Document:

EX-4.1 SUPPLEMENTAL INDENTURE

 

Exhibit 4.1

     First Supplemental Indenture (this “Supplemental Indenture”), dated as of
August 27, 2007, among COVENTRY HEALTH CARE, INC., a Delaware corporation (the
“Company”), and UNION BANK OF CALIFORNIA, N.A., a national banking association, as
trustee with respect to the series of Securities specified below under the Indenture
referred to below (the “New Trustee”).

WITNESSETH:

     WHEREAS, the Company has heretofore entered into an Indenture, dated as of March 20,
2007 (the “Indenture”), with The Bank of New York, as trustee (the “Initial Trustee”),
providing for the issuance of Securities of the Company;

     WHEREAS, Section 301 of the Indenture permits the Company to appoint as trustee for
any series of Securities a Person other than the Initial Trustee, and Section 901 of the
Indenture contemplates such appointment shall be evidenced by a Supplemental Indenture;

     WHEREAS, the Company desires to appoint the New Trustee, and the New Trustee desires
to accept the appointment, to act as Trustee under the Indenture with respect to the
Company’s 6.30% Senior Notes due 2014 (the “Notes”); and

     WHEREAS, all things necessary to make this Supplemental Indenture a valid and legally
binding agreement of the Company have been done.

     NOW THEREFORE, in consideration of the foregoing and for other good and valuable
consideration, the receipt of which is hereby acknowledged, the Company, and the New
Trustee mutually covenant and agree as follows:

ARTICLE I

AMENDMENTS TO THE INDENTURE

     1. Appointment of Trustee with respect to the Notes. The Company hereby appoints the
New Trustee, and the New Trustee hereby accepts its appointment, as the Trustee under the Indenture
with respect to the Notes with all rights, powers and obligations as set forth in the Indenture.

ARTICLE II

MISCELLANEOUS

     1. Ratification of Indenture; Supplemental Indentures Part of Indenture. Except as
expressly amended hereby, the Indenture is in all respects ratified and confirmed and all the
terms, conditions and provisions thereof shall remain in full force and effect. This Supplemental
Indenture shall form a part of the Indenture for all purposes, and every Holder of Notes heretofore
or hereafter authenticated and delivered shall be bound hereby.

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     2. Governing Law. THIS SUPPLEMENTAL INDENTURE SHALL BE GOVERNED BY, AND CONSTRUED IN
ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK.

     3. Concerning the Trustee. The recitals contained herein shall be taken as statements
of the Company and the New Trustee assumes no responsibility for their correctness. The New
Trustee assumes no duties, responsibilities or liabilities by reason of this Supplemental Indenture
other than as set forth in this Supplemental Indenture and the Indenture. In addition, the New
Trustee makes no representation as to the validity or sufficiency of this Supplemental Indenture.

     4. Defined Terms. Unless otherwise defined herein, terms used herein shall have the
meanings set forth in the Indenture.

     5. Separability. In case any provision in this Supplemental Indenture shall for any
reason be held to be invalid, illegal or unenforceable in any respect, the validity, legality and
enforceability of the remaining provisions of this Supplemental Indenture shall not in any way be
affected or impaired thereby.

     6. Counterparts. This Supplemental Indenture may be executed and delivered in any
number of counterparts, each of which when so executed and delivered shall be deemed to be an
original, and all such counterparts shall together constitute but one and the same instrument.

     7. Effect of Headings. The Section headings herein are for convenience only and shall
not effect the construction thereof.

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     IN WITNESS WHEREOF, the parties hereto have caused this
First Supplemental Indenture to be duly executed as of the date first above written.

	 	 	 	 	 
	 	COVENTRY HEALTH CARE, INC.

 	 
	 	By:  	/s/ Shawn
M. Guertin	 
	 	 	Name:  	Shawn M. Guertin 	 
	 	 	Title:  	Executive Vice President &
Chief
Financial Officer 	 
	 

	 	 	 	 	 
	 	UNION BANK OF CALIFORNIA, N.A.,

     as Trustee

 	 
	 	By:  	/s/ Luis
Perez	 
	 	 	Name:  	Luis Perez 	 
	 	 	Title:  	Vice PresidentEX-4.2 OFFICERS' CERTIFICATE

 

Exhibit 4.2

COVENTRY HEALTH CARE, INC.

OFFICERS’ CERTIFICATE PURSUANT TO THE INDENTURE

August 27, 2007

     Reference is made to the Indenture (the “Indenture”), dated as of March 20, 2007, among
Coventry Health Care, Inc., a Delaware corporation (the “Company”), and The Bank of New York, as
supplemented by the First Supplemental Indenture, dated as of August 27, 2007, among the Company
and Union Bank of California, N.A., as trustee (the “Trustee”), in connection with the issuance of
$400,000,000 of the Company’s 6.30% Senior Notes due 2014 (the “Notes”). Unless otherwise defined
herein, capitalized terms used in this certificate have the meaning assigned to them in the
Indenture. This certificate is issued pursuant to Section 301 of the Indenture.

     We, Dale B. Wolf and Shawn M. Guertin, the duly appointed Chief Executive Officer and
Executive Vice President, Chief Financial Officer and Treasurer, respectively, of the Company,
HEREBY CERTIFY that:

        1. We have read the provisions of the Indenture setting forth conditions precedent to
authentication and delivery by the Trustee of the Securities and all definitions in the Indenture
relating thereto;

        2. We have examined (i) the resolutions of the Board of Directors of the Company (the “Board”)
adopted July 30, 2007; (ii) such agreements, certificates of public officials and certificates of
officers or other representatives of the Company; and (iii) such other documents, certificates and
corporate or other records as we have deemed necessary as a basis for the opinions hereinafter
expressed;

        3. In the opinion of each of the undersigned, he has made such examination or investigation
as is necessary to enable him to express an informed opinion as to whether or not the conditions
referred to above have been complied with;

        4. We are of the opinion that the conditions to be satisfied by the Company as set forth in
the Indenture relating to the authentication and delivery of the Securities have been complied
with; and

        5. Pursuant to Section 301 of the Indenture, the terms and conditions of the Notes are
established and approved to be the following:

     a. Title:

“6.30% Senior Notes due 2014”.

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     b. Aggregate Principal Amount:

The Notes are not limited as to the aggregate principal amount of such
series that the Company may issue. The Notes have an aggregate original
principal amount of $400,000,000. The Company may create and issue
additional securities having the same terms and conditions as the Notes in
all respects, except for issue date, issue price and, if applicable, the
first payment of interest on such additional securities. Additional
securities issued in this manner will be consolidated with and will form a
single series with the Notes.

     c. Form of Security:

The Notes will be issued in global form, with the form of the Note attached
hereto as Exhibit A.

     d. Principal Repayment Date:

August 15, 2014.

     e. Interest:

Interest shall be paid at the rate of 6.30% per annum. Interest shall
accrue from August 27, 2007 or from the most recent Interest Payment Date to
which interest has been paid or duly provided for, semi-annually on February
15 and August 15 in each year, commencing February 15, 2008. The Regular
Record Dates shall be February 1 and August 1.

     f. Place of Payment of Interest and Principal:

The Corporate Trust Office of the Trustee.

     g. Redemption Provisions:

The redemption provisions of Article 11 of the Indenture, including, without
limitation, Section 1108(b), are applicable to the Notes, with the number of
basis points to be added to the Treasury Yield in determining the discount
rate in Section 1108(b) equal to 25 basis points.

     h. Sinking Fund Obligations:

The Notes shall not contain any Sinking Fund provisions and Article 12 of
the Indenture is inapplicable to the Notes.

     i. Denominations:

$2,000 and integral multiples of $1,000 in excess thereof.

     j. Additional Principal Payable Upon an Event of Default:

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Not applicable.

     k. Inapplicability of, or Additional, Events of Default:

Not applicable.

     l. Trustee Other than The Bank of New York:

Union Bank of California, N.A., with its Corporate Trust Office located at:

551 Madison Ave., 11th Floor

New York, NY 10022

Attn: Corporate Trust Department

     m. Payment of Principal and Interest in Non-U.S. Dollar Currencies:

Not applicable.

     n. Payment of Principal and Interest in Non-U.S. Dollar Currencies at Election of the Company:

Not applicable.

     o. Currency Determination Agent:

Not applicable.

     p. Satisfaction and Discharge Provisions Other Than as Set Forth in the Indenture:

Not applicable.

     q. Date of Global Securities if Other Than Original Issuance Date:

Not applicable.

     r. Guarantees:

Not applicable.

     s. Other Terms:

The definition of Independent Investment Banker contained in the Indenture
shall not apply to the Notes and shall be replaced by the following:

“Independent Investment Banker” means either Goldman, Sachs & Co., J.P.
Morgan Securities Inc. or Citigroup Global Markets Inc., as selected by us
or, if both such firms are unwilling or unable to select the applicable

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Comparable Treasury Issue, an independent investment banking institution of
national standing appointed by us.

The definition of Reference Treasury Dealer contained in the Indenture shall
not apply to the Notes and shall be replaced by the following:

“Reference Treasury Dealer” means Goldman, Sachs & Co., Citigroup Global
Markets Inc. or J.P. Morgan Securities Inc. and their respective successors
and at least two other primary U.S. government securities dealers in New
York City (each, a “Primary Treasury Dealer”) selected by the Independent
Investment Banker; provided, however, that if any of the foregoing shall
cease to be a Primary Treasury Dealer, the Company will substitute therefor
another Primary Treasury Dealer.

For purposes of Section 1108 of the Indenture, the Company shall calculate the redemption price in
accordance with the terms and provisions of the Indenture.

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     IN WITNESS WHEREOF, the
undersigned have executed this certificate as of the date first written above.

	 	 	 	 	 
	 	 	 
	 	By:  	
/s/ Dale B. Wolf	 
	 	 	Name:  	Dale B. Wolf 	 
	 	 	Title:  	Chief Executive Officer 	 
	 

	 	 	 	 	 
	 	 	 
	 	By:  	
/s/ Shawn M. Guertin	 
	 	 	Name:  	Shawn M. Guertin 	 
	 	 	Title:  	Executive Vice President, Chief

Financial Officer and Treasurer

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