Exhibit 10.66

SECOND AMENDMENT TO THIRD AMENDED AND RESTATED LOAN AGREEMENT

THIS SECOND AMENDMENT TO THIRD AMENDED AND RESTATED LOAN
AGREEMENT (this “Amendment”), dated as of August 2, 2011, by and among
INTEGRAMED AMERICA, INC. (the “Borrower”); the financial institutions signing
below and BANK OF AMERICA, N.A., as administrative agent for the Lenders party
to the Loan Agreement referred to below (in such capacity, together with its
successors and assigns in such capacity, the “Administrative Agent”).

RECITALS

A. The Borrower, the financial institutions party thereto as Lenders and the
Administrative Agent are parties to the Third Amended and Restated Loan
Agreement dated as of May 21, 2010 (as in effect from time to time, the “Loan
Agreement”).  Capitalized terms used herein without definition have the meanings
assigned to them in the Loan Agreement.
 
B. The Borrower has requested an amendment to the Loan Agreement.  The
Administrative Agent and the Lenders signing below are willing to effect such
amendment on the terms and conditions hereinafter set forth.
 
NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency
of which is hereby acknowledged, the parties hereto agree as follows:

I. AMENDMENTS TO LOAN AGREEMENT.  Subject to the satisfaction of each of the
conditions set forth herein, the Loan Agreement is hereby amended as follows:
 
A. Amendment.  Section 1.01 of the Loan Agreement is hereby amended by amending
the first paragraph of the definition of “Consolidated EBITDA” to read in its
entirety as follows:
 
“‘Consolidated EBITDA’ means, for any period, the sum of (a) Consolidated Net
Income for such period, plus (b) Consolidated Interest Expense for such period,
plus (c) depreciation, amortization and other non-cash charges for such period,
plus (d) the provision for Federal, state and local income taxes for such
period, minus (e) gains from discontinued operations and extraordinary items,
together with any related provision for taxes on any such gain, recorded or
recognized by Borrower or any of its Subsidiaries for such period, plus (f)
losses from discontinued operations and extraordinary items, together with any
related provision for the tax effect of any such losses, recorded or recognized
by Borrower or any of its Subsidiaries for such period, plus, (g) for the
periods of four consecutive fiscal quarters ending on June 30, 2011, September
30, 2011, December 31, 2011 and March 31, 2012 only, losses and/or expenses
arising from the settlement of Heather Kornick v. Lawrence A. Jacobs, M.D. and
Fertility Centers of Illinois, S.C., provided that the aggregate amount of
losses added back pursuant to this clause (g) shall not exceed $1,650,000, in
each case, with respect to clauses (a) through and including (g) above, of
Borrower and its Subsidiaries on a consolidated basis for such period, computed
in accordance with GAAP.”
 
 
 

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B. No Further Amendments. Except as specifically amended hereby, the text of the
Loan Agreement and all other Loan Documents shall remain unchanged and in full
force and effect.
 
II. REPRESENTATIONS, WARRANTIES AND COVENANTS.  The Borrower hereby represents
and warrants to, and covenants and agrees with, the Administrative Agent and the
Lenders that:
 
A. The execution and delivery of this Amendment has been duly authorized by all
requisite action on the part of the Borrower.
 
B. The representations and warranties contained in the Credit Agreement are true
and correct in all material respects on and as of the date of this Amendment as
though made at and as of such date (except to the extent that such
representations and warranties expressly relate to an earlier date).  No event
has occurred or failed to occur, which constitutes, or which, solely with the
passage of time or the giving of notice (or both) would constitute, an Event of
Default.
 
C. This Amendment constitutes the legal, valid and binding obligation of the
Borrower, enforceable against the Borrower in accordance with its terms, subject
to bankruptcy, insolvency, reorganization, moratorium and similar laws affecting
the rights and remedies of creditors generally or the application of principles
of equity, whether in any action at law or proceeding in equity, and subject to
the availability of the remedy of specific performance or of any other equitable
remedy or relief to enforce any right thereunder.
 
III. CONDITIONS.  The effectiveness of this Amendment is subject to the
following conditions:
 
A. The Borrower shall have executed and delivered to the Administrative Agent
(or shall have caused to be executed and delivered to the Administrative Agent
by the appropriate persons) the following:
 
1. This Amendment, executed and delivered by the Borrower, the Administrative
Agent and the Required Lenders;
 
2. Payment to the Administrative Agent on behalf of the Lenders signing below on
or before 5:00 p.m. (New York time) on August 2, 2011 of an amendment fee in the
amount of $25,000.00 (to be shared pro rata based upon such approving Lender's
Total Outstandings (including risk participation in L/C Obligations and Swing
Line Loans) and unused Revolving Commitments; and
 
 
 

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3. Such other supporting documents and certificates as the Administrative Agent
or its counsel may reasonably request.
 
B. All legal matters incident to the transactions contemplated hereby shall be
satisfactory to counsel for the Administrative Agent.
 
IV. MISCELLANEOUS.
 
A. As provided in the Agreement, the Borrower agrees to reimburse the
Administrative Agent upon demand for all out-of-pocket costs and expenses of the
Administrative Agent (including reasonable fees and disbursements of counsel to
the Administrative Agent) in connection with this Amendment and the other
agreements and instruments and documents executed pursuant hereto.
 
B. This Amendment shall be governed by and construed in accordance with the laws
of the State of New York (without giving effect to conflict of laws principles).
 
C. This Amendment may be executed by the parties hereto in several counterparts
hereof and by the different parties hereto on separate counterparts hereof, all
of which counterparts shall together constitute one and the same
agreement.  Delivery of an executed signature page of this Amendment by
facsimile transmission shall be effective as an in hand delivery of an original
executed counterpart hereof.
 

 
[The next page is the signature page.]

 
 

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IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be duly
executed by their duly authorized representatives, all as of the day and year
first above written.

INTEGRAMED AMERICA, N.A.

By: /s/ Timothy P Sheehan
Name:  Timothy P Sheehan
Title:    VP Finance and Interim CFO

 
 

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BANK OF AMERlCA, N.A., as AdministrativeAgent

By: /s/ Steven J. Melicharek
Name: Steven J. Melicharek
Title:   SVP

 
 

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BANK OF AMERICA, N.A., as L/C Issuer and as
Swing Line Lender

By: /s/ Steven J. Melicharek
Name: Steven J. Melicharek
Title:   SVP

 
 

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BANK OF AMERICA, N.A., as a Lender

By: /s/ Steven J. Melicharek
Name: Steven J. Melicharek
Title:   SVP

 
 

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TD BANK, N.A., as a Lender

By: /s/ Emily Alfieri-Weinberg
Name: Emily Alfieri-Weinberg
Title:  Vice President

 
 

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WEBSTER BANK, N.A., as a Lender

By: /s/ Michael P. McGovern
Name: Michael P. McGovern
Title:  Vice President