Document:

Form of Exchange Note (additional Original Notes)

 Exhibit 4.3.1 
 FORM OF 14.250% SENIOR SECURED NOTE 
 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 2.06 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 PLATINUM ENERGY SOLUTIONS, INC., A NEVADA CORPORATION (“PES”).

 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 PES 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. 

THIS NOTE IS ISSUED WITH ORIGINAL ISSUE DISCOUNT FOR PURPOSES OF SECTION 1271 ET SEQ. OF THE INTERNAL REVENUE CODE OF 1986, AS AMENDED. A
HOLDER MAY OBTAIN THE ISSUE PRICE, AMOUNT OF ORIGINAL ISSUE DISCOUNT, ISSUE DATE, AND YIELD TO MATURITY FOR THIS NOTE BY SUBMITTING A WRITTEN REQUEST FOR SUCH INFORMATION TO THE COMPANY AT THE FOLLOWING ADDRESS: 2100 WEST LOOP SOUTH, SUITE 1601,
HOUSTON, TEXAS 77027, ATTENTION: CHIEF FINANCIAL OFFICER. 

 [Face of Note] 

 
  
 CUSIP 727663 AH9 
 ISIN US727663AH98 

14.250% Senior Secured Notes due 2015 
  

			
	No. ___	  	$____________

 Platinum Energy Solutions, Inc. 
 promises to pay to ________________________ or registered assigns, 
 the principal sum of
__________________________________________________________ 
 DOLLARS on March 1, 2015. 

Interest Payment Dates: March 1 and September 1, commencing March 1, 2012 (provided, that for the first interest payment period, the
interest will accrue from September 1, 2011) 
 Record Dates: February 15 and August 15 

Dated: _______________, 2012 
  

			
	Platinum Energy Solutions, Inc.
		
	By:	 	 
		 	Name:
		 	Title:

 This is one of the Notes referred to in the within-mentioned Indenture: 

The Bank of New York Mellon Trust Company, N.A., 
     as Trustee 
  

									
					
	By:	  	 	  		  	Date:	  	 
		  	Authorized Signatory	  		  		  	

  
  

 

 [Back of Note] 
 14.250% Senior Secured Notes due 2015 
 Capitalized terms used herein have the
meanings assigned to them in the Indenture referred to below unless otherwise indicated. 
 (1)
INTEREST. Platinum Energy Solutions, Inc., a Nevada corporation (“PES”), promises to pay interest on the principal amount of this Note at 14.250% per annum from September 1, 2011 until
maturity. PES shall pay the Additional Interest, if any, payable pursuant to the Registration Rights Agreement referred to below. PES will pay interest and Additional Interest, if any, semi-annually in arrears on March 1 and September 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 Notes will accrue from the most recent date to which interest has been paid or, if no
interest has been paid, from the date of issuance (or, in the case of the Additional Notes, the September 1, 2011 deemed 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 March 1, 2012. PES will 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 will 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. 
 (2) METHOD OF PAYMENT. PES will 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 will be considered paid on the date due if the Paying
Agent, if other than PES or a Subsidiary thereof, holds as of 10:00 a.m. Eastern Time on the due date money deposited by PES in immediately available funds and designated for and sufficient to pay all principal, premium, if any, and interest then
due. PES will pay all Additional Interest, if any, in the same manner on the dates and in the amounts set forth in the Registration Rights Agreement. 
 (3) PAYING AGENT AND REGISTRAR. Initially, The Bank of New York Mellon Trust Company, N.A., the Trustee under the
Indenture, will act as Paying Agent and Registrar. PES may change any Paying Agent or Registrar without notice to any Holder. PES or any of its Subsidiaries may act in any such capacity. 

(4) INDENTURE. PES issued the Notes under an Indenture dated as of March 3,
2011, as amended by the First Supplemental Indenture dated September 26, 2011 and the Second Supplemental Indenture dated September 29, 2011 (as so supplemented, the “Indenture”) among PES, the Guarantors and the Trustee.
The terms of the Notes include those stated in the Indenture and those made part of the Indenture by reference to the TIA. The Notes are subject to all such terms, and Holders are referred to the Indenture

 
and to the TIA 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 secured obligations of PES as provided in the Indenture and the Security Documents. The Indenture does not limit the aggregate principal amount of Notes that may be issued thereunder. 

(5) Optional Redemption. 
 (a) Except as set forth in subparagraphs (b) and (c) of this Paragraph 5, the Notes will not be redeemable at PES’s option prior to March 1, 2013. On or after March 1, 2013, PES
may redeem the Notes, in whole or in part, 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 Notes redeemed, to, but not including, the applicable redemption date, if redeemed during the period set forth below, subject to the rights of Holders on the relevant record date to receive interest on the relevant Interest Payment Date:

  

			
	 For the period below
	  	Percentage
	 On or after March 1, 2013 to February 28, 2014
	  	107.125%
	 On or after March 1, 2014 and thereafter
	  	100.000%

 Unless PES defaults in the payment of the redemption price, interest will cease to accrue
on the Notes or portions thereof called for redemption on the applicable redemption date. 
 (b) At any time on
or prior to March 1, 2013, PES may on any one or more occasions redeem up to 35% of the aggregate principal amount of the Notes issued under this Indenture at a redemption price of 114.250% of the aggregate principal amount, plus accrued and
unpaid interest and Additional Interest, if any, on the Notes to be redeemed to but not including the redemption date (subject to the right of Holders of record on the relevant record date to receive interest due on an Interest Payment Date that is
on or prior to the redemption date), with the net cash proceeds of one or more Equity Offerings by PES, provided that: 
  

	 	(i)	at least 65% of the aggregate principal amount of Notes originally issued under this Indenture remains outstanding immediately after the occurrence of such redemption
(excluding Notes held by PES and its Subsidiaries); and 

  

	 	(ii)	the redemption occurs within 90 days of the date of the closing of such Equity Offering. 

(c) In addition, at any time prior to March 1, 2013, PES may also redeem all or a part of the Notes, upon not less
than 30 nor more than 60 days’ prior notice mailed by first-class mail to each Holder’s registered address (or transmitted otherwise in accordance with applicable procedures of DTC), with a copy to the

 
Trustee, at a redemption price equal to 100% of the principal amount of Notes redeemed plus the Applicable Premium, and accrued and unpaid interest and Additional Interest, if any, to, but not
including, the redemption date, subject to the rights of holders of Notes on the relevant record date to receive interest due on the relevant Interest Payment Date. 
 Unless PES defaults in the payment of the redemption price, interest will cease to accrue on the Notes or portions thereof called for redemption on the applicable redemption date. 

(6) MANDATORY REDEMPTION. 

PES is not required to make mandatory redemption or sinking fund payments with respect to the Notes. PES may at any time
and from time to time purchase the Notes in the open market or otherwise if such purchase complies with the then applicable agreements of PES, including this Indenture. 

(7) REPURCHASE AT THE OPTION OF
HOLDER. 
 (a) Upon the occurrence of a Change of Control, PES will make an offer (a “Change of Control
Offer”) to each Holder to repurchase all or any part (equal to $2,000 or an integral multiple of $1,000 in excess thereof) of that Holder’s Notes at a purchase price in cash equal to 101% of the aggregate principal amount of Notes
repurchased plus accrued and unpaid interest and Additional Interest, if any, on the Notes repurchased to the date of settlement (the “Change of Control Payment Date”), 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 15 days following any Change of Control, PES will mail a notice to each Holder and the Trustee describing the transaction or
transactions that constitute the Change of Control and offering to repurchase Notes as of the Change of Control Payment Date specified in the notice, which date will be no earlier than 30 days and no later than 60 days from the date such notice is
mailed, pursuant to the procedures required by the Indenture and described in such notice. 
 (b) If PES or a Restricted
Subsidiary of PES consummates any Asset Sales, on the 361st day after the Asset Sale (or, at PES’s option, any earlier date), if the aggregate amount of Excess Proceeds then exceeds $5.0 million, PES will make an Asset Sale Offer to all Holders
of Notes, and, at PES’s option, all holders of Other Pari Passu Obligations, to purchase the maximum principal amount of Notes and such other pari passu Indebtedness that may be purchased out of the Excess Proceeds. The offer price in any Asset
Sale Offer will be equal to 100% of principal amount plus accrued and unpaid interest and Additional Interest, if any, to the date of settlement, subject to the right of Holders of record on the relevant record date to receive interest due on an
Interest Payment Date that is on or prior to the date of settlement, and will be payable in cash. If any Excess Proceeds remain after consummation of an Asset Sale Offer, PES may use those Excess Proceeds for any purpose not otherwise prohibited by
the Indenture. If the 

 
aggregate principal amount of Notes and, if applicable, Other Pari Passu Obligations tendered into such Asset Sale Offer exceeds the amount of Excess Proceeds, the Trustee will select the Notes
and such Other Pari Passu Obligations to be purchased on a pro rata basis. Upon completion of each Asset Sale Offer, the amount of Excess Proceeds will be reset at zero. 
 (c) Within 100 days after each Determination Date for which the Excess Cash Flow of PES and its Restricted Subsidiaries for the applicable Excess Cash Flow Offer Determination Period exceeds $2.5 million
(the “Excess Cash Flow Offer Threshold”), and to the extent permitted by its Credit Facilities, PES will make an offer in cash in an amount equal to the Excess Cash Flow Offer Amount to purchase Notes (an “Excess Cash Flow
Offer”) at an offer price equal to 100% of the aggregate principal amount thereof plus accrued and unpaid interest and Additional Interest, if any, to the date of purchase (the “Excess Cash Flow Offer Payment”). If the aggregate
principal amount of Notes tendered in such Excess Cash Flow Offer exceeds the Excess Cash Flow Offer Amount, the Trustee will select the Notes to be purchased on a pro rata basis, by lot or by such other method as the Trustee deems fair and
appropriate. To the extent that the aggregate amount of Notes tendered pursuant to an Excess Cash Flow Offer is less than the Excess Cash Flow Offer Amount, PES may use any remaining Excess Cash Flow Amount for any purpose not otherwise prohibited
by the Indenture. Upon completion of any such Excess Cash Flow Offer, the Excess Cash Flow Amount shall be reset at zero; provided that PES will not be deemed to be in default under this covenant for any failure to make an Excess Cash Flow
Offer or an Excess Cash Flow Offer Payment by virtue of any adjustment in the amount calculated for any Excess Cash Flow Offer Determination Period due to normal year-end accounting adjustments or other changes concurred in by its public
accountants; provided further that any such adjustment in the calculation of the Excess Cash Flow for a prior Excess Cash Flow Offer Determination Period, whether positive or negative, shall be carried forward to the next subsequent Excess
Cash Flow Offer Determination Period. Within 100 days following each such Determination Date, PES will mail a notice to each Holder and the Trustee offering to repurchase Notes as of the date specified in the notice (the “Excess Cash Flow Offer
Purchase Date”), which date will be no earlier than 30 days and no later than 60 days from the date such notice is mailed, pursuant to the procedures required by the Indenture and described in such notice. 

(8) NOTICE OF REDEMPTION. Notice of redemption will be
mailed at least 30 days but not more than 60 days before a redemption date, PES will 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. Notes in denominations larger than $2,000 may be
redeemed in part but only in whole multiples of $1,000, unless all of the Notes held by a Holder are to be redeemed. 

 (9) DENOMINATIONS, TRANSFER,
EXCHANGE. The Notes are in registered form without coupons in denominations of $2,000 and integral multiples of $1,000. The transfer of Notes may be registered and 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 PES may require a Holder to pay any taxes and fees required by law or permitted by the Indenture. PES
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, PES need not exchange or register the transfer of any Notes for a period
of 15 days before a selection of 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. The Indenture or the
Notes or Guarantees may be amended or supplemented as specified in the Indenture. 
 (12)
DEFAULTS AND REMEDIES. Events of Default are specified in Indenture. In the case of an Event of Default arising under Section 6.01(10) or (11) of the Indenture, all
outstanding Notes will 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 principal amount of the then outstanding Notes may
declare all the Notes to be due and payable immediately. Holders may not enforce the Indenture or the Notes except as provided in the Indenture. Subject to certain limitations, Holders of a majority in aggregate principal amount of the then
outstanding Notes may direct the Trustee in its exercise of any trust or power. The Trustee may withhold notice of any continuing Default or Event of Default from Holders of the Notes if it determines that withholding notice is in their interest,
except a Default or Event of Default relating to the payment of principal of, or interest, premium or Additional Interest, if any, on, the Notes. 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 and its consequences, if the rescission would not conflict with any judgment or decree and if all existing Events of Default (except nonpayment of principal, interest or
premium or Additional Interest, if any, that has become due solely because of the acceleration) have been cured or waived. 
 (13) TRUSTEE DEALINGS WITH PES. The Trustee, in its individual or any other capacity, may make loans to, accept deposits from, and perform services for
PES or its Affiliates, and may otherwise deal with PES or its Affiliates, as if it were not the Trustee. 
 (14)
NO RECOURSE AGAINST OTHERS. A director, officer, employee, incorporator or stockholder or other owner of Capital Stock of PES or any of the Guarantors, as such, will
not have any liability for any obligations of PES or the Guarantors under the Notes, the Note Guarantees, the Security Documents or the Indenture 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 Notes. 

(15) AUTHENTICATION. This Note will not be valid until authenticated by the manual
signature of the Trustee or an authenticating agent. 
 (16) 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). 
 (17) ADDITIONAL
RIGHTS OF HOLDERS OF RESTRICTED GLOBAL NOTES AND RESTRICTED DEFINITIVE
NOTES. In addition to the rights provided to Holders of Notes (including Additional Notes) under the Indenture, Holders of Restricted Global Notes and Restricted Definitive Notes will have all the rights set forth
in one or more registration rights agreements, if any, among PES, the Guarantors and the other parties thereto, relating to rights given by PES and the Guarantors to the purchasers of Notes, including Additional Notes (collectively, the
“Registration Rights Agreement”). 
 (18) CUSIP NUMBERS.
Pursuant to a recommendation promulgated by the Committee on Uniform Security Identification Procedures, PES has caused CUSIP numbers to be printed on the 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 Notes or as contained in any notice of redemption, and reliance may be placed only on the other identification numbers placed thereon. 

(19) GOVERNING LAW. THE INTERNAL LAW OF THE STATE OF NEW YORK WILL GOVERN AND BE USED TO CONSTRUE THE INDENTURE,
THIS NOTE AND THE GUARANTEES. 
 (20) Anything herein to the contrary notwithstanding, the liens and security
interests securing the obligations evidenced by this promissory note, the exercise of any right or remedy with respect thereto, and certain of the rights of the Holder hereof may be subject to the provisions of an Intercreditor Agreement entered
into after March 3, 2011 (as amended, restated, supplemented, or otherwise modified from time to time, the “Intercreditor Agreement”), by and between a First Lien Agent, and The Bank of New York Mellon Trust Company, N.A., as
Second Lien Trustee and Collateral Agent. In the event of any conflict between the terms of the Intercreditor Agreement and this promissory note, the terms of the Intercreditor Agreement shall govern and control. 

PES will 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: 
 Platinum Energy Solutions, Inc. 
 2100 W. Loop South, Suite 1601 
 Houston, Texas 77027 

Attention: Chief Financial Officer 

 ASSIGNMENT FORM 

To assign this Note, fill in the form below: 
  

			
	(I) or (we) assign and transfer this 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 Note on the books of PES. The agent may substitute another to act for him. 

Date: _______________ 
 Your
Signature:______________________________________ 
 (Sign exactly as your name appears on the face of this Note) 

Signature Guarantee*: _________________________ 

* Participant in a recognized Signature Guarantee Medallion Program (or other signature guarantor acceptable to the Trustee). 

 Option of Holder to Elect Purchase 

If you want to elect to have this Note purchased by PES pursuant to Section 4.06, Section 4.10 or
Section 4.15 of the Indenture, check the appropriate box below: 
  

									
		 	 ̈    Section 4.06	 	 ̈    Section 4.10	 	 ̈    Section 4.15	 	

 If you want to elect to have only part of the Note purchased by PES pursuant to Section 4.06,
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 Note) 
 Tax Identification No.: _______________________________ 
 Signature Guarantee:
_________________________ 
 SCHEDULE OF EXCHANGES OF
INTERESTS IN THE GLOBAL NOTE * 
 The following
exchanges of a part of this Global Note for an interest in another Global Note or for a Definitive Note, or exchanges of a part of another Global Note or Definitive Note for an interest in this Global Note, have been made: 

 

									
	 Date of
Exchange
	 	Amount of
decrease in
Principal
Amount

[at maturity] of
this Global Note	 	Amount of
increase in
Principal
Amount

[at maturity] of
this Global Note	 	Principal
Amount 
[at maturity] of
this Global Note
following such
decrease 
(or
increase)	 	Signature of
authorized
Officer of
Trustee or
Custodian
		 		 		 		 	

  

	*	This schedule should be included only if the Note is issued in global form. 

 NOTATION OF GUARANTEE 

For value received, each Guarantor (which term includes any successor Person under the Indenture (as defined below)) agrees, subject to
the provisions in the Indenture dated as of March 3, 2011, as amended by the First Supplemental Indenture dated September 26, 2011 and the Second Supplemental Indenture dated September 29, 2011 (as so supplemented, the
“Indenture”) among PLATINUM ENERGY SOLUTIONS, INC., (“PES”), the Guarantors party thereto and The Bank of New York Mellon Trust Company, N.A., as trustee (in such capacity, the “Trustee”) and as
collateral agent (in such capacity, the “Collateral Agent”), (a) the undersigned, jointly and severally with the other Guarantors, irrevocably, absolutely, and unconditionally guarantees to each Holder of Notes and the Trustee the
prompt and complete payment and performance when due, and no matter how the same shall become due, of all Guaranteed Obligations subject to any limitation set forth therein; (b) that each reference in the Indenture to a “Guarantor”
shall also mean and be a reference to the undersigned; (c) the obligations of the Guarantors to the Holders of Notes and to the Trustee pursuant to 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 Guarantee; (d) to be bound by such provisions; and (e) authorizes and directs the Trustee, on behalf of such Holder, to take such action as may be necessary or appropriate to effectuate
such provisions. 
 NEW YORK LAW TO GOVERN. THE INTERNAL LAW OF THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO CONSTRUE THIS
NOTATION OF GUARANTEE. 
 Capitalized terms used but not defined herein have the meanings given to them in the Indenture.

  

			
	[NAME OF GUARANTOR(S)]
		
	By:	 	 
		 	Title:
		 	Name:2012 Incentive Program

 Exhibit 10.1 
 COMPUTER PROGRAMS AND SYSTEMS, INC. 
 2012 EXECUTIVE OFFICER INCENTIVE
PROGRAM 
 1. Purpose and Administration of the 2012 Incentive Program. The 2012 Executive Officer Incentive Program
(the “2012 Incentive Program”) has been established by Computer Programs and Systems, Inc. (the “Corporation”) to encourage outstanding performance from its executive officers. Subject to applicable law, all designations,
determinations, interpretations, and other decisions under or with respect to the 2012 Incentive Program or any bonus award hereunder shall be within the sole discretion of the Compensation Committee (the “Compensation Committee”) of the
Board of Directors (the “Board”) of the Corporation, may be made at any time and shall be final, conclusive and binding upon all persons. Designations, determinations, interpretations, and other decisions made by the Compensation Committee
with respect to the 2012 Incentive Program or any bonus award hereunder, including but not limited to the application of the Recoupment Policy described herein, need not be uniform and may be made selectively among Eligible Executives, whether or
not such Eligible Executives are similarly situated. 
 2. Participation. All executives officers of the Corporation,
except executives who receive commission-based compensation, are eligible to receive a bonus award pursuant to the 2012 Incentive Program (each, an “Eligible Executive”). Each Eligible Executive selected by the Board to receive a bonus
award under the 2012 Incentive Program is referred to herein as a Participant. 
 3. Calculation and Payment of Awards.
Bonus awards shall be calculated based on the financial results of the Corporation for the 2012 fiscal year. The bonus awards to be paid pursuant to the 2012 Incentive Program (each, an “Award”) shall be on such terms as the Board may
prescribe, at the Compensation Committee’s recommendation, based on the performance criteria set forth on Schedule A hereto. The target(s) for the performance criteria shall be determined by the Board, in its discretion, at the
recommendation of the Compensation Committee, as set forth on Schedule A hereto. As soon as practicable following the 2012 fiscal year, the Compensation Committee shall determine and certify whether and to what extent the performance goal has
been met, as well as the amount of the Award that each Participant has earned under the 2012 Incentive Program. A Participant is required to remain employed with the Corporation through the end of the 2012 fiscal year in order to have a legally
binding right to the Award. 
 Awards pursuant to the 2012 Incentive Program will be paid solely in cash. All amounts due to
Participants under the 2012 Incentive Program shall be paid as soon as administratively feasible after the end of the 2012 fiscal year, and, in any event, no later than March 15, 2013. Except as the Compensation Committee may otherwise
determine in its sole and absolute discretion, termination of a Participant’s employment prior to the end of the 2012 fiscal year will result in the forfeiture of the Award by the Participant, and no payments shall be made with respect thereto.
This 2012 Incentive Program is not a qualified plan for federal income tax purposes, and any payments are subject to applicable tax withholding requirements. 
 4. Adjustments for Unusual or Nonrecurring Events. The Compensation Committee is hereby authorized to make adjustments in the terms and conditions of, and the criteria included in, bonus awards
under the 2012 Incentive Program in recognition of unusual or nonrecurring events affecting any Participant, the Corporation, or the financial statements of the Corporation; in the event of changes in applicable laws, regulations or accounting
principles; or in the event the Compensation Committee determines that such adjustments are appropriate in order to prevent dilution or enlargement of the benefits or potential benefits intended to be made available under the 2012 Incentive Program.
The Compensation Committee is also authorized to adjust performance targets or bonus awards downward to avoid unwarranted windfalls. Notwithstanding the foregoing, the Compensation Committee shall not have the discretion to increase any Award
payable to a Participant in excess of that provided by the application of the terms and conditions set forth in Schedule A hereto. 
 5. Recoupment Policy. The Corporation may recover from any Participant any incentive compensation awarded or paid pursuant to this 2012 Incentive Program based on (i) achievement of financial
results that were subsequently the subject of a restatement due to material noncompliance with any financial reporting requirement under either GAAP or the federal securities laws, other than as a result of changes to accounting rules

  

 
and regulations, or (ii) a subsequent finding that the financial information or performance metrics used by the Compensation Committee to determine the amount of the incentive compensation
were materially inaccurate, in each case regardless of individual fault. In addition, the Corporation may recover any incentive compensation awarded or paid pursuant to this 2012 Incentive Program based on a Participant’s conduct which is not
in good faith and which materially disrupts, damages, impairs or interferes with the business of the Corporation. This Recoupment Policy applies to any incentive compensation earned or paid to an Eligible Executive pursuant to this 2012 Incentive
Program. Subsequent changes in status, including retirement or termination of employment, do not affect the Corporation’s rights to recover compensation under this policy. The Compensation Committee will administer this policy and exercise its
discretion and business judgment in the fair application of this policy based on the facts and circumstances as it deems relevant in its sole discretion. More specifically, the Compensation Committee shall determine in its discretion any appropriate
amounts to recoup, the officers from whom such amounts shall be recouped (which need not be all officers who received the bonus compensation at issue) and the timing and form of recoupment; provided, that only compensation paid or settled within
three years prior to the Compensation Committee taking action under this Recoupment Policy shall be subject to recoupment; provided further, that any recoupment pursuant to clause (i) or (ii) of the first sentence of this paragraph shall
not exceed the portion of any applicable bonus paid hereunder that is in excess of the amount of performance-based or incentive compensation that would have been paid or granted based on the actual, restated financial statements or actual level of
the applicable financial or performance metrics as determined by the Compensation Committee in its sole discretion. 
 For
avoidance of doubt, the Corporation may set off the amounts of any such required recoupment against any amounts otherwise owed by the Corporation to a Participant as determined by the Compensation Committee in its sole discretion, solely to the
extent any such offset complies with the requirements of Section 409A of the Internal Revenue Code, as amended (the “Code”), and the guidance issued thereunder. 
 If any restatement of the Corporation’s financial results indicates that the Corporation should have made higher performance-based payments than those actually made under the 2012 Incentive Program
for the period affected by the restatement, then the Compensation Committee shall have discretion, but not the obligation to cause the Corporation to make appropriate incremental payments to affected Participants then-currently employed by the
Corporation. The Compensation Committee will determine, in its sole discretion, the amount, form and timing of any such incremental payments, which shall be no more than the difference between the amount of performance-based compensation that was
paid or awarded and the amount that would have been paid or granted based on the actual, restated financial statements. 
 6.
No Right to Employment. The grant of an Award under the 2012 Incentive Program shall not be construed as giving a Participant the right to be retained in the employ of the Corporation. 

7. No Trust or Fund Created. Neither the 2012 Incentive Program nor any Award shall create or be construed to create a trust or
separate fund of any kind or a fiduciary relationship between the Corporation and a Participant or any other person. To the extent that any person acquires a right to receive payments from the Corporation pursuant to an Award, such right shall be no
greater than the right of any unsecured general creditor of the Corporation. 
 8. No Rights to Awards. No person shall
have any claim to be granted any Award and there is no obligation for uniformity of treatment among Participants. The terms and conditions of Awards, if any, need not be the same with respect to each Participant. The Corporation reserves the right
to terminate the 2012 Incentive Program at any time in the Corporation’s sole discretion. 
 9. Section 409A of the
Internal Revenue Code. This 2012 Incentive Program is intended to be exempt from Section 409A of the Code. 
 10.
Interpretation and Governing Law. This 2012 Incentive Program shall be governed by and interpreted and construed in accordance with the internal laws of the State of Alabama, without reference to principles of conflicts or choices of laws. In
the event the terms of this 2012 Incentive Program are inconsistent with the terms of any written agreement between a Participant and the Corporation, the terms of such written agreement shall govern the Participant’s participation in the 2012
Incentive Program. 

  

 Schedule A 
 to 2012 Incentive Program 
 Performance Metric; Determination of
Percentage of Target Bonus Amount Earned 
 The performance metric selected by the Board is the
Corporation’s EBITDA.1 The percentage of the target
award (“Target Bonus Amount”) that is earned by a Participant is based on the Corporation’s EBITDA in 2012 (“2012 EBITDA”) compared to the Corporation’s EBITDA in 2011 (“2011 EBITDA”), as follows: 

 

	 	•	 	 Threshold: 75% of the Participant’s Target Bonus Amount is earned if 2012 EBITDA is 95% of 2011 EBITDA. No bonus is earned if 2012 EBITDA
is less than 95% of 2011 EBITDA. 

  

	 	•	 	 Target: 100% of the Participant’s Target Bonus Amount is earned if 2012 EBITDA is 105% of 2011 EBITDA. 

 

	 	•	 	 Maximum: 150% of the Participant’s Target Bonus Amount is earned if 2012 EBITDA equals or exceeds 130% of 2011 EBITDA.

  

	 	•	 	 Interpolation: The Corporation will interpolate between the threshold, target, and maximum goals in the manner set forth in the following table:

  

			
	 2012 EBITDA
	  	 Percentage of Target Bonus Amount

Earned by Participant

		
	 Less than 95% of 2011 EBITDA
	  	No bonus earned
	 95% of 2011 EBITDA
	  	75% of Target Bonus Amount
	 100% of 2011 EBITDA
	  	90% of Target Bonus Amount
	 105% of 2011 EBITDA
	  	100% of Target Bonus Amount
	 110% of 2011 EBITDA
	  	110% of Target Bonus Amount
	 115% of 2011 EBITDA
	  	120% of Target Bonus Amount
	 120% of 2011 EBITDA
	  	130% of Target Bonus Amount
	 125% of 2011 EBITDA
	  	140% of Target Bonus Amount
	 130% or more of 2011 EBITDA
	  	150% of Target Bonus Amount

 The Corporation will linearly interpolate between the amounts set forth above. For example, (i) if
2012 EBITDA is 97.5% of 2011 EBITDA, each Participant will earn 82.5% of his Target Bonus Amount, (ii) if 2012 EBITDA is 107.5% of 2011 EBITDA, each Participant will earn 105% of his Target Bonus Amount, and (iii) if 2012 EBITDA is 122.5%
of 2011 EBITDA, each Participant will earn 135% of his Target Bonus Amount. 
  

 

	1 	 “EBITDA” means earnings before interest, income taxes, depreciation and amortization, as determined in good faith by the Board or the
Compensation Committee, in consultation with the Chief Executive Officer of the Corporation.

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