisition or retirement for value of any
Equity Interests of the Issuer or any Restricted Subsidiary held by any current or former
officer, director, employee or consultant of the Issuer or any of its Restricted
Subsidiaries, and any dividend payment or other distribution by the Issuer or a Restricted
Subsidiary to Holdings or any other direct or indirect parent holding company of the Issuer
utilized for the repurchase, redemption or other acquisition or retirement for value of any
Equity Interests of Holdings or such other direct or indirect parent holding company held by
any current or former officer, director, employee or consultant of the Issuer or any of its
Restricted Subsidiaries or Holdings or such other parent holding company, in each case,
pursuant to any equity subscription agreement, stock option agreement, shareholders’
agreement or similar agreement or benefit plan of any kind; provided that the aggregate
price paid for all such repurchased, redeemed, acquired or retired Equity

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Interests may not exceed $5.0 million in any fiscal year (it being understood, however,
that unused amounts permitted to be paid pursuant to this proviso are available to be
carried over to subsequent fiscal years); provided further that such amount in any fiscal
year may be increased by an amount not to exceed:

     (A) the cash proceeds from the sale of Equity Interests of the Issuer and, to
the extent contributed to the Issuer as equity capital (other than Disqualified
Stock), Equity Interests of Holdings or any other direct or indirect parent company
of the Issuer, in each case to members of management, directors or consultants of
the Issuer, any of its Subsidiaries, Holdings or any other direct or indirect parent
company of the Issuer that occurs after the Issue Date, to the extent the cash
proceeds from the sale of such Equity Interests have not otherwise been applied to
the payment of Restricted Payments by virtue of clause (3)(B) of Section 4.07(a),
and excluding Excluded Contributions, plus

     (B) the cash proceeds of key man life insurance policies received by the Issuer
and its Restricted Subsidiaries after the Issue Date, less

     (C) the amount of any Restricted Payments previously made pursuant to clauses
(A) and (B) of this clause (8);

and provided, further, that cancellation of Indebtedness owing to the Issuer or any
Restricted Subsidiary from members of management of the Issuer, any of the Issuer’s
direct or indirect parent companies or any of the Issuer’s Restricted Subsidiaries
in connection with a repurchase of Equity Interests of the Issuer or any of its
direct or indirect parent companies will not be deemed to constitute a Restricted
Payment for purposes of this covenant or any other provision of the Indenture;

     (9) the repurchase of Equity Interests deemed to occur upon the exercise of options,
rights or warrants to the extent such Equity Interests represent a portion of the exercise
price of those options, rights or warrants;

     (10) the repurchase, redemption, defeasance or other acquisition or retirement for
value of Indebtedness of the Issuer or any Guarantor that is contractually subordinated to
the Notes or to any Subsidiary Guarantee with any Excess Proceeds that remain after
consummation of an Asset Sale Offer;

     (11) so long as no Default has occurred and is continuing or would be caused thereby,
after the occurrence of a Change of Control and within 60 days after the completion of the
offer to repurchase the Notes pursuant to Section 4.15 (including the purchase of the Notes
tendered), any purchase or redemption of Indebtedness that is contractually subordinated to
the Notes or to any Subsidiary Guarantee required pursuant to the terms thereof as a result
of such Change of Control at a purchase or redemption price not to exceed 101% of the
outstanding principal amount thereof, plus any accrued and unpaid interest; provided,
however, the Issuer would be able to incur at least $1.00 of additional Indebtedness
pursuant to the Fixed Charge Coverage Ratio test set forth in Section 4.09(a) after giving
pro forma effect to such Restricted Payment;

     (12) cash payments in lieu of fractional shares issuable as dividends on preferred
stock or upon the conversion of any convertible debt securities of the Issuer or any of its
Restricted Subsidiaries;

     (13) Permitted Payments to Parent;

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     (14) so long as no Default has occurred and is continuing or would be caused thereby,
the payment:

     (A) by the Issuer or any Restricted Subsidiary to Holdings or any other direct
or indirect parent of the Issuer, which payment is used by the Person receiving such
payment, following the first initial public offering of common Equity Interests by
such Person, to pay dividends of up to 6% per annum of the net proceeds received by
such Person in such public offering (or any subsequent public offering of common
Equity Interests of such Person) that are contributed to the Issuer as equity
capital (other than Disqualified Stock), or

     (B) by the Issuer, following the first initial public offering of common Equity
Interests by the Issuer, to pay dividends of up to 6% per annum of the net proceeds
received by or contributed to the Issuer in such public offering (or any subsequent
public offering of common Equity Interests by the Issuer);

(excluding, in the case of both clause (A) and clause (B), public offerings of common Equity
Interests registered on Form S-8 and any other public sale to the extent the proceeds
thereof are Excluded Contributions);

     (15) Investments that are made with Excluded Contributions;

     (16) distributions or payments of Receivables Fees;

     (17) payment of fees and reimbursement of other expenses to the Permitted Holders
and/or their Affiliates in connection with the Transactions as described in the Offering
Memorandum under the caption “Certain Relationships and Related Transactions”;

     (18) all other payments made or to be made in connection with the Transactions as
described in the Offering Memorandum and all payments made to former stockholders of the
Issuer who have validly exercised appraisal rights in connection with the Transactions; and

     (19) so long as no Default has occurred and is continuing or would be caused thereby,
other Restricted Payments in an aggregate amount taken together with all other Restricted
Payments made pursuant to this clause (19) not to exceed the greater of (a) $50.0 million
and (b) 2.5% of Total Assets at the time made.

     (c) The amount of all Restricted Payments (other than cash) shall be the Fair Market Value on
the date of the Restricted Payment of the asset(s) or securities proposed to be transferred or
issued by the Issuer or such Restricted Subsidiary, as the case may be, pursuant to the Restricted
Payment. The Fair Market Value of any assets or securities that are required to be valued by this
Section 4.07 shall be, if the fair market value thereof exceeds $20.0 million, determined by the
Board of Directors of the Issuer, whose resolution with respect thereto shall be delivered to the
Trustee.

     For purposes of determining compliance with the provisions of this Section 4.07, in the event
that a Restricted Payment meets the criteria of more than one of the types of Restricted Payments
described in the above clauses, the Issuer, in its sole discretion, may order and classify, and
from time to time may reorder and reclassify, such Restricted Payment, if it would have been
permitted at the time such Restricted Payment was made and at the time of any such
reclassification.

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SECTION 4.08 Dividend and Other Payment Restrictions Affecting Restricted Subsidiaries.

     (a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly
or indirectly, create or permit to exist or become effective any consensual encumbrance or
restriction on the ability of any Restricted Subsidiary to:

     (1) pay dividends or make any other distributions on its Capital Stock to the Issuer or
any of its Restricted Subsidiaries, or with respect to any other interest or participation
in, or measured by, its profits, or pay any indebtedness owed to the Issuer or any of its
Restricted Subsidiaries;

     (2) make loans or advances to the Issuer or any of its Restricted Subsidiaries; or

     (3) sell, lease or transfer any of its properties or assets to the Issuer or any of its
Restricted Subsidiaries.

     (b) Section 4.08(a) shall not apply to encumbrances or restrictions existing under or by
reason of:

     (1) agreements governing Existing Indebtedness and the Credit Agreement as in effect on
the Issue Date;

     (2) this Indenture, the Notes and the Subsidiary Guarantees;

     (3) applicable law, rule, regulation or order;

     (4) any instrument or agreement governing Indebtedness or Capital Stock of a Restricted
Subsidiary acquired by the Issuer or any of its Restricted Subsidiaries as in effect at the
time of such acquisition (except to the extent such Indebtedness or Capital Stock was
incurred in connection with or in contemplation of such acquisition), which encumbrance or
restriction is not applicable to any Person, or the properties or assets of any Person,
other than the Person or any of its Subsidiaries, or the property or assets of the Person or
any of its Subsidiaries, so acquired; provided that, in the case of Indebtedness, such
Indebtedness was permitted by the terms of this Indenture to be incurred;

     (5) customary non-assignment provisions in contracts, leases, subleases, licenses and
sublicenses entered into in the ordinary course of business;

     (6) customary restrictions in leases (including capital leases), security agreements or
mortgages or other purchase money obligations for property acquired in the ordinary course
of business that impose restrictions on the property purchased or leased of the nature
described in clause (3) of Section 4.08(a);

     (7) any agreement for the sale or other disposition of all or substantially all the
Capital Stock or the assets of a Restricted Subsidiary that restricts distributions by that
Restricted Subsidiary pending the sale or other disposition;

     (8) any instrument or agreement governing Permitted Refinancing Indebtedness; provided
that the restrictions contained therein are not materially more restrictive, taken as a
whole, than those contained in the agreements governing the Indebtedness being refinanced;

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     (9) Liens permitted to be incurred under Section 4.12 of this Indenture that limit the
right of the debtor to dispose of the assets subject to such Liens;

     (10) provisions limiting the disposition or distribution of assets or property in joint
venture agreements, asset sale agreements, sale-leaseback agreements, stock sale agreements
and other similar agreements, which limitation is applicable only to the assets that are the
subject of such agreements;

     (11) restrictions on cash or other deposits or net worth imposed by customers under
contracts entered into in the ordinary course of business;

     (12) customary provisions imposed on the transfer of copyrighted or patented materials;

     (13) customary provisions restricting dispositions of real property interests set forth
in any reciprocal easement agreements of the Issuer or any Restricted Subsidiary;

     (14) Indebtedness or other contractual requirements of a Receivables Subsidiary in
connection with a Qualified Receivables Transaction; provided that such restrictions apply
only to such Receivables Subsidiary;

     (15) contracts entered into in the ordinary course of business, not relating to any
Indebtedness, and that do not, individually or in the aggregate, detract from the value of
property or assets of the Issuer or any Restricted Subsidiary in any manner material to the
Issuer or any Restricted Subsidiary;

     (16) restrictions on the transfer of property or assets required by any regulatory
authority having jurisdiction over the Issuer or any Restricted Subsidiary or any of their
businesses;

     (17) any instrument or agreement governing Indebtedness or preferred stock (i) of any
Foreign Subsidiary and (ii) of the Issuer or any Restricted Subsidiary that is incurred or
issued subsequent to the Issue Date and not in violation of Section 4.09; provided that (x)
in the case of preferred stock, such encumbrances and restrictions are not materially more
restrictive in the aggregate than the restrictions contained in this Indenture and (y) in
the case of Senior Debt, are not materially more restrictive in the aggregate than the
restrictions contained in the Credit Agreement;

     (18) restrictions in Management Agreements that require the payment of management fees
to the Issuer or one of its Restricted Subsidiaries prior to payment of dividends or
distributions;

     (19) Permitted Payment Restrictions; and

     (20) any amendments, modifications, restatements, renewals, increases, supplements,
refundings, replacements or refinancings of the Indebtedness, preferred stock, Liens,
agreements, contracts, licenses, leases, subleases, instruments or obligations referred to
in clauses (1), (2), (4) through (15) and (17) above; provided, however, that such
amendments, modifications, restatements, renewals, increases, supplements, refundings,
replacements or refinancings are in the good faith judgment of the Issuer’s Board of
Directors, whose determination shall be conclusive, not materially more restrictive, taken
as a whole, than those restrictions contained in the Indebtedness, preferred stock, Liens,
agreements, contracts, licenses, leases, subleases, instruments or obligations

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 referred to in clauses (1), (2), (4) through (15), (17) and (18) above, as
applicable prior to such amendment, modification, restatement, renewal, increase,
supplement, refunding, replacement or refinancing.

SECTION 4.09 Incurrence of Indebtedness and Issuance of Disqualified Stock and Preferred Stock.

     (a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly
or indirectly, create, incur, issue, assume, guarantee or otherwise become directly or indirectly
liable, contingently or otherwise, with respect to (collectively, “incur”) any Indebtedness
(including Acquired Debt), and the Issuer shall not issue any Disqualified Stock and shall not
permit any of its Restricted Subsidiaries to issue any shares of preferred stock; provided,
however, that (x) the Issuer and the Guarantors may incur Indebtedness (including Acquired Debt) or
issue Disqualified Stock or preferred stock, if the Fixed Charge Coverage Ratio for the Issuer’s
most recently ended four full fiscal quarters for which internal financial statements are available
immediately preceding the date on which such additional Indebtedness is incurred or such
Disqualified Stock or such preferred stock is issued, as the case may be, would have been at least
2.0 to 1, determined on a pro forma basis (including a pro forma application of the net proceeds
therefrom), as if the additional Indebtedness had been incurred or the Disqualified Stock or the
preferred stock had been issued, as the case may be, at the beginning of such four-quarter period
and (y) Restricted Subsidiaries may incur Indebtedness (including Acquired Debt) or issue
Disqualified Stock or preferred stock if all such Indebtedness incurred, or Disqualified Stock or
preferred stock issued, in reliance upon this clause (y) (together with the aggregate principal
amount of all Indebtedness of Restricted Subsidiaries outstanding on the Issue Date (other than
under the Credit Agreement, the Notes or the related Guarantees) and any Permitted Refinancing
Indebtedness with respect thereto, less the aggregate sum of all principal payments made from time
to time after the Issue Date with respect to such Indebtedness (other than with the proceeds of
Permitted Refinancing Indebtedness)) does not exceed 1.25x Facility-Level EBITDA for the Issuer’s
most recently ended four full fiscal quarters for which internal financial statements are available
immediately preceding the date on which such additional Indebtedness is incurred or such
Disqualified Stock or such preferred stock is issued, as the case may be, determined on a pro forma
basis (including a pro forma application of net proceeds therefrom), as if the additional
Indebtedness has been incurred or the Disqualified Stock or the preferred stock had been issued, as
the case may be.

     (b) Section 4.09(a) shall not prohibit the incurrence of any of the following items of
Indebtedness or the issuance of any of the following items of Disqualified Stock or preferred stock
(collectively, “Permitted Debt”):

     (1) the incurrence by the Issuer and/or any Restricted Subsidiary of Indebtedness under
the Credit Agreement and other Credit Facilities entered into after the date of the Credit
Agreement in an aggregate principal amount at any one time outstanding under this clause (1)
not to exceed $905.0 million, less the aggregate amount of all Net Proceeds of Asset Sales
of the Issuer or any Domestic Subsidiary applied since the Issue Date to repay any term
Indebtedness under a Credit Facility or to repay any revolving credit Indebtedness under a
Credit Facility and effect a corresponding commitment reduction thereunder pursuant to
Section 4.10; provided, that the incurrence by Non-Guarantor Subsidiaries of Indebtedness
pursuant to this clause (1) shall not exceed $125.0 million in the aggregate at any time
outstanding; less the aggregate amount of proceeds from asset sales of any such
Non-Guarantor Subsidiaries thereunder;

     (2) the incurrence by the Issuer and its Restricted Subsidiaries of the Existing
Indebtedness after giving effect to the Transactions;

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     (3) the incurrence by the Issuer and the Guarantors of Indebtedness represented by the
Notes (including PIK Notes and any related Guarantee) to be issued on the Issue Date,
replacement Notes in respect thereof, if any, and the related Subsidiary Guarantees and the
Exchange Notes and related Subsidiary Guarantees to be issued pursuant to the Registration
Rights Agreement;

     (4) the incurrence or issuance by the Issuer or any of its Qualified Restricted
Subsidiaries of Indebtedness (including Capital Lease Obligations), Disqualified Stock or
preferred stock, in each case, incurred or issued for the purpose of financing all or any
part of the purchase price or cost of design, construction, lease, installation or
improvement of property, plant or equipment used or useful in a Permitted Business, in an
aggregate principal amount, including all Permitted Refinancing Indebtedness and Replacement
Preferred Stock incurred to renew, refund, refinance, replace, defease or discharge any
Indebtedness incurred pursuant to this clause (4) not to exceed $25.0 million at any time
outstanding;

     (5) the incurrence by the Issuer or any of its Restricted Subsidiaries of Permitted
Refinancing Indebtedness or Replacement Preferred Stock in exchange for, or the net proceeds
of which are used to renew, refund, refinance, replace, defease or discharge any
Indebtedness (other than intercompany Indebtedness) or any Disqualified Stock or preferred
stock that was permitted by this Indenture to be incurred under Section 4.09(a) or clauses
(2), (3), (4), (5), (14), (16), (18), (19) or (20) of this Section 4.09(b);

     (6) the incurrence by the Issuer or any of its Qualified Restricted Subsidiaries of
intercompany Indebtedness between or among the Issuer and any of its Qualified Restricted
Subsidiaries; provided, however, that:

     (A) if the Issuer or any Guarantor is the obligor on such Indebtedness and the
payee is not the Issuer or a Guarantor, such Indebtedness must be expressly
subordinated to the prior payment in full in cash of all Obligations with respect to
the Notes, in the case of the Issuer or the Subsidiary Guarantee, in the case of a
Guarantor, except to the extent such subordination would violate any applicable law,
rule or regulation; and

     (B) (i) any subsequent issuance or transfer of Equity Interests that results in
any such Indebtedness being held by a Person other than the Issuer or a Qualified
Restricted Subsidiary and (ii) any sale or other transfer of any such Indebtedness
to a Person that is not either the Issuer or a Qualified Restricted Subsidiary,
shall be deemed, in each case, to constitute a new incurrence of such Indebtedness
by the Issuer or such Restricted Subsidiary, as the case may be, which new
incurrence is not permitted by this clause (6);

     (7) the issuance by any of the Issuer’s Qualified Restricted Subsidiaries to the Issuer
or to any of its Restricted Subsidiaries of shares of preferred stock; provided, however,
that:

     (A) any subsequent issuance or transfer of Equity Interests that results in any
such preferred stock being held by a Person other than the Issuer or a Qualified
Restricted Subsidiary; and

     (B) any sale or other transfer of any such preferred stock to a Person that is
not either the Issuer or a Qualified Restricted Subsidiary,

will be deemed, in each case, to constitute a new issuance of such preferred stock by such
Restricted Subsidiary which new issuance is not permitted by this clause (7);

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     (8) the incurrence by the Issuer or any of its Restricted Subsidiaries of Hedging
Obligations in the ordinary course of business;

     (9) the Guarantee:

     (A) by the Issuer or any of the Guarantors of Indebtedness of the Issuer or a
Restricted Subsidiary that was permitted to be incurred by another provision of this
Section 4.09; provided that if the Indebtedness being guaranteed is subordinated to
or pari passu with the Notes, then the Guarantee shall be subordinated or pari
passu, as applicable, to the same extent as the Indebtedness guaranteed; and

     (B) by any Non-Guarantor Subsidiary of Indebtedness of a Non-Guarantor
Subsidiary;

     (10) the incurrence by the Issuer or any of its Restricted Subsidiaries of Indebtedness
in respect of workers’ compensation claims, self-insurance obligations, bankers’
acceptances, letters of credit, performance bonds, surety bonds, appeal bonds or other
similar bonds in the ordinary course of business; provided, however, that upon the drawing
of letters of credit for reimbursement obligations, including with respect to workers’
compensation claims, or the incurrence of other Indebtedness with respect to reimbursement
type obligations regarding workers’ compensation claims, such obligations are reimbursed
within 30 days following such drawing or incurrence;

     (11) the incurrence by the Issuer or any of its Restricted Subsidiaries of Indebtedness
arising from the honoring by a bank or other financial institution of a check, draft or
similar instrument inadvertently (except in the case of daylight overdrafts) drawn against
insufficient funds in the ordinary course of business, so long as such Indebtedness is
extinguished within five Business Days;

     (12) the incurrence of Indebtedness arising from agreements of the Issuer or a
Restricted Subsidiary providing for indemnification, adjustment of purchase price, holdback,
contingency payment obligations or similar obligations, in each case, incurred or assumed in
connection with the disposition or acquisition of any business, assets or Capital Stock of
the Issuer or any Restricted Subsidiary;

     (13) Indebtedness of the Issuer or any of its Restricted Subsidiaries supported by a
letter of credit issued pursuant to any Credit Facilities, in a principal amount not in
excess of the stated amount of such letter of credit;

     (14) the incurrence of Indebtedness resulting from endorsements of negotiable
instruments for collection in the ordinary course of business;

     (15) Indebtedness, Disqualified Stock or preferred stock of Persons that are acquired
by the Issuer or any Qualified Restricted Subsidiary (including by way of merger or
consolidation) in accordance with the terms of this Indenture; provided that such
Indebtedness, Disqualified Stock or preferred stock is not incurred in contemplation of such
acquisition or merger; and provided further that after giving effect to such acquisition or
merger, either

     (A) the Issuer would be permitted to incur at least $1.00 of additional
Indebtedness pursuant to the Fixed Charge Coverage Ratio; or

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     (B) the Issuer’s Fixed Charge Coverage Ratio after giving pro forma effect to
such acquisition or merger would be greater than the Issuer’s actual Fixed Charge
Coverage Ratio immediately prior to such acquisition or merger;

     (16) Indebtedness of the Issuer or a Restricted Subsidiary in respect of netting
services, overdraft protection and otherwise in connection with deposit accounts; provided
that such Indebtedness remains outstanding for ten Business Days or less;

     (17) the incurrence by a Receivables Subsidiary of Indebtedness in a Qualified
Receivables Transaction;

     (18) the incurrence or issuance by the Issuer or any of its Qualified Restricted
Subsidiaries of additional Indebtedness, Disqualified Stock or preferred stock in an
aggregate principal amount (or accreted value or liquidation preference, as applicable) at
any time outstanding, including all Permitted Refinancing Indebtedness and all Replacement
Preferred Stock incurred to renew, refund, refinance, replace, defease or discharge any
Indebtedness, Disqualified Stock and preferred stock incurred or issued pursuant to this
clause (18), not to exceed $100.0 million;

     (19) the incurrence by the Issuer or any of its Restricted Subsidiaries of Indebtedness
in the form of loans from a Captive Insurance Subsidiary; and

     (20) Indebtedness in respect of promissory notes issued to physicians, consultants,
employees or directors or former employees, consultants or directors in connection with
repurchases of Equity Interests permitted by Section 4.07(b)(8).

     For purposes of determining compliance with this Section 4.09, in the event that an item of
proposed Indebtedness meets the criteria of more than one of the categories of Permitted Debt
described in clauses (1) through (20) above, or is entitled to be incurred pursuant to Section
4.09(a), the Issuer shall be permitted to classify such item of Indebtedness on the date of its
incurrence, or later reclassify all or a portion of such item of Indebtedness, in any manner that
complies with this Section 4.09 except that Indebtedness under the Credit Agreement outstanding on
the Issue Date will be deemed to have been incurred on such date in reliance on the exception
provided by clause (1) of this Section 4.09(b). The accrual of interest, the accretion or
amortization of original issue discount, the payment of interest on any Indebtedness in the form of
additional Indebtedness with the same terms, the reclassification of preferred stock as
Indebtedness due to a change in accounting principles, and the payment of dividends on Disqualified
Stock or preferred stock in the form of additional shares of the same class of Disqualified Stock
or preferred stock shall not be deemed to be an incurrence of Indebtedness or an issuance of
Disqualified Stock or preferred stock for purposes of this Section 4.09; provided in each such
case, that the amount thereof is included in Fixed Charges of the Issuer as accrued (other than the
reclassification of preferred stock as Indebtedness due to a change in accounting principles).

     The amount of any Indebtedness outstanding as of any date will be:

     (1) the accreted value of the Indebtedness, in the case of any Indebtedness issued with
original issue discount;

     (2) the principal amount of the Indebtedness, in the case of any other Indebtedness;
and

     (3) in respect of Indebtedness of another Person secured by a Lien on the assets of the
specified Person, the lesser of:

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     (A) the Fair Market Value of such assets at the date of determination; and

     (B) the amount of the Indebtedness of the other Person.

SECTION 4.10 Asset Sales.

     (a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to,
consummate an Asset Sale unless:

     (1) the Issuer (or the Restricted Subsidiary, as the case may be) receives
consideration at the time of the Asset Sale at least equal to the Fair Market Value of the
assets or Equity Interests issued or sold or otherwise disposed of; and

     (2) at least 75% of the consideration received in the Asset Sale by the Issuer or such
Restricted Subsidiary is in the form of cash. For purposes of this paragraph (2), each of
the following shall be deemed to be cash:

     (A) Cash Equivalents;

     (B) any liabilities, as shown on the Issuer’s most recent consolidated balance
sheet, of the Issuer or any Restricted Subsidiary (other than contingent liabilities
and liabilities that are by their terms subordinated to the Notes or any Subsidiary
Guarantee) that are assumed by the transferee of any such assets pursuant to a
customary novation agreement that releases the Issuer or such Restricted Subsidiary
from further liability;

     (C) any securities, notes or other obligations received by the Issuer or any
such Restricted Subsidiary from such transferee that are converted by the Issuer or
such Restricted Subsidiary into cash within 180 days of receipt, to the extent of
the cash received in that conversion;

     (D) (i) any Designated Noncash Consideration received by the Issuer or a
Restricted Subsidiary in connection with the sale or contribution of assets by the
Issuer or a Restricted Subsidiary to a joint venture with a Strategic Investor,
provided, however, that (x) any such Designated Noncash Consideration that is
converted into Cash Equivalents shall be treated as Net Proceeds in the manner set
forth below and (y) in the event such Designated Noncash Consideration is other than
in the form of Indebtedness, such Designated Noncash Consideration shall be deemed
to have been acquired and consequently reduce amounts available under clause (15)
and (18) of the definition of “Permitted Investments” as determined by the Issuer
and (ii) other Designated Noncash Consideration the Fair Market Value of which, when
taken together with all other Designated Noncash Consideration received pursuant to
this clause (ii) (and not subsequently converted into Cash Equivalents that are
treated as Net Proceeds of an Asset Sale), does not exceed 5% of Total Assets at the
time of receipt since the Issue Date, with the Fair Market Value of each item of
Designated Noncash Consideration being measured at the time received and without
giving effect to subsequent changes in value; and

     (E) any stock or assets of the kind referred to in clauses (2) or (4) of
Section 4.10(b).

     Notwithstanding the foregoing, the 75% limitation referred to in clause (2) above shall not
apply to any Asset Sale in which the cash or Cash Equivalent portion of the consideration received
therefrom,

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determined in accordance with the foregoing provision, is equal to or greater than what the
after-tax proceeds would have been had such Asset Sale complied with the aforementioned 75%
limitation.

     (b) Within 450 days after the receipt of any Net Proceeds from an Asset Sale, the Issuer (or
the applicable Restricted Subsidiary, as the case may be) may apply such Net Proceeds at its
option:

     (1) to repay Senior Debt (or, in the case of Non-Guarantor Subsidiaries, any
Indebtedness of such Non-Guarantor Subsidiaries but excluding any Intercompany Indebtedness)
and, if the Senior Debt (or Indebtedness) repaid is revolving credit Indebtedness, to
correspondingly reduce commitments with respect thereto;

     (2) to (x) acquire all or substantially all of the assets of, or any Capital Stock of,
another Permitted Business, if, after giving effect to any such acquisition of Capital
Stock, the Permitted Business is or becomes a Restricted Subsidiary or (y) make Investments
pursuant to clause (15) or (18) of the definition of “Permitted Investments”

     (3) to make a capital expenditure with respect to a Permitted Business; or

     (4) to acquire Additional Assets;

provided that the requirements of clauses (2) through (4) above shall be deemed to be satisfied if
an agreement (including a lease, whether a capital lease or an operating lease) committing to make
the acquisitions or expenditures referred to in any of clauses (2) through (4) above is entered
into by the Issuer or its Restricted Subsidiary within 450 days after the receipt of such Net
Proceeds with the good faith expectation that such Net Proceeds will be applied to satisfy such
commitment in accordance with such agreement within 180 days of such commitment and if such Net
Proceeds are not so applied within such 180 day period, then such Net Proceeds shall constitute
Excess Proceeds (as defined below).

     Pending the final application of any Net Proceeds, the Issuer may temporarily reduce revolving
credit borrowings or otherwise invest such Net Proceeds in any manner that is not prohibited by
this Indenture.

     (c) Any Net Proceeds from Asset Sales that are not applied or invested as provided in Section
4.10(b) shall constitute “Excess Proceeds.” When the aggregate amount of Excess Proceeds exceeds
$25.0 million, within ten Business Days thereof, the Issuer shall make an Asset Sale Offer to all
Holders and if the Issuer elects (or is required by the terms of such other pari passu
Indebtedness), all holders of other Indebtedness that is pari passu with the Notes. The offer
price in any Asset Sale Offer shall be equal to 100% of the principal amount plus accrued and
unpaid interest and Additional Interest, if any, to the date of purchase, and shall be payable in
cash. If any Excess Proceeds remain after consummation of an Asset Sale Offer, the Issuer (or a
Restricted Subsidiary) may use such Excess Proceeds for any purpose not otherwise prohibited by
this Indenture. If the aggregate principal amount of Notes and such other pari passu Indebtedness
tendered into such Asset Sale Offer exceeds the amount of Excess Proceeds, the Trustee shall select
the Notes and such other pari passu Indebtedness to be purchased on a pro rata basis. Upon
completion of each Asset Sale Offer, the amount of Excess Proceeds shall be reset at zero.

     (d) The Issuer 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 each repurchase of Notes pursuant to an Asset Sale Offer. To the
extent that the provisions of any securities laws or regulations conflict with the provisions of
Section 3.09 or this Section 4.10, the Issuer shall comply with the applicable securities laws and
regulations and shall not be deemed to have breached its obligations under Section 3.09 or this
Section 4.10 by virtue of such compliance.

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SECTION 4.11 Transactions with Affiliates.

     (a) The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, make any
payment to, or sell, lease, transfer or otherwise dispose of any of its properties or assets to, or
purchase any property or assets from, or enter into or make or amend any transaction, contract,
agreement, understanding, loan, advance or guarantee with, or for the benefit of, any Affiliate of
the Issuer involving aggregate consideration in excess of $5.0 million (each, an “Affiliate
Transaction”), unless:

     (1) the Affiliate Transaction is on terms that, taken as a whole, are not materially
less favorable to the Issuer or the relevant Restricted Subsidiary than those that would
have been obtained in a comparable transaction by the Issuer or such Restricted Subsidiary
with an unrelated Person; and

     (2) the Issuer delivers to the Trustee:

     (A) with respect to any Affiliate Transaction or series of related Affiliate
Transactions involving aggregate consideration in excess of $20.0 million, an
Officers’ Certificate certifying that such Affiliate Transaction complies with
clause (1) of this Section 4.11(a) and that such Affiliate Transaction has been
approved by a majority of the members of the Board of Directors of the Issuer,
together with a certified copy of the resolutions of the Board of Directors of the
Issuer approving such Affiliate Transaction or Affiliate Transactions; and

     (B) with respect to any Affiliate Transaction or series of related Affiliate
Transactions involving aggregate consideration in excess of $30.0 million, an
opinion as to the fairness to the Issuer or such Restricted Subsidiary of such
Affiliate Transaction from a financial point of view issued by an accounting,
appraisal or investment banking firm of national standing.

     (b) The following items shall not be deemed to be Affiliate Transactions and, therefore, shall
not be subject to the provisions of Section 4.11(a):

     (1) any employment agreement, employee benefit plan, officer or director
indemnification agreement or any similar arrangement entered into by the Issuer or any of
its Restricted Subsidiaries in the ordinary course of business and payments pursuant
thereto;

     (2) transactions between or among the Issuer and/or its Restricted Subsidiaries;

     (3) transactions with a Person (other than an Unrestricted Subsidiary of the Issuer)
that is an Affiliate of the Issuer solely because the Issuer owns, directly or through a
Restricted Subsidiary, an Equity Interest in, or controls, such Person;

     (4) payment of reasonable directors’ fees;

     (5) any issuance of Equity Interests (other than Disqualified Stock) of the Issuer to
Affiliates of the Issuer;

     (6) Permitted Investments or Restricted Payments that do not violate Section 4.07;

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     (7) payment of fees and the reimbursement of other expenses to the Permitted Holders
and/or their Affiliates in connection with the Transactions as described in the Offering
Memorandum under the caption “Certain Relationships and Related Transactions”;

     (8) payments by the Issuer or any of its Restricted Subsidiaries to Welsh, Carson,
Anderson & Stowe X, L.P. and/or any of its Affiliates for any financial advisory, financing,
underwriting or placement services or in respect of other investment banking activities,
including, without limitation, in connection with acquisitions or divestitures, which
payments are approved by the majority of the disinterested members of the Board of Directors
of the Issuer in good faith in an aggregate amount for all such fees not to exceed 2.00% of
the aggregate transaction value in respect of which such services are rendered;

     (9) loans (or cancellation of loans) or advances to employees in the ordinary course of
business;

     (10) transactions with customers, suppliers, contractors, joint venture partners or
purchasers or sellers of goods or services, in each case which are in the ordinary course of
business (including, without limitation, pursuant to joint venture agreements) and otherwise
in compliance with the terms of this Indenture, and which are fair to the Issuer or its
Restricted Subsidiaries, as applicable, in the reasonable determination of the Board of
Directors, chief executive officer or chief financial officer of the Issuer or its
Restricted Subsidiaries, as applicable, or are on terms at least as favorable as might
reasonably have been obtained at such time from an unaffiliated party;

     (11) the existence of, or the performance by the Issuer or any Restricted Subsidiary of
their obligations, if any, or obligations of Holdings under the terms of, any subscription,
registration rights or stockholders agreement, partnership agreement or limited liability
company agreement to which Holdings, the Issuer or any Restricted Subsidiary is a party as
of the Issue Date and which is disclosed in the Offering Memorandum under the caption
“Certain Relationships and Related Transactions” and any similar agreements which the
Issuer, any Restricted Subsidiary, Holdings or any other direct or indirect parent company
of the Issuer may enter into thereafter; provided, however, that the entering into by the
Issuer or any Restricted Subsidiary or the performance by the Issuer or any Restricted
Subsidiary of obligations under any future amendment to any such existing agreement or under
any similar agreement entered into after the Issue Date will only be permitted by this
clause to the extent that the terms of any such amendment or new agreement, taken as a
whole, are not materially disadvantageous to the holders of the notes, as determined in good
faith by the Board of Directors, chief executive officer or chief financial officer of the
Issuer;

     (12) the Transactions, including all payments made or to be made in connection with the
Transactions as described in the Offering Memorandum;

     (13) any Qualified Receivables Transaction;

     (14) Permitted Payments to Parent;

     (15) any management, consulting, monitoring, financial advisory, financing,
underwriting or placement services or any other investment banking, banking or similar
services involving the Issuer and any of its Restricted Subsidiaries (including without
limitation any payments in cash, Equity Interests or other consideration made by the Issuer
or any of its Restricted Subsidiaries in connection therewith) on the one hand and the
Permitted Holders on the other hand, which services (and payments and other transactions in
connection therewith) are approved

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as fair to the Issuer or such Restricted Subsidiary by a majority of the members of the
Board of Directors of the Issuer in good faith;

     (16) the issuance of Equity Interests (other than Disqualified Stock) in the Issuer or
any Restricted Subsidiary for compensation purposes;

     (17) any lease entered into between the Issuer or any Restricted Subsidiary, as lessee
and any Affiliate of the Issuer, as lessor, which is approved by a majority of the
disinterested members of the Board of Directors of the Issuer in good faith;

     (18) intellectual property licenses in the ordinary course of business;

     (19) Existing Indebtedness and any other obligations pursuant to an agreement existing
on the Issue Date and described in the Offering Memorandum, including any amendment thereto
(so long as such amendment is not disadvantageous to the Holders in any material respect);

     (20) transactions in which the Issuer or any Restricted Subsidiary delivers to the
Trustee a letter from an accounting, appraisal or investment banking firm of national
standing stating that such transaction is fair to the Issuer or such Restricted Subsidiary
from a financial point of view and which are approved by a majority of the disinterested
members of the Board of Directors of the Issuer in good faith; and

     (21) payments by the Issuer or any of its Restricted Subsidiaries of reasonable
insurance premiums to, and any borrowings or dividends received from, any Captive Insurance
Subsidiary.

SECTION 4.12 Liens.

     The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to create,
incur, assume or otherwise cause or suffer to exist or become effective any Lien of any kind (other
than Permitted Liens) securing Indebtedness upon any of their property or assets, now owned or
hereafter acquired, unless all payments due under this Indenture and the Notes are secured on an
equal and ratable basis with the obligations so secured until such time as such obligations are no
longer secured by a Lien.

SECTION 4.13 Business Activities.

     The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, engage in
any business other than Permitted Businesses, except to such extent as would not be material to the
Issuer and its Restricted Subsidiaries taken as a whole.

SECTION 4.14 Corporate Existence.

     Subject to Article 5, the Issuer shall do or cause to be done all things necessary to preserve
and keep in full force and effect its corporate existence in accordance with its organizational
documents (as the same may be amended from time to time).

SECTION 4.15 Offer To Repurchase Upon Change of Control.

     (a) If a Change of Control occurs, each Holder shall have the right to require the Issuer to
make an offer (a “Change of Control Offer”) to repurchase all or any part (equal to $2,000 or an
integral

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multiple of $1,000) of that Holder’s Notes at a purchase price equal to 101% of the aggregate
principal amount thereof plus accrued and unpaid interest and Additional Interest, if any, on the
Notes repurchased to the date of purchase subject to the rights of Holders on the relevant record
date to receive interest due on the relevant interest payment date (the “Change of Control
Payment”). Within 30 days following any Change of Control, the Issuer shall mail a notice to each
Holder describing the transaction or transactions that constitute the Change of Control and
stating:

     (1) that the Change of Control Offer is being made pursuant to this Section 4.15 and
that all Notes tendered shall be accepted for payment;

     (2) the purchase price and the purchase date, which shall 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”);

     (3) that any Note not tendered shall continue to accrue interest;

     (4) that, unless the Issuer defaults in the payment of the Change of Control Payment,
all Notes accepted for payment pursuant to the Change of Control Offer shall cease to accrue
interest and Additional Interest after the Change of Control Payment Date;

     (5) that Holders electing to have any Notes purchased pursuant to a Change of Control
Offer shall be required to surrender the Notes, with the form entitled “Option of Holder to
Elect Purchase” attached to the Notes completed, or transfer by book-entry transfer, to the
Paying Agent at the address specified in the notice prior to the close of business on the
third Business Day preceding the Change of Control Payment Date;

     (6) that Holders shall be entitled to withdraw their election if the Paying Agent
receives, not later than the close of business on the second Business Day preceding the
Change of Control Payment Date, a telegram, telex, facsimile transmission or letter setting
forth the name of the Holder, the principal amount of Notes delivered for purchase, and a
statement that such Holder is withdrawing his election to have the Notes purchased;

     (7) that Holders whose Notes are being purchased only in part shall be issued new Notes
equal in principal amount to the unpurchased portion of the Notes surrendered, which
unpurchased portion must be equal to $2,000 in principal amount or an integral multiple of
$1,000 in excess thereof; and

     (8) that Holders electing to have a Note purchased pursuant to a Change of Control
Offer may elect to have Notes purchased in a minimum amount of $2,000 or an integral
multiple of $1,000 in excess thereof only.

     The Issuer 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 in Control. To
the extent that the provisions of any securities laws or regulations conflict with the provisions
of Sections 3.09 or 4.15 of this Indenture, the Issuer shall comply with the applicable securities
laws and regulations and shall not be deemed to have breached its obligations under Section 3.09 or
this Section 4.15 by virtue of such compliance.

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     (b) On the Change of Control Payment Date, the Issuer 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 so accepted together with
an Officer’s Certificate stating the aggregate principal amount of Notes or portions of
Notes being purchased by the Issuer.

     The Paying Agent shall promptly mail (but in any case not later than five days after the
Change of Control Payment Date) 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 principal amount to any unpurchased
portion of the Notes surrendered, if any. The Issuer shall publicly announce the results of the
Change of Control Offer on or as soon as practicable after the Change of Control Payment Date.

     Prior to complying with any of the provisions of this Section 4.15, but in any event within 90
days following a Change of Control, the Issuer shall either repay all its outstanding Senior Debt
or obtain the requisite consents, if any, under all agreements governing their outstanding Senior
Debt to permit the repurchase of Notes required by this Section 4.15.

     (c) Notwithstanding anything to the contrary in this Section 4.15, the Issuer shall not be
required to make a Change of Control Offer upon a Change of Control if (1) a third party makes the
Change of Control Offer in the manner, at the times and otherwise in compliance with the
requirements set forth in this Section 4.15 and purchases all Notes validly tendered and not
withdrawn under the Change of Control Offer, or (2) notice of redemption has been given pursuant to
Section 3.07 of this Indenture, unless and until there is a Default in payment of the applicable
redemption price. A Change of Control Offer may be made in advance of a Change of Control,
conditional upon such Change of Control, if a definitive agreement is in place for the Change of
Control at the time of making of the Change of Control Offer.

     (d) Other than as specifically provided in this Section 4.15, any purchase pursuant to this
Section 4.15 shall be made pursuant to the provisions of Sections 3.02, 3.05 and 3.06 hereof.

SECTION 4.16 No Layering of Debt.

     The Issuer shall not incur, create, issue, assume, guarantee or otherwise become liable for
any Indebtedness that is contractually subordinate or junior in right of payment to any Senior Debt
of the Issuer and senior in right of payment to the Notes. No Guarantor shall incur, create,
issue, assume, guarantee or otherwise become liable for any Indebtedness that is contractually
subordinate or junior in right of payment to the Senior Debt of such Guarantor and senior in right
of payment to such Guarantor’s Subsidiary Guarantee. No such Indebtedness shall be considered to
be senior by virtue of being secured on a first or junior priority basis.

SECTION 4.17 Designation of Restricted and Unrestricted Subsidiaries.

     The Board of Directors of the Issuer may designate any Restricted Subsidiary to be an
Unrestricted Subsidiary if that designation would not cause a Default. If a Restricted Subsidiary
is designated

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as an Unrestricted Subsidiary, the aggregate Fair Market Value of all outstanding Investments
owned by the Issuer and its Restricted Subsidiaries in the Subsidiary designated as an Unrestricted
Subsidiary shall be deemed to be an Investment made as of the time of the designation and shall
reduce the amount available for Restricted Payments under Section 4.07 or under one or more clauses
of the definition of Permitted Investments, as determined by the Issuer. That designation shall
only be permitted if the Investment would be permitted at that time and if the Restricted
Subsidiary otherwise meets the definition of an Unrestricted Subsidiary.

     Any designation of a Subsidiary of the Issuer as an Unrestricted Subsidiary shall be evidenced
to the Trustee by filing with the Trustee a certified copy of a resolution of the Board of
Directors of the Issuer giving effect to such designation and an Officer’s Certificate certifying
that such designation complied with the preceding conditions and was permitted by Section 4.07.
If, at any time, any Unrestricted Subsidiary would fail to meet the preceding requirements as an
Unrestricted Subsidiary, it shall thereafter cease to be an Unrestricted Subsidiary for purposes of
this Indenture and any Indebtedness of such Subsidiary shall be deemed to be incurred by a
Restricted Subsidiary as of such date and, if such Indebtedness is not permitted to be incurred as
of such date under Section 4.09, the Issuer shall be in Default of Section 4.09. The Board of
Directors of the Issuer may at any time designate any Unrestricted Subsidiary to be a Restricted
Subsidiary; provided that such designation shall be deemed to be an incurrence of Indebtedness by a
Restricted Subsidiary of any outstanding Indebtedness of such Unrestricted Subsidiary, and such
designation shall only be permitted if such Indebtedness is permitted under Section 4.09 and no
Default or Event of Default would be in existence following such designation.

SECTION 4.18 Payments for Consent.

     The Issuer shall not, and shall not permit any of its Restricted Subsidiaries to, directly or
indirectly, pay or cause to be paid any consideration to or for the benefit of any Holder for or as
an inducement to any consent, waiver or amendment of any of the terms or provisions of this
Indenture or the Notes unless such consideration is offered to be paid and is paid to all Holders
that consent, waive or agree to amend in the time frame set forth in the solicitation documents
relating to such consent, waiver or agreement.

SECTION 4.19 Additional Subsidiary Guarantees.

     If the Issuer or any of its Restricted Subsidiaries, acquires or creates another Subsidiary,
other than a Non-Guarantor Subsidiary, after the Issue Date that guarantees Indebtedness under the
Credit Agreement, then that newly acquired or created Subsidiary shall become a Guarantor and
execute a supplemental indenture substantially in the form attached as Exhibit E and
deliver an Opinion of Counsel to the Trustee within 30 Business Days of the date on which it was
acquired or created.

SECTION 4.20 Distributions by Qualified Restricted Subsidiaries.

     Except to the extent restricted pursuant to any Permitted Payment Restrictions, the Issuer
shall, and shall cause each Restricted Subsidiary to, cause each Qualified Restricted Subsidiary to
declare and pay regular monthly, quarterly or semiannual dividends or distributions to the holders
of its Capital Stock in an amount equal to substantially all of the available cash flow of such
Restricted Subsidiary for such period as determined in good faith by the board of directors, board
of governors or such other individuals performing similar functions, subject to such ordinary and
customary reserves and other amounts as, in the good faith judgment of such individuals, may be
necessary so that the business of such Restricted Subsidiary may be properly and advantageously
conducted at all times.

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     If, at any time, any Restricted Subsidiary would fail to meet the requirements set forth in
the definition of “Qualified Restricted Subsidiary”, it will thereafter cease to be a Qualified
Restricted Subsidiary for purposes of the indenture governing the notes and any Indebtedness of
such Subsidiary will be deemed to be incurred by a Restricted Subsidiary that is not a Qualified
Restricted Subsidiary as of such date and, if such Indebtedness is not permitted to be incurred as
of such date under Section 4.09, the Issuer will be in default of such covenant. The Board of
Directors of the Issuer may at any time designate any Restricted Subsidiary not to be a Qualified
Restricted Subsidiary; provided that such designation will be deemed to be an incurrence of
Indebtedness by such Restricted Subsidiary of any outstanding Indebtedness of such Restricted
Subsidiary, and such designation will only be permitted if (1) such Indebtedness is permitted under
Section 4.09 and (2) no Default or Event of Default would be in existence following such
designation. In the event (x) a Restricted Subsidiary fails to meet the requirements to be a
Qualified Restricted Subsidiary or (y) the Board of Directors designates a Qualified Restricted
Subsidiary not to be a Restricted Subsidiary, then all Investments in such Subsidiary since the
Issue Date shall be deemed to have been acquired and consequently reduce the amount available for
Restricted Payments under Section 4.07 or the amount available for Restricted Investments under
clause (15) or (18) of the definition of “Permitted Investments” as determined by the Issuer.

ARTICLE 5.

SUCCESSORS

SECTION 5.01 Merger, Consolidation, or Sale of Assets.

     (a) The Issuer shall not, directly or indirectly: consolidate or merge with or into another
Person (whether or not the Issuer is the surviving corporation); or sell, assign, transfer, convey
or otherwise dispose of all or substantially all of the properties or assets of the Issuer and its
Restricted Subsidiaries taken as a whole, in one or more related transactions, to another Person,
unless:

     (1) either:

     (A) the Issuer is the surviving entity; or

     (B) the Person formed by or surviving any such consolidation or merger (if
other than the Issuer) or to which such sale, assignment, transfer, conveyance or
other disposition has been made is an entity organized or existing under the laws of
the United States, any state of the United States or the District of Columbia;

     (2) the Person formed by or surviving any such consolidation or merger (if other than
the Issuer) or the Person to which such sale, assignment, transfer, conveyance or other
disposition has been made assumes all the obligations of the Issuer under the Notes, this
Indenture and the Registration Rights Agreement pursuant to agreements reasonably
satisfactory to the Trustee; provided, however, that at all times, a corporation organized
and existing under the laws of the United States of America, any State thereof or the
District of Columbia must be a co-issuer or the issuer of the Notes if such surviving Person
is not a corporation;

     (3) immediately after such transaction, no Default or Event of Default exists; and

     (4) the Issuer or the Person formed by or surviving any such consolidation or merger
(if other than the Issuer), or to which such sale, assignment, transfer, conveyance or other
disposition has been made would, on the date of such transaction after giving pro forma
effect thereto

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and any related financing transactions as if the same had occurred at the beginning of
the applicable four-quarter period:

     (A) be permitted to incur at least $1.00 of additional Indebtedness pursuant to
the Fixed Charge Coverage Ratio test set forth in Section 4.09(a) or

     (B) have a Fixed Charge Coverage Ratio that is greater than the actual Fixed
Charge Coverage Ratio of the Issuer immediately prior to such transaction.

     In addition, the Issuer shall not, directly or indirectly, lease all or substantially all of
the properties and assets of it and its Restricted Subsidiaries taken as a whole, in one or more
related transactions, to any other Person.

     (b) Clauses (3) and (4) of Section 5.01(a) shall not apply to:

     (1) a merger of the Issuer with an Affiliate solely for the purpose of reincorporating
the Issuer in another jurisdiction;

     (2) any consolidation or merger, or any sale, assignment, transfer, conveyance, lease
or other disposition of assets between or among the Issuer and its Restricted Subsidiaries;
and

     (3) transfers of accounts receivable and related assets of the type specified in the
definition of Qualified Receivables Transaction (or a fractional undivided interest therein)
by a Receivables Subsidiary in a Qualified Receivables Transaction.

SECTION 5.02 Successor Corporation Substituted.

     Upon any consolidation or merger, or any sale, assignment, transfer, lease, conveyance or
other disposition of all or substantially all of the assets of the Issuer in a transaction that is
subject to, and that complies with the provisions of, Section 5.01, the successor Person formed by
such consolidation or into or with which the Issuer is merged or to which such sale, assignment,
transfer, lease, conveyance or other disposition is made shall succeed to, and be substituted for
(so that from and after the date of such consolidation, merger, sale, assignment, transfer, lease,
conveyance or other disposition, the provisions of this Indenture referring to the “Issuer” shall
refer instead to the successor Person and not to the Issuer), and may exercise every right and
power of the Issuer under this Indenture with the same effect as if such successor Person had been
named as the Issuer herein, and when a successor Person assumes all obligations of its predecessor
under this Indenture or the Notes, the predecessor shall be released from those obligations;
provided, however, that in the case of a transfer by lease, the predecessor shall not be released
from those obligations.

ARTICLE 6.

DEFAULTS AND REMEDIES

SECTION 6.01 Events of Default.

     Each of the following is an “Event of Default”:

     (1) default for 30 days in the payment when due of interest on, or Additional Interest,
if any, with respect to, the Notes, whether or not prohibited by the subordination
provisions of this Indenture;

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     (2) default in the payment when due (at maturity, upon redemption or otherwise) of the
principal of, or premium, if any, on, the Notes, whether or not prohibited by the
subordination provisions of this Indenture;

     (3) failure by the Issuer or any of its Restricted Subsidiaries to comply with the
provisions of Section 5.01 hereof;

     (4) failure by the Issuer or any of its Restricted Subsidiaries for 60 days after
notice to the Issuer by the Trustee or the Holders of at least 25% in aggregate principal
amount of the Notes then outstanding voting as a single class to comply with any of the
other agreements in this Indenture;

     (5) default under any mortgage, indenture or instrument under which there may be issued
or by which there may be secured or evidenced any Indebtedness for money borrowed by the
Issuer or any of its Significant Subsidiaries (or the payment of which is guaranteed by the
Issuer or any of its Significant Subsidiaries), whether such Indebtedness or Guarantee now
exists, or is created after the Issue Date, if that default:

     (A) is caused by a failure to pay principal at the final Stated Maturity of
such Indebtedness (a “Payment Default”); or

     (B) results in the acceleration of such Indebtedness prior to its express
maturity;

and, in each case, the principal amount of such Indebtedness, together with the principal
amount of any other such Indebtedness under which there has been a Payment Default or the
maturity of which has been so accelerated, aggregates $20.0 million or more;

     (6) with respect to any judgment or decree for the payment of money (net of any amount
covered by insurance issued by a reputable and creditworthy insurer that has not contested
coverage or reserved rights with respect to an underlying claim) in excess of $20.0 million
or its foreign currency equivalent against the Issuer or any Significant Subsidiary of the
Issuer, the failure by the Issuer or such Significant Subsidiary, as applicable, to pay such
judgment or decree, which judgment or decree has remained outstanding for a period of 60
days after such judgment or decree became final and nonappealable without being paid,
discharged, waived or stayed;

     (7) except as permitted by this Indenture, any Subsidiary Guarantee of any Significant
Subsidiary is declared to be unenforceable or invalid by any final and nonappealable
judgment or decree or ceases for any reason to be in full force and effect, or any Guarantor
that is a Significant Subsidiary or any Person acting on behalf of any Guarantor that is a
Significant Subsidiary denies or disaffirms its obligations in writing under its Subsidiary
Guarantee and such Default continues for 10 days after notice thereof is delivered to the
Issuer by the Trustee or the Holders of at least 25% in aggregate principal amount of the
Notes then outstanding voting as a single class;

     (8) the Issuer or any of the Restricted Subsidiaries that is a Significant Subsidiary
pursuant to or within the meaning of Bankruptcy Law:

     (A) commences a voluntary case,

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     (B) consents to the entry of an order for relief against it in an involuntary
case,

     (C) consents to the appointment of a custodian of it or for all or
substantially all of its property,

     (D) makes a general assignment for the benefit of its creditors, or

     (E) generally is not paying its debts as they become due; and

     (9) a court of competent jurisdiction enters an order or decree under any Bankruptcy
Law that:

     (A) is for relief against the Issuer or any of the Issuer’s Restricted
Subsidiaries that is a Significant Subsidiary in an involuntary case;

     (B) appoints a custodian of the Issuer or any of the Issuer’s Restricted
Subsidiaries that is a Significant Subsidiary for all or substantially all of the
property of the Issuer or any of the Issuer’s Restricted Subsidiaries that is a
Significant Subsidiary; or

     (C) orders the liquidation of the Issuer or any of the Issuer’s Restricted
Subsidiaries that is a Significant Subsidiary;

and the order or decree remains unstayed and in effect for 60 consecutive days.

SECTION 6.02 Acceleration.

     In the case of an Event of Default arising under clause (8) or (9) of Section 6.01, all
outstanding Notes shall become due and payable immediately without further action or notice. If
any other Event of Default occurs and is continuing, the Trustee or the Holders of at least 25% in
aggregate principal amount of the then outstanding Notes may declare all the Notes to be due and
payable immediately; provided that so long as any Indebtedness permitted to be incurred pursuant to
the Credit Agreement is outstanding, such acceleration shall not be effective until the earlier of
(i) the acceleration of such Indebtedness under the Credit Agreement or (ii) five Business Days
after receipt by the Issuer and the representative under the Credit Agreement of written notice of
such acceleration.

     Upon any such declaration, the Notes shall become due and payable immediately. The Holders of
a majority in aggregate principal amount of the then outstanding Notes by written notice to the
Trustee may, on behalf of all of the Holders, rescind an acceleration or waive any existing Default
or Event of Default and its consequences under this Indenture except a continuing Default or Event
of Default in the payment of interest or premium or Additional Interest, if any, on, or the
principal of, the Notes.

SECTION 6.03 Other Remedies.

     If an Event of Default occurs and is continuing, the Trustee may pursue any available remedy
to collect the payment of principal, premium and Additional Interest, if any, and interest on the
Notes or to enforce the performance of any provision of the Notes or this Indenture.

     The Trustee may maintain a proceeding even if it does not possess any of the Notes or does not
produce any of them in the proceeding. A delay or omission by the Trustee or any Holder of a Note
in exercising any right or remedy accruing upon an Event of Default shall not impair the right or
remedy or

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constitute a waiver of or acquiescence in the Event of Default. All remedies are cumulative
to the extent permitted by law.

SECTION 6.04 Waiver of Past Defaults.

     Holders of a majority in aggregate principal amount of the then outstanding Notes by notice to
the Trustee may on behalf of the Holders of all of the Notes waive an existing Default or Event of
Default and its consequences hereunder, except a continuing Default or Event of Default in the
payment of the principal of, premium and Additional Interest, if any, or interest on, the Notes
(including in connection with an offer to purchase); provided, however, that the Holders of a
majority in aggregate principal amount of the then outstanding Notes may rescind an acceleration
and its consequences, including any related payment default that resulted from such acceleration.
Upon any such waiver, such Default shall cease to exist, and any Event of Default arising therefrom
shall be deemed to have been cured for every purpose of this Indenture; but no such waiver shall
extend to any subsequent or other Default or impair any right consequent thereon. In case of any
such waiver, the Issuer, the Trustee and the Holders shall be restored to their former positions
and rights hereunder and under the Notes, respectively.

SECTION 6.05 Control by Majority.

     Holders of a majority in principal amount of the then outstanding Notes may direct the time,
method and place of conducting any proceeding for exercising any remedy available to the Trustee or
exercising any trust or power conferred on it. However, the Trustee may refuse to follow any
direction that conflicts with law or this Indenture that the Trustee determines may be unduly
prejudicial to the rights of other Holders or that may involve the Trustee in personal liability.
Prior to taking any action under this Indenture, the Trustee shall be entitled to reasonable
indemnification against all losses and expenses caused by taking or not taking such action.

SECTION 6.06 Limitation on Suits.

     A Holder may pursue a remedy with respect to this Indenture or the Notes only if:

     (1) such Holder has previously given the Trustee notice that an Event of Default is
continuing;

     (2) Holders of at least 25% in aggregate principal amount of the then outstanding Notes
have requested the Trustee to pursue the remedy;

     (3) such Holders have offered the Trustee reasonable security or indemnity reasonably
satisfactory to it against any loss, liability or expense;

     (4) the Trustee has not complied with such request within 60 days after the receipt of
the request and the offer of security or indemnity; and

     (5) Holders of a majority in aggregate principal amount of the then outstanding Notes
have not given the Trustee a direction inconsistent with such request within such 60-day
period.

SECTION 6.07 Rights of Holders To Receive Payment.

     Notwithstanding any other provision of this Indenture, the right of any Holder of a Note to
receive payment of principal, premium and Additional Interest, if any, and interest on the Note, on
or after

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the respective due dates expressed in the Note (including in connection with an offer to
purchase), or to bring suit for the enforcement of any such payment on or after such respective
dates, shall not be impaired or affected without the consent of such Holder.

SECTION 6.08 Collection Suit by Trustee.

     If an Event of Default specified in clauses (1) or (2) of Section 6.01 or occurs and is
continuing, the Trustee is authorized to recover judgment in its own name and as trustee of an
express trust against the Issuer and each Guarantor for the whole amount of principal of, premium
and Additional Interest, if any, and interest remaining unpaid on the Notes and interest on overdue
principal and, to the extent lawful, interest and such further amount as shall be sufficient to
cover the costs and expenses of collection, including the reasonable compensation, expenses,
disbursements and advances of the Trustee, its agents and counsel.

SECTION 6.09 Trustee May File Proofs of Claim.

     The Trustee is authorized to file such proofs of claim and other papers or documents as may be
necessary or advisable in order to have the claims of the Trustee (including any claim for the
reasonable compensation, expenses, disbursements and advances of the Trustee, its agents and
counsel) and the Holders of the Notes allowed in any judicial proceedings relative to the Issuer
(or any other obligor upon the Notes), its creditors or its property and shall be entitled and
empowered to collect, receive and distribute any money or other property payable or deliverable on
any such claims and any custodian in any such judicial proceeding is hereby authorized by each
Holder to make such payments to the Trustee, and in the event that the Trustee shall consent to the
making of such payments directly to the Holders, to pay to the Trustee any amount due to it for the
reasonable compensation, expenses, disbursements and advances of the Trustee, its agents and
counsel, and any other amounts due to the Trustee under Section 7.07. Nothing herein contained
shall be deemed to authorize the Trustee to authorize or consent to or accept or adopt on behalf of
any Holder any plan of reorganization, arrangement, adjustment or composition affecting the Notes
or the rights of any Holder, or to authorize the Trustee to vote in respect of the claim of any
Holder in any such proceeding. The Trustee may participate as a member of any official committee
of creditors appointed in the matters as it deems necessary or advisable.

SECTION 6.10 Priorities.

     If the Trustee collects any money pursuant to this Article 6, it shall pay out the money in
the following order:

     First: to the Trustee, its agents and attorneys for amounts due under Section 7.07,
including payment of all compensation, expenses and liabilities incurred, and all advances
made, by the Trustee and the costs and expenses of collection;

     Second: to Holders for amounts due and unpaid on the Notes for principal, premium and
Additional Interest, if any, and interest, ratably, without preference or priority of any
kind, according to the amounts due and payable on the Notes for principal, premium and
Additional Interest, if any, and interest, respectively; and

     Third: to the Issuer or to such party as a court of competent jurisdiction shall
direct.

     The Trustee may fix a record date and payment date for any payment to Holders pursuant to this
Section 6.10.

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SECTION 6.11 Undertaking for Costs.

     In any suit for the enforcement of any right or remedy under this Indenture or in any suit
against the Trustee for any action taken or omitted by it as a Trustee, a court in its discretion
may require the filing by any party litigant in the suit of an undertaking to pay the costs of the
suit, and the court in its discretion may assess reasonable costs, including reasonable attorneys’
fees and expenses, against any party litigant in the suit, having due regard to the merits and good
faith of the claims or defenses made by the party litigant. This Section 6.11 does not apply to a
suit by the Trustee, a suit by a Holder of a Note pursuant to Section 6.07, or a suit by Holders of
more than 10% in principal amount of the then outstanding Notes.

ARTICLE 7.

TRUSTEE

SECTION 7.01 Duties of Trustee.

     (a) If an Event of Default has occurred and is continuing, the Trustee shall exercise such of
the rights and powers vested in it by this Indenture, and use the same degree of care and skill in
its exercise, as a prudent person would exercise or use under the circumstances in the conduct of
such person’s own affairs.

     (b) Except during the continuance of an Event of Default:

     (1) the duties of the Trustee shall be determined solely by the express provisions of
this Indenture and the Trustee need perform only those duties that are specifically set
forth in this Indenture and no others, and no implied covenants or obligations shall be read
into this Indenture against the Trustee; and

     (2) in the absence of bad faith on its part, the Trustee may conclusively rely, as to
the truth of the statements and the correctness of the opinions expressed therein, upon
certificates or opinions furnished to the Trustee and conforming to the requirements of this
Indenture. However, in the case of certificates or opinions specifically required by any
provision hereof to be furnished to it, the Trustee shall examine the certificates and
opinions to determine whether or not they conform to the requirements of this Indenture.

     (c) The Trustee may not be relieved from liabilities for its own negligent action, its own
negligent failure to act, or its own willful misconduct, except that:

     (1) this paragraph does not limit the effect of paragraph of this Section 7.01;

     (2) the Trustee shall not be liable for any error of judgment made in good faith by a
Responsible Officer, unless it is proved that the Trustee was negligent in ascertaining the
pertinent facts; and

     (3) the Trustee shall not be liable with respect to any action it takes or omits to
take in good faith in accordance with a direction received by it pursuant to Section 6.05
hereof.

     (d) Whether or not therein expressly so provided, every provision of this Indenture that in
any way relates to the Trustee is subject to paragraphs (a) and (b) of this Section 7.01.

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     (e) No provision of this Indenture shall require the Trustee to expend or risk its own funds
or incur any liability if it shall have reasonable grounds to believe that repayment of such funds
or adequate indemnity against such risk or liability is not reasonably assured to it.

     (f) The Trustee shall not be liable for interest on any money received by it except as the
Trustee may agree in writing with the Issuer. Money held in trust by the Trustee need not be
segregated from other funds except to the extent required by law.

     (g) In the absence of bad faith, negligence or willful misconduct on the part of the Trustee,
the Trustee shall not be responsible for the application of any money by any Paying Agent other
than the Trustee.

SECTION 7.02 Rights of Trustee.

     (a) The Trustee may conclusively rely upon any document believed by it to be genuine and to
have been signed or presented by the proper Person. The Trustee need not investigate any fact or
matter stated in the document.

     (b) Before the Trustee acts or refrains from acting, it may require an Officer’s Certificate
or an Opinion of Counsel or both. The Trustee shall not be liable for any action it takes or omits
to take in good faith in reliance on such Officer’s Certificate or Opinion of Counsel. The Trustee
may consult with counsel of its own selection and the written advice of such counsel or any Opinion
of Counsel shall be full and complete authorization and protection from liability in respect of any
action taken, suffered or omitted by it hereunder in good faith and in reliance thereon.

     (c) The Trustee may act through its attorneys and agents and shall not be responsible for the
misconduct or negligence of any agent appointed with due care.

     (d) The Trustee shall not be liable for any action it takes or omits to take in good faith
that it believes to be authorized or within the rights or powers conferred upon it by this
Indenture provided, however, that the Trustee’s conduct does not constitute willful misconduct, bad
faith or negligence.

     (e) Unless otherwise specifically provided in this Indenture, any demand, request, direction
or notice from the Issuer shall be sufficient if signed by an Officer of the Issuer.

     (f) The Trustee shall be under no obligation to exercise any of the rights or powers vested in
it by this Indenture at the request or direction of any of the Holders unless such Holders have
offered to the Trustee security or indemnity reasonably satisfactory to it against the costs,
expenses and liabilities that might be incurred by it in compliance with such request or direction.

     (g) Except with respect to Section 4.01, the Trustee shall have no duty to inquire as to the
performance of the Issuer with respect to the covenants contained in Article 4. In addition, the
Trustee shall not be deemed to have knowledge of an Event of Default except (i) any Default or
Event of Default occurring pursuant to Sections 4.01, 6.01(1) or 6.01(2) or (ii) any Default or
Event of Default of which the Trustee shall have received written notification or obtained actual
knowledge.

     (h) The rights, privileges, protections, immunities and benefits given to the Trustee,
including, without limitation, its right to be indemnified, are extended to, and shall be
enforceable by, the Trustee in each of its capacities hereunder.

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     (i) The Trustee may request that the Issuer deliver an Officer’s Certificate setting forth the
names of individuals and/or titles of officers authorized at such time to take specified actions
pursuant to this Indenture, which Officer’s Certificate may be signed by any person authorized to
sign an Officer’s Certificate, including any person specified as so authorized in any such
certificate previously delivered and not superseded.

     (j) The Trustee shall not be bound to make any investigation into the facts or matters stated
in any resolution, certificate (including any Officers’ Certificate), statement, instrument,
opinion (including any Opinion of Counsel), notice, request, direction, consent, order, bond,
debenture, or other paper or document.

     (k) The Trustee shall not be required to give any bond or surety in respect of the performance
of its powers and duties hereunder.

     (l) The permissive rights of the trustee to do things enumerated in this Indenture shall not
be construed as duties.

SECTION 7.03 Individual Rights of Trustee.

     The Trustee in its individual or any other capacity may become the owner or pledgee of Notes
and may otherwise deal with the Issuer or any Affiliate of the Issuer with the same rights it would
have if it were not Trustee. However, in the event that the Trustee acquires any conflicting
interest it must eliminate such conflict within 90 days, apply to the SEC for permission to
continue as Trustee (if this Indenture has been qualified under the TIA) or resign. Any Agent may
do the same with like rights and duties. The Trustee is also subject to Sections 7.10 and 7.11
hereof.

SECTION 7.04 Trustee’s Disclaimer.

     The Trustee shall not be responsible for and makes no representation as to the validity or
adequacy of this Indenture or the Notes, it shall not be accountable for the Issuer’s use of the
proceeds from the Notes or any money paid to the Issuer or upon the Issuer’s direction under any
provision of this Indenture, it shall not be responsible for the use or application of any money
received by any Paying Agent other than the Trustee, and it shall not be responsible for any
statement or recital herein or any statement in the Notes or any other document in connection with
the sale of the Notes or pursuant to this Indenture other than its certificate of authentication.

SECTION 7.05 Notice of Defaults.

     If a Default or Event of Default occurs and is continuing and if it is known to the Trustee,
the Trustee shall mail to Holders a notice of the Default or Event of Default within 90 days after
it occurs. Except in the case of a Default or Event of Default in payment of principal of, premium
or Additional Interest, if any, or interest on, any Note, the Trustee may withhold the notice if
and so long as a committee of its Responsible Officers in good faith determines that withholding
the notice is in the interests of the Holders of the Notes.

SECTION 7.06 Reports by Trustee to Holders of the Notes.

     (a) Within 60 days after each May 15 beginning with the May 15 following the date of this
Indenture, and for so long as Notes remain outstanding, the Trustee shall mail to the Holders of
the Notes a brief report dated as of such reporting date that complies with TIA Section 313;
provided that if no event described in TIA Section 313 has occurred within the twelve months
preceding such reporting date,

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no report need be transmitted. The Trustee also shall comply with TIA Section 313(b)(2). The
Trustee shall also transmit by mail all reports as required by TIA Section 313(c).

     (b) A copy of each report at the time of its mailing to the Holders shall be mailed by the
Trustee to the Issuer and filed by the Trustee with the SEC and each stock exchange on which the
Notes are listed in accordance with TIA Section 313(d). The Issuer shall promptly notify the
Trustee when the Notes are listed on any stock exchange or delisted therefrom.

SECTION 7.07 Compensation and Indemnity.

     (a) The Issuer shall pay to the Trustee from time to time reasonable compensation as agreed to
between the Issuer and the Trustee for its acceptance of this Indenture and services hereunder.
The Trustee’s compensation shall not be limited by any law on compensation of a trustee of an
express trust. The Issuer shall reimburse the Trustee promptly upon request for all reasonable
disbursements, advances and expenses incurred or made by it in addition to the compensation for its
services. Such expenses shall include the reasonable compensation, disbursements and expenses of
the Trustee’s agents and counsel.

     (b) The Issuer shall indemnify the Trustee against any and all losses, liabilities, claims,
damages or expenses incurred by it arising out of or in connection with the acceptance or
administration of its duties under this Indenture, including the costs and expenses of enforcing
this Indenture against the Issuer and the Guarantors (including this Section 7.07) and defending
itself against any claim (whether asserted by the Issuer, the Guarantors, any Holder or any other
Person) or liability in connection with the exercise or performance of any of its powers or duties
hereunder, except to the extent any such loss, liability or expense shall be determined to have
been caused by its own negligence or willful misconduct. The Trustee shall notify the Issuer
promptly of any claim for which it may seek indemnity. Failure by the Trustee to so notify the
Issuer shall not relieve the Issuer of its obligations hereunder. The Issuer shall defend the
claim and the Trustee shall cooperate in the defense. The Trustee may have separate counsel and
the Issuer shall pay the reasonable fees and expenses of such counsel; provided that the Issuer
shall not be required to pay such fees and expenses if it assumes the Trustee’s defense, and, in
the Trustee’s reasonable judgment, there is no conflict of interest between the Issuer and the
Trustee in connection with such defense. The Issuer shall not be required to pay for any
settlement made without its consent, which consent shall not be unreasonably withheld.

     (c) The obligations of the Issuer under this Section 7.07 shall survive the satisfaction and
discharge of this Indenture.

     (d) To secure the Issuer’s payment obligations in this Section 7.07, the Trustee shall have a
Lien prior to the Notes on all money or property held or collected by the Trustee, except that held
in trust to pay principal and interest on particular Notes. Such Lien shall survive the
satisfaction and discharge of this Indenture.

     (e) When the Trustee incurs expenses or renders services after an Event of Default specified
in Section 6.01(8) or (9) occurs, the expenses and the compensation for the services (including the
fees and expenses of its agents and counsel) are intended to constitute expenses of administration
under any Bankruptcy Law.

     (f) The Trustee shall comply with the provisions of TIA Section 313(b) to the extent
applicable.

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SECTION 7.08 Replacement of Trustee.

     (a) A resignation or removal of the Trustee and appointment of a successor Trustee shall
become effective only upon the successor Trustee’s acceptance of appointment as provided in this
Section 7.08.

     (b) The Trustee may resign in writing at any time and be discharged from the trust hereby
created by so notifying the Issuer. The Holders of a majority in principal amount of the then
outstanding Notes may remove the Trustee by so notifying the Trustee and the Issuer in writing.
The Issuer may remove the Trustee if:

     (1) the Trustee fails to comply with Section 7.10 hereof;

     (2) the Trustee is adjudged bankrupt or insolvent or an order for relief is entered
with respect to the Trustee under any Bankruptcy Law;

     (3) a custodian or public officer takes charge of the Trustee or its property; or

     (4) the Trustee becomes incapable of acting.

     (c) If the Trustee resigns or is removed or if a vacancy exists in the office of the Trustee
for any reason, the Issuer shall promptly appoint a successor Trustee. Within one year after the
successor Trustee takes office, the Holders of a majority in principal amount of the then
outstanding Notes may appoint a successor Trustee to replace the successor Trustee appointed by the
Issuer.

     (d) If a successor Trustee does not take office within 60 days after the retiring Trustee
resigns or is removed, the retiring Trustee, the Issuer, or the Holders of at least 10% in
principal amount of the then outstanding Notes may petition, at the expense of the Issuer, any
court of competent jurisdiction for the appointment of a successor Trustee.

     (e) If the Trustee, after written request by any Holder who has been a Holder for at least six
months, fails to comply with Section 7.10, such Holder may petition any court of competent
jurisdiction for the removal of the Trustee and the appointment of a successor Trustee.

     (f) A successor Trustee shall deliver a written acceptance of its appointment to the retiring
Trustee and to the Issuer. Thereupon, the resignation or removal of the retiring Trustee shall
become effective, and the successor Trustee shall have all the rights, powers and duties of the
Trustee under this Indenture. The successor Trustee shall mail a notice of its succession to the
Holders. The retiring Trustee shall promptly transfer all property held by it as Trustee to the
successor Trustee, provided all sums owing to the Trustee hereunder have been paid and subject to
the Lien provided for in Section 7.07. Notwithstanding replacement of the Trustee pursuant to this
Section 7.08, the Issuer’s obligations under Section 7.07 shall continue for the benefit of the
retiring Trustee.

SECTION 7.09 Successor Trustee by Merger, etc.

     If the Trustee consolidates, merges or converts into, or transfers all or substantially all of
its corporate trust business to, another corporation, the successor corporation without any further
act shall be the successor Trustee.

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SECTION 7.10 Eligibility; Disqualification.

     There shall at all times be a Trustee hereunder that is a corporation organized and doing
business under the laws of the United States of America or of any state thereof that is authorized
under such laws to exercise corporate trustee power, that is subject to supervision or examination
by federal or state authorities and that together with its affiliates has a combined capital and
surplus of at least $100.0 million as set forth in its most recent published annual report of
condition.

     This Indenture shall always have a Trustee who satisfies the requirements of TIA Sections
310(a)(1), (2) and (5). The Trustee is subject to TIA Section 310(b).

SECTION 7.11 Preferential Collection of Claims Against Issuer.

     The Trustee is subject to TIA Section 311(a), excluding any creditor relationship listed in
TIA Section 311(b). A Trustee who has resigned or been removed shall be subject to TIA Section 311
to the extent indicated therein.

ARTICLE 8.

LEGAL DEFEASANCE AND COVENANT DEFEASANCE

SECTION 8.01 Option To Effect Legal Defeasance or Covenant Defeasance.

     The Issuer may, at any time, elect to have either Section 8.02 or 8.03 be applied to all
outstanding Notes and all obligations of the Guarantors with respect to the Subsidiary Guarantees
upon compliance with the conditions set forth below in this Article 8.

SECTION 8.02 Legal Defeasance and Discharge.

     Upon the Issuer’s exercise under Section 8.01 of the option applicable to this Section 8.02,
the Issuer and each of the Guarantors shall, subject to the satisfaction of the conditions set
forth in Section 8.04, be deemed to have been discharged from their obligations with respect to all
outstanding Notes (including the Subsidiary Guarantees) on the date the conditions set forth in
Section 8.04 are satisfied (hereinafter, “Legal Defeasance”). For this purpose, Legal Defeasance
means that the Issuer and the Guarantors shall be deemed to have paid and discharged the entire
Indebtedness represented by the outstanding Notes (including the Subsidiary Guarantees), which
shall thereafter be deemed to be “outstanding” only for the purposes of Section 8.05 and the other
Sections of this Indenture referred to in clauses (1) and (2) below, and to have satisfied all
their other obligations under such Notes, the Subsidiary Guarantees and this Indenture (and the
Trustee, on demand of and at the expense of the Issuer, shall execute proper instruments
acknowledging the same), except for the following provisions which shall survive until otherwise
terminated or discharged hereunder:

     (1) the rights of Holders of outstanding Notes to receive payments in respect of the
principal of, or interest or premium and Additional Interest, if any, on such Notes when
such payments are due from the trust referred to in Section 8.04 hereof;

     (2) the Issuer’s obligations with respect to such Notes under Sections 2.05, 2.06,
2.07, 2.08 and 4.02 hereof;

     (3) the rights, powers, trusts, duties and immunities of the Trustee hereunder and the
Issuer’s and the Guarantors’ obligations in connection therewith; and

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     (4) this Article 8.

     Subject to compliance with this Section 8.02, the Issuer may exercise its option under this
Section 8.02 notwithstanding the prior exercise of its option under Section 8.03 hereof.

SECTION 8.03 Covenant Defeasance.

     Upon the Issuer’s exercise under Section 8.01 of the option applicable to this Section 8.03,
the Issuer and the Guarantors shall, subject to the satisfaction of the conditions set forth in
Section 8.04, be released from each of their obligations under Sections 4.03, 4.07, 4.08, 4.09,
4.10, 4.11, 4.12, 4.13, 4.15, 4.16, 4.17, 4.18 and 4.19 and Section 5.01(a) with respect to the
outstanding Notes on and after the date the conditions set forth in Section 8.04 are satisfied
(hereinafter, “Covenant Defeasance”), and the Notes shall thereafter be deemed not “outstanding”
for the purposes of any direction, waiver, consent or declaration or act of Holders (and the
consequences of any thereof) in connection with such covenants, but shall continue to be deemed
“outstanding” for all other purposes hereunder (it being understood that such Notes shall not be
deemed outstanding for accounting purposes). For this purpose, Covenant Defeasance means that,
with respect to the outstanding Notes and the Subsidiary Guarantees, the Issuer and the Guarantors
may omit to comply with and shall have no liability in respect of any term, condition or limitation
set forth in any such covenant, whether directly or indirectly, by reason of any reference
elsewhere herein to any such covenant or by reason of any reference in any such covenant to any
other provision herein or in any other document and such omission to comply shall not constitute a
Default or an Event of Default under Section 6.01, but, except as specified above, the remainder of
this Indenture and such Notes and Subsidiary Guarantees shall be unaffected thereby. In addition,
upon the Issuer’s exercise under Section 8.01 of the option applicable to this Section 8.03 subject
to the satisfaction of the conditions set forth in Section 8.04, Sections 6.01(4) through 6.01(7)
and, to the extent relating to a Significant Subsidiary, 6.01(8) and 6.01(9) shall not constitute
Events of Default.

SECTION 8.04 Conditions to Legal or Covenant Defeasance.

     In order to exercise either Legal Defeasance or Covenant Defeasance under either Section 8.02
or 8.03 hereof:

     (1) the Issuer must irrevocably deposit with the Trustee, in trust, for the benefit of
the Holders of the Notes, cash in U.S. dollars, non-callable Government Securities, or a
combination of cash in U.S. dollars and non-callable Government Securities, in amounts as
shall be sufficient, in the opinion of a nationally recognized investment bank, appraisal
firm or firm of independent public accountants, to pay the principal of, or interest and
premium and Additional Interest, if any, on, the outstanding Notes on the stated date for
payment thereof or on the applicable redemption date, as the case may be, and the Issuer
must specify whether the Notes are being defeased to such stated date for payment or to a
particular redemption date;

     (2) in the case of Legal Defeasance, the Issuer must deliver to the Trustee an Opinion
of Counsel reasonably acceptable to the Trustee confirming that the Issuer has received
from, or there has been published by, the Internal Revenue Service a ruling or since the
Issue Date, there has been a change in the applicable federal income tax law, in either case
to the effect that, and based thereon such Opinion of Counsel shall confirm that, the
Holders of the outstanding Notes shall not recognize income, gain or loss for federal income
tax purposes as a result of such Legal Defeasance and shall be subject to federal income tax
on the same amounts, in the same manner and at the same times as would have been the case if
such Legal Defeasance had not occurred;

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     (3) in the case of Covenant Defeasance, the Issuer must deliver to the Trustee an
Opinion of Counsel reasonably acceptable to the Trustee confirming that the Holders of the
outstanding Notes shall not recognize income, gain or loss for federal income tax purposes
as a result of such Covenant Defeasance and shall be subject to federal income tax on the
same amounts, in the same manner and at the same times as would have been the case if such
Covenant Defeasance had not occurred;

     (4) such Legal Defeasance or Covenant Defeasance shall not result in a breach or
violation of, or constitute a default under, any material agreement (including, without
limitation, the Credit Agreement) or instrument (other than this Indenture) to which the
Issuer or any of its Subsidiaries is a party or by which the Issuer or any of its
Subsidiaries is bound;

     (5) the Issuer must deliver to the Trustee an Officer’s Certificate stating that the
deposit was not made by the Issuer with the intent of preferring the Holders over the other
creditors of the Issuer with the intent of defeating, hindering, delaying or defrauding any
creditors of the Issuer or others; and

     (6) the Issuer must deliver to the Trustee an Officer’s Certificate and an Opinion of
Counsel, each stating that all conditions precedent relating to the Legal Defeasance or the
Covenant Defeasance have been complied with.

SECTION
8.05 Deposited Money and Government Securities To Be Held in
Trust;

Other Miscellaneous Provisions.

     Subject to Section 8.06, all money and non-callable Government Securities (including the
proceeds thereof) deposited with the Trustee (or other qualifying trustee, collectively for
purposes of this Section 8.05, the “Trustee”) pursuant to Section 8.04 in respect of the
outstanding Notes shall be held in trust and applied by the Trustee, in accordance with the
provisions of such Notes and this Indenture, to the payment, either directly or through any Paying
Agent (including the Issuer acting as Paying Agent) as the Trustee may determine, to the Holders of
such Notes of all sums due and to become due thereon in respect of principal, premium and
Additional Interest, if any, and interest, but such money need not be segregated from other funds
except to the extent required by law.

     The Issuer shall pay and indemnify the Trustee against any tax, fee or other charge imposed on
or assessed against the cash or non-callable Government Securities deposited pursuant to Section
8.04 or the principal and interest received in respect thereof other than any such tax, fee or
other charge which by law is for the account of the Holders of the outstanding Notes.

     Notwithstanding anything in this Article 8 to the contrary, the Trustee shall deliver or pay
to the Issuer from time to time upon the request of the Issuer any money or non-callable Government
Securities held by it as provided in Section 8.04 which, in the opinion of a nationally recognized
firm of independent public accountants expressed in a written certification thereof delivered to
the Trustee (which may be the opinion delivered under Section 8.04 hereof), are in excess of the
amount thereof that would then be required to be deposited to effect an equivalent Legal Defeasance
or Covenant Defeasance.

SECTION 8.06 Repayment to Issuer.

     Any money deposited with the Trustee or any Paying Agent, or then held by the Issuer, in trust
for the payment of the principal of, premium or Additional Interest, if any, or interest on any
Note and remaining unclaimed for two years after such principal, premium or Additional Interest, if
any, or interest has become due and payable shall be paid to the Issuer on its request or (if then
held by the Issuer) shall

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be discharged from such trust; and the Holder of such Note shall thereafter be permitted to
look only to the Issuer for payment thereof, and all liability of the Trustee or such Paying Agent
with respect to such trust money, and all liability of the Issuer as trustee thereof, shall
thereupon cease; provided, however, that the Trustee or such Paying Agent, before being required to
make any such repayment, may at the expense of the Issuer cause to be published once, in The New
York Times and The Wall Street Journal (national edition), notice that such money remains unclaimed
and that, after a date specified therein, which shall not be less than 30 days from the date of
such notification or publication, any unclaimed balance of such money then remaining shall be
repaid to the Issuer.

SECTION 8.07 Reinstatement.

     If the Trustee or Paying Agent is unable to apply any United States dollars or non-callable
Government Securities in accordance with Section 8.02 or 8.03, as the case may be, by reason of any
order or judgment of any court or governmental authority enjoining, restraining or otherwise
prohibiting such application, then the Issuer’s and the Guarantors’ obligations under this
Indenture and the Notes and the Subsidiary Guarantees shall be revived and reinstated as though no
deposit had occurred pursuant to Section 8.02 or 8.03 until such time as the Trustee or Paying
Agent is permitted to apply all such money in accordance with Section 8.02 or 8.03, as the case may
be; provided, however, that, if the Issuer makes any payment of principal of, premium or Additional
Interest, if any, or interest on any Note following the reinstatement of their obligations, the
Issuer shall be subrogated to the rights of the Holders of such Notes to receive such payment from
the cash or Government Securities held by the Trustee or Paying Agent.

ARTICLE 9.

AMENDMENT, SUPPLEMENT AND WAIVER

SECTION 9.01 Without Consent of Holders.

     (a) Notwithstanding Section 9.02 of this Indenture, the Issuer and the Trustee may amend or
supplement this Indenture, the Subsidiary Guarantees or the Notes without the consent of any Holder
of a Note:

     (1) to cure any ambiguity, defect or inconsistency;

     (2) to provide for uncertificated Notes in addition to or in place of certificated
Notes;

     (3) to provide for the assumption of the Issuer’s or a Guarantor’s obligations to the
Holders and Subsidiary Guarantees by a successor to the Issuer pursuant to Article 5 or
Section 11.05, respectively, hereof;

     (4) to make any change that would provide any additional rights or benefits to the
Holders or that does not adversely affect the legal rights hereunder of any Holder;

     (5) to comply with requirements of the SEC in order to effect or maintain the
qualification of this Indenture under the TIA;

     (6) to conform the text of this Indenture, the Subsidiary Guarantees or the Notes to
any provision of the “Description of Notes” section of the Offering Memorandum to the extent
that such provision in that “Description of Notes” section was intended to be a verbatim
recitation of a provision of this Indenture, the Subsidiary Guarantees or the Notes;

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     (7) to provide for the issuance of Additional Notes in accordance with the limitations
set forth in this Indenture as of the Issue Date;

     (8) to allow any Guarantor to execute a supplemental indenture and/or a Subsidiary
Guarantee with respect to the Notes, or to secure the Notes; or

     (9) to issue the additional notes in accordance with the terms herein.

     (b) Upon the request of the Issuer accompanied by a resolution of its Board of Directors
authorizing the execution of any such amended or supplemental indenture, and upon receipt by the
Trustee of the documents described in Section 7.02, the Trustee shall join with the Issuer in the
execution of any amended or supplemental indenture authorized or permitted by the terms of this
Indenture and to make any further appropriate agreements and stipulations that may be therein
contained, but the Trustee shall not be obligated to enter into such amended or supplemental
indenture that affects its own rights, duties or immunities under this Indenture or otherwise.

SECTION 9.02 With Consent of Holders.

     (a) Except as provided below in this Section 9.02, the Issuer and the Trustee may amend or
supplement this Indenture (including, without limitation, Section 3.09, 4.10 and 4.15 hereof), the
Subsidiary Guarantees and the Notes with the consent of the Holders of at least a majority in
aggregate principal amount of the Notes (including, without limitation, consents obtained in
connection with a tender offer or exchange offer for, or purchase of, the Notes); provided,
however, that if any amendment, waiver or other modification will affect only the Cash Pay Notes or
Toggle Notes, only the consent of the holders of at least a majority in principal amount of the
then outstanding Cash Pay Notes or Toggle Notes (and not the consent of at least a majority of all
Notes), as the case may be, shall be required and, subject to Sections 6.04 and 6.07, any existing
Default or Event of Default (other than a Default or Event of Default in the payment of the
principal of, premium or Additional Interest, if any, or interest on the Notes, except a payment
default resulting from an acceleration that has been rescinded) or compliance with any provision of
this Indenture, the Subsidiary Guarantees or the Notes may be waived with the consent of the
Holders of a majority in aggregate principal amount of the then outstanding Notes (including
consents obtained in connection with a tender offer or exchange offer for, or purchase of, the
Notes).

     (b) Upon the request of the Issuer accompanied by a resolution of its Board of Directors
authorizing the execution of any such amended or supplemental indenture, and upon the filing with
the Trustee of evidence satisfactory to the Trustee of the consent of the Holders as aforesaid, and
upon receipt by the Trustee of the documents described in Section 7.02, the Trustee shall join with
the Issuer in the execution of such amended or supplemental indenture unless such amended or
supplemental indenture directly affects the Trustee’s own rights, duties or immunities under this
Indenture or otherwise, in which case the Trustee may in its discretion, but shall not be obligated
to, enter into such amended or supplemental indenture.

     (c) It is not be necessary for the consent of the Holders under this Section 9.02 to approve
the particular form of any proposed amendment or waiver, but it is sufficient if such consent
approves the substance thereof.

     (d) After an amendment, supplement or waiver under this Section 9.02 becomes effective, the
Issuer shall mail to the Holders affected thereby a notice briefly describing the amendment,
supplement or waiver. Any failure of the Issuer to mail such notice, or any defect therein, shall
not, however, in any way impair or affect the validity of any such amended or supplemental
indenture or waiver. Subject to Sections 6.04 and 6.07, the Holders of a majority in aggregate
principal amount of the Notes then outstanding,

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voting as a single class, may waive compliance in a particular instance by the
Issuer and the Guarantors with any provision of this Indenture, the Notes, or the Subsidiary
Guarantees. However, without the consent of each Holder affected, an amendment, supplement or
waiver under this Section 9.02 may not (with respect to any Notes held by a non-consenting Holder):

     (1) reduce the principal amount of Notes whose Holders must consent to an amendment,
supplement or waiver;

     (2) reduce the principal of or change the fixed maturity of any Note or alter the
provisions with respect to the optional redemption of the Notes contained in Section 5 of
the Notes (except the notice period contained therein or in Sections 3.01, 3.02 and 3.03);

     (3) reduce the rate of or change the time for payment of interest, including default
interest, on any Note;

     (4) waive a Default or Event of Default in the payment of principal of, or interest or
premium, or Additional Interest, if any, on, the Notes (except a rescission of acceleration
of the Notes by the Holders of at least a majority in aggregate principal amount of the then
outstanding Notes and a waiver of the payment default that resulted from such acceleration);

     (5) make any Note payable in money other than that stated in the Notes;

     (6) make any change in the provisions of this Indenture relating to waivers of past
Defaults or the rights of Holders to receive payments of principal of, or interest or
premium or Additional Interest, if any, on, the Notes; or

     (7) make any change in the preceding amendment and waiver provisions.

SECTION 9.03 Amendments regarding Subordination.

     Notwithstanding Section 9.01 and 9.02, except as provided in Section 9.01(a)(6), any amendment
to the provisions of Article 10 (including the definitions of “Senior Debt” and “Designated Senior
Debt”) that adversely affects the rights of any holder of Senior Debt of the Issuer then
outstanding requires the consent of the holders of such Senior Debt (or any group or representative
thereof authorized to give consent), and any amendment or waiver of the provisions of Article 10
that adversely affects the rights of the Holders requires the consent of the Holders of at least
66-2/3% in aggregate principal amount of Notes then outstanding.

SECTION 9.04 Compliance with Trust Indenture Act.

     Every amendment or supplement to this Indenture or the Notes shall be set forth in an amended
or supplemental indenture that complies with the TIA as then in effect.

SECTION 9.05 Revocation and Effect of Consents.

     Until an amendment, supplement or waiver becomes effective, a consent to it by a Holder of a
Note is a continuing consent by the Holder of a Note and every subsequent Holder of a Note or
portion of a Note that evidences the same debt as the consenting Holder’s Note, even if notation of
the consent is not made on any Note. However, any such Holder of a Note or subsequent Holder of a
Note may revoke the consent as to its Note if the Trustee receives written notice of revocation
before the date the waiver, supplement

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or amendment becomes effective. An amendment, supplement or waiver becomes effective
in accordance with its terms and thereafter binds every Holder.

SECTION 9.06 Notation on or Exchange of Notes.

     The Trustee may place an appropriate notation about an amendment, supplement or waiver on any
Note thereafter authenticated. The Issuer in exchange for all Notes may issue and the Trustee
shall, upon receipt of an Authentication Order, authenticate new Notes that reflect the amendment,
supplement or waiver.

     Failure to make the appropriate notation or issue a new Note shall not affect the validity and
effect of such amendment, supplement or waiver.

SECTION 9.07 Trustee To Sign Amendments, etc.

     The Trustee shall sign any amended or supplemental indenture authorized pursuant to this
Article 9 if the amendment or supplement does not adversely affect the rights, duties, liabilities
or immunities of the Trustee. The Issuer may not sign an amended or supplemental indenture until
the Board of Directors approves it. In executing any amended or supplemental indenture, the
Trustee shall be provided with and (subject to Section 7.01 hereof) shall be fully protected in
relying upon, in addition to the documents required by Section 13.04, an Officer’s Certificate and
an Opinion of Counsel stating that the execution of such amended or supplemental indenture is
authorized or permitted by this Indenture.

ARTICLE 10.

SUBORDINATION

SECTION 10.01 Agreement to Subordinate.

     The Issuer agrees, and each Holder by accepting a Note agrees, that all Obligations in respect
of the Notes are subordinated in right of payment, to the extent and in the manner provided in this
Article 10, to the prior payment in full in cash of all Senior Debt of the Issuer (whether
outstanding on the Issue Date or created, incurred, assumed or guaranteed thereafter), and that the
subordination is for the benefit of the holders of Senior Debt of the Issuer.

SECTION 10.02 Liquidation; Dissolution; Bankruptcy.

     The holders of Senior Debt of the Issuer shall be entitled to receive payment in full in cash
of all Obligations due in respect of such Senior Debt (including interest after the commencement of
any bankruptcy proceeding at the rate specified in the applicable Senior Debt whether or not such
interest is an allowable claim) before the Holders shall be entitled to receive any payment (by
setoff or otherwise) with respect to the Notes (except that Holders may receive and retain
Permitted Junior Securities and payments made from any trust created pursuant to Article 8 or
Article 12 hereof), in the event of any distribution to creditors of the Issuer:

     (1) in a liquidation or dissolution of the Issuer;

     (2) in a bankruptcy, reorganization, insolvency, receivership or similar proceeding
relating to the Issuer or its property;

     (3) in an assignment for the benefit of the Issuer’s creditors; or

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     (4) in any marshaling of the Issuer’s assets and liabilities.

SECTION 10.03 Default on Designated Senior Debt.

     (a) The Issuer may not make any payment (by setoff or otherwise) in respect of the Notes or
acquire or redeem any Notes for cash or property or otherwise (other than Permitted Junior
Securities and payments made from any trust created pursuant to Article 8 or Article 12 hereof) or
make any deposit pursuant to Article 8 or Article 12 hereof if:

     (1) a payment default on Designated Senior Debt occurs and is continuing beyond any
applicable grace period; or

     (2) any other default occurs and is continuing on any series of Designated Senior Debt
that permits holders of that series of Designated Senior Debt to accelerate its maturity and
the Trustee receives a notice of such default (a “Payment Blockage Notice”) from a
Representative of the holders of any Designated Senior Debt.

     The notes shall not be subject to more than one Payment Blockage Notice in any consecutive
360-day period irrespective of the number of defaults with respect to Designated Senior Debt during
such period; provided that if any Payment Blockage Notice is delivered to the Trustee by or on
behalf of the holders of Designated Senior Debt (other than the holders of Indebtedness under the
Credit Agreement), a representative of holders of Indebtedness under the Credit Agreement may give
another Payment Blockage Notice within such period. However, in no event may the total number of
days during which any Payment Blockage Notice on the notes is in effect exceed 179 days in the
aggregate during any consecutive 360-day period, and there must be at least 181 days during any
consecutive 360-day period during which no Payment Blockage Notice is in effect.

     No nonpayment default that existed or was continuing on the date of delivery of any Payment
Blockage Notice to the Trustee will be, or will be made, the basis for a subsequent Payment
Blockage Notice unless such default has been cured or waived for a period of not less than 90 days
(it being acknowledged that any subsequent action, or any breach of any financial covenants during
the period after the date of delivery of such initial Payment Blockage Notice, that, in either
case, would give rise to a non-payment default pursuant to any provisions under which a non-payment
default previously existed or was continuing shall constitute a new non-payment default for this
purpose).

     (b) The Issuer may and shall resume payments on and distributions in respect of the Notes:

     (1) in the case of a payment default, upon the date upon which such default is cured or
waived,

     (2) in the case of any such acceleration, when such acceleration has been rescinded or
such Designated Senior Debt has been paid in full in cash, and

     (3) in the case of a nonpayment default, upon the earliest of the date on which such
nonpayment default is cured or waived, the applicable Payment Blockage Notice is rescinded,
the Designated Senior Debt has been repaid in full in cash or 179 days after the date on
which the applicable Payment Blockage Notice is received, unless the maturity of any
Designated Senior Debt has been accelerated or a payment default exists on any Designated
Senior Debt if this Article 10 otherwise permits the payment, distribution or acquisition at
the time of such payment, distribution or acquisition.

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SECTION 10.04 Acceleration of Notes.

     If payment of the Notes is accelerated because of an Event of Default, the Issuer shall
promptly notify holders of Senior Debt of the Issuer of the acceleration.

SECTION 10.05 When Distribution Must Be Paid Over.

     In the event that the Trustee or any Holder receives any payment (including a payment by a
Guarantor under its Subsidiary Guarantee) in respect of the Notes (other than Permitted Junior
Securities and payments made from any trust created pursuant to Article 8 or Article 12 hereof)
prohibited by Section 10.03, such payment shall be held by the Trustee or such Holder, in trust for
the benefit of, and shall be paid forthwith over and delivered, upon written request, to, the
holders of Senior Debt as their interests may appear or their Representative under the agreement,
indenture or other document (if any) pursuant to which Senior Debt may have been issued, as their
respective interests may appear, for application to the payment of all Obligations with respect to
Senior Debt remaining unpaid to the extent necessary to pay such Obligations in full in accordance
with their terms, after giving effect to any concurrent payment or distribution to or for the
holders of Senior Debt.

     With respect to the holders of Senior Debt, the Trustee undertakes to perform only those
obligations on the part of the Trustee as are specifically set forth in this Article 10, and no
implied covenants or obligations with respect to the holders of Senior Debt shall be read into this
Indenture against the Trustee. The Trustee shall not be deemed to owe any fiduciary duty to the
holders of Senior Debt, and shall not be liable to any such holders if the Trustee pays over or
distributes to or on behalf of Holders or the Issuer or any other Person money or assets to which
any holders of Senior Debt are then entitled by virtue of this Article 10, except if such payment
is made as a result of the willful misconduct or gross negligence of the Trustee.

SECTION 10.06 Notice by Issuer.

     The Issuer shall promptly notify the Trustee and the Paying Agent of any facts known to the
Issuer that would cause a payment in respect of the Notes to violate this Article 10, but failure
to give such notice shall not affect the subordination of the Notes to the Senior Debt as provided
in this Article 10.

SECTION 10.07 Subrogation.

     After all Senior Debt of the Issuer is paid in full and until the Notes are paid in full,
Holders shall be subrogated (equally and ratably with all other Indebtedness pari passu with the
Notes) to the rights of holders of such Senior Debt to receive distributions applicable to such
Senior Debt to the extent that distributions otherwise payable to the Holders have been applied to
the payment of such Senior Debt. A distribution made under this Article 10 to holders of Senior
Debt that otherwise would have been made to Holders is not, as between the Issuer and Holders, a
payment by the Issuer on such Senior Debt.

SECTION 10.08 Relative Rights.

     This Article 10 defines the relative rights of Holders and holders of Senior Debt of the
Issuer. Nothing in this Indenture shall:

     (1) impair, as between the Issuer and Holders, the obligation of the Issuer, which is
absolute and unconditional, to pay principal of, premium and interest and Additional
Interest, if any, on the Notes in accordance with their terms;

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     (2) affect the relative rights of Holders and creditors of the Issuer other than their
rights in relation to holders of Senior Debt of the Issuer; or

     (3) prevent the Trustee or any Holder from exercising its available remedies upon a
Default or Event of Default, subject to the rights of holders of Senior Debt of the Issuer
to receive distributions and payments otherwise payable to Holders.

     If the Issuer fails because of this Article 10 to pay principal of, premium or interest or
Additional Interest, if any, on a Note on the due date, the failure is still a Default or Event of
Default.

SECTION 10.09 Subordination May Not Be Impaired by the Issuer.

     No right of any holder of Senior Debt of the Issuer to enforce the subordination of the
Indebtedness evidenced by the Notes may be impaired by any act or failure to act by the Issuer or
any Holder or by the failure of the Issuer or any Holder to comply with this Indenture.

SECTION 10.10 Distribution or Notice to Representative.

     Whenever a distribution is to be made or a notice given to holders of Senior Debt of the
Issuer, the distribution may be made and the notice given to their Representative.

     Upon any payment or distribution of assets of the Issuer referred to in this Article 10, the
Trustee and the Holders shall be entitled to rely upon any order or decree made by any court of
competent jurisdiction or upon any certificate of such Representative or of the liquidating trustee
or agent or other Person making any distribution to the Trustee or to the Holders for the purpose
of ascertaining the Persons entitled to participate in such distribution, the holders of the Senior
Debt and other Indebtedness of the Issuer, the amount thereof or payable thereon, the amount or
amounts paid or distributed thereon and all other facts pertinent thereto or to this Article 10.

SECTION 10.11 Rights of Trustee and Paying Agent.

     Notwithstanding the provisions of this Article 10 or any other provision of this Indenture,
the Trustee shall not be charged with knowledge of the existence of any facts that would prohibit
the making of any payment or distribution by the Trustee, and the Trustee and the Paying Agent may
continue to make payments on the Notes, unless the Trustee has received at its Corporate Trust
Office at least five Business Days prior to the date of such payment written notice of facts that
would cause the payment in respect of the Notes to violate this Article 10. Only the Issuer or a
Representative of a series of Designated Senior Debt may give the notice. Nothing in this Article
10 shall impair the claims of, or payments to, the Trustee under or pursuant to Section 7.07
hereof.

     The Trustee in its individual or any other capacity may hold Senior Debt with the same rights
it would have if it were not Trustee. Any Agent may do the same with like rights.

SECTION 10.12 Authorization To Effect Subordination.

     Each Holder by the Holder’s acceptance thereof, agrees to be bound by the subordination
provisions in Article 10 hereof and authorizes and expressly directs the Trustee on such Holder’s
behalf to take such action as may be necessary or appropriate to effectuate the subordination as
provided in this Article 10, and appoints the Trustee to act as such Holder’s attorney-in-fact for
any and all such purposes. If the Trustee does not file a proper proof of claim or proof of debt
in the form required in any proceeding referred to in Section 6.09 at least 30 days before the
expiration of the time to file such claim, the holders of

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Designated Senior Debt (or their Representatives) are hereby authorized to file an appropriate
claim for and on behalf of the Holders of the Notes.

ARTICLE 11.

SUBSIDIARY GUARANTEES

SECTION 11.01 Guarantee.

     (a) Subject to this Article 11, each of the Guarantors hereby, jointly and severally,
unconditionally guarantees to each Holder of a Note authenticated and delivered by the Trustee and
to the Trustee and its successors and assigns, irrespective of the validity and enforceability of
this Indenture, the Notes or the obligations of the Issuer hereunder or thereunder, that:

     (1) the principal of, premium and Additional Interest, if any, and interest on the
Notes shall be promptly paid in full when due, whether at maturity, by acceleration,
redemption or otherwise, and interest on the overdue principal of and interest on the Notes,
if any, if lawful, and all other Obligations of the Issuer to the Holders or the Trustee
hereunder or thereunder shall be promptly paid in full or performed, all in accordance with
the terms hereof and thereof; and

     (2) in case of any extension of time of payment or renewal of any Notes or any of such
other Obligations, that same shall be promptly paid in full when due or performed in
accordance with the terms of the extension or renewal, whether at stated maturity, by
acceleration or otherwise.

     Failing payment when due of any amount so guaranteed or any performance so guaranteed for
whatever reason, the Guarantors shall be jointly and severally obligated to pay the same
immediately. Each Guarantor agrees that this is a guarantee of payment and not a guarantee of
collection.

     (b) The Guarantors hereby agree that their obligations hereunder are unconditional,
irrespective of the validity, regularity or enforceability of the Notes or this Indenture, the
absence of any action to enforce the same, any waiver or consent by any Holder of the Notes with
respect to any provisions hereof or thereof, the recovery of any judgment against the Issuer, any
action to enforce the same or any other circumstance which might otherwise constitute a legal or
equitable discharge or defense of a guarantor. Each Guarantor hereby waives diligence,
presentment, demand of payment, filing of claims with a court in the event of insolvency or
bankruptcy of the Issuer, any right to require a proceeding first against the Issuer, protest,
notice and all demands whatsoever and covenant that this Subsidiary Guarantee shall not be
discharged except by complete performance of the obligations contained in the Notes and this
Indenture or by release in accordance with the provisions of this Indenture.

     (c) If any Holder or the Trustee is required by any court or otherwise to return to the
Issuer, the Guarantors or any custodian, trustee, liquidator or other similar official acting in
relation to either the Issuer or the Guarantors, any amount paid by the Issuer or the Guarantors to
the Trustee or such Holder, this Subsidiary Guarantee, to the extent theretofore discharged, shall
be reinstated in full force and effect.

     (d) Each Guarantor agrees that it shall not be entitled to any right of subrogation in
relation to the Holders in respect of any obligations guaranteed hereby until payment in full of
all Obligations guaranteed hereby. Each Guarantor further agrees that, as between the Guarantors,
on the one hand, and the Holders and the Trustee, on the other hand, the maturity of the
Obligations guaranteed hereby may be accelerated as provided in Article 6 for the purposes of this
Subsidiary Guarantee, notwithstanding any stay, injunction or other prohibition preventing such
acceleration in respect of the Obligations guaranteed

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hereby, and in the event of any declaration of acceleration of such Obligations as provided in
Article 6, such Obligations (whether or not due and payable) shall forthwith become due and payable
by the Guarantors for the purpose of this Subsidiary Guarantee. The Guarantors shall have the
right to seek contribution from any non-paying Guarantor so long as the exercise of such right does
not impair the rights of the Holders under the Subsidiary Guarantee.

SECTION 11.02 Subordination of Subsidiary Guarantee.

     The Obligations of each Guarantor under its Subsidiary Guarantee pursuant to this Article 11
shall be junior and subordinated to the Senior Debt of such Guarantor on the same basis as the
Notes are junior and subordinated to Senior Debt of the Issuer. For the purposes of the foregoing
sentence, the Trustee and the Holders shall have the right to receive and/or retain payments by any
of the Guarantors only at such times as they may receive and/or retain payments in respect of the
Notes pursuant to this Indenture, including Article 10 hereof.

SECTION 11.03 Limitation on Guarantor Liability.

     Each Guarantor, and by its acceptance of Notes, each Holder, hereby confirms that it is the
intention of all such parties that the Subsidiary Guarantee of such Guarantor not constitute a
fraudulent transfer or conveyance for purposes of Bankruptcy Law, the Uniform Fraudulent Conveyance
Act, the Uniform Fraudulent Transfer Act or any similar federal or state law to the extent
applicable to any Subsidiary Guarantee. To effectuate the foregoing intention, the Trustee, the
Holders and the Guarantors hereby irrevocably agree that the obligations of such Guarantor shall be
limited to the maximum amount that shall, after giving effect to such maximum amount and all other
contingent and fixed liabilities of such Guarantor that are relevant under such laws, and after
giving effect to any collections from, rights to receive contribution from or payments made by or
on behalf of any other Guarantor in respect of the obligations of such other Guarantor under this
Article 11, result in the obligations of such Guarantor under its Subsidiary Guarantee not
constituting a fraudulent transfer or conveyance.

SECTION 11.04 Execution and Delivery of Subsidiary Guarantee.

     To evidence its Subsidiary Guarantee set forth in Section 11.01, each Guarantor hereby agrees
that a notation of such Subsidiary Guarantee substantially in the form attached as Exhibit
E shall be endorsed by an Officer (or other person serving in a similar capacity) of such
Guarantor on each Note authenticated and delivered by the Trustee and that this Indenture shall be
executed on behalf of such Guarantor by one of its Officers (or other person serving in a similar
capacity).

     Each Guarantor hereby agrees that its Subsidiary Guarantee set forth in Section 11.01 shall
remain in full force and effect notwithstanding any failure to endorse on each Note a notation of
such Subsidiary Guarantee.

     If an Officer (or other person serving in a similar capacity) whose signature is on this
Indenture or on the Subsidiary Guarantee no longer holds that office at the time the Trustee
authenticates the Note on which a Subsidiary Guarantee is endorsed, the Subsidiary Guarantee shall
be valid nevertheless.

     The delivery of any Note by the Trustee, after the authentication thereof hereunder, shall
constitute due delivery of the Subsidiary Guarantee set forth in this Indenture on behalf of the
Guarantors.

     In the event that the Issuer or any of its Restricted Subsidiaries creates or acquires any
Subsidiary after the date of this Indenture, if required by Section 4.19, the Issuer shall cause
such Subsidiary to comply with the provisions of Section 4.19 and this Article 11, to the extent
applicable.

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SECTION 11.05 Guarantors May Consolidate, etc., on Certain Terms.

     Except as otherwise provided in this Section 11.05, no Guarantor may sell or otherwise dispose
of all or substantially all of its assets to, or consolidate with or merge with or into (whether or
not such Guarantor is the surviving Person) another Person, other than either of the Issuer or
another Guarantor, unless:

     (1) immediately after giving effect to such transaction, no Default or Event of Default
exists; and

     (2) either:

     (a) the Person (if other than either of the Issuer or a Guarantor) acquiring
the property in any such sale or disposition or the Person (if other than either of
the Issuer or a Guarantor) formed by or surviving any such consolidation or merger
unconditionally assumes all the obligations of that Guarantor, pursuant to a
supplemental indenture in form and substance reasonably satisfactory to the Trustee,
under this Indenture, the Subsidiary Guarantee and the Registration Rights Agreement
on the terms set forth herein or therein; or

     (b) such transaction does not violate Section 4.10 and the Net Proceeds of such
sale or other disposition are applied in accordance with the applicable provisions
of this Indenture, including without limitation, Section 4.10.

     In case of any such consolidation, merger, sale or conveyance and upon the assumption by the
successor Person, by supplemental indenture, executed and delivered to the Trustee and satisfactory
in form to the Trustee, of the Subsidiary Guarantee endorsed upon the Notes and the due and
punctual performance of all of the covenants and conditions of this Indenture to be performed by
the Guarantor, such successor Person shall succeed to and be substituted for the Guarantor with the
same effect as if it had been named herein as a Guarantor. Such successor Person thereupon may
cause to be signed any or all of the Subsidiary Guarantees to be endorsed upon all of the Notes
issuable hereunder which theretofore shall not have been signed by the Issuer and delivered to the
Trustee. All the Subsidiary Guarantees so issued shall in all respects have the same legal rank
and benefit under this Indenture as the Subsidiary Guarantees theretofore and thereafter issued in
accordance with the terms of this Indenture as though all of such Subsidiary Guarantees had been
issued at the date of the execution hereof.

     Except as set forth in Articles 4 and 5, and notwithstanding clauses and above, nothing
contained in this Indenture or in any of the Notes shall prevent any consolidation or merger of a
Guarantor with or into either of the Issuer or another Guarantor, or shall prevent any sale or
conveyance of the property of a Guarantor as an entirety or substantially as an entirety to the
Issuer or another Guarantor.

SECTION 11.06 Releases.

     The Subsidiary Guarantee of a Guarantor will be released:

     (a) in connection with any sale or other disposition of all or substantially all of the assets
of that Guarantor (including by way of merger or consolidation) to a Person that is not (either
before or after giving effect to such transaction) the Issuer or a Restricted Subsidiary if the
sale or other disposition does not violate Section 4.10;

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     (b) in connection with any sale or other disposition of all of the Capital Stock of that
Guarantor to a Person that is not (either before or after giving effect to such transaction) the
Issuer or a Restricted Subsidiary if the sale or other disposition does not violate Section 4.10;

     (c) if the Issuer designates any Restricted Subsidiary that is a Guarantor to be an
Unrestricted Subsidiary in accordance with Section 4.17 or a Non-Guarantor Subsidiary in accordance
with the definition of that term;

     (d) if that Guarantor is released from its guarantee under the Credit Agreement; or

     (e) upon legal defeasance or covenant defeasance in accordance with Article 8 or satisfaction
and discharge in accordance with Article 12.

     If any Guarantor is released from its Subsidiary Guarantee, any of its Subsidiaries that are
Guarantors will be released from their Subsidiary Guarantees, if any.

     Any Guarantor not released from its obligations under its Subsidiary Guarantee as provided in
this Section 11.06 shall remain liable for the full amount of principal of and interest on the
Notes and for the other obligations of any Guarantor under this Indenture as provided in this
Article 11.

ARTICLE 12.

SATISFACTION AND DISCHARGE

SECTION 12.01 Satisfaction and Discharge.

     This Indenture shall be discharged and shall cease to be of further effect as to all Notes
issued hereunder, when:

     (1) either:

     (a) all Notes that have been authenticated, except lost, stolen or destroyed
Notes that have been replaced or paid and Notes for whose payment money has
theretofore been deposited in trust and thereafter repaid to the Issuer, have been
delivered to the Trustee for cancellation; or

     (b) all Notes that have not been delivered to the Trustee for cancellation have
become due and payable by reason of the mailing of a notice of redemption or
otherwise or shall become due and payable within one year and the Issuer or any
Guarantor has irrevocably deposited or caused to be deposited with the Trustee as
trust funds in trust solely for the benefit of the Holders, cash in U.S. dollars,
non-callable Government Securities, or a combination of cash in U.S. dollars and
non- callable Government Securities, in amounts as shall be sufficient, without
consideration of any reinvestment of interest, to pay and discharge the entire
Indebtedness on the Notes not delivered to the Trustee for cancellation for
principal, premium and Additional Interest, if any, and accrued interest to the date
of maturity or redemption;

     (2) no Default or Event of Default has occurred and is continuing on the date of the
deposit (other than a Default or Event of Default resulting from the borrowing of funds to
be applied to such deposit) and the deposit shall not result in a breach or violation of, or
constitute a

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default under, any other instrument to which the Issuer or any Guarantor is a party or
by which the Issuer or any Guarantor is bound;

     (3) the Issuer or any Guarantor has paid or caused to be paid all sums payable by it
under this Indenture; and

     (4) the Issuer has delivered irrevocable instructions to the Trustee under this
Indenture to apply the deposited money toward the payment of the Notes at maturity or on the
redemption date, as the case may be.

     In addition, the Issuer must deliver an Officer’s Certificate and an Opinion of Counsel to the
Trustee stating that all conditions precedent to satisfaction and discharge have been satisfied.

     Notwithstanding the satisfaction and discharge of this Indenture, if money has been deposited
with the Trustee pursuant to sub-clause of clause of this Section, the provisions of Sections 12.02
and 8.06 shall survive. In addition, nothing in this Section 12.01 shall be deemed to discharge
those provisions of Section 7.07, that, by their terms, survive the satisfaction and discharge of
this Indenture.

SECTION 12.02 Application of Trust Money.

     Subject to the provisions of Section 8.06, all money deposited with the Trustee pursuant to
Section 12.01 shall be held in trust and applied by it, in accordance with the provisions of the
Notes and this Indenture, to the payment, either directly or through any Paying Agent (including
the Issuer acting as its own Paying Agent) as the Trustee may determine, to the Persons entitled
thereto, of the principal (and premium, if any) and interest for whose payment such money has been
deposited with the Trustee; but such money need not be segregated from other funds except to the
extent required by law.

     To the extent that and so long as the Trustee or Paying Agent is unable to apply any money or
Government Securities in accordance with Section 12.01 by reason of any legal proceeding or by
reason of any order or judgment of any court or governmental authority enjoining, restraining or
otherwise prohibiting such application, the Issuer’s and any Guarantor’s obligations under this
Indenture and the Notes shall be revived and reinstated as though no deposit had occurred pursuant
to Section 12.01; provided, however, that if the Issuer has made any payment of principal of,
premium, if any, or interest on any Notes following the reinstatement of their obligations, the
Issuer shall be subrogated to the rights of the Holders of such Notes to receive such payment from
the money or Government Securities held by the Trustee or Paying Agent.

ARTICLE 13.

MISCELLANEOUS

SECTION 13.01 Trust Indenture Act Controls.

     If any provision of this Indenture limits, qualifies or conflicts with the duties imposed by
TIA Section 318(c), the imposed duties shall control.

SECTION 13.02 Notices.

     Any notice or communication by either of the Issuer, any Guarantor or the Trustee to the
others is duly given if in writing and delivered in Person or mailed by first class mail
(registered or certified, return

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receipt requested), telex, telecopier or overnight air courier guaranteeing next day delivery,
to the others’ address:

     If to the Issuer and/or any Guarantor:

United Surgical Partners International, Inc.

15305 Dallas Parkway, Suite 1600

Addison, Texas 75001

Telecopier No.: (972) 767-0604

Attention: Vice President and General Counsel

     If to the Trustee:

U.S. Bank National Association

60 Livingston Avenue

EP-MN-WS3C

St. Paul, MN 55107-2292

Tellecopier No.: (651) 495-8097

Attn: Corporate Trust Administration

     The Issuer, any Guarantor or the Trustee, by notice to the others, may designate additional or
different addresses for subsequent notices or communications.

     All notices and communications (other than those sent to Holders) shall be deemed to have been
duly given: at the time delivered by hand, if personally delivered; five Business Days after being
deposited in the mail, postage prepaid, if mailed; when answered back, if telexed; when receipt
acknowledged, if telecopied; and the next Business Day after timely delivery to the courier, if
sent by overnight air courier guaranteeing next day delivery.

     Any notice or communication to a Holder shall be mailed by first class mail, certified or
registered, return receipt requested, or by overnight air courier guaranteeing next day delivery to
its address shown on the register kept by the Registrar. Any notice or communication shall also be
so mailed to any Person described in TIA Section 313(c), to the extent required by the TIA.
Failure to mail a notice or communication to a Holder or any defect in it shall not affect its
sufficiency with respect to other Holders.

     If a notice or communication is mailed in the manner provided above within the time
prescribed, it is duly given, whether or not the addressee receives it.

     If the Issuer mails a notice or communication to Holders, it shall mail a copy to the Trustee
and each Agent at the same time.

SECTION 13.03 Communication by Holders with Other Holders.

     Holders may communicate pursuant to TIA Section 312 with other Holders with respect to their
rights under this Indenture or the Notes. The Issuer, the Trustee, the Registrar and anyone else
shall have the protection of TIA Section 312(c).

SECTION 13.04 Certificate and Opinion as to Conditions Precedent.

     Upon any request or application by the Issuer to the Trustee to take any action under this
Indenture, the Issuer shall furnish to the Trustee:

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     (1) an Officer’s Certificate in form and substance reasonably satisfactory to the
Trustee (which must include the statements set forth in Section 13.05) stating that, in the
opinion of the signers, all conditions precedent and covenants, if any, provided for in this
Indenture relating to the proposed action have been satisfied; and

     (2) an Opinion of Counsel in form and substance reasonably satisfactory to the Trustee
(which must include the statements set forth in Section 13.05) stating that, in the opinion
of such counsel, all such conditions precedent and covenants have been satisfied.

SECTION 13.05 Statements Required in Certificate or Opinion.

     Each certificate or opinion with respect to compliance with a condition or covenant provided
for in this Indenture (other than a certificate provided pursuant to TIA Section 314(a)(4)) must
comply with the provisions of TIA Section 314 and must include:

     (1) a statement that the Person making such certificate or opinion has read such
covenant or condition;

     (2) a brief statement as to the nature and scope of the examination or investigation
upon which the statements or opinions contained in such certificate or opinion are based;

     (3) a statement that, in the opinion of such Person, he or she has made such
examination or investigation as is necessary to enable him or her to express an informed
opinion as to whether or not such covenant or condition has been satisfied; and

     (4) a statement as to whether or not, in the opinion of such Person, such condition or
covenant has been satisfied.

SECTION 13.06 Rules by Trustee and Agents.

     The Trustee may make reasonable rules for action by or at a meeting of Holders. The Registrar
or Paying Agent may make reasonable rules and set reasonable requirements for its functions.

SECTION 13.07 No Personal Liability of Directors, Officers, Employees and Stockholders.

     No director, officer, employee, incorporator, stockholder, member, partner or other holder of
Equity Interests of the Issuer or any Guarantor, as such, shall have any liability for any
obligations of the Issuer or the Guarantors under the Notes, this Indenture, the Subsidiary
Guarantees or for any claim based on, in respect of, or by reason of, such obligations or their
creation. Each Holder by accepting a Note waives and releases all such liability. The waiver and
release are part of the consideration for issuance of the Notes. The waiver may not be effective
to waive liabilities under the federal securities laws.

SECTION 13.08 Governing Law.

     THIS INDENTURE, THE NOTES AND THE SUBSIDIARY GUARANTEES SHALL BE GOVERNED BY, AND CONSTRUED IN
ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.

-101-

 

SECTION 13.09 No Adverse Interpretation of Other Agreements.

     This Indenture may not be used to interpret any other indenture, loan or debt agreement of the
Issuer or its Subsidiaries or of any other Person. Any such indenture, loan or debt agreement may
not be used to interpret this Indenture.

SECTION 13.10 Successors.

     All agreements of the Issuer in this Indenture and the Notes shall bind its successors. All
agreements of the Trustee in this Indenture shall bind its successors. All agreements of each
Guarantor in this Indenture shall bind its successors, except as otherwise provided in Section
11.05.

SECTION 13.11 Severability.

     In case any provision in this Indenture or in the Notes is invalid, illegal or unenforceable,
the validity, legality and enforceability of the remaining provisions shall not in any way be
affected or impaired thereby.

SECTION 13.12 Counterpart Originals.

     The parties may sign any number of copies of this Indenture. Each signed copy shall be an
original, but all of them together represent the same agreement.

SECTION 13.13 Table of Contents, Headings, etc.

     The Table of Contents, Cross-Reference Table and Headings of the Articles and Sections of this
Indenture have been inserted for convenience of reference only, are not to be considered a part of
this Indenture and shall in no way modify or restrict any of the terms or provisions hereof.

(Signature Pages Follow)

-102-

 

SIGNATURES

Dated as of April 19, 2007

	 	 	 	 	 
	 	UNITED SURGICAL PARTNERS INTERNATIONAL, INC.,

  as Issuer

 	 
	 	By:  	/s/   Mark A. Kopser
 	 
	 	 	Title: Chief Financial Officer 	 
	 	 	 	 

 

 

	 	 	 	 	 

	 	 	 	 	 
	 	THE GUARANTORS SET FORTH ON SCHEDULE I HERETO,

  as Guarantors

 	 
	 	By:  	/s/ William H. Wilcox
 	 
	 	 	Title: President 	 
	 	 	 	 

-2-

 

	 	 	 	 	 

	 	 	 	 	 
	 	PASADENA HOLDINGS, LLC

USP NEVADA HOLDINGS, LLC,

By: USP North Texas, Inc., its manager

 	 
	 	By:  	/s/ William H. Wilcox
 	 
	 	 	Title: President 	 
	 	 	 	 

-3-

 

	 	 	 	 	 

	 	 	 	 	 
	 	SAME DAY MANAGEMENT, L.L.C.,

By: Same Day Surgery LLC, its sole member

 	 
	 	By:  	/s/  William H. Wilcox
 	 
	 	 	Title: President 	 
	 	 	 	 

-4-

 

	 	 	 	 	 

	 	 	 	 	 
	 	WHASA, L.C.,

By: Surginet, Inc., its sole member

 	 
	 	By:  	/s/ William H. Wilcox
 	 
	 	 	Title: President 	 
	 	 	 	 

-5-

 

	 	 	 	 	 

	 	 	 	 	 
	 	USP ASSURANCE COMPANY,

 	 
	 	By:  	/s/ John J. Wellik
 	 
	 	 	Title: President 	 
	 	 	 	 

-6-

 

	 	 	 	 	 

	 	 	 	 	 
	 	PHYSICIANS DATA PROFESSIONALS, INC.,

 	 
	 	By:  	/s/ John J. Wellik
 	 
	 	 	Title: Secretary 	 
	 	 	 	 

-7-

 

	 	 	 	 	 

	 	 	 	 	 
	 	USP SECURITIES CORPORATION

 	 
	 	By:  	/s/ Kim Tillett
 	 
	 	 	Title: President 	 
	 	 	 	 

-8-

 

	 	 	 	 	 

	 	 	 	 	 
	 	USP TEXAS, L.P.,

By: USP North Texas, Inc., its general partner

 	 
	 	By:  	/s/ William H. Wilcox
 	 
	 	 	Title: President 	 
	 	 	 	 

-9-

 

	 	 	 	 	 

	 	 	 	 	 
	 	USP TEXAS AIR, LLC

By: USP North Texas, Inc., its sole member

 	 
	 	By:  	/s/ William H. Wilcox
 	 
	 	 	Title: President 	 
	 	 	 	 

-10-

 

	 	 	 	 	 

	 	 	 	 	 
	 	SURGERY CENTERS OF AMERICA II, L.L.C.,

 	 
	 	By:  	/s/ William H. Wilcox
 	 
	 	 	Title: Manager 	 
	 	 	 	 

-11-

 

	 	 	 	 	 

	 	 	 	 	 
	 	ISS-ORLANDO, LLC

 	 
	 	By:  	/s/ William H. Wilcox
 	 
	 	 	Title: Manager 	 
	 	 	 	 

-12-

 

	 	 	 	 	 

	 	 	 	 	 
	 	SURGERY CENTERS HOLDINGS COMPANY, L.L.C.,

By: Surgery Centers of America II, L.L.C., its sole

member

 	 
	 	By:  	/s/ John J. Wellik
 	 
	 	 	Title: Manager 	 
	 	 	 	 

-13-

 

	 	 	 	 	 

	 	 	 	 	 
	 	U.S. BANK NATIONAL ASSOCIATION,

  as Trustee

 	 
	 	By:  	/s/ Richard Prokosch
 	 
	 	 	Title: Vice President 	 
	 	 	 	 

-14-

 

	 	 	 	 	 

SCHEDULE I

GUARANTORS

Georgia Musculoskeletal Network, Inc.

Health Horizons of Kansas City, Inc.

Health Horizons of Murfreesboro, Inc.

Health Horizons of Nashville, Inc.

Medcenter Management Services, Inc.

North MacArthur Surgery Center, LLC

Ortho Excel, Inc.

OrthoLink ASC Corporation

OrthoLink Physicians Corporation

OrthoLink Radiology Services Corporation

OrthoLink/Georgia ASC, Inc.

OrthoLink/New Mexico ASC, Inc.

OrthoLink/TN ASC, Inc.

Same Day Surgery, L.L.C.

Specialty Surgicenters, Inc.

SSI Holdings, Inc.

Surginet of Northwest Houston, Inc.

Surginet of Rivergate, Inc.

Surginet, Inc.

Surgis Management Services, Inc.

Surgis of Chico, Inc.

Surgis of Pearland, Inc.

Surgis of Phoenix, Inc.

Surgis of Redding, Inc.

Surgis of Sand Lake, Inc.

Surgis of Sonoma, Inc.

Surgis of Victoria, Inc.

Surgis of Willowbrook, Inc.

Surgis, Inc.

United Surgical of Atlanta, Inc.

United Surgical Partners Holdings, Inc.

USP Alexandria, Inc.

USP Austin, Inc.

USP Austintown, Inc.

USP Baltimore, Inc.

USP Baton Rouge, Inc.

USP Bridgeton, Inc.

USP Cedar Park, Inc

USP Central New Jersey, Inc.

USP Chesterfield, Inc.

USP Chicago, Inc.

Schedule I-1 

 

USP Cleveland, Inc.

USP Coast, Inc.

USP Columbia, Inc.

USP Corpus Christi, Inc.

USP Cottonwood, Inc.

USP Creve Coeur, Inc.

USP Decatur, Inc.

USP Des Peres, Inc.

USP Destin, Inc.

USP Domestic Holdings, Inc.

USP Florissant, Inc.

USP Fredericksburg, Inc.

USP Glendale, Inc.

USP Harbour View, Inc.

USP Houston, Inc.

USP Indiana, Inc.

USP International Holdings, Inc.

USP Kansas City, Inc.

USP Las Cruces, Inc.

USP Long Island, Inc.

USP Lyndhurst, Inc.

USP Mason Ridge, Inc.

USP Michigan, Inc.

USP Midwest, Inc.

USP Mission Hills, Inc.

USP Nevada, Inc.

USP New Jersey, Inc.

USP Newport News, Inc.

USP North Kansas City, Inc.

USP North Texas, Inc.

USP Oklahoma, Inc.

USP Olive, Inc.

USP Oxnard, Inc.

USP Phoenix, Inc.

USP Reading, Inc.

USP Richmond II, Inc.

USP Richmond, Inc.

USP Sacramento, Inc.

USP San Antonio, Inc.

USP San Gabriel, Inc.

USP Sarasota, Inc.

USP St. Peters, Inc.

USP Sunset Hills, Inc.

USP Tennessee, Inc.

USP Torrance, Inc.

USP Virginia Beach, Inc.

Sch. I-2 

 

USP Webster Groves, Inc.

USP West Covina, Inc.

USP Westwood, Inc.

USP Winter Park, Inc.

USPI San Diego, Inc.

Sch. I-3 

 

EXHIBIT A1

[Face of Note]

CUSIP                     

87/8% Senior Subordinated Note due 2017

			
	 	 	 
	No.                     
	 	$                    

UNITED SURGICAL PARTNERS INTERNATIONAL, INC.

UNITED SURGICAL PARTNERS INTERNATIONAL, INC.. promises to pay to [     ] or registered
assigns, the principal sum of ______ DOLLARS on May 1, 2017.

Interest Payment Dates: May 1 and November 1

Record Dates: April 15 and October 15

Dated: April 19, 2007

	 	 	 	 	 
	 	UNITED SURGICAL PARTNERS INTERNATIONAL, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 

A1-1 

 

	 	 	 	 	 

This is one of the Notes referred to

in the within-mentioned Indenture:

U.S. BANK NATIONAL ASSOCIATION,

  as Trustee

	 	 	 	 	 
	By:

	 	 	 	 
	 

	 	 	 	 
	 

	 	Authorized Signatory	 	 

A1-2 

 

[Back of Note]

87/8% Senior Subordinated Note due 2017

[Insert the Global Note Legend, if applicable pursuant to the provisions of the Indenture]

[Insert the Private Placement Legend, if applicable pursuant to the provisions of the Indenture]

     Capitalized terms used herein have the meanings assigned to them in the Indenture referred to
below unless otherwise indicated.

     (1) INTEREST. United Surgical Partners International, Inc., a Delaware corporation
(the “Issuer”), promises to pay interest on the principal amount of this Note at 87/8% per annum from
April 19, 2007 until maturity and shall pay the Additional Interest, if any, payable pursuant to
the Registration Rights Agreement referred to below. The Issuer shall pay interest and Additional
Interest, if any, semi-annually in arrears on May 1 and November 1 of each year, or if any such day
is not a Business Day, on the next succeeding Business Day (each, an “Interest Payment Date”).
Interest on the Cash Pay Notes shall accrue from the most recent date to which interest has been
paid or, if no interest has been paid, from the date of issuance; provided that if there is no
existing Default in the payment of interest, and if this Note is authenticated between a record
date referred to on the face hereof and the next succeeding Interest Payment Date, interest shall
accrue from such next succeeding Interest Payment Date; provided further that the first Interest
Payment Date shall be November 1, 2007. The Issuer shall pay interest (including post-petition
interest in any proceeding under any Bankruptcy Law) on overdue principal and premium, if any, from
time to time on demand at a rate that is 1% per annum in excess of the rate then in effect; it
shall pay interest (including post-petition interest in any proceeding under any Bankruptcy Law) on
overdue installments of interest and Additional Interest, if any, (without regard to any applicable
grace periods) from time to time on demand at the same rate to the extent lawful. Interest shall
be computed on the basis of a 360-day year of twelve 30-day months.

     (2) METHOD OF PAYMENT. The Issuer shall pay interest on the Cash Pay Notes (except
defaulted interest) and Additional Interest, if any, to the Persons who are registered Holders at
the close of business on the April 15 or October 15 next preceding the Interest Payment Date, even
if such Cash Pay Notes are canceled after such record date and on or before such Interest Payment
Date, except as provided in Section 2.12 of the Indenture with respect to defaulted interest. The
Cash Pay Notes shall be payable as to principal, interest and premium and Additional Interest, if
any, at the office or agency of the Paying Agent within the City and State of New York, or payment
of interest and Additional Interest, if any, may, at the option of the Issuer, be made by check
mailed to the Holders at their addresses set forth in the register of Holders; provided that
payment by wire transfer of immediately available funds shall be required with respect to principal
of and interest, premium and Additional Interest, if any, on, all Global Notes and all other Notes
the Holder (if such Holder holds at least $1.0 million in aggregate principal amount of Notes) of
which shall have provided wire transfer instructions to the Issuer prior to the record date.
Payment of principal of, premium, if any, and interest and Additional Interest on, Global Notes
registered in the name of or held by DTC or any successor depositary or its nominee will be made by
wire transfer of immediately available funds to such depositary or its nominee, as the case may be,
as the registered Holder of such Global note. Such payment shall be 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.

     (3) PAYING AGENT AND REGISTRAR. Initially, U.S. Bank National Association, the
Trustee under the Indenture, shall act as Paying Agent and Registrar. The Issuer may change any
Paying Agent or Registrar without notice to any Holder. The Issuer or any of its Subsidiaries may
act in any such capacity.

A1-3 

 

     (4) INDENTURE. The Issuer issued the Cash Pay Notes under an Indenture dated as of
April 19, 2007 (the “Indenture”), among the Issuer, the Guarantors and the Trustee. The terms of
the Cash Pay Notes include those stated in the Indenture and those made part of the Indenture by
reference to the TIA (15 U.S. Code Sections 77aaa-77bbbb). The Cash Pay Notes are subject to all
such terms, and Holders are referred to the Indenture and such Act for a statement of such terms.
To the extent any provision of this Note conflicts with the express provisions of the Indenture,
the provisions of the Indenture shall govern and be controlling. The Cash Pay Notes are general
unsecured obligations of the Issuer. Subject to the conditions set forth in the Indenture, the
Issuer may issue Additional Notes.

     (5) OPTIONAL REDEMPTION.

     (a) Except as set forth in subparagraph (b) or (c) of this Paragraph 5, on or after May 1,
2012, the Issuer may redeem all or a part of the Cash Pay Notes upon not less than 30 nor more than
60 days’ notice, at the redemption prices (expressed as percentages of principal amount) set forth
below plus accrued and unpaid interest and Additional Interest, if any, on the Cash Pay Notes
redeemed, to the applicable redemption date, if redeemed during the twelve-month period beginning
on May 1 of the years indicated below, subject to the rights of holders of Cash Pay Notes on the
relevant record date to receive interest on the relevant interest payment date:

	 	 	 	 	 
	Year	 	Percentage
	2012
	 	 	104.438	%
	2013
	 	 	102.958	%
	2014
	 	 	101.479	%
	2015 and thereafter
	 	 	100.000	%

     (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time prior
to May 1, 2010, the Issuer may, on any one or more occasions, redeem up to 35% of the aggregate
principal amount of Cash Pay Notes issued under the Indenture at a redemption price of 108.875% of
the principal amount, plus accrued and unpaid interest and Additional Interest, if any, to the
redemption date, with the net cash proceeds of one or more Equity Offerings by the Issuer or a
contribution to the equity capital of the Issuer (other than Disqualified Stock) from the net
proceeds of one or more Equity Offerings by the Issuer, Holdings or any other direct or indirect
parent of the Issuer (in each case, other than Excluded Contributions); provided that:

     (1) at least 65% of the aggregate principal amount of Cash Pay Notes originally issued
under the Indenture (excluding Cash Pay Notes held by the Issuer and its Subsidiaries)
remains outstanding immediately after the occurrence of such redemption; and

     (2) the redemption occurs within 90 days of the date of the closing of such Equity
Offering or equity contribution.

     (c) Before May 1, 2012, the Issuer may also redeem all or any portion of the Cash Pay Notes
upon not less than 30 nor more than 60 days’ prior notice, at a redemption price equal to 100% of
the principal amount thereof plus the Applicable Premium as of, and accrued and unpaid interest
thereon, if any, to, the date of redemption (a “Make-Whole Cash Pay Notes Redemption Date”).

     (6) MANDATORY REDEMPTION. The Issuer shall not be required to make mandatory
redemption payments with respect to the Cash Pay Notes.

A1-4 

 

     (7) REPURCHASE AT THE OPTION OF HOLDER.

     (a) If there is a Change of Control, each Holder shall have the right to require the Issuer to
make an offer (a “Change of Control Offer”) to repurchase all or any part (a minimum amount of
$2,000 or an integral multiple of $1,000 in excess thereof) of that Holder’s Cash Pay Notes at a
purchase price equal to 101% of the aggregate principal amount thereof plus accrued and unpaid
interest and Additional Interest, if any, on the Cash Pay Notes repurchased, if any, to the date of
purchase, subject to the rights of the Holders on the relevant record date to receive interest due
on the relevant Interest Payment Date (the “Change of Control Payment”). Within 30 days following
any Change of Control, the Issuer shall mail a notice to each Holder setting forth the procedures
governing the Change of Control Offer as required by the Indenture.

     (b) If the Issuer or a Restricted Subsidiary consummates any Asset Sales, within 10 Business
Days of each date on which the aggregate amount of Excess Proceeds exceeds $25.0 million, the
Issuer shall commence an Asset Sale Offer to all Holders and if the Issuer elects (or is required
by the terms of such other pari passu indebtedness) all holders of other Indebtedness that is pari
passu with the Cash Pay Notes pursuant to Section 3.09 of the Indenture to purchase the maximum
principal amount of Cash Pay Notes and other pari passu Indebtedness that may be purchased out of
the Excess Proceeds at an offer price in cash in an amount equal to 100% of the principal amount
thereof plus accrued and unpaid interest and Additional Interest, if any, to the Purchase Date in
accordance with the procedures set forth in the Indenture. To the extent that the aggregate amount
of Cash Pay Notes and other pari passu Indebtedness tendered pursuant to an Asset Sale Offer is
less than the Excess Proceeds, the Issuer (or such Restricted Subsidiary) may use the remaining
Excess Proceeds for any purpose not otherwise prohibited by the Indenture. If the aggregate
principal amount of Cash Pay Notes and other pari passu Indebtedness surrendered by holders thereof
exceeds the amount of Excess Proceeds, the Trustee shall select the Cash Pay Notes and other pari
passu Indebtedness to be purchased on a pro rata basis. Holders to whom an Asset Sale Offer is
addressed shall receive an Asset Sale Offer from the Issuer prior to the related Purchase Date and
may elect to have such Cash Pay Notes purchased by completing the form entitled “Option of Holder
to Elect Purchase” attached to the Cash Pay Notes.

     (8) NOTICE OF REDEMPTION. Notice of redemption shall be mailed at least 30 days but
not more than 60 days before the redemption date to each Holder whose Notes are to be redeemed at
its registered address, except that redemption notices may be mailed more than 60 days prior to a
redemption date if the notice is issued in connection with a defeasance of the Notes or a
satisfaction and discharge of the Indenture. Notes in denominations larger than $2,000 may be
redeemed in part but only in whole multiples of $1,000 in excess thereof, unless all of the Notes
held by a Holder are to be redeemed. On and after the redemption date interest and Additional
Interest will cease to accrue on Notes or portions thereof called for redemption.

     (9) DENOMINATIONS, TRANSFER, EXCHANGE. The Cash Pay Notes are in registered form
without coupons in denominations of $2,000 and integral multiples of $1,000 in excess thereof. The
transfer of Cash Pay Notes may be registered and Cash Pay Notes may be exchanged as provided in the
Indenture. The Registrar and the Trustee may require a Holder, among other things, to furnish
appropriate endorsements and transfer documents and the Issuer may require a Holder to pay any
taxes and fees required by law or permitted by the Indenture. The Issuer need not exchange or
register the transfer of any Note or portion of a Note selected for redemption, except for the
unredeemed portion of any Note being redeemed in part. Also, the Issuer need not exchange or
register the transfer of any Cash Pay Notes for a period of 15 days before a selection of Cash Pay
Notes to be redeemed or during the period between a record date and the corresponding Interest
Payment Date.

A1-5 

 

     (10) PERSONS DEEMED OWNERS. The registered Holder of a Note may be treated as its
owner for all purposes.

     (11) AMENDMENT, SUPPLEMENT AND WAIVER. Subject to certain exceptions, the Indenture,
the Subsidiary Guarantees or the Cash Pay Notes may be amended or supplemented with the consent of
the Holders of at least a majority in aggregate principal amount of the then outstanding Cash Pay
Notes, including without limitation, consents obtained in connection with a purchase of, or tender
offer or exchange offer for, Cash Pay Notes, and any existing Default or Event of Default or
compliance with any provision of the Indenture, the Subsidiary Guarantees or the Cash Pay Notes may
be waived with the consent of the Holders of a majority in aggregate principal amount of the then
outstanding Cash Pay Notes, including without limitation, consents obtained in connection with a
purchase of, or tender offer or exchange offer for, Cash Pay Notes. Without the consent of any
Holder, the Indenture, the Subsidiary Guarantees or the Cash Pay Notes may be amended or
supplemented (i) to cure any ambiguity, defect or inconsistency, (ii) to provide for uncertificated
Cash Pay Notes in addition to or in place of certificated Cash Pay Notes, (iii) to provide for the
assumption of the Issuer’s or any Guarantor’s obligations to Holders of the Cash Pay Notes in case
of a merger or consolidation, (iv) to make any change that would provide any additional rights or
benefits to the Holders or that does not adversely affect the legal rights under the Indenture of
any such Holder, (v) to comply with the requirements of the SEC in order to effect or maintain the
qualification of the Indenture under the TIA, (vi) to conform the text of the Indenture, the
Subsidiary Guarantees or the Cash Pay Notes to any provision of the “Description of Notes” section
of the Offering Memorandum to the extent that such provision in that “Description of Notes” was
intended to be a verbatim recitation of a provision of the Indenture, the Subsidiary Guarantees or
the Cash Pay Notes, (vii) to provide for the issuance of Additional Notes in accordance with the
limitations set forth in the Indenture as of the Issue Date, (viii) to allow any Guarantor to
execute a supplemental indenture and/or a Subsidiary Guarantee with respect to the Cash Pay Notes
or to secure the Cash Pay Notes, or (ix) to issue additional notes in accordance with the terms of
the Indenture. In addition, except as provided in clause (vi) of the preceding sentence, any
amendment to the provisions of Article 10 of the Indenture (including the definitions of “Senior
Debt” and “Designated Senior Debt”) that adversely affects the rights of any holder of Designated
Senior Debt of the Issuer then outstanding requires the consent of a majority of the holders of
such Designated Senior Debt (or any group or representative thereof authorized to give a consent),
and any amendment or waiver of the provisions of Article 10 of the Indenture that adversely affects
the rights of the Holders requires the consent of the Holders of at least 66-2/3% in aggregate
principal amount of Cash Pay Notes then outstanding.

     (12) DEFAULTS AND REMEDIES. Events of Default include: (i) default for 30 days in
the payment when due of interest on or Additional Interest, if any, with respect to, the Notes,
whether or not prohibited by the subordination provisions of the Indenture; (ii) default in payment
when due (at maturity, upon redemption or otherwise) of the principal of, or premium, if any, on
the Notes whether or not prohibited by the subordination provisions of the Indenture; (iii) failure
by the Issuer to comply with Section 5.01 of the Indenture; (iv) failure by the Issuer or any of
its Restricted Subsidiaries for 60 days after notice to the Issuer by the Trustee or the Holders of
at least 25% in aggregate principal amount of Cash Pay Notes then outstanding voting as a single
class to comply with any of the other agreements in the Indenture; (v) default under any mortgage,
indenture or instrument under which there may be issued or by which there may be secured or
evidenced any Indebtedness for money borrowed by the Issuer or any of its Significant Subsidiaries
(or the payment of which is guaranteed by the Issuer or any of its Significant Subsidiaries),
whether such Indebtedness or Guarantee now exists, or is created after the Issue Date, if that
default: (A) is caused by a failure to pay principal at the final Stated Maturity of such
Indebtedness (a “Payment Default”) or (B) results in the acceleration of such Indebtedness prior to
its express maturity, and, in each case, the principal amount of such Indebtedness, together with
the principal amount of any other such Indebtedness under which there has been a Payment Default or
the maturity of which has been

A1-6 

 

so accelerated, aggregates $20.0 million or more; (vi) certain final judgments and decrees for
the payment of money that remain undischarged for a period of 60 days after such judgment or decree
has become final and nonappealable without being paid, discharged, waived or stayed; (vii) except
as permitted by the Indenture, any Subsidiary Guarantee of any Significant Subsidiary is declared
to be unenforceable or invalid by any final and nonappealable judgment or decree or ceases for any
reason to be in full force and effect, or any Guarantor that is a Significant Subsidiary or any
Person acting on behalf of any Guarantor that is a Significant Subsidiary denies or disaffirms its
obligations in writing under its Subsidiary Guarantee and such Default continues for 10 days after
receipt of the notice specified in the Indenture and (viii) certain events of bankruptcy or
insolvency with respect to the Issuer or any of the Issuer’s Restricted Subsidiaries that is a
Significant Subsidiary. If any Event of Default occurs and is continuing, the Trustee or the
Holders of at least 25% in aggregate principal amount of the then outstanding Cash Pay Notes may
declare all the Cash Pay Notes to be due and payable; provided that so long as any Indebtedness
permitted to be incurred under the Credit Agreement is outstanding, such acceleration will not be
effective until the earlier of the acceleration of such Indebtedness under the Credit Agreement or
five Business Days after receipt by the Issuer and the representative under the Credit Agreement of
written notice of such acceleration. Notwithstanding the foregoing, in the case of an Event of
Default arising from certain events of bankruptcy or insolvency, all outstanding Cash Pay Notes
shall become due and payable without further action or notice. Holders may not enforce the
Indenture or the Cash Pay Notes except as provided in the Indenture. Subject to certain
limitations, Holders of a majority in principal amount of the then outstanding Cash Pay Notes may
direct the Trustee in its exercise of any trust or power. The Trustee may withhold from Holders
notice of any continuing Default or Event of Default (except a Default or Event of Default relating
to the payment of principal, premium or interest or Additional Interest) if a committee of its
Responsible Officer determines in good faith that withholding notice is in their interest. The
Holders of a majority in aggregate principal amount of the Cash Pay Notes then outstanding by
notice to the Trustee may on behalf of the Holders of all of the Cash Pay Notes waive any existing
Default or Event of Default and its consequences under the Indenture except a continuing Default or
Event of Default in the payment of the principal of, premium and Additional Interest, if any, or
interest on, the Cash Pay Notes (including in connection with an offer to purchase). The Issuer is
required to deliver to the Trustee annually a statement regarding compliance with the Indenture,
and the Issuer is required within 30 days of becoming aware of any Default or Event of Default, to
deliver to the Trustee a statement specifying such Default or Event of Default.

     (13) SUBORDINATION. All Obligations in respect of the Cash Pay Notes are subordinated
to the prior payment in full in cash of all Senior Debt of the Issuer (whether outstanding on the
Issue Date or created, incurred, assumed or guaranteed thereafter) on the terms provided in the
Indenture.

     (14) TRUSTEE DEALINGS WITH ISSUER. The Trustee, in its individual or any other
capacity, may make loans to, accept deposits from, and perform services for the Issuer or its
Affiliates, and may otherwise deal with the Issuer or its Affiliates, as if it were not the
Trustee.

     (15) NO RECOURSE AGAINST OTHERS. No director, officer, employee, incorporator,
stockholder, member partner or other holder of Equity Interests of the Issuer or any Guarantor, as
such, shall have any liability for any obligations of the Issuer or any such Guarantor under the
Indenture, the Cash Pay Notes or the Subsidiary Guarantees or for any claim based on, in respect
of, or by reason of, such obligations or their creation. Each Holder by accepting a Note waives
and releases all such liability. The waiver and release are part of the consideration for the
issuance of the Cash Pay Notes.

     (16) AUTHENTICATION. This Note shall not be valid until authenticated by the manual
signature of the Trustee or an authenticating agent.

A1-7 

 

     (17) ABBREVIATIONS. Customary abbreviations may be used in the name of a Holder or an
assignee, such as: TEN COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (=
joint tenants with right of survivorship and not as tenants in common), CUST (= Custodian), and
U/G/M/A (= Uniform Gifts to Minors Act).

     (18) ADDITIONAL RIGHTS OF HOLDERS OF RESTRICTED GLOBAL NOTES AND RESTRICTED DEFINITIVE
NOTES. In addition to the rights provided to Holders under the Indenture, Holders of
Restricted Global Notes and Restricted Definitive Notes shall have all the rights set forth in the
Registration Rights Agreement dated as of April 19, 2007, among the Issuer, the Guarantors and the
other parties named on the signature pages thereof (the “Registration Rights Agreement”).

     (19) CUSIP NUMBERS. Pursuant to a recommendation promulgated by the Committee on
Uniform Security Identification Procedures, the Issuer has caused CUSIP numbers to be printed on
the Cash Pay Notes and the Trustee may use CUSIP numbers in notices of redemption as a convenience
to Holders. No representation is made as to the accuracy of such numbers either as printed on the
Cash Pay Notes or as contained in any notice of redemption and reliance may be placed only on the
other identification numbers placed thereon.

     The Issuer shall furnish to any Holder upon written request and without charge a copy of the
Indenture and/or the Registration Rights Agreement. Requests may be made to:

United Surgical Partners International, Inc.

15305 Dallas Parkway, Suite 1600

Addison, Texas 75001

Telecopier No.: (972) 767-0604

Attention: Vice President and General Counsel

A1-8 

 

ASSIGNMENT FORM

To assign this Cash Pay Note, fill in the form below:

	 	 	 
	          (I) or (we) assign and transfer this Cash Pay Note to:
	 	 
	 

	 	 
	 

	 	(Insert assignee’s legal name)

 

 

(Insert assignee’s soc. sec. or tax I.D. no.)

 

 

 

 

 

 

 

 

(Print or type assignee’s name, address and zip code)

and irrevocably appoint                                                            to transfer this Cash Pay Note
on the books of the Issuer. The agent may substitute another to act for him.

Date:                     

	 	 	 	 	 	 	 
	 

	 	Your Signature:
	 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Cash Pay Note)	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A1-9 

 

OPTION OF HOLDER TO ELECT PURCHASE

     If you want to elect to have this Cash Pay Note purchased by the Issuer pursuant to Section
4.10 or 4.15 of the Indenture, check the appropriate box below:

o Section 4.10            o Section 4.15

     If you want to elect to have only part of the Cash Pay Note purchased by the Issuer pursuant
to Section 4.10 or Section 4.15 of the Indenture, state the amount you elect to have purchased:

$                    

Date:                     

	 	 	 	 	 	 	 
	 

	 	Your Signature:
	 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Cash Pay Note)	 	 
	 
	 	 	 	 	 	 
	 

	 	Tax Identification No.:	 	 	 	 
	 

	 	 	 	 	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A1-10 

 

SCHEDULE OF EXCHANGES OF GLOBAL NOTE

     The following exchanges of a part of this Global Note for an interest in another Global Note,
or exchanges in part of another other Restricted Global Note for an interest in this Global Note,
have been made:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Principal Amount	 	 
	 	 	 	 	Amount of	 	of this	 	 
	 	 	Amount of	 	increase in	 	Global Note	 	Signature of
	 	 	decrease in	 	Principal Amount	 	following such	 	authorized
	Date of	 	Principal Amount	 	of this Global	 	decrease (or	 	officer of Trustee
	Exchange	 	of this Global Note	 	Note	 	increase)	 	or Custodian
	 
	 	 
	 	 
	 	 
	 	 
	 	 	 	 	 	 	 	 	 

 

			
	*	 	This schedule should be included only if the Note is issued in global form.

A1-11 

 

EXHIBIT A2

[Face of Note]

CUSIP                     

91/4%/10% Senior Subordinated Toggle Note due 2017

			
	 	 	 
	No.                     
	 	$                    

UNITED SURGICAL PARTNERS INTERNATIONAL, INC.

UNITED SURGICAL PARTNERS INTERNATIONAL, INC.. promises to pay to [           ] or registered
assigns, the principal sum of                                          DOLLARS on May 1, 2017.

Interest Payment Dates: May 1 and November 1

Record Dates: April 15 and October 15

Dated: April 19, 2007

	 	 	 	 	 
	 	UNITED SURGICAL PARTNERS

INTERNATIONAL, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 

A2-1 

 

	 	 	 	 	 

This is one of the Notes referred to

in the within-mentioned Indenture:

U.S. BANK NATIONAL ASSOCIATION,

  as Trustee

	 	 	 	 	 
	By:

	 	 	 	 
	 

	 	Authorized Signatory	 	 

A2-2 

 

[Back of Note]

91/4%/10% Senior Subordinated Toggle Note due 2017

[Insert the Global Note Legend, if applicable pursuant to the provisions of the Indenture]

[Insert the Private Placement Legend, if applicable pursuant to the provisions of the Indenture]

     Capitalized terms used herein have the meanings assigned to them in the Indenture referred to
below unless otherwise indicated.

     (1) INTEREST. United Surgical Partners International, Inc., a Delaware corporation
(the “Issuer”), promises to pay interest on the principal amount of this Toggle Note as follows:
Cash Interest on the Toggle Notes will accrue at a rate of 91/4% per annum and be payable in cash.
PIK Interest on the Toggle Notes will accrue at a rate of 10% per annum and be payable (x) with
respect to Toggle Notes represented by one or more global notes registered in the name of, or held
by, The Depository Trust Company (“DTC”) or its nominee on the relevant record date, by increasing
the principal amount of the outstanding global Toggle Note by an amount equal to the amount of PIK
Interest for the applicable interest period (rounded up to the nearest $1,000) and (y) with respect
to Toggle Notes represented by certificated notes, by issuing PIK Notes in certificated form in an
aggregate principal amount equal to the amount of PIK Interest for the applicable period (rounded
up to the nearest whole dollar), and the Trustee will, at the request of the Issuer, authenticate
and deliver such PIK Notes in certificated form for original issuance to the Holders on the
relevant record date, as shown by the records of the register of Holders. In the event that the
Issuer elects to pay Partial PIK Interest for any interest period, each Holder will be entitled to
receive Cash Interest in respect of 50% of the principal amount of the Toggle Notes held by such
Holder on the relevant record date and PIK Interest in respect of 50% of the principal amount of
the Toggle Notes held by such Holder on the relevant record date. Following an increase in the
principal amount of the outstanding Global Toggle Notes as a result of a PIK Payment, the Global
Toggle Notes will bear interest on such increased principal amount from and after the date of such
PIK Payment. Any PIK Notes issued in certificated form will be dated as of the applicable interest
payment date and will bear interest from and after such date. All Toggle Notes issued pursuant to
a PIK Payment will mature on May 1, 2017 and will be governed by, and subject to the terms,
provisions and conditions of, the Indenture and shall have the same rights and benefits as the
Toggle Notes issued on the Issue Date. Any certificated PIK Notes will be issued with the
description “PIK” on the face of such PIK Note.

     The Issuer shall pay interest (including post-petition interest in any proceeding under any
Bankruptcy Law) on overdue principal and premium, if any, from time to time on demand at a rate
that is 1% per annum in excess of the rate then in effect; it shall pay interest (including
post-petition interest in any proceeding under any Bankruptcy Law) on overdue installments of
interest and Additional Interest, if any, (without regard to any applicable grace periods) from
time to time on demand at the same rate to the extent lawful. Interest shall be computed on the
basis of a 360-day year of twelve 30-day months.

     (2) METHOD OF PAYMENT. For any interest payment period ending after the initial
interest payment period and on or prior to May 1, 2012, the Issuer may, at its option, elect to pay
interest on the Toggle Notes:

	 	•	 	entirely in cash (“Cash Interest”);
	 
	 	•	 	entirely by increasing the principal amount of the outstanding Toggle Notes or
by issuing PIK Notes (“PIK Interest”); or

A2-3 

 

	 	•	 	on 50% of the outstanding principal amount of the Toggle Notes in cash and on
50% of the principal amount by increasing the principal amount of the outstanding
Toggle Notes or by issuing PIK Notes (“Partial PIK Interest”).

     The Issuer must elect the form of interest payment with respect to each interest period by
delivering a notice to the trustee at least 30 days prior to the beginning of each interest period.
The trustee shall promptly deliver a corresponding notice to the holders. In the absence of such
an election for any interest period, interest on the Toggle notes shall be payable according to the
election for the previous interest period. Interest for the first interest period commencing on
the Issue Date shall be payable entirely in cash. After May 1, 2012, the Issuer will make all
interest payments on the Toggle Notes entirely in cash. Notwithstanding anything to the contrary,
the payment of accrued interest in connection with any redemption of Toggle Notes as described
under Sections 3.07, 4.10 and 4.15 of the Indenture shall be made solely in cash.

     The Issuer shall pay interest on the Toggle Notes (except defaulted interest) and Additional
Interest, if any, to the Persons who are registered Holders at the close of business on the April
15 or October 15 next preceding the Interest Payment Date, even if such Toggle Notes are canceled
after such record date and on or before such Interest Payment Date, except as provided in Section
2.12 of the Indenture with respect to defaulted interest. The Toggle Notes shall be payable as to
principal, interest and premium and Additional Interest, if any, at the office or agency of the
Paying Agent within the City and State of New York, or payment of interest and Additional Interest,
if any, may, at the option of the Issuer, be made by check mailed to the Holders at their addresses
set forth in the register of Holders; provided that payment by wire transfer of immediately
available funds shall be required with respect to principal of and interest, premium and Additional
Interest, if any, on, all Global Notes and all other Notes the Holder (if such Holder holds at
least $1.0 million in aggregate principal amount of Notes) of which shall have provided wire
transfer instructions to the Issuer prior to the record date. Payment of principal of, premium, if
any, and interest and Additional Interest on, Global Notes registered in the name of or held by DTC
or any successor depositary or its nominee will be made by wire transfer of immediately available
funds to such depositary or its nominee, as the case may be, as the registered Holder of such
Global note. Such payment shall be 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.

     (3) PAYING AGENT AND REGISTRAR. Initially, U.S. Bank National Association, the
Trustee under the Indenture, shall act as Paying Agent and Registrar. The Issuer may change any
Paying Agent or Registrar without notice to any Holder. The Issuer or any of its Subsidiaries may
act in any such capacity.

     (4) INDENTURE. The Issuer issued the Toggle Notes under an Indenture dated as of
April 19, 2007 (the “Indenture”), among the Issuer, the Guarantors and the Trustee. The terms of
the Toggle Notes include those stated in the Indenture and those made part of the Indenture by
reference to the TIA (15 U.S. Code Sections 77aaa-77bbbb). The Toggle Notes are subject to all
such terms, and Holders are referred to the Indenture and such Act for a statement of such terms.
To the extent any provision of this Note conflicts with the express provisions of the Indenture,
the provisions of the Indenture shall govern and be controlling. The Toggle Notes are general
unsecured obligations of the Issuer. Subject to the conditions set forth in the Indenture, the
Issuer may issue Additional Notes.

     (5) OPTIONAL REDEMPTION.

     (a) Except as set forth in subparagraph (b) or (c) of this Paragraph 5, on or after May 1,
2012, the Issuer may redeem all or a part of the Toggle Notes upon not less than 30 nor more than
60

A2-4 

 

days’ notice, at the redemption prices (expressed as percentages of principal amount) set
forth below plus accrued and unpaid interest and Additional Interest, if any, on the Toggle Notes
redeemed, to the applicable redemption date, if redeemed during the twelve-month period beginning
on May 1 of the years indicated below, subject to the rights of holders of Toggle Notes on the
relevant record date to receive interest on the relevant interest payment date:

	 	 	 	 	 
	Year	 	Percentage
	2012
	 	 	104.625	%
	2013
	 	 	103.083	%
	2014
	 	 	101.542	%
	2015 and thereafter
	 	 	100.000	%

     (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time prior
to May 1, 2010, the Issuer may, on any one or more occasions, redeem up to 35% of the aggregate
principal amount of Toggle Notes issued under the indenture at a redemption price of 109.25% of the
principal amount, plus accrued and unpaid interest and Additional Interest, if any, to the
redemption date, with the net cash proceeds of one or more Equity Offerings by the Issuer or a
contribution to the equity capital of the Issuer (other than Disqualified Stock) from the net
proceeds of one or more Equity Offerings by the Issuer, Holdings or any other direct or indirect
parent of the Issuer (in each case, other than Excluded Contributions); provided that:

     (1) at least 65% of the aggregate principal amount of Toggle Notes originally issued
under the indenture (excluding Toggle Notes held by the Issuer and its Subsidiaries) remains
outstanding immediately after the occurrence of such redemption; and

     (2) the redemption occurs within 90 days of the date of the closing of such Equity
Offering or equity contribution.

     (c) Before May 1, 2012, the Issuer may also redeem all or any portion of the Toggle Notes upon
not less than 30 nor more than 60 days’ prior notice, at a redemption price equal to 100% of the
principal amount thereof plus the Applicable Premium as of, and accrued and unpaid interest
thereon, if any, to, the date of redemption (a “Make-Whole Toggle Notes Redemption Date”).

     (6) MANDATORY REDEMPTION.

     (a) Except as set forth below, the Issuer will not be required to make any mandatory
redemption or sinking fund payments with respect to the Notes.

     (b) If the Toggle Notes would otherwise constitute “applicable high yield discount
obligations” within the meaning of Section 163(i)(1) of the Code, at the end of the first accrual
period ending after the fifth anniversary of the Toggle Notes’ issuance, the Issuer will be
required to redeem for cash a portion of each toggle note then outstanding equal to the Mandatory
Principal Redemption Amount. The redemption price for the portion of each toggle note redeemed
pursuant to a Mandatory Principal Redemption will be 100% of the principal amount of such portion
plus any accrued interest thereon on the date of redemption. The “Mandatory Principal Redemption
Amount” means the portion of a toggle note required to be redeemed to prevent such Toggle Note from
being treated as an “applicable high yield discount obligation” within the meaning of Section
163(i)(1) of the Code. No partial redemption or repurchase of the Toggle Notes prior to the AHYDO
Redemption Date pursuant to any other provision of the indenture will alter the Issuer’s obligation
to make the Mandatory Principal Redemption with respect to any Toggle Notes that remain outstanding
on the AHYDO Redemption Date. It is intended that this

A2-5 

 

provision prevent any Toggle Note from being treated as an “applicable high yield debt
obligation” within the meaning of Section 163(i)(1) of the Code, and this provision shall be
interpreted in accordance with such intent.

     (7) REPURCHASE AT THE OPTION OF HOLDER.

     (a) If there is a Change of Control, each Holder shall have the right to require the Issuer to
make an offer (a “Change of Control Offer”) to repurchase all or any part (a minimum amount of
$2,000 or an integral multiple of $1,000 in excess thereof) of that Holder’s Toggle Notes at a
purchase price equal to 101% of the aggregate principal amount thereof plus accrued and unpaid
interest and Additional Interest, if any, on the Toggle Notes repurchased, if any, to the date of
purchase, subject to the rights of the Holders on the relevant record date to receive interest due
on the relevant Interest Payment Date (the “Change of Control Payment”). Within 30 days following
any Change of Control, the Issuer shall mail a notice to each Holder setting forth the procedures
governing the Change of Control Offer as required by the Indenture.

     (b) If the Issuer or a Restricted Subsidiary consummates any Asset Sales, within 10 Business
Days of each date on which the aggregate amount of Excess Proceeds exceeds $25.0 million, the
Issuer shall commence an Asset Sale Offer to all Holders and if the Issuer elects (or is required
by the terms of such other pari passu indebtedness) all holders of other Indebtedness that is pari
passu with the Toggle Notes pursuant to Section 3.09 of the Indenture to purchase the maximum
principal amount of Toggle Notes and other pari passu Indebtedness that may be purchased out of the
Excess Proceeds at an offer price in cash in an amount equal to 100% of the principal amount
thereof plus accrued and unpaid interest and Additional Interest, if any, to the Purchase Date in
accordance with the procedures set forth in the Indenture. To the extent that the aggregate amount
of Toggle Notes and other pari passu Indebtedness tendered pursuant to an Asset Sale Offer is less
than the Excess Proceeds, the Issuer (or such Restricted Subsidiary) may use the remaining Excess
Proceeds for any purpose not otherwise prohibited by the Indenture. If the aggregate principal
amount of Toggle Notes and other pari passu Indebtedness surrendered by holders thereof exceeds the
amount of Excess Proceeds, the Trustee shall select the Toggle Notes and other pari passu
Indebtedness to be purchased on a pro rata basis. Holders to whom an Asset Sale Offer is addressed
shall receive an Asset Sale Offer from the Issuer prior to the related Purchase Date and may elect
to have such Toggle Notes purchased by completing the form entitled “Option of Holder to Elect
Purchase” attached to the Toggle Notes.

     (8) NOTICE OF REDEMPTION. Notice of redemption shall be mailed at least 30 days but
not more than 60 days before the redemption date to each Holder whose Notes are to be redeemed at
its registered address, except that redemption notices may be mailed more than 60 days prior to a
redemption date if the notice is issued in connection with a defeasance of the Notes or a
satisfaction and discharge of the Indenture. Notes in denominations larger than $2,000 may be
redeemed in part but only in whole multiples of $1,000 in excess thereof, unless all of the Notes
held by a Holder are to be redeemed. On and after the redemption date interest and Additional
Interest will cease to accrue on Notes or portions thereof called for redemption.

     (9) DENOMINATIONS, TRANSFER, EXCHANGE. The Toggle Notes are in registered form
without coupons in denominations of $2,000 and integral multiples of $1,000 in excess thereof. The
transfer of Toggle Notes may be registered and Toggle Notes may be exchanged as provided in the
Indenture. The Registrar and the Trustee may require a Holder, among other things, to furnish
appropriate endorsements and transfer documents and the Issuer may require a Holder to pay any
taxes and fees required by law or permitted by the Indenture. The Issuer need not exchange or
register the transfer of any Note or portion of a Note selected for redemption, except for the
unredeemed portion of any Note being

A2-6 

 

redeemed in part. Also, the Issuer need not exchange or register the transfer of any Toggle
Notes for a period of 15 days before a selection of Toggle Notes to be redeemed or during the
period between a record date and the corresponding Interest Payment Date.

     (10) PERSONS DEEMED OWNERS. The registered Holder of a Note may be treated as its
owner for all purposes.

     (11) AMENDMENT, SUPPLEMENT AND WAIVER. Subject to certain exceptions, the Indenture,
the Subsidiary Guarantees or the Toggle Notes may be amended or supplemented with the consent of
the Holders of at least a majority in aggregate principal amount of the then outstanding Toggle
Notes, including without limitation, consents obtained in connection with a purchase of, or tender
offer or exchange offer for, Toggle Notes, and any existing Default or Event of Default or
compliance with any provision of the Indenture, the Subsidiary Guarantees or the Toggle Notes may
be waived with the consent of the Holders of a majority in aggregate principal amount of the then
outstanding Toggle Notes, including without limitation, consents obtained in connection with a
purchase of, or tender offer or exchange offer for, Toggle Notes. Without the consent of any
Holder, the Indenture, the Subsidiary Guarantees or the Toggle Notes may be amended or supplemented
(i) to cure any ambiguity, defect or inconsistency, (ii) to provide for uncertificated Toggle Notes
in addition to or in place of certificated Toggle Notes, (iii) to provide for the assumption of the
Issuer’s or any Guarantor’s obligations to Holders of the Toggle Notes in case of a merger or
consolidation, (iv) to make any change that would provide any additional rights or benefits to the
Holders or that does not adversely affect the legal rights under the Indenture of any such Holder,
(v) to comply with the requirements of the SEC in order to effect or maintain the qualification of
the Indenture under the TIA, (vi) to conform the text of the Indenture, the Subsidiary Guarantees
or the Toggle Notes to any provision of the “Description of Notes” section of the Offering
Memorandum to the extent that such provision in that “Description of Notes” was intended to be a
verbatim recitation of a provision of the Indenture, the Subsidiary Guarantees or the Toggle Notes,
(vii) to provide for the issuance of Additional Notes in accordance with the limitations set forth
in the Indenture as of the Issue Date, (viii) to allow any Guarantor to execute a supplemental
indenture and/or a Subsidiary Guarantee with respect to the Toggle Notes or to secure the Toggle
Notes, or (ix) to issue additional notes in accordance with the terms of the Indenture. In
addition, except as provided in clause (vi) of the preceding sentence, any amendment to the
provisions of Article 10 of the Indenture (including the definitions of “Senior Debt” and
“Designated Senior Debt”) that adversely affects the rights of any holder of Designated Senior Debt
of the Issuer then outstanding requires the consent of a majority of the holders of such Designated
Senior Debt (or any group or representative thereof authorized to give a consent), and any
amendment or waiver of the provisions of Article 10 of the Indenture that adversely affects the
rights of the Holders requires the consent of the Holders of at least 66-2/3% in aggregate
principal amount of Toggle Notes then outstanding.

     (12) DEFAULTS AND REMEDIES. Events of Default include: (i) default for 30 days in
the payment when due of interest on or Additional Interest, if any, with respect to, the Notes,
whether or not prohibited by the subordination provisions of the Indenture; (ii) default in payment
when due (at maturity, upon redemption or otherwise) of the principal of, or premium, if any, on
the Notes whether or not prohibited by the subordination provisions of the Indenture; (iii) failure
by the Issuer to comply with Section 5.01 of the Indenture; (iv) failure by the Issuer or any of
its Restricted Subsidiaries for 60 days after notice to the Issuer by the Trustee or the Holders of
at least 25% in aggregate principal amount of Toggle Notes then outstanding voting as a single
class to comply with any of the other agreements in the Indenture; (v) default under any mortgage,
indenture or instrument under which there may be issued or by which there may be secured or
evidenced any Indebtedness for money borrowed by the Issuer or any of its Significant Subsidiaries
(or the payment of which is guaranteed by the Issuer or any of its Significant Subsidiaries),
whether such Indebtedness or Guarantee now exists, or is created after the Issue Date, if

A2-7 

 

that default: (A) is caused by a failure to pay principal at the final Stated Maturity of
such Indebtedness (a “Payment Default”) or (B) results in the acceleration of such Indebtedness
prior to its express maturity, and, in each case, the principal amount of such Indebtedness,
together with the principal amount of any other such Indebtedness under which there has been a
Payment Default or the maturity of which has been so accelerated, aggregates $20.0 million or more;
(vi) certain final judgments and decrees for the payment of money that remain undischarged for a
period of 60 days after such judgment or decree has become final and nonappealable without being
paid, discharged, waived or stayed; (vii) except as permitted by the Indenture, any Subsidiary
Guarantee of any Significant Subsidiary is declared to be unenforceable or invalid by any final and
nonappealable judgment or decree or ceases for any reason to be in full force and effect, or any
Guarantor that is a Significant Subsidiary or any Person acting on behalf of any Guarantor that is
a Significant Subsidiary denies or disaffirms its obligations in writing under its Subsidiary
Guarantee and such Default continues for 10 days after receipt of the notice specified in the
Indenture and (viii) certain events of bankruptcy or insolvency with respect to the Issuer or any
of the Issuer’s Restricted Subsidiaries that is a Significant Subsidiary. If any Event of Default
occurs and is continuing, the Trustee or the Holders of at least 25% in aggregate principal amount
of the then outstanding Toggle Notes may declare all the Toggle Notes to be due and payable;
provided that so long as any Indebtedness permitted to be incurred under the Credit Agreement is
outstanding, such acceleration will not be effective until the earlier of the acceleration of such
Indebtedness under the Credit Agreement or five Business Days after receipt by the Issuer and the
representative under the Credit Agreement of written notice of such acceleration. Notwithstanding
the foregoing, in the case of an Event of Default arising from certain events of bankruptcy or
insolvency, all outstanding Toggle Notes shall become due and payable without further action or
notice. Holders may not enforce the Indenture or the Toggle Notes except as provided in the
Indenture. Subject to certain limitations, Holders of a majority in principal amount of the then
outstanding Toggle Notes may direct the Trustee in its exercise of any trust or power. The Trustee
may withhold from Holders notice of any continuing Default or Event of Default (except a Default or
Event of Default relating to the payment of principal, premium or interest or Additional Interest)
if a committee of its Responsible Officer determines in good faith that withholding notice is in
their interest. The Holders of a majority in aggregate principal amount of the Toggle Notes then
outstanding by notice to the Trustee may on behalf of the Holders of all of the Toggle Notes waive
any existing Default or Event of Default and its consequences under the Indenture except a
continuing Default or Event of Default in the payment of the principal of, premium and Additional
Interest, if any, or interest on, the Toggle Notes (including in connection with an offer to
purchase). The Issuer is required to deliver to the Trustee annually a statement regarding
compliance with the Indenture, and the Issuer is required within 30 days of becoming aware of any
Default or Event of Default, to deliver to the Trustee a statement specifying such Default or Event
of Default.

     (13) SUBORDINATION. All Obligations in respect of the Toggle Notes are subordinated
to the prior payment in full in cash of all Senior Debt of the Issuer (whether outstanding on the
Issue Date or created, incurred, assumed or guaranteed thereafter) on the terms provided in the
Indenture.

     (14) TRUSTEE DEALINGS WITH ISSUER. The Trustee, in its individual or any other
capacity, may make loans to, accept deposits from, and perform services for the Issuer or its
Affiliates, and may otherwise deal with the Issuer or its Affiliates, as if it were not the
Trustee.

     (15) NO RECOURSE AGAINST OTHERS. No director, officer, employee, incorporator,
stockholder, member partner or other holder of Equity Interests of the Issuer or any Guarantor, as
such, shall have any liability for any obligations of the Issuer or any such Guarantor under the
Indenture, the Toggle Notes or the Subsidiary Guarantees or for any claim based on, in respect of,
or by reason of, such obligations or their creation. Each Holder by accepting a Note waives and
releases all such liability. The waiver and release are part of the consideration for the issuance
of the Toggle Notes.

A2-8 

 

     (16) AUTHENTICATION. This Note shall not be valid until authenticated by the manual
signature of the Trustee or an authenticating agent.

     (17) ABBREVIATIONS. Customary abbreviations may be used in the name of a Holder or an
assignee, such as: TEN COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (=
joint tenants with right of survivorship and not as tenants in common), CUST (= Custodian), and
U/G/M/A (= Uniform Gifts to Minors Act).

     (18) ADDITIONAL RIGHTS OF HOLDERS OF RESTRICTED GLOBAL NOTES AND RESTRICTED DEFINITIVE
NOTES. In addition to the rights provided to Holders under the Indenture, Holders of
Restricted Global Notes and Restricted Definitive Notes shall have all the rights set forth in the
Registration Rights Agreement dated as of April 19, 2007, among the Issuer, the Guarantors and the
other parties named on the signature pages thereof (the “Registration Rights Agreement”).

     (19) CUSIP NUMBERS. Pursuant to a recommendation promulgated by the Committee on
Uniform Security Identification Procedures, the Issuer has caused CUSIP numbers to be printed on
the Toggle Notes and the Trustee may use CUSIP numbers in notices of redemption as a convenience to
Holders. No representation is made as to the accuracy of such numbers either as printed on the
Toggle Notes or as contained in any notice of redemption and reliance may be placed only on the
other identification numbers placed thereon.

     The Issuer shall furnish to any Holder upon written request and without charge a copy of the
Indenture and/or the Registration Rights Agreement. Requests may be made to:

United Surgical Partners International, Inc.

15305 Dallas Parkway, Suite 1600

Addison, Texas 75001

Telecopier No.: (972) 767-0604

Attention: Vice President and General Counsel

A2-9 

 

ASSIGNMENT FORM

To assign this Toggle Note, fill in the form below:

	 	 	 
	          (I) or (we) assign and transfer this Toggle Note to:
	 	 
	 

	 	 
	 

	 	(Insert assignee’s legal name)

 

 

(Insert assignee’s soc. sec. or tax I.D. no.)

 

 

 

 

 

 

 

 

(Print or type assignee’s name, address and zip code)

and irrevocably appoint                                         to transfer this Toggle Note on
the books of the Issuer. The agent may substitute another to act for him.

Date:                     

	 	 	 	 	 	 	 
	 

	 	Your Signature:
	 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Toggle Note)	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A2-10 

 

OPTION OF HOLDER TO ELECT PURCHASE

     If you want to elect to have this Toggle Note purchased by the Issuer pursuant to Section 4.10
or 4.15 of the Indenture, check the appropriate box below:

o Section 4.10            o Section 4.15

     If you want to elect to have only part of the Toggle Note purchased by the Issuer pursuant to
Section 4.10 or Section 4.15 of the Indenture, state the amount you elect to have purchased:

$                    

Date:                     

	 	 	 	 	 	 	 
	 

	 	Your Signature:
	 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Toggle Note)	 	 
	 
	 	 	 	 	 	 
	 

	 	Tax Identification No.:	 	 	 	 
	 

	 	 	 	 	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A2-11 

 

SCHEDULE OF EXCHANGES OF GLOBAL NOTE

     The following exchanges of a part of this Global Note for an interest in another Global Note,
or exchanges in part of another other Restricted Global Note for an interest in this Global Note,
have been made:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Principal Amount	 	 
	 	 	 	 	Amount of	 	of this	 	 
	 	 	Amount of	 	increase in	 	Global Note	 	Signature of
	 	 	decrease in	 	Principal Amount	 	following such	 	authorized
	Date of	 	Principal Amount	 	of this Global	 	decrease (or	 	officer of Trustee
	Exchange	 	of this Global Note	 	Note	 	increase)	 	or Custodian
	 
	 	 
	 	 
	 	 
	 	 
	 	 	 	 	 	 	 	 	 

 

			
	*	 	This schedule should be included only if the Note is issued in global form.

A2-12 

 

EXHIBIT A3

[Face of Regulation S Temporary Global Note]

CUSIP                     

87/8% Senior Subordinated Note due 2017

			
	 	 	 
	No.                     
	 	$                    

UNITED SURGICAL PARTNERS INTERNATIONAL, INC.

UNITED SURGICAL PARTNERS INTERNATIONAL, INC. promises to pay to [          ] or registered
assigns, the principal sum of                                          DOLLARS on May 1, 2017.

Interest Payment Dates: May 1 and November 1

Record Dates: April 15 and October 15

Dated: April 19, 2007

	 	 	 	 	 
	 	UNITED SURGICAL PARTNERS

INTERNATIONAL, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 

A3-1 

 

	 	 	 	 	 

This is one of the Notes referred to

in the within-mentioned Indenture:

U.S. BANK NATIONAL ASSOCIATION

  as Trustee

	 	 	 	 	 
	By:

	 	 	 	 
	 

	 	 	 	 
	 

	 	Authorized Signatory	 	 

A3-2 

 

[Back of Regulation S Temporary Global Note]

87/8% Senior Subordinated Note due 2017

THE RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS AND PROCEDURES
GOVERNING ITS EXCHANGE FOR CERTIFICATED NOTES, ARE AS SPECIFIED IN THE INDENTURE (AS DEFINED
HEREIN). NEITHER THE HOLDER NOR THE BENEFICIAL OWNERS OF THIS REGULATION S TEMPORARY GLOBAL NOTE
SHALL BE ENTITLED TO RECEIVE PAYMENT OF PRINCIPAL HEREOF OR INTEREST HEREON.

THIS GLOBAL NOTE IS HELD BY THE DEPOSITARY (AS DEFINED IN THE INDENTURE GOVERNING THIS NOTE) OR ITS
NOMINEE IN CUSTODY FOR THE BENEFIT OF THE BENEFICIAL OWNERS HEREOF, AND IS NOT TRANSFERABLE TO ANY
PERSON UNDER ANY CIRCUMSTANCES EXCEPT THAT (1) THE TRUSTEE MAY MAKE SUCH NOTATIONS HEREON AS MAY BE
REQUIRED PURSUANT TO SECTION 2.01 AND SECTION 2.06 OF THE INDENTURE, (2) THIS GLOBAL NOTE MAY BE
EXCHANGED IN WHOLE BUT NOT IN PART PURSUANT TO SECTION 2.06(a) OF THE INDENTURE, (3) THIS GLOBAL
NOTE MAY BE DELIVERED TO THE TRUSTEE FOR CANCELLATION PURSUANT TO SECTION 2.11 OF THE INDENTURE AND
(4) THIS GLOBAL NOTE MAY BE TRANSFERRED TO A SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF
THE ISSUERS.

UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR NOTES IN DEFINITIVE FORM, THIS NOTE MAY
NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF THE DEPOSITARY OR BY A
NOMINEE OF THE DEPOSITARY TO THE DEPOSITARY OR ANOTHER NOMINEE OF THE DEPOSITARY OR BY THE
DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY.
UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST
COMPANY (55 WATER STREET, NEW YORK, NEW YORK) (“DTC”), TO THE ISSUER OR ITS AGENT FOR REGISTRATION
OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE &
CO. OR SUCH OTHER NAME AS MAY BE REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT
IS MADE TO CEDE & CO. OR SUCH OTHER ENTITY AS MAY BE 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.

THE NOTES EVIDENCED HEREBY HAVE NOT BEEN REGISTERED UNDER THE UNITED STATES SECURITIES ACT OF 1933
(THE ‘SECURITIES ACT’) AND MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED EXCEPT (A)
(1) TO A PERSON WHO THE SELLER REASONABLY BELIEVES IS A QUALIFIED INSTITUTIONAL BUYER WITHIN THE
MEANING OF RULE 144A UNDER THE SECURITIES ACT PURCHASING FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT OF
A QUALIFIED INSTITUTIONAL BUYER IN A TRANSACTION MEETING THE REQUIREMENTS OF RULE 144A, (2) IN AN
OFFSHORE TRANSACTION COMPLYING WITH RULE 903 OR RULE 904 OF REGULATION S UNDER THE SECURITIES ACT,
(3) TO AN INSTITUTIONAL ACCREDITED INVESTOR IN A TRANSACTION EXEMPT FROM THE REGISTRATION
REQUIREMENTS OF THE SECURITIES ACT, (4) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE
SECURITIES ACT PROVIDED BY RULE 144 THEREUNDER (IF AVAILABLE) OR

A3-3 

 

(5) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT AND (B) IN ACCORDANCE
WITH ALL APPLICABLE SECURITIES LAWS OF THE STATES OF THE UNITED STATES.

     Capitalized terms used herein have the meanings assigned to them in the Indenture referred to
below unless otherwise indicated.

     (1) INTEREST. United Surgical Partners International, Inc., a Delaware corporation
(the “Issuer”), promises to pay interest on the principal amount of this Note at 87/8% per annum from
April 19, 2007 until maturity and shall pay the Additional Interest, if any, payable pursuant to
the Registration Rights Agreement referred to below. The Issuer shall pay interest and Additional
Interest, if any, semi-annually in arrears on May 1 and November 1 of each year, or if any such day
is not a Business Day, on the next succeeding Business Day (each, an “Interest Payment Date”).
Interest on the Cash Pay Notes shall accrue from the most recent date to which interest has been
paid or, if no interest has been paid, from the date of issuance; provided that if there is no
existing Default in the payment of interest, and if this Note is authenticated between a record
date referred to on the face hereof and the next succeeding Interest Payment Date, interest shall
accrue from such next succeeding Interest Payment Date; provided further that the first Interest
Payment Date shall be November 1, 2007. The Issuer shall pay interest (including post-petition
interest in any proceeding under any Bankruptcy Law) on overdue principal and premium, if any, from
time to time on demand at a rate that is 1% per annum in excess of the rate then in effect; it
shall pay interest (including post-petition interest in any proceeding under any Bankruptcy Law) on
overdue installments of interest and Additional Interest, if any, (without regard to any applicable
grace periods) from time to time on demand at the same rate to the extent lawful. Interest shall
be computed on the basis of a 360-day year of twelve 30-day months.

     (2) METHOD OF PAYMENT. The Issuer shall pay interest on the Notes (except defaulted
interest) and Additional Interest, if any, to the Persons who are registered Holders at the close
of business on the April 15 or October 15 next preceding the Interest Payment Date, even if such
Notes are canceled after such record date and on or before such Interest Payment Date, except as
provided in Section 2.12 of the Indenture with respect to defaulted interest. The Notes shall be
payable as to principal, interest and premium and Additional Interest, if any, at the office or
agency of the Paying Agent within the City and State of New York, or, at the option of the Issuer,
payment of interest and Additional Interest, if any, may be made by check mailed to the Holders at
their addresses set forth in the register of Holders; provided that payment by wire transfer of
immediately available funds shall be required with respect to principal of and interest, premium
and Additional Interest, if any, on, all Global Notes and all other Notes the Holder (if such
Holder holds at least $1.0 million in aggregate principal amount of Notes) of which shall have
provided wire transfer instructions to the Issuer prior to the record date. Payment of principal
of, premium, if any, and interest and Additional Interest on, Global Notes registered in the name
of or held by DTC or any successor depositary or its nominee will be made by wire transfer of
immediately available funds to such depositary or its nominee, as the case may be, as the
registered Holder of such Global note. Such payment shall be 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.

     (3) PAYING AGENT AND REGISTRAR. Initially, U.S. Bank National Association, the
Trustee under the Indenture, shall act as Paying Agent and Registrar. The Issuer may change any
Paying Agent or Registrar without notice to any Holder. The Issuer or any of its Subsidiaries may
act in any such capacity.

     (4) INDENTURE. The Issuer issued the Notes under an Indenture dated as of April 19, 2007 (the
“Indenture”), among the Issuer, the Guarantors (following the Merger) and the Trustee. The terms
of

A3-4 

 

the Notes include those stated in the Indenture and those made part of the Indenture by
reference to the TIA (15 U.S. Code Sections 77aaa-77bbbb). The Notes are subject to all such
terms, and Holders are referred to the Indenture and such Act for a statement of such terms. To
the extent any provision of this Note conflicts with the express provisions of the Indenture, the
provisions of the Indenture shall govern and be controlling. The Notes are general unsecured
obligations of the Issuer. Subject to the conditions set forth in the Indenture, the Issuer may
issue Additional Notes.

     (5) OPTIONAL REDEMPTION.

     (a) Except as set forth in subparagraph (b) or (c) of this Paragraph 5, on or after May 1,
2012, the Issuer may redeem all or a part of the Cash Pay Notes upon not less than 30 nor more than
60 days’ notice, at the redemption prices (expressed as percentages of principal amount) set forth
below plus accrued and unpaid interest and Additional Interest, if any, on the Cash Pay Notes
redeemed, to the applicable redemption date, if redeemed during the twelve-month period beginning
on May 1 of the years indicated below, subject to the rights of holders of Cash Pay Notes on the
relevant record date to receive interest on the relevant interest payment date:

	 	 	 	 	 
	Year	 	Percentage
	2012
	 	 	104.438	%
	2013
	 	 	102.958	%
	2014
	 	 	101.479	%
	2015 and thereafter
	 	 	100.000	%

     (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time prior
to May 1, 2010, the Issuer may, on any one or more occasions, redeem up to 35% of the aggregate
principal amount of Cash Pay Notes issued under the indenture at a redemption price of 108.875% of
the principal amount, plus accrued and unpaid interest and Additional Interest, if any, to the
redemption date, with the net cash proceeds of one or more Equity Offerings by the Issuer or a
contribution to the equity capital of the Issuer (other than Disqualified Stock) from the net
proceeds of one or more Equity Offerings by the Issuer, Holdings or any other direct or indirect
parent of the Issuer (in each case, other than Excluded Contributions); provided that:

     (1) at least 65% of the aggregate principal amount of Cash Pay Notes originally issued
under the Indenture (excluding Cash Pay Notes held by the Issuer and its Subsidiaries)
remains outstanding immediately after the occurrence of such redemption; and

     (2) the redemption occurs within 90 days of the date of the closing of such Equity
Offering or equity contribution.

     (c) Before May 1, 2012, the Issuer may also redeem all or any portion of the Cash Pay Notes
upon not less than 30 nor more than 60 days’ prior notice, at a redemption price equal to 100% of
the principal amount thereof plus the Applicable Premium as of, and accrued and unpaid interest
thereon, if any, to, the date of redemption (a “Make-Whole Cash Pay Notes Redemption Date”).

     (6) MANDATORY REDEMPTION. The Issuer shall not be required to make mandatory
redemption payments with respect to the Cash Pay Notes.

A3-5 

 

     (7) REPURCHASE AT THE OPTION OF HOLDER.

     (a) If there is a Change of Control, each Holder shall have the right to require the Issuer to
make an offer (a “Change of Control Offer”) to repurchase all or any part (a minimum amount of
$2,000 or an integral multiple of $1,000 in excess thereof) of that Holder’s Cash Pay Notes at a
purchase price equal to 101% of the aggregate principal amount thereof plus accrued and unpaid
interest and Additional Interest, if any, on the Cash Pay Notes repurchased, if any, to the date of
purchase, subject to the rights of the Holders on the relevant record date to receive interest due
on the relevant Interest Payment Date (the “Change of Control Payment”). Within 30 days following
any Change of Control, the Issuer shall mail a notice to each Holder setting forth the procedures
governing the Change of Control Offer as required by the Indenture.

     (b) If the Issuer or a Restricted Subsidiary consummates any Asset Sales, within 10 Business
Days of each date on which the aggregate amount of Excess Proceeds exceeds $25.0 million, the
Issuer shall commence an Asset Sale Offer to all Holders and if the Issuer elects (or is required
by the terms of such other pari passu indebtedness) all holders of other Indebtedness that is pari
passu with the Cash Pay Notes pursuant to Section 3.09 of the Indenture to purchase the maximum
principal amount of Cash Pay Notes and other pari passu Indebtedness that may be purchased out of
the Excess Proceeds at an offer price in cash in an amount equal to 100% of the principal amount
thereof plus accrued and unpaid interest and Additional Interest, if any, to the Purchase Date in
accordance with the procedures set forth in the Indenture. To the extent that the aggregate amount
of Cash Pay Notes and other pari passu Indebtedness tendered pursuant to an Asset Sale Offer is
less than the Excess Proceeds, the Issuer (or such Restricted Subsidiary) may use the remaining
Excess Proceeds for any purpose not otherwise prohibited by the Indenture. If the aggregate
principal amount of Cash Pay Notes and other pari passu Indebtedness surrendered by holders thereof
exceeds the amount of Excess Proceeds, the Trustee shall select the Cash Pay Notes and other pari
passu Indebtedness to be purchased on a pro rata basis. Holders to whom an Asset Sale Offer is
addressed shall receive an Asset Sale Offer from the Issuer prior to the related Purchase Date and
may elect to have such Cash Pay Notes purchased by completing the form entitled “Option of Holder
to Elect Purchase” attached to the Cash Pay Notes.

     (8) NOTICE OF REDEMPTION. Notice of redemption shall be mailed at least 30 days but
not more than 60 days before the redemption date to each Holder whose Notes are to be redeemed at
its registered address, except that redemption notices may be mailed more than 60 days prior to a
redemption date if the notice is issued in connection with a defeasance of the Notes or a
satisfaction and discharge of the Indenture. Notes in denominations larger than $2,000 may be
redeemed in part but only in whole multiples of $1,000 in excess thereof, unless all of the Notes
held by a Holder are to be redeemed. On and after the redemption date interest and Additional
Interest will cease to accrue on Notes or portions thereof called for redemption.

     (9) DENOMINATIONS, TRANSFER, EXCHANGE. The Cash Pay Notes are in registered form
without coupons in denominations of $2,000 and integral multiples of $1,000 in excess thereof. The
transfer of Cash Pay Notes may be registered and Cash Pay Notes may be exchanged as provided in the
Indenture. The Registrar and the Trustee may require a Holder, among other things, to furnish
appropriate endorsements and transfer documents and the Issuer may require a Holder to pay any
taxes and fees required by law or permitted by the Indenture. The Issuer need not exchange or
register the transfer of any Note or portion of a Note selected for redemption, except for the
unredeemed portion of any Note being redeemed in part. Also, the Issuer need not exchange or
register the transfer of any Cash Pay Notes for a period of 15 days before a selection of Cash Pay
Notes to be redeemed or during the period between a record date and the corresponding Interest
Payment Date.

A3-6 

 

     (10) PERSONS DEEMED OWNERS. The registered Holder of a Note may be treated as its
owner for all purposes.

     (11) AMENDMENT, SUPPLEMENT AND WAIVER. Subject to certain exceptions, the Indenture,
the Subsidiary Guarantees or the Cash Pay Notes may be amended or supplemented with the consent of
the Holders of at least a majority in aggregate principal amount of the then outstanding Cash Pay
Notes, including without limitation, consents obtained in connection with a purchase of, or tender
offer or exchange offer for, Cash Pay Notes, and any existing Default or Event of Default or
compliance with any provision of the Indenture, the Subsidiary Guarantees or the Cash Pay Notes may
be waived with the consent of the Holders of a majority in aggregate principal amount of the then
outstanding Cash Pay Notes, including without limitation, consents obtained in connection with a
purchase of, or tender offer or exchange offer for, Cash Pay Notes. Without the consent of any
Holder, the Indenture, the Subsidiary Guarantees or the Cash Pay Notes may be amended or
supplemented (i) to cure any ambiguity, defect or inconsistency, (ii) to provide for uncertificated
Cash Pay Notes in addition to or in place of certificated Cash Pay Notes, (iii) to provide for the
assumption of the Issuer’s or any Guarantor’s obligations to Holders of the Cash Pay Notes in case
of a merger or consolidation, (iv) to make any change that would provide any additional rights or
benefits to the Holders or that does not adversely affect the legal rights under the Indenture of
any such Holder, (v) to comply with the requirements of the SEC in order to effect or maintain the
qualification of the Indenture under the TIA, (vi) to conform the text of the Indenture, the
Subsidiary Guarantees or the Cash Pay Notes to any provision of the “Description of Notes” section
of the Offering Memorandum to the extent that such provision in that “Description of Notes” was
intended to be a verbatim recitation of a provision of the Indenture, the Subsidiary Guarantees or
the Cash Pay Notes, (vii) to provide for the issuance of Additional Notes in accordance with the
limitations set forth in the Indenture as of the Issue Date, (viii) to allow any Guarantor to
execute a supplemental indenture and/or a Subsidiary Guarantee with respect to the Cash Pay Notes
or to secure the Cash Pay Notes, or (ix) to issue additional notes in accordance with the terms of
the Indenture. In addition, except as provided in clause (vi) of the preceding sentence, any
amendment to the provisions of Article 10 of the Indenture (including the definitions of “Senior
Debt” and “Designated Senior Debt”) that adversely affects the rights of any holder of Designated
Senior Debt of the Issuer then outstanding requires the consent of a majority of the holders of
such Designated Senior Debt (or any group or representative thereof authorized to give a consent),
and any amendment or waiver of the provisions of Article 10 of the Indenture that adversely affects
the rights of the Holders requires the consent of the Holders of at least 66-2/3% in aggregate
principal amount of Cash Pay Notes then outstanding.

     (12) DEFAULTS AND REMEDIES. Events of Default include: (i) default for 30 days in
the payment when due of interest on or Additional Interest, if any, with respect to, the Notes,
whether or not prohibited by the subordination provisions of the Indenture; (ii) default in payment
when due (at maturity, upon redemption or otherwise) of the principal of, or premium, if any, on
the Notes whether or not prohibited by the subordination provisions of the Indenture; (iii) failure
by the Issuer to comply with Section 5.01 of the Indenture; (iv) failure by the Issuer or any of
its Restricted Subsidiaries for 60 days after notice to the Issuer by the Trustee or the Holders of
at least 25% in aggregate principal amount of Cash Pay Notes then outstanding voting as a single
class to comply with any of the other agreements in the Indenture; (v) default under any mortgage,
indenture or instrument under which there may be issued or by which there may be secured or
evidenced any Indebtedness for money borrowed by the Issuer or any of its Significant Subsidiaries
(or the payment of which is guaranteed by the Issuer or any of its Significant Subsidiaries),
whether such Indebtedness or Guarantee now exists, or is created after the Issue Date, if that
default: (A) is caused by a failure to pay principal at the final Stated Maturity of such
Indebtedness (a “Payment Default”) or (B) results in the acceleration of such Indebtedness prior to
its express maturity, and, in each case, the principal amount of such Indebtedness, together with
the principal amount of any other such Indebtedness under which there has been a Payment Default or
the maturity of which has been

A3-7 

 

so accelerated, aggregates $20.0 million or more; (vi) certain final judgments and decrees for
the payment of money that remain undischarged for a period of 60 days after such judgment or decree
has become final and nonappealable without being paid, discharged, waived or stayed; (vii) except
as permitted by the Indenture, any Subsidiary Guarantee of any Significant Subsidiary is declared
to be unenforceable or invalid by any final and nonappealable judgment or decree or ceases for any
reason to be in full force and effect, or any Guarantor that is a Significant Subsidiary or any
Person acting on behalf of any Guarantor that is a Significant Subsidiary denies or disaffirms its
obligations in writing under its Subsidiary Guarantee and such Default continues for 10 days after
receipt of the notice specified in the Indenture and (viii) certain events of bankruptcy or
insolvency with respect to the Issuer or any of the Issuer’s Restricted Subsidiaries that is a
Significant Subsidiary. If any Event of Default occurs and is continuing, the Trustee or the
Holders of at least 25% in aggregate principal amount of the then outstanding Cash Pay Notes may
declare all the Cash Pay Notes to be due and payable; provided that so long as any Indebtedness
permitted to be incurred under the Credit Agreement is outstanding, such acceleration will not be
effective until the earlier of the acceleration of such Indebtedness under the Credit Agreement or
five Business Days after receipt by the Issuer and the representative under the Credit Agreement of
written notice of such acceleration. Notwithstanding the foregoing, in the case of an Event of
Default arising from certain events of bankruptcy or insolvency, all outstanding Cash Pay Notes
shall become due and payable without further action or notice. Holders may not enforce the
Indenture or the Cash Pay Notes except as provided in the Indenture. Subject to certain
limitations, Holders of a majority in principal amount of the then outstanding Cash Pay Notes may
direct the Trustee in its exercise of any trust or power. The Trustee may withhold from Holders
notice of any continuing Default or Event of Default (except a Default or Event of Default relating
to the payment of principal, premium or interest or Additional Interest) if a committee of its
Responsible Officer determines in good faith that withholding notice is in their interest. The
Holders of a majority in aggregate principal amount of the Cash Pay Notes then outstanding by
notice to the Trustee may on behalf of the Holders of all of the Cash Pay Notes waive any existing
Default or Event of Default and its consequences under the Indenture except a continuing Default or
Event of Default in the payment of the principal of, premium and Additional Interest, if any, or
interest on, the Cash Pay Notes (including in connection with an offer to purchase). The Issuer is
required to deliver to the Trustee annually a statement regarding compliance with the Indenture,
and the Issuer is required within 30 days of becoming aware of any Default or Event of Default, to
deliver to the Trustee a statement specifying such Default or Event of Default.

     (13) SUBORDINATION. All Obligations in respect of the Cash Pay Notes are subordinated
to the prior payment in full in cash of all Senior Debt of the Issuer (whether outstanding on the
Issue Date or created, incurred, assumed or guaranteed thereafter) on the terms provided in the
Indenture.

     (14) TRUSTEE DEALINGS WITH ISSUER. The Trustee, in its individual or any other
capacity, may make loans to, accept deposits from, and perform services for the Issuer or its
Affiliates, and may otherwise deal with the Issuer or its Affiliates, as if it were not the
Trustee.

     (15) NO RECOURSE AGAINST OTHERS. No director, officer, employee, incorporator,
stockholder, member partner or other holder of Equity Interests of the Issuer or any Guarantor, as
such, shall have any liability for any obligations of the Issuer or any such Guarantor under the
Indenture, the Cash Pay Notes or the Subsidiary Guarantees or for any claim based on, in respect
of, or by reason of, such obligations or their creation. Each Holder by accepting a Note waives
and releases all such liability. The waiver and release are part of the consideration for the
issuance of the Cash Pay Notes.

     (16) AUTHENTICATION. This Note shall not be valid until authenticated by the manual
signature of the Trustee or an authenticating agent.

A3-8 

 

     (17) ABBREVIATIONS. Customary abbreviations may be used in the name of a Holder or an
assignee, such as: TEN COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (=
joint tenants with right of survivorship and not as tenants in common), CUST (= Custodian), and
U/G/M/A (= Uniform Gifts to Minors Act).

     (18) ADDITIONAL RIGHTS OF HOLDERS OF RESTRICTED GLOBAL NOTES AND RESTRICTED DEFINITIVE
NOTES. In addition to the rights provided to Holders under the Indenture, Holders of
Restricted Global Notes and Restricted Definitive Notes shall have all the rights set forth in the
Registration Rights Agreement dated as of April 19, 2007, among the Issuer, the Guarantors and the
other parties named on the signature pages thereof (the “Registration Rights Agreement”).

     (19) CUSIP NUMBERS. Pursuant to a recommendation promulgated by the Committee on
Uniform Security Identification Procedures, the Issuer has caused CUSIP numbers to be printed on
the Cash Pay Notes and the Trustee may use CUSIP numbers in notices of redemption as a convenience
to Holders. No representation is made as to the accuracy of such numbers either as printed on the
Cash Pay Notes or as contained in any notice of redemption and reliance may be placed only on the
other identification numbers placed thereon.

     The Issuer shall furnish to any Holder upon written request and without charge a copy of the
Indenture and/or the Registration Rights Agreement. Requests may be made to:

United Surgical Partners International, Inc.

15305 Dallas Parkway, Suite 1600

Addison, Texas 75001

Telecopier No.: (972) 767-0604

Attention: Vice President and General Counsel

A3-9 

 

ASSIGNMENT FORM

To assign this Cash Pay Note, fill in the form below:

	 	 	 
	          (I) or (we) assign and transfer this Cash Pay Note to: 
	 	 
	 

	 	 
	 

	 	(Insert assignee’s legal name)

 

 

(Insert assignee’s soc. sec. or tax I.D. no.)

 

 

 

 

 

 

 

 

(Print or type assignee’s name, address and zip code)

and irrevocably appoint                                         to transfer this Cash Pay Note
on the books of the Issuer. The agent may substitute another to act for him.

Date:                     

	 	 	 	 	 	 	 
	 

	 	Your Signature:
	 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Cash Pay Note)	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A3-10 

 

OPTION OF HOLDER TO ELECT PURCHASE

     If you want to elect to have this Cash Pay Note purchased by the Issuer pursuant to Section
4.10 or 4.15 of the Indenture, check the appropriate box below:

o Section 4.10           o Section 4.15

     If you want to elect to have only part of the Cash Pay Note purchased by the Issuer pursuant
to Section 4.10 or Section 4.15 of the Indenture, state the amount you elect to have purchased:

$                    

Date:                     

	 	 	 	 	 	 	 
	 

	 	Your Signature:	 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Cash Pay Note)	 	 
	 
	 	 	 	 	 	 
	 

	 	Tax Identification No.:
	 	 	 	 
	 

	 	 	 	 	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A3-11 

 

SCHEDULE OF EXCHANGES OF REGULATION S TEMPORARY GLOBAL NOTE

     The following exchanges of a part of this Regulation S Temporary Global Note for an interest
in another Global Note, or exchanges in part of another other Restricted Global Note for an
interest in this Regulation S Temporary Global Note, have been made:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Principal Amount	 	 
	 	 	 	 	Amount of	 	of this	 	 
	 	 	Amount of	 	increase in	 	Global Note	 	Signature of
	 	 	decrease in	 	Principal Amount	 	following such	 	authorized
	Date of	 	Principal Amount	 	of this Global	 	decrease (or	 	officer of Trustee
	Exchange	 	of this Global Note	 	Note	 	increase)	 	or Custodian
	 
	 	 
	 	 
	 	 
	 	 
	 	 	 	 	 	 	 	 	 

 

			
	*	 	This schedule should be included only if the Note is issued in global form.

A3-12 

 

EXHIBIT A4

[Face of Regulation S Temporary Global Note]

CUSIP                     

91/4%/10% Senior Subordinated Toggle Note due 2017

			
	 	 	 
	No.                     
	 	$                    

[          ]

[          ] promises to pay to [          ] or registered assigns, the
principal sum of                                          DOLLARS on May 1, 2017.

Interest Payment Dates: May 1 and November 1

Record Dates: April 15 and October 15

Dated: April 19, 2007

	 	 	 	 	 
	 	UNITED SURGICAL PARTNERS

INTERNATIONAL, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 

A4-1 

 

	 	 	 	 	 

This is one of the Notes referred to

in the within-mentioned Indenture:

U.S. BANK NATIONAL ASSOCIATION

  as Trustee

	 	 	 	 	 
	By:
	 	 	 	 
	 

	 	 	 	 
	 

	 	Authorized Signatory
	 	 

A4-2 

 

[Back of Regulation S Temporary Global Note]

91/4%/10% Senior Subordinated Toggle Note due 2017

THE RIGHTS ATTACHING TO THIS REGULATION S TEMPORARY GLOBAL NOTE, AND THE CONDITIONS AND PROCEDURES
GOVERNING ITS EXCHANGE FOR CERTIFICATED NOTES, ARE AS SPECIFIED IN THE INDENTURE (AS DEFINED
HEREIN). NEITHER THE HOLDER NOR THE BENEFICIAL OWNERS OF THIS REGULATION S TEMPORARY GLOBAL NOTE
SHALL BE ENTITLED TO RECEIVE PAYMENT OF PRINCIPAL HEREOF OR INTEREST HEREON.

THIS GLOBAL NOTE IS HELD BY THE DEPOSITARY (AS DEFINED IN THE INDENTURE GOVERNING THIS NOTE) OR ITS
NOMINEE IN CUSTODY FOR THE BENEFIT OF THE BENEFICIAL OWNERS HEREOF, AND IS NOT TRANSFERABLE TO ANY
PERSON UNDER ANY CIRCUMSTANCES EXCEPT THAT (1) THE TRUSTEE MAY MAKE SUCH NOTATIONS HEREON AS MAY BE
REQUIRED PURSUANT TO SECTION 2.01 AND SECTION 2.06 OF THE INDENTURE, (2) THIS GLOBAL NOTE MAY BE
EXCHANGED IN WHOLE BUT NOT IN PART PURSUANT TO SECTION 2.06(a) OF THE INDENTURE, (3) THIS GLOBAL
NOTE MAY BE DELIVERED TO THE TRUSTEE FOR CANCELLATION PURSUANT TO SECTION 2.11 OF THE INDENTURE AND
(4) THIS GLOBAL NOTE MAY BE TRANSFERRED TO A SUCCESSOR DEPOSITARY WITH THE PRIOR WRITTEN CONSENT OF
THE ISSUERS.

UNLESS AND UNTIL IT IS EXCHANGED IN WHOLE OR IN PART FOR NOTES IN DEFINITIVE FORM, THIS NOTE MAY
NOT BE TRANSFERRED EXCEPT AS A WHOLE BY THE DEPOSITARY TO A NOMINEE OF THE DEPOSITARY OR BY A
NOMINEE OF THE DEPOSITARY TO THE DEPOSITARY OR ANOTHER NOMINEE OF THE DEPOSITARY OR BY THE
DEPOSITARY OR ANY SUCH NOMINEE TO A SUCCESSOR DEPOSITARY OR A NOMINEE OF SUCH SUCCESSOR DEPOSITARY.
UNLESS THIS CERTIFICATE IS PRESENTED BY AN AUTHORIZED REPRESENTATIVE OF THE DEPOSITORY TRUST
COMPANY (55 WATER STREET, NEW YORK, NEW YORK) (“DTC”), TO THE ISSUER OR ITS AGENT FOR REGISTRATION
OF TRANSFER, EXCHANGE OR PAYMENT, AND ANY CERTIFICATE ISSUED IS REGISTERED IN THE NAME OF CEDE &
CO. OR SUCH OTHER NAME AS MAY BE REQUESTED BY AN AUTHORIZED REPRESENTATIVE OF DTC (AND ANY PAYMENT
IS MADE TO CEDE & CO. OR SUCH OTHER ENTITY AS MAY BE 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.

THE NOTES EVIDENCED HEREBY HAVE NOT BEEN REGISTERED UNDER THE UNITED STATES SECURITIES ACT OF 1933
(THE ‘SECURITIES ACT’) AND MAY NOT BE OFFERED, SOLD, PLEDGED OR OTHERWISE TRANSFERRED EXCEPT (A)
(1) TO A PERSON WHO THE SELLER REASONABLY BELIEVES IS A QUALIFIED INSTITUTIONAL BUYER WITHIN THE
MEANING OF RULE 144A UNDER THE SECURITIES ACT PURCHASING FOR ITS OWN ACCOUNT OR FOR THE ACCOUNT OF
A QUALIFIED INSTITUTIONAL BUYER IN A TRANSACTION MEETING THE REQUIREMENTS OF RULE 144A, (2) IN AN
OFFSHORE TRANSACTION COMPLYING WITH RULE 903 OR RULE 904 OF REGULATION S UNDER THE SECURITIES ACT,
(3) TO AN INSTITUTIONAL ACCREDITED INVESTOR IN A TRANSACTION EXEMPT FROM THE REGISTRATION
REQUIREMENTS OF THE SECURITIES ACT, (4) PURSUANT TO AN EXEMPTION FROM REGISTRATION UNDER THE
SECURITIES ACT PROVIDED BY RULE 144 THEREUNDER (IF AVAILABLE) OR

A4-3 

 

(5) PURSUANT TO AN EFFECTIVE REGISTRATION STATEMENT UNDER THE SECURITIES ACT AND (B) IN ACCORDANCE
WITH ALL APPLICABLE SECURITIES LAWS OF THE STATES OF THE UNITED STATES.

     Capitalized terms used herein have the meanings assigned to them in the Indenture referred to
below unless otherwise indicated.

     (1) INTEREST. United Surgical Partners International, Inc., a Delaware corporation
(the “Issuer”), promises to pay interest on the principal amount of this Toggle Note as follows:
Cash Interest on the Toggle Notes will accrue at a rate of 91/4 % per annum and be payable in cash.
PIK Interest on the Toggle Notes will accrue at a rate of 10% per annum and be payable (x) with
respect to Toggle Notes represented by one or more global notes registered in the name of, or held
by, The Depository Trust Company (“DTC”) or its nominee on the relevant record date, by increasing
the principal amount of the outstanding global Toggle Note by an amount equal to the amount of PIK
Interest for the applicable interest period (rounded up to the nearest $1,000) and (y) with respect
to Toggle Notes represented by certificated notes, by issuing PIK Notes in certificated form in an
aggregate principal amount equal to the amount of PIK Interest for the applicable period (rounded
up to the nearest whole dollar), and the Trustee will, at the request of the Issuer, authenticate
and deliver such PIK Notes in certificated form for original issuance to the Holders on the
relevant record date, as shown by the records of the register of Holders. In the event that the
Issuer elects to pay Partial PIK Interest for any interest period, each Holder will be entitled to
receive Cash Interest in respect of 50% of the principal amount of the Toggle Notes held by such
Holder on the relevant record date and PIK Interest in respect of 50% of the principal amount of
the Toggle Notes held by such Holder on the relevant record date. Following an increase in the
principal amount of the outstanding Global Toggle Notes as a result of a PIK Payment, the Global
Toggle Notes will bear interest on such increased principal amount from and after the date of such
PIK Payment. Any PIK Notes issued in certificated form will be dated as of the applicable interest
payment date and will bear interest from and after such date. All Toggle Notes issued pursuant to
a PIK Payment will mature on May 1, 2017 and will be governed by, and subject to the terms,
provisions and conditions of, the Indenture and shall have the same rights and benefits as the
Toggle Notes issued on the Issue Date. Any certificated PIK Notes will be issued with the
description “PIK” on the face of such PIK Note.

     The Issuer shall pay interest (including post-petition interest in any proceeding under any
Bankruptcy Law) on overdue principal and premium, if any, from time to time on demand at a rate
that is 1% per annum in excess of the rate then in effect; it shall pay interest (including
post-petition interest in any proceeding under any Bankruptcy Law) on overdue installments of
interest and Additional Interest, if any, (without regard to any applicable grace periods) from
time to time on demand at the same rate to the extent lawful. Interest shall be computed on the
basis of a 360-day year of twelve 30-day months.

     (2) METHOD OF PAYMENT. For any interest payment period ending after the initial
interest payment period and on or prior to May 1, 2012, the Issuer may, at its option, elect to pay
interest on the Toggle Notes:

	 	•	 	entirely in cash (“Cash Interest”);
	 
	 	•	 	entirely by increasing the principal amount of the outstanding Toggle Notes or
by issuing PIK Notes (“PIK Interest”); or
	 
	 	•	 	on 50% of the outstanding principal amount of the Toggle Notes in cash and on
50% of the principal amount by increasing the principal amount of the outstanding
Toggle Notes or by issuing PIK Notes (“Partial PIK Interest”).

A4-4 

 

     The Issuer must elect the form of interest payment with respect to each interest period by
delivering a notice to the trustee at least 30 days prior to the beginning of each interest period.
The trustee shall promptly deliver a corresponding notice to the holders. In the absence of such
an election for any interest period, interest on the Toggle notes shall be payable according to the
election for the previous interest period. Interest for the first interest period commencing on
the Issue Date shall be payable entirely in cash. After May 1, 2012, the Issuer will make all
interest payments on the Toggle Notes entirely in cash. Notwithstanding anything to the contrary,
the payment of accrued interest in connection with any redemption of Toggle Notes as described
under Sections 3.07, 4.10 and 4.15 of the Indenture shall be made solely in cash.

     The Issuer shall pay interest on the Toggle Notes (except defaulted interest) and Additional
Interest, if any, to the Persons who are registered Holders at the close of business on the April
15 or October 15 next preceding the Interest Payment Date, even if such Toggle Notes are canceled
after such record date and on or before such Interest Payment Date, except as provided in Section
2.12 of the Indenture with respect to defaulted interest. The Toggle Notes shall be payable as to
principal, interest and premium and Additional Interest, if any, at the office or agency of the
Paying Agent within the City and State of New York, or payment of interest and Additional Interest,
if any, may, at the option of the Issuer, be made by check mailed to the Holders at their addresses
set forth in the register of Holders; provided that payment by wire transfer of immediately
available funds shall be required with respect to principal of and interest, premium and Additional
Interest, if any, on, all Global Notes and all other Notes the Holder (if such Holder holds at
least $1.0 million in aggregate principal amount of Notes) of which shall have provided wire
transfer instructions to the Issuer prior to the record date. Payment of principal of, premium, if
any, and interest and Additional Interest on, Global Notes registered in the name of or held by DTC
or any successor depositary or its nominee will be made by wire transfer of immediately available
funds to such depositary or its nominee, as the case may be, as the registered Holder of such
Global note. Such payment shall be 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.

     (3) PAYING AGENT AND REGISTRAR. Initially, U.S. Bank National Association, the
Trustee under the Indenture, shall act as Paying Agent and Registrar. The Issuer may change any
Paying Agent or Registrar without notice to any Holder. The Issuer or any of its Subsidiaries may
act in any such capacity.

     (4) INDENTURE. The Issuer issued the Toggle Notes under an Indenture dated as of April 19,
2007 (the “Indenture”), among the Issuer, the Guarantors and the Trustee. The terms of the Toggle
Notes include those stated in the Indenture and those made part of the Indenture by reference to
the TIA (15 U.S. Code Sections 77aaa-77bbbb). The Toggle Notes are subject to all such terms, and
Holders are referred to the Indenture and such Act for a statement of such terms. To the extent
any provision of this Note conflicts with the express provisions of the Indenture, the provisions
of the Indenture shall govern and be controlling. The Toggle Notes are general unsecured
obligations of the Issuer. Subject to the conditions set forth in the Indenture, the Issuer may
issue Additional Notes.

     (5) OPTIONAL REDEMPTION.

     (a) Except as set forth in subparagraph (b) or (c) of this Paragraph 5, on or after May 1,
2012, the Issuer may redeem all or a part of the Toggle Notes upon not less than 30 nor more than
60 days’ notice, at the redemption prices (expressed as percentages of principal amount) set forth
below plus accrued and unpaid interest and Additional Interest, if any, on the Toggle Notes
redeemed, to the applicable redemption date, if redeemed during the twelve-month period beginning
on May 1 of the years indicated

A4-5 

 

below, subject to the rights of holders of Toggle Notes on the relevant record date to
receive interest on the relevant interest payment date:

	 	 	 	 	 
	Year	 	Percentage
	2012
	 	 	104.625	%
	2013
	 	 	103.083	%
	2014
	 	 	101.542	%
	2015 and thereafter
	 	 	100.000	%

     (b) Notwithstanding the provisions of subparagraph (a) of this Paragraph 5, at any time prior
to May 1, 2010, the Issuer may, on any one or more occasions, redeem up to 35% of the aggregate
principal amount of Toggle Notes issued under the indenture at a redemption price of 109.25% of the
principal amount, plus accrued and unpaid interest and Additional Interest, if any, to the
redemption date, with the net cash proceeds of one or more Equity Offerings by the Issuer or a
contribution to the equity capital of the Issuer (other than Disqualified Stock) from the net
proceeds of one or more Equity Offerings by the Issuer, Holdings or any other direct or indirect
parent of the Issuer (in each case, other than Excluded Contributions); provided that:

     (1) at least 65% of the aggregate principal amount of Toggle Notes originally issued
under the indenture (excluding Toggle Notes held by the Issuer and its Subsidiaries) remains
outstanding immediately after the occurrence of such redemption; and

     (2) the redemption occurs within 90 days of the date of the closing of such Equity
Offering or equity contribution.

     (c) Before May 1, 2012, the Issuer may also redeem all or any portion of the Toggle Notes upon
not less than 30 nor more than 60 days’ prior notice, at a redemption price equal to 100% of the
principal amount thereof plus the Applicable Premium as of, and accrued and unpaid interest
thereon, if any, to, the date of redemption (a “Make-Whole Toggle Notes Redemption Date”).

     (6) MANDATORY REDEMPTION.

     (a) Except as set forth below, the Issuer will not be required to make any mandatory
redemption or sinking fund payments with respect to the Notes.

     (b) If the Toggle Notes would otherwise constitute “applicable high yield discount
obligations” within the meaning of Section 163(i)(1) of the Code, at the end of the first accrual
period ending after the fifth anniversary of the Toggle Notes’ issuance, the Issuer will be
required to redeem for cash a portion of each toggle note then outstanding equal to the Mandatory
Principal Redemption Amount. The redemption price for the portion of each toggle note redeemed
pursuant to a Mandatory Principal Redemption will be 100% of the principal amount of such portion
plus any accrued interest thereon on the date of redemption. The “Mandatory Principal Redemption
Amount” means the portion of a toggle note required to be redeemed to prevent such Toggle Note from
being treated as an “applicable high yield discount obligation” within the meaning of Section
163(i)(1) of the Code. No partial redemption or repurchase of the Toggle Notes prior to the AHYDO
Redemption Date pursuant to any other provision of the indenture will alter the Issuer’s obligation
to make the Mandatory Principal Redemption with respect to any Toggle Notes that remain outstanding
on the AHYDO Redemption Date. It is intended that this provision prevent any Toggle Note from
being treated as an “applicable high yield debt obligation” within the meaning of Section 163(i)(1)
of the Code, and this provision shall be interpreted in accordance with such intent.

A4-6 

 

     (7) REPURCHASE AT THE OPTION OF HOLDER.

     (a) If there is a Change of Control, each Holder shall have the right to require the Issuer to
make an offer (a “Change of Control Offer”) to repurchase all or any part (a minimum amount of
$2,000 or an integral multiple of $1,000 in excess thereof) of that Holder’s Toggle Notes at a
purchase price equal to 101% of the aggregate principal amount thereof plus accrued and unpaid
interest and Additional Interest, if any, on the Toggle Notes repurchased, if any, to the date of
purchase, subject to the rights of the Holders on the relevant record date to receive interest due
on the relevant Interest Payment Date (the “Change of Control Payment”). Within 30 days following
any Change of Control, the Issuer shall mail a notice to each Holder setting forth the procedures
governing the Change of Control Offer as required by the Indenture.

     (b) If the Issuer or a Restricted Subsidiary consummates any Asset Sales, within 10 Business
Days of each date on which the aggregate amount of Excess Proceeds exceeds $25.0 million, the
Issuer shall commence an Asset Sale Offer to all Holders and if the Issuer elects (or is required
by the terms of such other pari passu indebtedness) all holders of other Indebtedness that is pari
passu with the Toggle Notes pursuant to Section 3.09 of the Indenture to purchase the maximum
principal amount of Toggle Notes and other pari passu Indebtedness that may be purchased out of the
Excess Proceeds at an offer price in cash in an amount equal to 100% of the principal amount
thereof plus accrued and unpaid interest and Additional Interest, if any, to the Purchase Date in
accordance with the procedures set forth in the Indenture. To the extent that the aggregate amount
of Toggle Notes and other pari passu Indebtedness tendered pursuant to an Asset Sale Offer is less
than the Excess Proceeds, the Issuer (or such Restricted Subsidiary) may use the remaining Excess
Proceeds for any purpose not otherwise prohibited by the Indenture. If the aggregate principal
amount of Toggle Notes and other pari passu Indebtedness surrendered by holders thereof exceeds the
amount of Excess Proceeds, the Trustee shall select the Toggle Notes and other pari passu
Indebtedness to be purchased on a pro rata basis. Holders to whom an Asset Sale Offer is addressed
shall receive an Asset Sale Offer from the Issuer prior to the related Purchase Date and may elect
to have such Toggle Notes purchased by completing the form entitled “Option of Holder to Elect
Purchase” attached to the Toggle Notes.

     (8) NOTICE OF REDEMPTION. Notice of redemption shall be mailed at least 30 days but
not more than 60 days before the redemption date to each Holder whose Notes are to be redeemed at
its registered address, except that redemption notices may be mailed more than 60 days prior to a
redemption date if the notice is issued in connection with a defeasance of the Notes or a
satisfaction and discharge of the Indenture. Notes in denominations larger than $2,000 may be
redeemed in part but only in whole multiples of $1,000 in excess thereof, unless all of the Notes
held by a Holder are to be redeemed. On and after the redemption date interest and Additional
Interest will cease to accrue on Notes or portions thereof called for redemption.

     (9) DENOMINATIONS, TRANSFER, EXCHANGE. The Toggle Notes are in registered form
without coupons in denominations of $2,000 and integral multiples of $1,000 in excess thereof. The
transfer of Toggle Notes may be registered and Toggle Notes may be exchanged as provided in the
Indenture. The Registrar and the Trustee may require a Holder, among other things, to furnish
appropriate endorsements and transfer documents and the Issuer may require a Holder to pay any
taxes and fees required by law or permitted by the Indenture. The Issuer need not exchange or
register the transfer of any Note or portion of a Note selected for redemption, except for the
unredeemed portion of any Note being redeemed in part. Also, the Issuer need not exchange or
register the transfer of any Toggle Notes for a period of 15 days before a selection of Toggle
Notes to be redeemed or during the period between a record date and the corresponding Interest
Payment Date.

A4-7 

 

     (10) PERSONS DEEMED OWNERS. The registered Holder of a Note may be treated as its
owner for all purposes.

     (11) AMENDMENT, SUPPLEMENT AND WAIVER. Subject to certain exceptions, the Indenture,
the Subsidiary Guarantees or the Toggle Notes may be amended or supplemented with the consent of
the Holders of at least a majority in aggregate principal amount of the then outstanding Toggle
Notes, including without limitation, consents obtained in connection with a purchase of, or tender
offer or exchange offer for, Toggle Notes, and any existing Default or Event of Default or
compliance with any provision of the Indenture, the Subsidiary Guarantees or the Toggle Notes may
be waived with the consent of the Holders of a majority in aggregate principal amount of the then
outstanding Toggle Notes, including without limitation, consents obtained in connection with a
purchase of, or tender offer or exchange offer for, Toggle Notes. Without the consent of any
Holder, the Indenture, the Subsidiary Guarantees or the Toggle Notes may be amended or supplemented
(i) to cure any ambiguity, defect or inconsistency, (ii) to provide for uncertificated Toggle Notes
in addition to or in place of certificated Toggle Notes, (iii) to provide for the assumption of the
Issuer’s or any Guarantor’s obligations to Holders of the Toggle Notes in case of a merger or
consolidation, (iv) to make any change that would provide any additional rights or benefits to the
Holders or that does not adversely affect the legal rights under the Indenture of any such Holder,
(v) to comply with the requirements of the SEC in order to effect or maintain the qualification of
the Indenture under the TIA, (vi) to conform the text of the Indenture, the Subsidiary Guarantees
or the Toggle Notes to any provision of the “Description of Notes” section of the Offering
Memorandum to the extent that such provision in that “Description of Notes” was intended to be a
verbatim recitation of a provision of the Indenture, the Subsidiary Guarantees or the Toggle Notes,
(vii) to provide for the issuance of Additional Notes in accordance with the limitations set forth
in the Indenture as of the Issue Date, (viii) to allow any Guarantor to execute a supplemental
indenture and/or a Subsidiary Guarantee with respect to the Toggle Notes or to secure the Toggle
Notes, or (ix) to issue additional notes in accordance with the terms of the Indenture. In
addition, except as provided in clause (vi) of the preceding sentence, any amendment to the
provisions of Article 10 of the Indenture (including the definitions of “Senior Debt” and
“Designated Senior Debt”) that adversely affects the rights of any holder of Designated Senior Debt
of the Issuer then outstanding requires the consent of a majority of the holders of such Designated
Senior Debt (or any group or representative thereof authorized to give a consent), and any
amendment or waiver of the provisions of Article 10 of the Indenture that adversely affects the
rights of the Holders requires the consent of the Holders of at least 66-2/3% in aggregate
principal amount of Toggle Notes then outstanding.

     (12) DEFAULTS AND REMEDIES. Events of Default include: (i) default for 30 days in
the payment when due of interest on or Additional Interest, if any, with respect to, the Notes,
whether or not prohibited by the subordination provisions of the Indenture; (ii) default in payment
when due (at maturity, upon redemption or otherwise) of the principal of, or premium, if any, on
the Notes whether or not prohibited by the subordination provisions of the Indenture; (iii) failure
by the Issuer to comply with Section 5.01 of the Indenture; (iv) failure by the Issuer or any of
its Restricted Subsidiaries for 60 days after notice to the Issuer by the Trustee or the Holders of
at least 25% in aggregate principal amount of Toggle Notes then outstanding voting as a single
class to comply with any of the other agreements in the Indenture; (v) default under any mortgage,
indenture or instrument under which there may be issued or by which there may be secured or
evidenced any Indebtedness for money borrowed by the Issuer or any of its Significant Subsidiaries
(or the payment of which is guaranteed by the Issuer or any of its Significant Subsidiaries),
whether such Indebtedness or Guarantee now exists, or is created after the Issue Date, if that
default: (A) is caused by a failure to pay principal at the final Stated Maturity of such
Indebtedness (a “Payment Default”) or (B) results in the acceleration of such Indebtedness prior to
its express maturity, and, in each case, the principal amount of such Indebtedness, together with
the principal amount of any other such Indebtedness under which there has been a Payment Default or
the maturity of which has been

A4-8 

 

so accelerated, aggregates $20.0 million or more; (vi) certain final judgments and decrees for
the payment of money that remain undischarged for a period of 60 days after such judgment or decree
has become final and nonappealable without being paid, discharged, waived or stayed; (vii) except
as permitted by the Indenture, any Subsidiary Guarantee of any Significant Subsidiary is declared
to be unenforceable or invalid by any final and nonappealable judgment or decree or ceases for any
reason to be in full force and effect, or any Guarantor that is a Significant Subsidiary or any
Person acting on behalf of any Guarantor that is a Significant Subsidiary denies or disaffirms its
obligations in writing under its Subsidiary Guarantee and such Default continues for 10 days after
receipt of the notice specified in the Indenture and (viii) certain events of bankruptcy or
insolvency with respect to the Issuer or any of the Issuer’s Restricted Subsidiaries that is a
Significant Subsidiary. If any Event of Default occurs and is continuing, the Trustee or the
Holders of at least 25% in aggregate principal amount of the then outstanding Toggle Notes may
declare all the Toggle Notes to be due and payable; provided that so long as any Indebtedness
permitted to be incurred under the Credit Agreement is outstanding, such acceleration will not be
effective until the earlier of the acceleration of such Indebtedness under the Credit Agreement or
five Business Days after receipt by the Issuer and the representative under the Credit Agreement of
written notice of such acceleration. Notwithstanding the foregoing, in the case of an Event of
Default arising from certain events of bankruptcy or insolvency, all outstanding Toggle Notes shall
become due and payable without further action or notice. Holders may not enforce the Indenture or
the Toggle Notes except as provided in the Indenture. Subject to certain limitations, Holders of a
majority in principal amount of the then outstanding Toggle Notes may direct the Trustee in its
exercise of any trust or power. The Trustee may withhold from Holders notice of any continuing
Default or Event of Default (except a Default or Event of Default relating to the payment of
principal, premium or interest or Additional Interest) if a committee of its Responsible Officer
determines in good faith that withholding notice is in their interest. The Holders of a majority
in aggregate principal amount of the Toggle Notes then outstanding by notice to the Trustee may on
behalf of the Holders of all of the Toggle Notes waive any existing Default or Event of Default and
its consequences under the Indenture except a continuing Default or Event of Default in the payment
of the principal of, premium and Additional Interest, if any, or interest on, the Toggle Notes
(including in connection with an offer to purchase). The Issuer is required to deliver to the
Trustee annually a statement regarding compliance with the Indenture, and the Issuer is required
within 30 days of becoming aware of any Default or Event of Default, to deliver to the Trustee a
statement specifying such Default or Event of Default.

     (13) SUBORDINATION. All Obligations in respect of the Toggle Notes are subordinated
to the prior payment in full in cash of all Senior Debt of the Issuer (whether outstanding on the
Issue Date or created, incurred, assumed or guaranteed thereafter) on the terms provided in the
Indenture.

     (14) TRUSTEE DEALINGS WITH ISSUER. The Trustee, in its individual or any other
capacity, may make loans to, accept deposits from, and perform services for the Issuer or its
Affiliates, and may otherwise deal with the Issuer or its Affiliates, as if it were not the
Trustee.

     (15) NO RECOURSE AGAINST OTHERS. No director, officer, employee, incorporator,
stockholder, member partner or other holder of Equity Interests of the Issuer or any Guarantor, as
such, shall have any liability for any obligations of the Issuer or any such Guarantor under the
Indenture, the Toggle Notes or the Subsidiary Guarantees or for any claim based on, in respect of,
or by reason of, such obligations or their creation. Each Holder by accepting a Note waives and
releases all such liability. The waiver and release are part of the consideration for the issuance
of the Toggle Notes.

     (16) AUTHENTICATION. This Note shall not be valid until authenticated by the manual
signature of the Trustee or an authenticating agent.

A4-9 

 

     (17) ABBREVIATIONS. Customary abbreviations may be used in the name of a Holder or an
assignee, such as: TEN COM (= tenants in common), TEN ENT (= tenants by the entireties), JT TEN (=
joint tenants with right of survivorship and not as tenants in common), CUST (= Custodian), and
U/G/M/A (= Uniform Gifts to Minors Act).

     (18) ADDITIONAL RIGHTS OF HOLDERS OF RESTRICTED GLOBAL NOTES AND RESTRICTED DEFINITIVE
NOTES. In addition to the rights provided to Holders under the Indenture, Holders of
Restricted Global Notes and Restricted Definitive Notes shall have all the rights set forth in the
Registration Rights Agreement dated as of April 19, 2007, among the Issuer, the Guarantors and the
other parties named on the signature pages thereof (the “Registration Rights Agreement”).

     (19) CUSIP NUMBERS. Pursuant to a recommendation promulgated by the Committee on
Uniform Security Identification Procedures, the Issuer has caused CUSIP numbers to be printed on
the Toggle Notes and the Trustee may use CUSIP numbers in notices of redemption as a convenience to
Holders. No representation is made as to the accuracy of such numbers either as printed on the
Toggle Notes or as contained in any notice of redemption and reliance may be placed only on the
other identification numbers placed thereon.

     The Issuer shall furnish to any Holder upon written request and without charge a copy of the
Indenture and/or the Registration Rights Agreement. Requests may be made to:

United Surgical Partners International, Inc.

15305 Dallas Parkway, Suite 1600

Addison, Texas 75001

Telecopier No.: (972) 767-0604

Attention: Vice President and General Counsel

A4-10 

 

ASSIGNMENT FORM

To assign this Toggle Note, fill in the form below:

	 	 	 
	          (I) or (we) assign and transfer this Toggle Note to: 
	 	 
	 

	 	 
	 

	 	(Insert assignee’s legal name)

 

(Insert assignee’s soc. sec. or tax I.D. no.)

 

 

 

 

 

 

 

 

(Print or type assignee’s name, address and zip code)

and irrevocably appoint                                         to transfer this Toggle Note on
the books of the Issuer. The agent may substitute another to act for him.

Date:                     

	 	 	 	 	 	 	 
	 

	 	Your Signature:
	 	 	 	 
	 

	 	 	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Toggle Note)	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A4-11 

 

OPTION OF HOLDER TO ELECT PURCHASE

     If you want to elect to have this Toggle Note purchased by the Issuer pursuant to Section 4.10
or 4.15 of the Indenture, check the appropriate box below:

o Section 4.10           o Section 4.15

     If you want to elect to have only part of the Toggle Note purchased by the Issuer pursuant to
Section 4.10 or Section 4.15 of the Indenture, state the amount you elect to have purchased:

$                    

Date:                     

	 	 	 	 	 
	 

	 	Your Signature:	 	 
	 

	 	 	 	 
	 

	 	 	 	(Sign exactly as your name appears on
the face of this Toggle Note)
	 
	 	 	 	 
	 

	 	Tax Identification No.:	 	 
	 

	 	 	 	 

Signature Guarantee*:                                         

 

			
	*	 	Participant in a recognized Signature Guarantee Medallion Program (or other signature
guarantor acceptable to the Trustee).

A4-12 

 

SCHEDULE OF EXCHANGES OF REGULATION S TEMPORARY GLOBAL NOTE

     The following exchanges of a part of this Regulation S Temporary Global Note for an interest
in another Global Note, or exchanges in part of another other Restricted Global Note for an
interest in this Regulation S Temporary Global Note, have been made:

	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	Principal Amount	 	 
	 	 	 	 	Amount of	 	of this	 	 
	 	 	Amount of	 	increase in	 	Global Note	 	Signature of
	 	 	decrease in	 	Principal Amount	 	following such	 	authorized
	Date of	 	Principal Amount	 	of this Global	 	decrease (or	 	officer of Trustee
	Exchange	 	of this Global Note	 	Note	 	increase)	 	or Custodian
	 
	 	 
	 	 
	 	 
	 	 
	 	 	 	 	 	 	 	 	 

 

			
	*	 	This schedule should be included only if the Note is issued in global form.

A4-13 

 

EXHIBIT B

FORM OF CERTIFICATE OF TRANSFER

United Surgical Partners International, Inc.

15305 Dallas Parkway

Suite 1600

Addison, Texas 75001

U.S. Bank National Association

Corporate Trust Services

100 Wall Street — Suite 1600

New York, New York 10005

			
	     Re:     	 	87/8% Senior Subordinated Notes due 2017 and

91/4%/10% Senior Subordinated Toggle Notes due 2017

     Reference is hereby made to the Indenture, dated as of April 19, 2007 (the “Indenture”), by
and among United Surgical Partners International, Inc., a Delaware corporation (the “Issuer”), the
Guarantors party thereto and U.S. Bank National Association as trustee. Capitalized terms used but
not defined herein shall have the meanings given to them in the Indenture.

     ______ (the “Transferor”) owns and proposes to transfer the Note[s] or interest
in such Note[s] specified in Annex A hereto, in the principal amount of $___ in such
Note[s] or interests (the “Transfer”), to ______ (the “Transferee”), as
further specified in Annex A hereto. In connection with the Transfer, the Transferor hereby
certifies that:

[CHECK ALL THAT APPLY]

     1. o CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN THE 144A GLOBAL
NOTE OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO RULE 144A. The Transfer is being effected
pursuant to and in accordance with Rule 144A under the Securities Act of 1933, as amended (the
“Securities Act”), and, accordingly, the Transferor hereby further certifies that the beneficial
interest or Definitive Note is being transferred to a Person that the Transferor reasonably
believes is purchasing the beneficial interest or Definitive Note for its own account, or for one
or more accounts with respect to which such Person exercises sole investment discretion, and such
Person and each such account is a “qualified institutional buyer” within the meaning of Rule 144A
in a transaction meeting the requirements of Rule 144A, and such Transfer is in compliance with any
applicable blue sky securities laws of any state of the United States. Upon consummation of the
proposed Transfer in accordance with the terms of the Indenture, the transferred beneficial
interest or Definitive Note shall be subject to the restrictions on transfer enumerated in the
Private Placement Legend printed on the 144A Global Note and/or the Restricted Definitive Note and
in the Indenture and the Securities Act.

     2. o CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN THE REGULATION S
GLOBAL NOTE OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO REGULATION S. The Transfer is being
effected pursuant to and in accordance with Rule 903 or Rule 904 under the Securities Act and,
accordingly, the Transferor hereby further certifies that

B-1 

 

(i) the Transfer is not being made to a Person in the United States and (x) at the time the
buy order was originated, the Transferee was outside the United States or such Transferor and any
Person acting on its behalf reasonably believed and believes that the Transferee was outside the
United States or (y) the transaction was executed in, on or through the facilities of a designated
offshore securities market and neither such Transferor nor any Person acting on its behalf knows
that the transaction was prearranged with a buyer in the United States, (ii) no directed selling
efforts have been made in contravention of the requirements of Rule 903 or Rule 904 of Regulation S
under the Securities Act, (iii) the transaction is not part of a plan or scheme to evade the
registration requirements of the Securities Act and (iv) if the proposed transfer is being made
prior to the expiration of the Restricted Period, the transfer is not being made to a U.S. Person
or for the account or benefit of a U.S. Person (other than an Initial Purchaser). Upon
consummation of the proposed transfer in accordance with the terms of the Indenture, the
transferred beneficial interest or Definitive Note shall be subject to the restrictions on Transfer
enumerated in the Private Placement Legend printed on the Regulation S Global Note and/or the
Restricted Definitive Note and in the Indenture and the Securities Act.

     3. o CHECK AND COMPLETE IF TRANSFEREE WILL TAKE DELIVERY OF A BENEFICIAL INTEREST IN A
RESTRICTED GLOBAL NOTE OR A RESTRICTED DEFINITIVE NOTE PURSUANT TO ANY PROVISION OF THE SECURITIES
ACT OTHER THAN RULE 144A OR REGULATION S. The Transfer is being effected in compliance with the
transfer restrictions applicable to beneficial interests in Restricted Global Notes and Restricted
Definitive Notes and pursuant to and in accordance with the Securities Act and any applicable blue
sky securities laws of any state of the United States, and accordingly the Transferor hereby
further certifies that (check one):

     (a) o such Transfer is being effected pursuant to and in accordance with Rule 144
under the Securities Act;

or

     (b) o such Transfer is being effected to the Issuer or a subsidiary thereof;

or

     (c) o such Transfer is being effected pursuant to an effective registration
statement under the Securities Act.

     4. o CHECK IF TRANSFEREE SHALL TAKE DELIVERY OF A BENEFICIAL INTEREST IN AN UNRESTRICTED
GLOBAL NOTE OR OF AN UNRESTRICTED DEFINITIVE NOTE.

     (a) o CHECK IF TRANSFER IS PURSUANT TO RULE 144. (i) The Transfer is being effected
pursuant to and in accordance with Rule 144 under the Securities Act and in compliance with the
transfer restrictions contained in the Indenture and any applicable blue sky securities laws of any
state of the United States and (ii) the restrictions on transfer contained in the Indenture and the
Private Placement Legend are not required in order to maintain compliance with the Securities Act.
Upon consummation of the proposed Transfer in accordance with the terms of the Indenture, the
transferred beneficial interest or Definitive Note shall no longer be subject to the restrictions
on transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes, on
Restricted Definitive Notes and in the Indenture.

     (b) o CHECK IF TRANSFER IS PURSUANT TO REGULATION S. (i) The Transfer is being effected
pursuant to and in accordance with Rule 903 or Rule 904 under the Securities Act and in compliance
with the transfer restrictions contained in the Indenture and any applicable blue sky securities

B-2 

 

laws of any state of the United States and (ii) the restrictions on transfer contained in the
Indenture and the Private Placement Legend are not required in order to maintain compliance with
the Securities Act. Upon consummation of the proposed Transfer in accordance with the terms of the
Indenture, the transferred beneficial interest or Definitive Note shall no longer be subject to the
restrictions on transfer enumerated in the Private Placement Legend printed on the Restricted
Global Notes, on Restricted Definitive Notes and in the Indenture.

     (c) o CHECK IF TRANSFER IS PURSUANT TO OTHER EXEMPTION. (i) The Transfer is being effected
pursuant to and in compliance with an exemption from the registration requirements of the
Securities Act other than Rule 144, Rule 903 or Rule 904 and in compliance with the transfer
restrictions contained in the Indenture and any applicable blue sky securities laws of any State of
the United States and (ii) the restrictions on transfer contained in the Indenture and the Private
Placement Legend are not required in order to maintain compliance with the Securities Act. Upon
consummation of the proposed Transfer in accordance with the terms of the Indenture, the
transferred beneficial interest or Definitive Note shall not be subject to the restrictions on
transfer enumerated in the Private Placement Legend printed on the Restricted Global Notes or
Restricted Definitive Notes and in the Indenture.

     This certificate and the statements contained herein are made for your benefit and the benefit
of the Issuer.

	 	 	 	 	 
	 	 	 	 	 
	 	[Insert Name of Transferor]

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

Dated:                                         

B-3 

 

ANNEX A TO CERTIFICATE OF TRANSFER

	1.	 	The Transferor owns and proposes to transfer the following:

[CHECK ONE OF (a) OR (b)]

	 	(a)	 	o a beneficial interest in the:

	 	(i)	 	o 144A Global Note (CUSIP ___), or
	 
	 	(ii)	 	o Regulation S Global Note (CUSIP ___), or

	 	(b)	 	o a Restricted Definitive Note.

	2.	 	After the Transfer the Transferee shall hold:

[CHECK ONE]

	 	(a)	 	o a beneficial interest in the:

	 	(i)	 	o 144A Global Note (CUSIP ___), or
	 
	 	(ii)	 	o Regulation S Global Note (CUSIP ___), or
	 
	 	(iii)	 	o Unrestricted Global Note (CUSIP ___); or

	 	(b)	 	o a Restricted Definitive Note; or
	 
	 	(c)	 	o an Unrestricted Definitive Note,

in accordance with the terms of the Indenture.

 

 

EXHIBIT C

FORM OF CERTIFICATE OF EXCHANGE

United Surgical Partners International, Inc.

15305 Dallas Parkway

Suite 1600

Addison, Texas 75001

U.S. Bank National Association

Corporate Trust Services

100 Wall Street — Suite 1600

New York, New York 10005

			
	     Re:     	 	87/8% Senior Subordinated Notes due 2017 and

91/4 %/10% Senior Subordinated Toggle Notes due 2017

(CUSIP                     )

     Reference is hereby made to the Indenture, dated as of April 19, 2007 (the “Indenture”), by
and among United Surgical Partners International, Inc., a Delaware corporation (the “Issuer”), the
Guarantors party thereto and U.S. Bank National Association as trustee. Capitalized terms used but
not defined herein shall have the meanings given to them in the Indenture.

     ______ (the “Owner”) owns and proposes to exchange the Note[s] or interest
in such Note[s] specified herein, in the principal amount of $___ in such Note[s] or
interests (the “Exchange”). In connection with the Exchange, the Owner hereby certifies that:

     1. EXCHANGE OF RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN A RESTRICTED GLOBAL NOTE
FOR UNRESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN AN UNRESTRICTED GLOBAL NOTE

     (a) o CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO
BENEFICIAL INTEREST IN AN UNRESTRICTED GLOBAL NOTE. In connection with the Exchange of the Owner’s
beneficial interest in a Restricted Global Note for a beneficial interest in an Unrestricted Global
Note in an equal principal amount, the Owner hereby certifies (i) the beneficial interest is being
acquired for the Owner’s own account without transfer, (ii) such Exchange has been effected in
compliance with the transfer restrictions applicable to the Global Notes and pursuant to and in
accordance with the Securities Act of 1933, as amended (the “Securities Act”), (iii) the
restrictions on transfer contained in the Indenture and the Private Placement Legend are not
required in order to maintain compliance with the Securities Act and (iv) the beneficial interest
in an Unrestricted Global Note is being acquired in compliance with any applicable blue sky
securities laws of any state of the United States.

     (b) o CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO
UNRESTRICTED DEFINITIVE NOTE. In connection with the Exchange of the Owner’s beneficial interest
in a Restricted Global Note for an Unrestricted Definitive Note, the Owner hereby certifies (i) the
Definitive Note is being acquired for the Owner’s own account without transfer, (ii) such Exchange
has been effected in compliance with the transfer restrictions applicable to the

C-1

 

Restricted Global Notes and pursuant to and in accordance with the Securities Act, (iii) the
restrictions on transfer contained in the Indenture and the Private Placement Legend are not
required in order to maintain compliance with the Securities Act and (iv) the Definitive Note is
being acquired in compliance with any applicable blue sky securities laws of any state of the
United States.

     (c) o CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO BENEFICIAL INTEREST IN AN
UNRESTRICTED GLOBAL NOTE. In connection with the Owner’s Exchange of a Restricted Definitive Note
for a beneficial interest in an Unrestricted Global Note, the Owner hereby certifies (i) the
beneficial interest is being acquired for the Owner’s own account without transfer, (ii) such
Exchange has been effected in compliance with the transfer restrictions applicable to Restricted
Definitive Notes and pursuant to and in accordance with the Securities Act, (iii) the restrictions
on transfer contained in the Indenture and the Private Placement Legend are not required in order
to maintain compliance with the Securities Act and (iv) the beneficial interest is being acquired
in compliance with any applicable blue sky securities laws of any state of the United States.

     (d) o CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO UNRESTRICTED DEFINITIVE NOTE.
In connection with the Owner’s Exchange of a Restricted Definitive Note for an Unrestricted
Definitive Note, the Owner hereby certifies (i) the Unrestricted Definitive Note is being acquired
for the Owner’s own account without transfer, (ii) such Exchange has been effected in compliance
with the transfer restrictions applicable to Restricted Definitive Notes and pursuant to and in
accordance with the Securities Act, (iii) the restrictions on transfer contained in the Indenture
and the Private Placement Legend are not required in order to maintain compliance with the
Securities Act and (iv) the Unrestricted Definitive Note is being acquired in compliance with any
applicable blue sky securities laws of any state of the United States.

     2. EXCHANGE OF RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN RESTRICTED GLOBAL NOTES
FOR RESTRICTED DEFINITIVE NOTES OR BENEFICIAL INTERESTS IN RESTRICTED GLOBAL NOTES

     (a) o CHECK IF EXCHANGE IS FROM BENEFICIAL INTEREST IN A RESTRICTED GLOBAL NOTE TO
RESTRICTED DEFINITIVE NOTE. In connection with the Exchange of the Owner’s beneficial interest in
a Restricted Global Note for a Restricted Definitive Note with an equal principal amount, the Owner
hereby certifies that the Restricted Definitive Note is being acquired for the Owner’s own account
without transfer. Upon consummation of the proposed Exchange in accordance with the terms of the
Indenture, the Restricted Definitive Note issued shall continue to be subject to the restrictions
on transfer enumerated in the Private Placement Legend printed on the Restricted Definitive Note
and in the Indenture and the Securities Act.

     (b) o CHECK IF EXCHANGE IS FROM RESTRICTED DEFINITIVE NOTE TO BENEFICIAL INTEREST IN A
RESTRICTED GLOBAL NOTE. In connection with the Exchange of the Owner’s Restricted Definitive Note
for a beneficial interest in the [CHECK ONE] “144A Global Note,” Regulation S Global Note with an
equal principal amount, the Owner hereby certifies (i) the beneficial interest is being acquired
for the Owner’s own account without transfer and (ii) such Exchange has been effected in compliance
with the transfer restrictions applicable to the Restricted Global Notes and pursuant to and in
accordance with the Securities Act, and in compliance with any applicable blue sky securities laws
of any state of the United States. Upon consummation of the proposed Exchange in accordance with
the terms of the Indenture, the beneficial interest issued shall be subject to the restrictions on
transfer enumerated in the Private Placement Legend printed on the relevant Restricted Global Note
and in the Indenture and the Securities Act.

C-2

 

     This certificate and the statements contained herein are made for your benefit and the benefit
of the Issuer.

	 	 	 	 	 
	 	 	 	 	 

	 	
[Insert Name of Transferor]

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 

Dated:                                         

C-3

 

EXHIBIT D

[FORM OF NOTATION OF SUBSIDIARY GUARANTEE]

     For value received, each Guarantor (which term includes any successor Person under the
Indenture) has, jointly and severally, unconditionally guaranteed, to the extent set forth in, and
subject to the provisions contained in, the Indenture dated as of April 19, 2007 (the “Indenture”)
by and among United Surgical Partners International, Inc., a Delaware corporation (the “Issuer”),
the Guarantors party thereto and U.S. Bank National Association (the “Trustee”), the due and
punctual payment of the principal of, premium and Additional Interest, if any, and interest on, the
Notes, whether at maturity, by acceleration, redemption or otherwise, the due and punctual payment
of interest on overdue principal of and interest on the Notes, if any, if lawful, and the due and
punctual performance of all other Obligations of the Issuer to the Holders or the Trustee all in
accordance with the terms of the Indenture and in case of any extension of time of payment or
renewal of any Notes or any of such other Obligations, that the same shall be promptly paid in full
when due or performed in accordance with the terms of the extension or renewal, whether at stated
maturity, by acceleration or otherwise. The obligations of the Guarantors to the Holders and to
the Trustee pursuant to the Subsidiary Guarantee and the Indenture are expressly set forth in
Article 11 of the Indenture and reference is hereby made to the Indenture for the precise terms of
the Subsidiary Guarantee. Each Holder of a Note, by accepting the same, agrees to and shall be
bound by such provisions, authorizes and directs the Trustee, on behalf of such Holder, to take
such action as may be necessary or appropriate to effectuate the subordination as provided in the
Indenture and appoints the Trustee attorney-in-fact of such Holder for such purpose.

     Capitalized terms used but not defined herein have the meanings given to them in the
Indenture.

	 	 	 	 	 
	 	[NAME OF GUARANTOR(S)]

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 

D-1 

 

	 	 	 	 	 

EXHIBIT E

FORM OF SUPPLEMENTAL INDENTURE

TO BE DELIVERED BY SUBSEQUENT GUARANTORS

     SUPPLEMENTAL INDENTURE (this “Supplemental Indenture”), dated as of ___, 200___, among
______ (the “Guaranteeing Subsidiary”), a subsidiary of United Surgical Partners
International, Inc., a Delaware corporation (the “Issuer”), the Issuer and U.S. Bank National
Association, as trustee under the Indenture referred to below (the “Trustee”).

WITNESSETH

     WHEREAS, the Issuer has heretofore executed and delivered to the Trustee an indenture (the
“Indenture”), dated as of April 19, 2007, providing for the issuance of 87/8% Senior Subordinated
Notes due 2017 and 91/4 %/10% Senior Subordinated Toggle Notes due 2017 (collectively, the “Notes”);

     WHEREAS, the Indenture provides that under certain circumstances the Guaranteeing Subsidiary
shall execute and deliver to the Trustee a supplemental indenture pursuant to which the
Guaranteeing Subsidiary shall unconditionally guarantee all of the Issuer’s Obligations under the
Notes and the Indenture on the terms and conditions set forth herein (the “Subsidiary Guarantee”);
and

     WHEREAS, pursuant to Section 9.01 of the Indenture, the Trustee is authorized to execute and
deliver this Supplemental Indenture.

     NOW THEREFORE, in consideration of the foregoing and for other good and valuable
consideration, the receipt of which is hereby acknowledged, the Guaranteeing Subsidiary and the
Trustee mutually covenant and agree for the equal and ratable benefit of the Holders of the Notes
as follows:

     1. CAPITALIZED TERMS. Capitalized terms used herein without definition shall have the
meanings assigned to them in the Indenture.

     2. AGREEMENT TO GUARANTEE. The Guaranteeing Subsidiary hereby agrees to provide an
unconditional Guarantee on the terms and subject to the conditions set forth in the Subsidiary
Guarantee and in this Indenture including but not limited to Article 11 thereof.

     3. NO RECOURSE AGAINST OTHERS. No past, present or future director, officer, employee,
incorporator, stockholder or agent of the Guaranteeing Subsidiary, as such, shall have any
liability for any obligations of the Issuer or any Guaranteeing Subsidiary under the Notes, any
Subsidiary Guarantees, the Indenture or this Supplemental Indenture or for any claim based on, in
respect of, or by reason of, such obligations or their creation. Each Holder of the Notes by
accepting a Note waives and releases all such liability. The waiver and release are part of the
consideration for issuance of the Notes. Such waiver may not be effective to waive liabilities
under the federal securities laws and it is the view of the SEC that such a waiver is against
public policy.

     4. NEW YORK LAW TO GOVERN. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN
ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.

E-1 

 

     5. COUNTERPARTS. The parties may sign any number of copies of this Supplemental Indenture.
Each signed copy shall be an original, but all of them together represent the same agreement.

     6. EFFECT OF HEADINGS. The Section headings herein are for convenience only and shall not
affect the construction hereof.

     7. THE TRUSTEE. The Trustee shall not be responsible in any manner whatsoever for or in
respect of the validity or sufficiency of this Supplemental Indenture or for or in respect of the
recitals contained herein, all of which recitals are made solely by the Guaranteeing Subsidiary and
the Issuer.

E-2 

 

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

Dated: _______________, 20___

	 	 	 	 	 
	 	[GUARANTEEING SUBSIDIARY]

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	UNITED SURGICAL PARTNERS

INTERNATIONAL, INC.

 	 
	 	By:  	 	 
	 	 	Name:  	 	 
	 	 	Title:  	 	 
	 
	 	U.S. BANK NATIONAL ASSOCIATION,

  as Trustee

 	 
	 	By:  	 	 
	 	 	 	 
	 	 	 	 
	 

E-3

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