EXHIBIT 4.1 NUMBER SHARES PHYSICIANS CARE FOR CONNECTICUT, INC. Class A Common Stock, No Par Value Per Share 3,000 Authorized Shares THIS CERTIFIES THAT IS THE ----------------------------------------------------------- REGISTERED HOLDER OF SHARES ----------------------------------------------------------- of the fully paid and non-assessable common stock of Physicians Care for Connecticut, Inc. TRANSFERABLE ONLY ON THE BOOKS OF THE CORPORATION BY THE HOLDER HEREOF IN PERSON OR BY ATTORNEY UPON SURRENDER OF THIS CERTIFICATE PROPERLY ENDORSED. IN WITNESS WHEREOF, THE SAID CORPORATION HAS CAUSED THIS CERTIFICATE TO BE SIGNED BY ITS DULY AUTHORIZED OFFICERS AND ITS CORPORATE SEAL TO BE HEREUNTO AFFIXED THIS day of A.D., -------------- -------------- ---- ---------------------------------- ------------------------------ President Secretary CERTIFICATE FOR SHARES OF THE ISSUED TO --------------------------------- DATED --------------------------- - ------------------------------------------------------------------------------- FOR VALUE RECEIVED _________ HEREBY SELL, ASSIGN, AND TRANSFER UNTO _________________________________________________________ _______________________________________________________ SHARES OF THE CAPITAL STOCK REPRESENTED BY THE WITHIN CERTIFICATE AND DO, HEREBY, IRREVOCABLY CONSTITUTE AND APPOINT ______________ _____________________________________________________ ATTORNEY TO TRANSFER THE SAID STOCK ON THE BOOKS OF THE WITHIN NAMED CORPORA- TION, WITH FULL POWER OF SUBSTITUTION ON THE PREMISES. DATED __________________ 19__. IN PRESENCE OF ________________________________ Notice is hereby given that the shares of stock represented by this certificate is subject to the provisions and restrictions on transfer and redemption included in the Certificate of Incorporation of the Corporation, a copy of which is on file at the office of the Corporation, and that any transfer of the shares of stock represented by this Certificate shall be void unless said transfer is in compliance with said Certificate.