Exhibit 10.76

 

EXHIBIT C TO

CREDIT AGREEMENT

 

FORM OF TERM NOTE B

 

$                       [                    ], 2004

 

FOR VALUE RECEIVED, SUNLINK HEALTH SYSTEMS, INC., a corporation organized under
the laws of the State of Ohio, SUNLINK HEALTHCARE LLC, a limited liability
company organized under the laws of the State of Georgia, DEXTER HOSPITAL, LLC,
a limited liability company organized under the laws of the State of Georgia,
CLANTON HOSPITAL, LLC, a limited liability company organized under the laws of
the State of Georgia, SOUTHERN HEALTH CORPORATION OF ELLIJAY, INC., a
corporation organized under the laws of the State of Georgia, SOUTHERN HEALTH
CORPORATION OF DAHLONEGA, INC., a corporation organized under the laws of the
State of Georgia, SOUTHERN HEALTH CORPORATION OF HOUSTON, INC., a corporation
organized under the laws of the State of Georgia, HEALTHMONT, INC., a
corporation organized under the laws of the State of Delaware, HEALTHMONT OF
GEORGIA, INC., a corporation organized under the laws of the State of Tennessee,
HEALTHMONT OF MISSOURI, INC., a corporation organized under the laws of the
State of Tennessee, HEALTHMONT, LLC, a limited liability company organized under
the laws of the State of Georgia, HEALTHMONT OF MISSOURI, LLC, a limited
liability company organized under the laws of the State of Georgia, SUNLINK
SERVICES, INC., a corporation organized under the laws of the State of Georgia,
OPTIMA HEALTHCARE CORPORATION, a corporation organized under the laws of the
State of Georgia, and KRUG PROPERTIES, INC., a corporation organized under the
laws of the State of Ohio, hereby jointly and severally promise to pay to the
order of RESIDENTIAL FUNDING CORPORATION (the “Lender”) in accordance with the
provisions of the Credit Agreement, in lawful money of the United States of
America in Immediately Available Funds (as such term, and each other capitalized
term used herein but not defined herein, are defined in the Credit Agreement
hereinafter referred to) the principal amount of                             
($                    ) and to pay interest (computed on the basis of actual
days elapsed and a year of 360 days) in like funds on the unpaid principal
amount hereof from time to time outstanding at the rates and times set forth in
the Credit Agreement.

 

The principal hereof is payable in (i) [            ] equal installments of
[$            ] each, commencing on                     , and on the first
Business Day of each month thereafter, and (ii) one balloon payment on the
Termination Date equal to any unpaid principal balance, together with all
accrued and unpaid interest.

 

This note is one of the Term Note(s) B referred to in the Credit Agreement dated
as of October [    ], 2004 (as the same may hereafter be from time to time
amended, restated or otherwise modified, the “Credit Agreement”) between the
undersigned and the Lender. This note is secured, it is subject to certain
mandatory prepayments and its maturity is subject to acceleration, in each case
upon the terms provided in said Credit Agreement.

 

Each of the undersigned waives demand, presentment, notice of nonpayment,
protest, notice of protest and notice of dishonor.

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THE VALIDITY, CONSTRUCTION AND ENFORCEABILITY OF THIS NOTE SHALL BE GOVERNED BY
THE INTERNAL LAWS OF THE STATE OF MINNESOTA WITHOUT GIVING EFFECT TO THE
CONFLICT OF LAWS PRINCIPLES THEREOF.

 

[Signature pages follow]

 

-2-

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SUNLINK HEALTH SYSTEMS, INC.

As a Borrower and Borrowers’ Agent

By  

 

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Title  

 

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SUNLINK HEALTHCARE, LLC

As a Borrower

By its Sole Member SunLink Health Systems, Inc. By  

 

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Title  

 

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DEXTER HOSPITAL, LLC

As a Borrower

By its Sole Member SunLink Healthcare, LLC     By its Sole Member SunLink Health
Systems, Inc.     By  

 

--------------------------------------------------------------------------------

    Title  

 

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CLANTON HOSPITAL, LLC

As a Borrower

By its Sole Member SunLink Healthcare, LLC     By its Sole Member SunLink Health
Systems, Inc.     By  

 

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    Title  

 

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SOUTHERN HEALTH CORPORATION OF ELLIJAY, INC.

As a Borrower

By  

 

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Title  

 

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SOUTHERN HEALTH CORPORATION OF DAHLONEGA, INC.

As a Borrower

By  

 

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Title  

 

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[Signature Page 1 to Term Note B]

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SOUTHERN HEALTH CORPORATION OF

HOUSTON, INC.

As a Borrower

By  

 

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Title  

 

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HEALTHMONT, INC.

As a Borrower

By  

 

--------------------------------------------------------------------------------

Title  

 

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HEALTHMONT OF GEORGIA, INC.

As a Borrower

By  

 

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Title  

 

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HEALTHMONT OF MISSOURI, INC.

As a Borrower

By  

 

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Title  

 

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HEALTHMONT, LLC

As a Borrower

By its Sole Member SunLink Health Systems, Inc. By  

 

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Title  

 

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HEALTHMONT OF MISSOURI, LLC

As a Borrower

By its Sole Member HealthMont, LLC     By its Sole Member SunLink Health
Systems, Inc.     By  

 

--------------------------------------------------------------------------------

    Title  

 

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[Signature Page 2 to Term Note B]

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SUNLINK SERVICES, INC.

As a Borrower

By  

 

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Title  

 

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OPTIMA HEALTHCARE CORPORATION

As a Borrower

By  

 

--------------------------------------------------------------------------------

Title  

 

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KRUG PROPERTIES, INC.

As a Borrower

By  

 

--------------------------------------------------------------------------------

Title  

 

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Address for All Borrowers

For Purposes of Notice:

900 Circle 75 Parkway

Suite 1300

Atlanta, GA 30339

Fax: (770) 933-7010

Attention: Joseph T. Morris,

Chief Financial Officer

 

[Signature Page 3 to Term Note B]