Document:

AMENDED AND RESTATED 1996 EXECUTIVE INCENTIVE COMPENSATION PLAN

 Exhibit 10.4 
 HEALTH MANAGEMENT ASSOCIATES, INC. 
 AMENDED AND RESTATED 1996 EXECUTIVE
INCENTIVE COMPENSATION PLAN 
 AWARD NOTICE 

 

					
	Grantee:	  	  
	  	
			
	Types of Award:	  	 Deferred Stock Award consisting of two components:
  

(i) a Time Vesting Component equal to two-thirds of the Number of Shares; and

 
 (ii) a Performance Vesting Component equal to one-third of the
Number of Shares.
  
	  	
			
	Number of Shares:	  	  
	  	
			
	Date of Grant:	  	 February 21, 2012
	  	

 1. Grant of Award. This Award Notice serves to notify you that the Compensation Committee (the
“Committee”) of the Board of Directors of Health Management Associates, Inc. (“Health Management”) hereby grants to you, under Health Management’s Amended and Restated 1996 Executive Incentive Compensation Plan (the
“Plan”) a deferred stock award for the Number of Shares of Health Management’s Class A Common Stock, par value $0.01 per share (the “Common Stock”) set forth above, consisting of a time vesting component (the “Time
Vesting Component”) and a performance vesting component (the “Performance Vesting Component,” and together with the Time Vesting Component, the “Deferred Stock Award” or the “Award”) on the terms and conditions set
forth in this Award Notice and the Plan. The Plan is incorporated herein by reference and made a part of this Award Notice. A copy of the Plan is available from Health Management’s Human Resources Department upon request. You should review the
terms of this Award Notice and the Plan carefully. The capitalized terms used and not defined in this Award Notice are defined in the Plan. 
 2. Definitions. The following terms have the meanings set forth in this Section 2: 
 (a) “Adjusted EBITDA” means, with respect to the First Grant Year, Health Management’s earnings before interest, income taxes, depreciation, amortization and non-controlling
interests for that Grant Year, as adjusted to exclude unusual and non-recurring items for that Grant Year. 
 (b)
“Adjusted EBITDA Requirement” means the achievement by Health Management, as determined by the Committee, of Adjusted EBITDA in an amount equal to the necessary percentage of Targeted Adjusted EBITDA as set forth in the following
table: 
  

					
	 Percentage of Targeted Adjusted EBITDA Achieved
During Grant Year
	  	Percentage of Performance Shares that
Becomes the Earned 
Performance Shares at the
Conclusion of the First Grant Year and
Becomes Eligible for Vesting	 
	 Less than 90.0%
	  	 	0	% 
	 90.0% - 92.4%
	  	 	50	% 
	 92.5% - 94.9%
	  	 	60	% 
	 95.0% - 97.4%
	  	 	75	% 
	 97.5% - 99.9%
	  	 	90	% 
	 100.0% or more
	  	 	100	% 

 (c) “Employer” means Health Management or one of its subsidiary hospitals
or other majority-owned or affiliated entities. 
 (d) “Fifth Grant Year” means the fiscal year of Health
Management immediately following the conclusion of the Fourth Grant Year. 
 (e) “First Grant Year” means the
fiscal year of Health Management during which the Date of Grant occurs. 
 (f) “Fourth Grant Year” means the
fiscal year of Health Management immediately following the conclusion of the Third Grant Year. 
 (g) “Grant
Year” means the First Grant Year, Second Grant Year, Third Grant Year, Fourth Grant Year and/or Fifth Grant Year, as the context suggests. 
 (h) “Second Grant Year” means the fiscal year of Health Management immediately following the conclusion of the First Grant Year. 

(i) “Targeted Adjusted EBITDA” means the total targeted annual Adjusted EBITDA established by Health Management’s
Board of Directors as reflected in its approved profit plan for the First Grant Year. 
 (j) “Third Grant Year”
means the fiscal year of Health Management immediately following the conclusion of the Second Grant Year. 
 3. Time Vesting
Component. Subject to the terms set forth in this Award Notice and the Plan, the number of shares of the Common Stock represented by the Time Vesting Component of the Deferred Stock Award (the “Time-Based Shares”) will vest as follows:

 (a) provided that you have remained an Eligible Person at all times from the Date of Grant until March 1 of the Second
Grant Year, one-fourth of the Time-Based Shares will vest on March 1 of the Second Grant Year; 
 (b) provided that you
have remained an Eligible Person at all times from the Date of Grant until March 1 of the Third Grant Year, an additional one-fourth of the Time-Based Shares will vest on March 1 of the Third Grant Year; 

  
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 (c) provided that you have remained an Eligible Person at all times from the Date of Grant
until March 1 of the Fourth Grant Year, an additional one-fourth of the Time-Based Shares will vest on March 1 of the Fourth Grant Year; and 
 (d) provided that you have remained an Eligible Person at all times from the Date of Grant until March 1 of the Fifth Grant Year, the remaining one-fourth of the Time-Based Shares will vest on
March 1 of the Fifth Grant Year. 
 4. Performance Vesting Component. The number of shares of Common Stock
represented by the Performance Vesting Component of the Deferred Stock Award is referred to herein as the “Performance Shares.” The portion of the Performance Shares that is eligible for vesting based upon the achievement by Health
Management of the Adjusted EBITDA Requirement during the First Grant Year is referred to herein as the “Earned Performance Shares,” and will be determined at the conclusion of the First Grant Year based upon the achievement by Health
Management of the Adjusted EBITDA Requirement during the First Grant Year. Subject to the terms set forth in this Award Notice and the Plan, including Committee certification pursuant to Section 5, the Earned Performance Shares will vest as
follows: 
 (a) provided that you have remained an Eligible Person at all times from the Date of Grant until March 1 of the
Second Grant Year, one-fourth of the Earned Performance Shares will vest on March 1 of the Second Grant Year; 
 (b)
provided that you have remained an Eligible Person at all times from the Date of Grant until March 1 of the Third Grant Year, an additional one-fourth of the Earned Performance Shares will vest on March 1 of the Third Grant Year;

 (c) provided that you have remained an Eligible Person at all times from the Date of Grant until March 1 of the Fourth
Grant Year, an additional one-fourth of the Earned Performance Shares will vest on March 1 of the Fourth Grant Year; and 

(d) provided that you have remained an Eligible Person at all times from the Date of Grant until March 1 of the Fifth Grant Year,
the remaining one-fourth of the Earned Performance Shares will vest on March 1 of the Fifth Grant Year. 
 5. Committee
Certification. As soon as practicable following the end of the First Grant Year, the Committee will determine and certify in writing if the Adjusted EBITDA Requirement was satisfied and the Earned Performance Shares, if any, to be vested and
paid based on the certified levels of performance. 
 6. Effect of Death, Termination or Retirement. Without limiting the
vesting and payment requirements set forth in Sections 3 and 4, in the event of the termination of your employment with Health Management prior to the complete vesting of the Award, or if you are otherwise not an Eligible Person prior to the
complete vesting of the Award, any and all unvested and unpaid portions of the Deferred Stock Award will be forfeited and will not vest or be paid. Notwithstanding the foregoing, if your employment with Health Management terminates: 

(a) because of your retirement from Health Management at or after the age of 62, the Time-Based Shares and the portion, if any, of the
Performance Shares that became the Earned Performance Shares before the date of your retirement will continue to vest and be paid in the manner and on the dates set forth above; provided, however, that the portion, if any, of the Performance Shares
that did not become the Earned Performance Shares before the date of your retirement will be forfeited; and, 

  
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 (b) because of your death or total and permanent disability, the Time-Based Shares and the
portion, if any, of the Performance Shares that becomes Earned Performance Shares before the date that is 13 months after the date that you die or become totally and permanently disabled will continue to vest and be paid in the manner and on the
dates set forth above; provided, however, that: 
 (i) the portion, if any, of the Performance Shares that will not have become
Earned Performance Shares before the date that is 13 months after the date that you die or become totally and permanently disabled will be forfeited; 
 (ii) the portion, if any, of the Time-Based Shares and of the Performance Shares that will not have vested by the third anniversary of the date that you died or became disabled will be forfeited.

 7. Effect of Change in Control. Upon the occurrence of a Change in Control of Health Management, your rights will be
determined in accordance with Section 9 of the Plan. For purposes of the Performance Vesting Component, the Adjusted EBITDA Requirement will be deemed to have been satisfied at a level of 100%. 

8. Nature of Shares of Deferred Stock. The shares of deferred stock represent book-keeping entries only, and constitute the
Company’s unfunded and unsecured promise to issue shares of Common Stock to you on a future date. As a holder of shares of deferred stock, you have no rights other than the rights of a general creditor of the Company. 

9. Issuance of Shares. The Company shall, provided that the conditions to vesting specified in this Award Notice are satisfied,
issue the shares of Common Stock representing the vested portion of the Award as promptly as practicable following each vesting date, but in no event later than 30 days thereafter. The shares of Common Stock may be issued during your lifetime only
to you, or after your death to your Beneficiary, or, in the absence of such Beneficiary, to your duly qualified personal representative. 
 10. Rights as a Stockholder. Prior to the issuance of the shares of Common Stock pursuant to Section 9 of this Award Notice, you will not have any of the rights of a stockholder with respect
to the shares of Common Stock underlying the Award, including, but not limited to, the right to receive cash dividends, if any, as may be declared on such shares of Common Stock from time to time or the right to vote (in person or by proxy) such
shares of Common Stock at any meeting of stockholders of the Company. No “Dividend Equivalents” (as that term is defined in the Plan) shall be paid with respect to the Award. 

11. Restrictions on Issuance of Shares. If at any time Health Management determines that the listing, registration or
qualification of the shares of Common Stock underlying the 

  
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Award upon any securities exchange or under any state or federal law, or the approval of any governmental agency, is necessary or advisable as a condition to the issuance of a certificate
representing any vested shares of Common Stock under this Award Notice, such issuance may not be made in whole or in part unless and until such listing, registration, qualification or approval shall have been effected or obtained free of any
conditions not acceptable to Health Management. 
 12. Effect of Breach of Restrictive Covenants. Notwithstanding any
other provision of this Award Notice, the unvested or unpaid portion of the Award shall be forfeited on the day on which you breach any provision of Section 13. 
 13. Restrictive Covenants. In consideration of the grant of the Award, you covenant and agree to observe each of the following promises: 

(a) Non-Competition. 
 (i) You will not during employment and for 12 months after the termination of employment for any reason, directly or indirectly (whether as director, stockholder, owner, partner, consultant, principal,
employee, agent or otherwise): (A) compete against an Employer in the business of owning, leasing, acquiring or operating hospitals, health care facilities, or related entities in markets which an Employer currently serves or has identified as
a market an Employer plans to serve; or (B) accept employment with or otherwise perform services that an Employer performs for any hospital, health care facility, or related entity that an Employer, or its related companies lease or manage.

 (ii) Notwithstanding the terms and conditions of Section 13(a)(i) to the contrary, Health Management covenants and
agrees that the restrictions on competition and acceptance of subsequent employment contained therein shall not apply if your employment is terminated by an Employer for reasons other than cause. 

(b) Non-solicitation/Employer Interests. During your employment and for 12 months after the termination of your employment
for any reason, you will not, directly or indirectly (whether as director, stockholder, owner, partner, consultant, principal, employee, agent or otherwise): (i) solicit, induce, entice, hire, employ or attempt to employ any individual employed
by an Employer as of the termination of your employment or during the prior 12 months; or (ii) take any action which is intended, or would reasonably be expected to, adversely affect an Employer, its business, reputation, or its relationship
with its clients or prospective clients, vendors, or other service providers, or any individual or entity with which an Employer maintains a business relationship. 
 (c) Non-Disclosure. You will hold all of each Employer’s Confidential Information in strictest confidence, and use it solely for the purpose of performing your duties for an Employer and for
no other purpose. You will not otherwise, directly or indirectly, take, publish, use or disclose any of an Employer’s Confidential Information during your employment or thereafter, except as may be required by law; provided, that you have first
given prompt written notice to the Employer of such legal requirement in enough time for the Employer to obtain an appropriate protective order or other remedy. 

  
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 (d) Damages. You acknowledge that damages to an Employer resulting from any breach of
this Section 13 will be substantial but difficult to ascertain. You therefore agree to indemnify and hold harmless Health Management and its directors, stockholders, and affiliated companies from and against any and all claims, suits,
obligations, liabilities and expenses (including without limitation attorneys’ fees and expenses) arising out of or relating to any breach or nonperformance of the covenants and obligations set forth in this Section 13. You further agree
that this provision for damages shall not limit or impair in any way an Employer’s right to obtain other remedies, or injunctive or other equitable relief, as specified herein. 

(e) Enforcement. You acknowledge that without limiting the provisions of Section 13(d), if you violate this Section 13,
an Employer may suffer irreparable harm and have no adequate remedy at law. You therefore consent to enforcement of this Award Notice by means of a temporary injunction or other appropriate equitable relief in any competent court, without the
necessity of proving the inadequacy of money damages, which shall be in addition to any other remedies an Employer may have under this Award Notice or otherwise. You hereby submit to the jurisdiction of the Courts of the State of Florida for the
purpose of such enforcement. You hereby waive, and agree not to assert, as a defense in any such action or proceeding, any claim that you were not subject thereto or that venue is improper for lack of residence, inconvenient forum or otherwise. You
agree that service of process may be made upon you by certified mail at your address last known to Health Management, and you waive your right to a jury trial. 
 (f) Terminology. For purposes of this Section 13, the term “Confidential Information” shall include trade secrets, know-how and other information that is disclosed to or acquired by
you during or in the course of your employment that relates to the business of an Employer and is not generally available to the public or generally known in the industry in which an Employer is, or may become engaged, including without limitation,
any formulas, patterns, devices, inventions, methods, techniques or processes, or combinations thereof, or compilations of information, records and specifications, acquisition and development data, which are owned by an Employer and regularly used
in the operation of its business and any other information of an Employer relating to its services (offered or to be offered), research, development, marketing, pricing, customers, clients and prospective customers and clients, suppliers and
potential suppliers, business methods, strategies, financial condition, personnel, plans, policies or prospects. 
 (g)
Survival. The provisions of this Section 13 and your obligations hereunder shall survive any forfeiture of the Award or any other termination of this Award Notice. 
 14. Performance Award. The Performance Vesting Component is intended to constitute a Performance Award under Section 8 of the Plan and will be interpreted and administered by the Committee
consistent with this intention. 
 15. Miscellaneous. 

(a) Binding Agreement. This Award Notice is binding on and enforceable by and against the parties, their successors, legal
representatives and assigns. 

  
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 (b) Entire Agreement. This Award Notice constitutes the whole agreement between the
parties relating to the subject matter hereof and supersedes any prior agreements or understandings related to such subject matter. 
 (c) Amendment of this Agreement. This Award Notice may not be amended, modified, or supplemented except by a written instrument executed by each of the parties hereto. 

(d) Transferability. 
 (i) The Award shall not be pledged, hypothecated or otherwise encumbered or subject to any lien, obligation or liability to any party (other than an Employer), or assigned or transferred other than by
will or the laws of descent and distribution or to a Beneficiary upon your death. Upon any attempt to transfer, assign, pledge, hypothecate or otherwise dispose of the Award or any right or privilege conferred thereby contrary to the provisions of
this Award Notice, or upon the sale or levy or attachment or similar process upon the rights and privileges conferred thereby, the Award shall immediately become null and void. 

(ii) The shares of Common Stock underlying the Award may not be sold, assigned, transferred, pledged, hypothecated, margined or
otherwise encumbered in any way prior to the vesting of such shares and the issuance of a stock certificate with respect thereto, whether by operation of law or otherwise, except by will or the laws of descent and distribution. After vesting and the
issuance of a stock certificate with respect thereto, the sale or other transfer of the shares of Common Stock shall be subject to applicable laws and regulations under the Securities Act of 1933. 

(e) Hedging Transactions Prohibited. You are prohibited from engaging in any hedging or monetization transactions involving the
Deferred Stock Award, as more fully explained in the “Hedging Transactions” section of Health Management’s Addendum to Policy on Non-Public Information and Trading in HMA Securities – Pre-clearance and Blackout Procedures, as
such Addendum or policy may be hereafter amended. 
 (f) No Right to Continued Employment. You understand that this Award
Notice does not constitute a contract of employment and that you or an Employer may terminate your employment at any time, for any or no reason, with or without notice unless a specific term of employment has been agreed to in a separate writing
signed by a duly authorized corporate officer of an Employer. Your right, if any, to continue to serve an Employer as an employee or otherwise will not be enlarged or otherwise affected by this Award Notice. 

(g) Plan Controls. The Award is subject to all of the provisions of the Plan, and is further subject to all the interpretations,
amendments, rules and regulations that may from time to time be promulgated and adopted by Health Management’s Board of Directors or the Committee pursuant to the Plan. In the event of any conflict among the provisions of the Plan and this
Award Notice, the provisions of the Plan will be controlling and determinative. 
 (h) Severability. If any provision of
this Award Notice shall be held unlawful or otherwise invalid or unenforceable in whole or in part by a court of competent jurisdiction, such provision shall (i) be deemed limited to the extent that such court of competent jurisdiction deems it
lawful, valid and/or enforceable and as so limited shall remain in full force and effect, 

  
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and (ii) not affect any other provision of this Award Notice or part thereof, each of which shall remain in full force and effect. If the making of any payment or the provision of any other
benefit required under this Award Notice shall be held unlawful or otherwise invalid or unenforceable by a court of competent jurisdiction, such unlawfulness, invalidity or unenforceability shall not prevent any other payment or benefit from being
made or provided under this Award Notice, and if the making of any payment in full or the provision of any other benefit required under this Award Notice in full would be unlawful or otherwise invalid or unenforceable, then such unlawfulness,
invalidity or unenforceability shall not prevent such payment or benefit from being made or provided in part, to the extent that it would not be unlawful, invalid or unenforceable, and the maximum payment or benefit that would not be unlawful,
invalid or unenforceable shall be made or provided under this Award Notice. 
 (i) Waiver. Any party’s failure to
insist on compliance or enforcement of any provision of this Award Notice shall not affect its validity or enforceability or constitute a waiver of future enforcement of that provision or of any other provision of this Award Notice. 

(j) Rights of Employer. This Award Notice does not affect the right of any Employer to take any corporate action whatsoever,
including without limitation its right to recapitalize, reorganize or make other changes in its capital structure or business, merge or consolidate, issue bonds, notes, shares of common stock or other securities, including preferred stock, or
options therefor, dissolve or liquidate, or sell or transfer any part of its assets or business. 
 (k) Rules of
Construction. The headings given to the Sections of this Award Notice are solely as a convenience to facilitate reference, and are not intended to narrow, limit or affect the substance or interpretation of the provisions contained herein. The
reference to any statute, regulation or other provision of law shall be construed to refer to any amendment to or successor of such provision of law. 
 (l) Governing Law. This Award Notice will be governed by and construed in accordance with the laws of the State of Delaware (without giving effect to such State’s conflicts of law provisions),
except that Section 13 and Section 15(e) of this Award Notice will be governed by and construed in accordance with the laws of the State of Florida (without giving effect to such State’s conflicts of law provisions) and except as may
be superseded by applicable federal law. 
 (m) Section 409A. This Award is intended to comply with the requirements
of Section 409A of the Code and the treasury regulations promulgated and other official guidance issued thereunder, and shall be administered and interpreted consistent with such intention. 

(n) Recoupment Policy. Without limiting any other provision hereof, this Award is subject to the Recoupment Policy for Incentive
Compensation set forth in Article VI, Section 8 of Health Management’s Corporate Governance Guidelines, as such policy or guidelines may be hereafter amended. 

  
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 Acceptance and Agreement. By your acceptance of the Award, you acknowledge receipt of, and understand
and agree to be bound by, this Award Notice and the Plan. You further acknowledge that: (i) this Award Notice and the Plan set forth the entire understanding between you and Health Management regarding the Award; and, (ii) this Award
Notice and the Plan supersede all prior oral and written agreements concerning the Award. 
  

					
	  
	 		 	  

	Name	 		 	Date

  
 9Form of Xylem Special Senior Executive Severance Pay Plan

 Exhibit 10.28 
 ORIGINALLY EFFECTIVE AS OF 10/31/11 
 AMENDED AS OF MARCH 26, 2012 

Form of Xylem Special Senior Executive Severance Pay Plan 

 

	1.	Purpose 

 The purpose of this
Xylem Special Senior Executive Severance Pay Plan (“Plan”) is to assist in occupational transition by providing Severance Benefits, as defined herein, for employees covered by this Plan whose employment is terminated under conditions set
forth in this Plan. 
 The Plan first became effective as of October 31, 2011 following the spin-off of Xylem Inc. from ITT
Corporation (the “Predecessor Corporation”) on October 31, 2011. The Predecessor Corporation maintained a similar plan prior to the spin-off (the “Predecessor Plan”), and the Plan was created to continue service accruals
under the Predecessor Plan. The Plan shall remain in effect as provided in Section 9 hereof, and covered employees shall receive full credit for their service and participation with the Predecessor Corporation as provided in Section 5
hereof. The Plan was modified on March 26, 2012 to reflect updated pension provisions for Section 5 and certain other technical updates. 
  

	2.	Covered Employees 

 Covered
employees under this Plan (“Special Severance Executives”) are active full-time, regular salaried employees of Xylem Inc., (“Xylem”) and of any subsidiary company (“Xylem Subsidiary”) (collectively or individually as
the context requires “Company” ; provided, however, that for purposes of service under the Predecessor Plan, Company shall include the Predecessor Corporation) (including Special Severance Executives who are short term disabled as of a
Potential Acceleration Event within the meaning of the Company’s short term disability plans) (other than Special Severance Executives on periodic severance as of a Potential Acceleration Event) who are in Band A or B or were in Band A or B at
any time within the two year period immediately preceding an Acceleration Event and such other employees of the Company who shall be designated as covered employees in Band A or B under the Plan by the Leadership Development and Compensation
Committee of Xylem’s Board of Directors. 
 “Bands A and B” shall have the meaning given such terms under the
executive classification system of the Xylem Human Resources Department as in effect immediately preceding an Acceleration Event. After the occurrence of an Acceleration Event, the terms “Xylem”, “Xylem Subsidiary” and
“Company” as used herein shall also include, respectively and as the context requires, any successor company to Xylem or any successor company to any Xylem Subsidiary and any affiliate of any such successor company.

	3.	Definitions 

 An
“Acceleration Event” shall occur if: 
 (i) a report on Schedule 13D shall be filed with the Securities and Exchange
Commission pursuant to Section 13(d) of the Securities Exchange Act of 1934 (the “Act”) disclosing that any person (within the meaning of Section 13(d) of the Act), other than the Company or a subsidiary of the Company or any
employee benefit plan sponsored by the Company or a subsidiary of the Company, is the beneficial owner directly or indirectly of twenty percent (20%) or more of the outstanding Common Stock $1 par value, of the Company (the “Stock”);

 (ii) any person (within the meaning of Section 13(d) of the Act), other than the Company or a subsidiary of the Company,
or any employee benefit plan sponsored by the Company or a subsidiary of the Company, shall purchase shares pursuant to a tender offer or exchange offer to acquire any Stock of the Company (or securities convertible into Stock) for cash, securities
or any other consideration, provided that after consummation of the offer, the person in question is the beneficial owner (as such term is defined in Rule 13d-3 under the Act), directly or indirectly, of twenty percent (20%) or more of the
outstanding Stock of the Company (calculated as provided in paragraph (d) of Rule 13d-3 under the Act in the case of rights to acquire Stock); 
 (iii) the consummation of (A) any consolidation, business combination or merger involving the Company, other than a consolidation, business combination or merger involving the Company in which
holders of Stock immediately prior to the consolidation, business combination or merger (x) hold fifty percent (50%) or more of the combined voting power of the Company (or the corporation resulting from the merger or consolidation or the
parent of such corporation) after the merger and (y) have the same proportionate ownership of common stock of the Company (or the corporation resulting from the merger or consolidation or the parent of such corporation), relative to other
holders of Stock immediately prior to the merger, business combination or consolidation, immediately after the merger as immediately before, or (B) any sale, lease, exchange or other transfer (in one transaction or a series of related
transactions) of all or substantially all the assets of the Company; 
 (iv) there shall have been a change in a majority of the
members of the Board of Directors of the Company within a 12-month period unless the election or nomination for election by the Company’s stockholders of each new director during such 12-month period was approved by the vote of two-thirds of
the directors then still in office who (x) were directors at the beginning of such 12-month period or (y) whose nomination for election or election as directors was recommended or approved by a majority of the directors who were directors
at the beginning of such 12-month period or 
 (v) any person (within the meaning of Section 13(d) of the Act) (other than
the Company or any subsidiary of the Company or any employee benefit plan (or related trust) sponsored by the Company or a subsidiary of the Company) becomes the beneficial owner (as such term is defined in Rule 13d-3 under the Act) of twenty
percent (20%) or more of the Stock. 

  
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 “Cause” shall mean action by the Special Severance Executive involving willful
malfeasance or gross negligence or the Special Severance Executive’s failure to act involving material nonfeasance that would tend to have a materially adverse effect on the Company. No act or omission on the part of the Special Severance
Executive shall be considered “willful” unless it is done or omitted in bad faith or without reasonable belief that the action or omission was in the best interests of the Company. 

“Code” shall mean the Internal Revenue Code of 1986, as amended. 

“Good Reason” shall mean: 
 (i) without the Special Severance Executive’s express written consent and excluding for this purpose an isolated, insubstantial and inadvertent action not taken in bad faith and which is remedied by
the Company or its affiliates within 30 days after receipt of notice thereof given by the Special Severance Executive, (A) a reduction in the Special Severance Executive’s annual base compensation (whether or not deferred), (B) the
assignment to the Special Severance Executive of any duties inconsistent in any material respect with the Special Severance Executive’s position (including status, offices, titles and reporting requirements), authority, duties or
responsibilities, or (C) any other action by the Company or its affiliates which results in a material diminution in such position, authority, duties or responsibilities; 
 (ii) without the Special Severance Executive’s express written consent, the Company’s requiring the Special Severance Executive’s work location to be other than within twenty-five
(25) miles of the location where such Special Severance Executive was principally working immediately prior to the Acceleration Event; or 
 (iii) any failure by the Company to obtain the express written assumption of this Plan from any successor to the Company; provided that “Good Reason” shall cease to exist for an event on the
90th day following the later of its occurrence or the Special Severance Executive’s knowledge thereof, unless the Special Severance Executive has given the Company notice thereof prior to such date. 

“Potential Acceleration Event” shall mean any execution of an agreement, the commencement of a tender offer or any other
transaction or event that if consummated would result in an Acceleration Event. 
  

	4.	Severance Benefits Upon Termination of Employment 

 If a Special Severance Executive’s employment with the Company is terminated due to a Qualifying Termination, he or she shall receive the severance benefits set forth in Section 5 hereof
(“Severance Benefits”). For purposes hereof, a “Qualifying Termination” shall mean a termination of a Special Severance Executive’s employment with the Company either; 

(x) by the Company without Cause (A) within the two (2) year period commencing on the date of the occurrence of an Acceleration
Event or (B) prior to the occurrence of an Acceleration Event and either (1) following the public announcement of the transaction or event which ultimately results in such Acceleration Event or (2) at the request of a party to, or
participant in, the transaction or event which ultimately results in an Acceleration Event; or 
 (y) by a Special Severance
Executive for Good Reason within the two (2) year period commencing with the date of the occurrence of an Acceleration Event. 

  
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	5.	Severance Benefits 

 Band A Benefits 

Severance Benefits for Special Severance Executives (i) in Band A at the time of a Qualifying Termination or at any time during the
two (2) year period immediately preceding the Acceleration Event or (ii) designated as a covered employee in Band A in accordance with Section 2 hereof: 
  

	 	•	 	 Accrued Rights - The Special Severance Executive’s base salary through the date of termination of employment, any annual bonus earned but unpaid
as of the date of termination for any previously completed fiscal year, reimbursement for any unreimbursed business expenses properly incurred by the Special Severance Executive in accordance with Company policy prior to the date of the Special
Severance Executive’s termination of employment and such employee benefits, if any, as to which the Special Severance Executive may be entitled under the employee benefit plans of the Company, including without limitation, the payment of any
accrued or unused vacation under the Company’s vacation policy. 

  

	 	•	 	 Severance Pay – The sum of: 

 (x) three (3) times the current annual base salary rate paid or in effect (whether or not deferred) with respect to the Special Severance Executive at the time of the Special Severance
Executive’s termination of employment, and 
 (y) three (3) times the most recent annual bonus paid to
or earned by the Special Severance Executive (whether or not deferred) in respect of the Company’s most recent completed fiscal year prior to the date of the Special Severance Executive’s termination of employment. 

 

	 	•	 	 Benefits 

> Continued health and life insurance benefits for a three (3) year period following the Special Severance Executive’s
termination of employment at the same cost to the Special Severance Executive, and at the same coverage levels, as provided to the Special Severance Executive (and the Special Severance Executive’s eligible dependents) immediately prior to his
or her termination of employment. In the event the Company changes health and/or life insurance programs, coverage levels, benefit providers and/or modifies benefit contributions, the Special Severance Executive would be treated consistent with
other Band A executives. In the event continuation of health and/or life insurance is not permissible, the Company may provide alternative benefits or payments as described under the subheading “General” below. 

> Payment of a lump sum amount (“Savings Plan Lump Sum Amount”) equal to three (3) times the following amount: the
product of (x) the current annual base salary rate and annual bonus as determined above as “Severance Pay” and (y) the current aggregate percentage used to determine “Company Contributions” which the Special Severance
Executive would have been 

  
 4 

 
eligible for under the Xylem Retirement Savings Plan for Salaried Employees (the “RSP”) and Xylem Supplemental Retirement Savings Plan (the “Supplemental Plan”) (or
corresponding savings plan arrangements outside of the United States or any successor plans thereto) in respect of the plan year during which the Special Severance Executive’s termination of employment occurs. 

“Company Contributions” means the sum of: 
 (i) Company core contributions (e.g., either 3% or 4% based on age and years of eligible service, based on the terms of the RSP and Supplemental Plan as in effect in March 2012); 

(ii) Company matching contributions (e.g., equal to 50% of the first 6% of eligible pay contributed to the RSP and Supplemental Plan,
based on the terms of the RSP and Supplemental Plan as in effect in March 2012; for calculation of Savings Plan Lump Sum Amount 3% will be applied); and 
 (iii) Company transition credit contributions (e.g., another 3% or 5% based on age and service as defined in the RSP and Supplemental Plan, based on the terms of the RSP and Supplemental Plan as in effect
in March 2012). 
 In aggregate, the maximum percentage of Company Contributions for calculating the Savings Plan Lump Sum
Amount may not exceed 12%. 
  

	 	•	 	 Outplacement – Outplacement services for one (1) year. 

 Band B Benefits 
 Severance Benefits for Special Severance Executives (i) in
Band B at the time of a Qualifying Termination or at any time during the two (2) year period immediately preceding the Acceleration Event or (ii) designated as a covered employee in Band B in accordance with Section 2 hereof;
provided, that a Special Severance Executive who is in Band B at the time of a Qualifying Termination but was in Band A anytime during the two (2) year period immediately preceding the Acceleration Event shall be entitled to Severance Benefits
as a Special Severance Executive in Band A and shall not be entitled to the Severance Benefits set forth below: 
  

	 	•	 	 Accrued Rights - The Special Severance Executive’s base salary through the date of termination of employment, any annual bonus earned but unpaid
as of the date of termination for any previously completed fiscal year, reimbursement for any unreimbursed business expenses properly incurred by the Special Severance Executive in accordance with Company policy prior to the date of the Special
Severance Executive’s termination of employment and such employee benefits, if any, as to which the Special Severance Executive may be entitled under the employee benefit plans of the Company, including without limitation, the payment of any
accrued or unused vacation under the Company’s vacation policy. 

  
 5 

	 	•	 	 Severance Pay – The sum of: 

 (x) two (2) times the current annual base salary rate paid or in effect (whether or not deferred) with respect to the Special Severance Executive at the time of the Special Severance Executive’s
termination of employment, and 
 (y) two (2) times the most recent annual bonus paid to or earned by the
Special Severance Executive (whether or not deferred) in respect of the Company’s most recent completed fiscal year prior to the date of the Special Severance Executive’s termination of employment. 

 

	 	•	 	 Benefits 

> Continued health and life insurance benefits for a two (2) year period following the Special Severance Executive’s
termination of employment at the same cost to the Special Severance Executive, and at the same coverage levels, as provided to the Special Severance Executive (and the Special Severance Executive’s eligible dependents) immediately prior to his
or her termination of employment. In the event the Company changes health and/or life insurance programs, coverage levels, benefit providers and/or modifies benefit contributions, the Special Severance Executive would be treated consistent with
other Band A executives. In the event continuation of health and/or insurance is not permissible, the Company may provide alternative benefits or payments as described under the subheading “General” below. 

> Payment of a lump sum amount (“Savings Plan Lump Sum Amount”) equal to two (2) times the following amount: the
product of (x) the current annual base salary rate and annual bonus as determined above as “Severance Pay” and (y) the current aggregate percentage used to determine “Company Contributions” which the Special Severance
Executive would have been eligible for under the RSP and Supplemental Plan (or corresponding savings plan arrangements outside of the United States or any successor plans thereto) in respect of the plan year during which the Special Severance
Executive’s termination of employment occurs. 
 “Company Contributions” means the sum of: 

(i) Company core contributions (e.g., either 3% or 4% based on age and years of eligible service, based on the terms of the RSP and
Supplemental Plan as in effect in March 2012); 
 (ii) Company matching contributions (e.g., equal to 50% of the first 6% of
eligible pay contributed to the RSP and Supplemental Plan, based on the terms of the RSP and Supplemental Plan as in effect in March 2012; for calculation of Savings Plan Lump Sum Amount 3% will be applied); and 

(iii) Company transition credit contributions (e.g., another 3% or 5% based on age and service as defined in the RSP and Supplemental
Plan, based on the terms of the RSP and Supplemental Plan as in effect in March 2012). 
 In aggregate, the maximum percentage
of Company Contributions for calculating the Savings Plan Lump Sum Amount may not exceed 12%. 
  

	 	•	 	 Outplacement – Outplacement services for one year. 

  
 6 

 General 
 With respect to the provision of benefits described above during the above described respective three and two year periods, if, for any reason at any time the Company is unable to treat the Special
Severance Executive as being eligible for ongoing participation in any Company employee benefit plans in existence immediately prior to the termination of employment of the Special Severance Executive, and if, as a result thereof, the Special
Severance Executive does not receive a benefit or receives a reduced benefit, the Company shall provide such benefits by making available equivalent benefits from other sources or making cash payments providing equivalent value (as reasonably
determined in good faith by the Company) in a manner consistent with Section 15 below. 
 Notwithstanding any other
provision of the Plan to the contrary, all prior service and participation by a Special Severance Executive with the Predecessor Corporation shall be credited in full towards a Special Severance Executive’s service and participation with the
Company. 
  

	6.	Form of Payment of Severance Pay and Lump Sum Payments 

 Severance Pay shall be paid in cash, in non-discounted equal periodic installment payments corresponding to the frequency and duration of the severance payments that the Special Severance Executive would
have been entitled to receive from the Company as a normal severance benefit under the terms of the Xylem Senior Executive Severance Pay Plan in the absence of the occurrence of an Acceleration Event. The Savings Plan Lump Sum Amount shall be paid
in cash within thirty (30) calendar days after the date the employment of the Special Severance Executive terminates. The timing of payments shall in all respects be subject to Section 15 hereof. 

 

	7.	Termination of Employment — Other 

 The Severance Benefits shall only be payable upon a Special Severance Executive’s termination of employment due to a Qualifying Termination; provided, that if, following the occurrence of an
Acceleration Event, a Special Severance Executive is terminated due to the Special Severance Executive’s death or disability (as defined in the long-term disability plan in which the Special Severance Executive is entitled to participate
(whether or not the Special Severance Executive voluntarily participates in such plan)) and, at the time of such termination, the Special Severance Executive had grounds to resign with Good Reason, such termination of employment shall be deemed to
be a Qualifying Termination. 
  

	8.	Administration of Plan 

 This
Plan shall be administered by the Company, who shall have the exclusive right to interpret this Plan, adopt any rules and regulations for carrying out this Plan as may be appropriate and decide any and all matters arising under this Plan, including
but not limited to the right to determine appeals. Subject to applicable Federal and state law, all interpretations and decisions by Xylem shall be final, conclusive and binding on all parties affected thereby. 

  
 7 

 Notwithstanding the preceding paragraph, following an Acceleration Event, any controversy
or claim arising out of or relating to this Plan, or the breach thereof, shall be settled by arbitration administered by the American Arbitration Association under its Commercial Arbitration Rules and the entire cost thereof shall be borne by the
Company. The location of the arbitration proceedings shall be reasonably acceptable to the Special Severance Executive. Judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. The Company shall
pay all legal fees, costs of litigation, prejudgment interest, and other expenses which are incurred in good faith by the Special Severance Executive as a result of the Company’s refusal to provide any of the Severance Benefits to which the
Special Severance Executive becomes entitled under this Plan, or as a result of the Company’s (or any third party’s) contesting the validity, enforceability, or interpretation of this Plan, or as a result of any conflict between the
Special Severance Executive and the Company pertaining to this Plan. The Company shall pay such fees and expenses from the general assets of the Company. 
  

	9.	Termination or Amendment 

 Xylem
may terminate or amend this Plan (“Plan Change”) at any time except that following the occurrence of (i) an Acceleration Event or (ii) a Potential Acceleration Event, no Plan Change that would adversely affect any Special
Severance Executive may be made without the prior written consent of such Special Severance Executive affected thereby; provided, however, that (ii) above shall cease to apply if such Potential Acceleration Event does not result in the
occurrence of an Acceleration Event. 
  

	10.	Offset 

 Any Severance Benefits
provided to a Special Severance Executive under this Plan shall be offset in a manner consistent with Section 15 by reducing (x) any Severance Pay hereunder by any severance pay, salary continuation pay, termination pay or similar pay or
allowance and (y) any other Severance Benefits hereunder by corresponding employee benefits, or outplacement services, which the Special Severance Executive receives or is entitled to receive, (i) under the Xylem Senior Executive Severance
Pay Plan; (ii) pursuant to any other Company policy, practice, program or arrangement; (iii) pursuant to any Company employment agreement or other agreement with the Company; or (iv) by virtue of any law, custom or practice excluding,
however, any unemployment compensation in the United States, unless the Special Severance Executive voluntarily expressly waives (which the Special Severance Executive shall have the exclusive right to do) in writing any such respective entitlement.

  

	11.	Excise Tax 

 In the event that it
shall be determined that any Payment would constitute an “excess parachute payment” within the meaning of Section 280G of the Code, then the aggregate of all Payments shall be reduced so that the Present Value of the aggregate of all
Payments does not exceed the Safe Harbor Amount; provided, however, that no such reduction shall be effected if the Net After-tax Benefit to the Special Severance Executive of receiving all of the Payments exceeds the Net After-tax Benefit to the
Special Severance Executive resulting from having such Payments so reduced. In the event a reduction is required pursuant hereto, the order of reduction shall be first all cash payments on a pro rata basis, then any equity compensation on a pro rata
basis, and lastly medical and dental coverage. 

  
 8 

 For purposes of this Section 11, the following terms have the following meanings:

 (i) “Net After-tax Benefit” shall mean the Present Value of a Payment net of all federal state and local income,
employment and excise taxes imposed on Special Severance Executive with respect thereto, determined by applying the highest marginal rate(s) applicable to an individual for the Special Severance Executive’s taxable year in which the Qualifying
Termination occurs. 
 (ii) “Payment” means any payment or distribution or provision of benefits by the Company to or
for the benefit of the Special Severance Executive, whether paid or payable or distributed or distributable pursuant to the terms of this Plan or otherwise, but determined without regard to any reductions required by this Section 11.

 (iii) “Present Value” shall mean such value determined in accordance with Section 280G(d)(4) of the Code.

 (iv) “Safe Harbor Amount” shall be an amount expressed in Present Value which maximizes the aggregate Present Value
of Payments without causing any Payment to be subject to excise tax under Section 4999 of the Code or the deduction limitation of Section 280G of the Code. 
 All determinations required to be made under this Section 11, including whether and when a reduction is required and the amount of such reduction and the assumptions to be utilized in arriving at
such determination, shall be made by a nationally recognized accounting firm mutually agreed to by the Special Severance Executive and the Company (the “Accounting Firm”) which shall provide detailed supporting calculations both to the
Company and the Special Severance Executive within ten (10) business days of the receipt of notice from the Special Severance Executive that there has been a Payment, or such earlier time as is requested by the Company; provided that for
purposes of determining the amount of any reduction, the Special Severance Executive shall be deemed to pay federal income tax at the highest marginal rates applicable to individuals in the calendar year in which any such Qualifying Termination
occurs. 
 All fees and expenses of the Accounting Firm shall be borne solely by the Company. If the Accounting Firm determines
that no excise tax is payable by the Special Severance Executive, it shall so indicate to the Special Severance Executive in writing. Any determination by the Accounting Firm shall be binding upon the Company and the Special Severance Executive.

  

	12.	Miscellaneous 

 The Special
Severance Executive shall not be entitled to any notice of termination or pay in lieu thereof. 
 Severance Benefits under this
Plan are paid entirely by the Company from its general assets. 

  
 9 

 This Plan is not a contract of employment, does not guarantee the Special Severance
Executive employment for any specified period and does not limit the right of the Company to terminate the employment of the Special Severance Executive at any time. 
 If a Special Severance Executive should die while any amount is still payable to the Special Severance Executive hereunder had the Special Severance Executive continued to live, all such amounts shall be
paid in accordance with this Plan to the Special Severance Executive’s designated heirs or, in the absence of such designation, to the Special Severance Executive’s estate. 

The numbered section headings contained in this Plan are included solely for convenience of reference and shall not in any way affect the
meaning of any provision of this Plan. 
 If, for any reason, any one or more of the provisions or part of a provision contained
in this Plan shall be held to be invalid, illegal or unenforceable in any respect, such invalidity, illegality or unenforceability shall not affect any other provision or part of a provision of this Plan not held so invalid, illegal or
unenforceable, and each other provision or part of a provision shall to the full extent consistent with law remain in full force and effect. 
 The Plan shall be governed by and construed in accordance with the laws of the State of New York without regard to the conflicts of laws provisions thereof. 

The Plan shall be binding on all successors and assigns of the Xylem Inc. and a Special Severance Executive. 

 

	13.	Notices 

 Any notice and all
other communication provided for in this Plan shall be in writing and shall be deemed to have been duly given when delivered by hand or overnight courier or three (3) days after it has been mailed by United States registered mail, return
receipt requested, postage prepaid, addressed to the respective addresses set forth below, or to such other address as either party may have furnished to the other in writing in accordance herewith, except that notice of change of address shall be
effective only upon receipt. 
 If to the Company: 
 Xylem Inc. 
 1133 Westchester Avenue, Suite N200 

White Plains, New York 10604 
 Attention: General Counsel 
 If to Special Severance Executive: 

To the most recent address of Special Severance Executive set forth in the personnel records of the Company. 

  
 10 

	14.	Adoption and Amendments 

 This
Plan was initially adopted by Xylem Inc. on October 31, 2011 (the “Adoption Date”) and subsequently amended on March 26, 2012; and does not apply to any termination of employment which occurred or which was communicated to the
Special Severance Executive prior to the Adoption Date. 
  

	15.	Section 409A 

 This Plan is
intended to comply with Section 409A of the Code and will be interpreted in a manner intended to comply with Section 409A of the Code. Notwithstanding anything herein to the contrary, (i) if at the time of the Special Severance
Executive’s termination of employment with the Company the Special Severance Executive is a “specified employee” as defined in Section 409A of the Code (and any related regulations or other pronouncements thereunder) and the
deferral of the commencement of any payments or benefits otherwise payable hereunder as a result of such termination of employment is necessary in order to prevent any accelerated or additional tax under Section 409A of the Code, then the
Company will defer the commencement of the payment of any such payments or benefits hereunder (without any reduction in such payments or benefits ultimately paid or provided to the Special Severance Executive) until the date that is six months
following the Special Severance Executive’s termination of employment with the Company (or the earliest date as is permitted under Section 409A of the Code), at which point all payments deferred pursuant to this Section 15 shall be
paid to the Special Severance Executive in a lump sum and (ii) if any other payments of money or other benefits due hereunder could cause the application of an accelerated or additional tax under Section 409A of the Code, such payments or
other benefits shall be deferred if deferral will make such payment or other benefits compliant under Section 409A of the Code, or otherwise such payment or other benefits shall be restructured, to the extent possible, in a manner, determined
by the Company, that does not cause such an accelerated or additional tax. To the extent any reimbursements or in-kind benefits due under this Plan constitute “deferred compensation” under Section 409A of the Code, any such
reimbursements or in-kind benefits shall be paid in a manner consistent with Treas. Reg. Section 1.409A-3(i)(1)(iv). Each payment made under this Plan shall be designated as a “separate payment” within the meaning of Section 409A
of the Code. The Company shall consult with Special Severance Executives in good faith regarding the implementation of the provisions of this section; provided that neither the Company nor any of its employees or representatives shall have any
liability to Special Severance Executives with respect thereto. 

  
 11

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