X0303 4 2009-10-26 0001421419 AGA Medical Holdings, Inc. AGAM 0001123639 WELSH CARSON ANDERSON & STOWE IX LP C/O WELSH, CARSON, ANDERSON & STOWE 320 PARK AVENUE, SUITE 2500 NEW YORK NY 10022 0 0 1 0 Common Stock 2009-10-26 4 C 0 19749603 A 23913988 D Series A Preferred Stock 2009-10-26 4 C 0 116789 D Common Stock 19749603 0 D Upon consummation of the Issuer's initial public offering, each share of Preferred Stock automatically converted into Common Stock, for no additional consideration. The number of shares of Common Stock received upon conversion of Preferred Stock included shares issued in payment of accrued and unpaid dividends on such Preferred Stock as of the date of conversion. Reflects the 7.15 for 1 reverse split of the Common Stock effective concurrently with the conversion of the Preferred Stock. /s/David Mintz, Attorney-in-Fact 2009-10-27