EXHIBIT 10.8

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED CREDIT
AGREEMENT, LIMITED WAIVER AND CONSENT

          THIS AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED CREDIT AGREEMENT,
LIMITED WAIVER AND CONSENT (the “Amendment Agreement”) is made and entered into
this 14th day of November, 2006, among RADIATION THERAPY SERVICES, INC., a
Florida corporation (the “Borrower”), each Subsidiary Guarantor party to a
Subsidiary Guaranty pursuant to the terms of the Credit Agreement (as defined
below), BANK OF AMERICA, N.A., as Administrative Agent (the “Administrative
Agent”), and the Lenders party hereto.  Unless the context otherwise requires,
capitalized terms used but not defined herein have the meanings ascribed thereto
in the Credit Agreement.

W I T N E S S E T H:

          WHEREAS, the Borrower, the Administrative Agent and the Lenders have
entered into that certain Fourth Amended and Restated Credit Agreement dated as
of December 16, 2005 (as hereby amended and as may be modified, supplemented,
amended or amended and restated from time to time, the “Credit Agreement”),
whereby the Lenders have made available to the Borrower a term loan B facility
and a revolving credit facility with a letter of credit subfacility and a swing
line subfacility; and

          WHEREAS, the Borrower has notified the Administrative Agent that it
proposes to acquire (through a newly created wholly-owned Subsidiary, Michigan
Radiation Therapy Management Services, Inc.) Michigan Institute for Radiation
Oncology, Inc.’s (“MIRO”) equity in Phoenix Management Company, LLC and American
Consolidated Technologies, LLC and the option to acquire certain assets of
and/or MIRO’s equity in Pontiac Investment Associates, LLC for an aggregate
Acquisition Amount of not to exceed $48,800,000 (collectively, the “MIRO
Acquisition”) (which notification is set forth as Exhibit A hereto), which
Acquisition Amount will cause the aggregate Acquisition Amounts for 2006 to
exceed the limitation set forth in Section 9.9 of the Credit Agreement, and the
Borrower has requested that Section 9.9 of the Credit Agreement be amended to
exclude the MIRO Acquisition from the limitation set forth therein for fiscal
year 2006; and

          WHEREAS, as set forth in Exhibit A, the Borrower has requested that
Section 11.10 of the Credit Agreement be amended to increase the Capital
Expenditures limitation set forth therein to $50,000,000 for fiscal year 2006;

          WHEREAS, as further set forth in Exhibit A, the Borrower has requested
that the Credit Agreement be amended to increase the allowance for purchase
money indebtedness to $70,000,000; and

          WHEREAS, the Lenders have previously indicated to the Administrative
Agent that the real property subject to the Mortgages has been taken as
Collateral out of an “abundance of caution”, within the meaning of Financial
Institutions Reform Recovery and Enforcement Act (FIRREA), to secure the
Obligations under the Credit Agreement; and

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          WHEREAS, the Borrower has requested that the deadline for receipt of
certain of the Mortgages and Mortgage Property Support Documents with respect to
the properties listed in Part 2 of Schedule 9.15 be extended until November 30,
2006 and any default under the Credit Agreement with respect to such Part 3 be
waived so long as such requirements are satisfied by November 30, 2006 (the
“Mortgage Document Delay”);

          WHEREAS, the Administrative Agent and the Lenders signatory hereto are
willing so to effect such waivers of certain covenants, amendments to certain
provisions and certain consents under the Credit Agreement, in each case as set
forth below pursuant to the terms and conditions contained in this Agreement;

          NOW, THEREFORE, the Borrower, the Administrative Agent and the Lenders
do hereby agree as follows:

          1.        Credit Agreement.  The term “Credit Agreement” as used
herein and in the Credit Documents (as defined in the Credit Agreement) shall
mean the Credit Agreement as hereby amended and modified. 

          2.        Amendment.  Subject to the conditions set forth herein, the
Credit Agreement is hereby amended as follows:

 

          (a)          Section 1.2 of the Credit Agreement is hereby amended to
add a new definition of “MIRO Acquisition” and to amend and restate in its
entirety the definition of “Mortgaged Property Support Documents”, to read as
follows:

 

 

 

          “MIRO Acquisition” means the acquisition by the Borrower (through its
wholly-owned Subsidiary, Michigan Radiation Therapy Management Services, Inc.)
of Michigan Institute for Radiation Oncology, Inc.’s (“MIRO”) equity in Phoenix
Management Company, LLC and American Consolidated Technologies, LLC and the
option to acquire certain assets of and/or MIRO’s equity in Pontiac Investment
Associates, LLC for an aggregate Acquisition Amount not to exceed $48,800,000.

 

 

 

          “Mortgaged Property Support Documents” shall mean, for each Mortgaged
Property, (i) the Title Policy pertaining thereto, (ii) such surveys, flood
hazard certifications and environmental assessments thereof as the
Administrative Agent may require prepared by recognized experts in their
respective fields selected by the Borrower and reasonably satisfactory to the
Administrative Agent, (iii) as to the Mortgaged Properties located in a flood
hazard area, such flood hazard insurance as the Administrative Agent may
require, (iv) if required by the Administrative Agent, appraisals conducted by
nationally recognized appraisal experts selected by the Administrative Agent in
its reasonable discretion and reasonably acceptable to the Borrower, (v) with
respect to facilities leased or

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subleased from third parties, such lessor’s estoppel, waiver and consent
certificates as the Administrative Agent may reasonably require and the Borrower
can deliver using its best efforts and subordination, nondisturbance and
attornment agreements as the Administrative Agent may reasonably require, (vi)
such owner’s or lessee’s affidavits as the Administrative Agent may reasonably
require, (vii) such opinions of local counsel with respect to the Mortgages, as
applicable, as the Administrative Agent may reasonably require, and (viii) such
other documentation as the Administrative Agent may reasonably require, in each
case as shall be in form and substance reasonably acceptable to the
Administrative Agent.

 

 

 

          (b)       Section 1.7(a) of the Credit Agreement is hereby amended and
restated in its entirety to read as follows:

 

 

 

(a)          Covenant Acquisition Adjustments.  Except as otherwise expressly
provided herein, for purposes of calculating the Leverage Ratio and the Fixed
Charge Coverage Ratio and, for purposes of Section 9.9(a)(ii), the prior fiscal
year’s Consolidated EBITDA for any period (or a portion of a period) that
includes the date of the consummation of any Permitted Acquisition, references
to “the Borrower and its Subsidiaries” shall include each acquired Person, or
lines of business, as applicable, the EBITDA of such acquired Person or line of
business (such EBITDA to be formulated on the basis of the definition of
Consolidated EBITDA set forth herein, subject to such customary adjustments by
the Borrower as to which the Required Lenders do not object) and the interest
expense of such acquired Person or line of business, as if the Acquisition had
been consummated on the first day of any such period of measurement.

 

 

 

 

 

          (c)       Section 9.9(a)(ii) of the Credit Agreement is hereby amended
and restated in its entirety to read as follows:

 

 

 

 

 

(ii)          the Required Lenders shall have given their consent to such
Acquisition which consent shall (A) not be unreasonably withheld and (B) be
given within ten (10) Business Days from the Administrative Agent’s receipt of
the information, in form and substance satisfactory to the Administrative Agent
in its reasonable discretion, referred to in clauses (b) and (c) of this Section
9.9; provided that no such consent will be required if the Acquisition Amount
with respect to such Acquisition, (y) shall not exceed $12,000,000, and (z)
together with the aggregate of the Acquisition Amounts for all other Permitted
Acquisitions consummated during the same fiscal year and the aggregate amount of
any “earnout” payments made in such fiscal year with respect to any Permitted
Acquisition, irrespective of when such Permitted Acquisition was consummated),
shall not exceed (1) in the case of fiscal year 2005, $50,000,000, or (2) in the
case of fiscal year 2006 and each fiscal year thereafter, 100% of Consolidated
EBITDA for the preceding fiscal year (excluding, for fiscal year 2006 only, the
Acquisition Amount attributable to the MIRO Acquisition in an amount not to
exceed $48,800,000).

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          (d)       Section 11.2(v) of the Credit Agreement is hereby amended
and restated in its entirety to read as follows:

 

 

 

 

 

(v)          purchase money Indebtedness of the Borrower and its Subsidiaries
(including any Excluded Subsidiary) incurred solely to finance the payment of
all or part of the purchase price of any equipment, real property or other fixed
assets and  Indebtedness in respect of capital lease obligations, and any
renewals, refinancings or replacements thereof, in an aggregate principal amount
(including any such purchase money Indebtedness and capital leases existing on
the Effective Date) outstanding at any time not exceeding $70,000,000;

 

 

 

 

 

          (e)       Section 11.10 of the Credit Agreement is hereby amended and
restated in its entirety to read as follows:

 

 

 

 

 

11.10      Capital Expenditures.  The Borrower will not permit the aggregate
Capital Expenditures of the Borrower and its Subsidiaries in any fiscal year to
be greater than (i) in the case of fiscal year 2005, $35,000,000, (ii) in the
case of fiscal year 2006, $50,000,000 and (iii) in the case of each other fiscal
year, the percentage of the net book value of the Borrower’s Capital Assets
determined as of the end of the immediately preceding fiscal year as set forth
below, in each case excluding any Capital Expenditures for any Permitted
Acquisition during such fiscal year:

Fiscal Year of
Capital Expenditure

 

Percentage
of Prior Fiscal Year’s
Capital Assets

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  2007

 

30%

2008 and thereafter

 

25%

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          3.        Consent to MIRO Acquisition.  Subject to the delivery of
final audited financial statements for Michigan Institute for Radiation
Oncology, Inc. and its subsidiaries, the Administrative Agent and the Lenders
signatory hereto hereby consent to the MIRO Acquisition.   The Lenders hereby
waive the requirement that the Borrower delivery the information required by
Section 9.9(b) not less than ten (10) Business Days prior to the consummation of
the MIRO Acquisition.  Notwithstanding the foregoing, the requirements set forth
in Section 9.10 with respect to Michigan Radiation Therapy Management Services,
Inc. must be timely satisfied, provided that, the Administrative Agent and the
Lenders signatory hereto hereby agree that the Borrower and the applicable
Subsidiaries shall have until February 28, 2007 to deliver the Mortgages and
Mortgage Property Support Documents required pursuant to such section.

          4.        Limited Waiver to Mortgage Document Delay.  Subject to the
terms and conditions set forth herein, the Administrative Agent and the Lenders
signatory hereto hereby waive any Default or Event of Default arising from the
Mortgage Document Delay, provided that the remaining Mortgages and Mortgage
Property Support Documents delivery requirements are satisfied by November 30,
2006.  The waivers set forth in this Section 4 are limited to the extent
specifically set forth above and no other terms, covenants or provisions of the
Credit Agreement or any other Credit Document are intended to be effected
hereby.

          5.        Representations, Warranties and Covenants.  The Borrower
hereby represents, warrants and covenants that:

 

          (a)          The representations and warranties made by the Borrower
in Article VIII of the Credit Agreement are true on and as of the date hereof,
except to the extent that such representations and warran-ties expressly relate
to an earlier date;

 

 

 

          (b)          There has been no Material Adverse Change in the
condition, financial or otherwise, of the Borrower since the date of the most
recent financial reports of the Borrower delivered pursuant to Section 9.1 of
the Credit Agreement;

 

 

 

          (c)          The business and properties of the Borrower are not and
have not been adversely affected in any substantial way as the result of any
fire, explosion, earthquake, accident, strike, lockout, combination of workers,
flood, embargo, riot, activities of armed forces, war or acts of God or the
public enemy, or cancellation or loss of any major contracts; and

 

 

 

          (d)          No Default or Event of Default, other than those
addressed herein, has occurred and is continuing immediately prior to the
effectiveness of this Amendment Agreement and no Default or Event of Default is
continuing immediately after the effectiveness of this Amendment Agreement.

          6.        Conditions.  This Amendment Agreement shall become effective
upon the Borrower delivering to the Administrative Agent the following:

 

          (a)          a counterpart of this Amendment Agreement duly executed
by the Administrative Agent, such Lenders as are necessary to constitute the
Required Lenders, the Borrower and the Subsidiary Guarantors;

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          (b)          all fees and expenses payable by the Borrower by reason
of this Amendment Agreement; and

 

 

 

          (c)          such other documentation, instruments, consents and
agreements as the Administrative Agent shall reasonably request.

          7.        Full Force and Effect of Agreement.  Except as hereby
specifically amended, modified or supplemented, the Credit Agreement and all of
the other Credit Documents are hereby confirmed and ratified in all respects and
shall remain in full force and effect according to their respective terms.

          8.        Counterparts.  This Amendment Agreement may be executed in
any number of counterparts and all the counterparts taken together shall be
deemed to constitute one and the same instrument.

          9.        Documentation.  All instruments and documents incident to
the consummation of the transactions contemplated hereby shall be satisfactory
in form and substance to the Administrative Agent and its counsel; the
Administrative Agent shall have received copies of all additional agreements,
instruments and documents which it may reasonably request in connection
therewith, such documents, when appropriate, to be certified by appropriate
corporate or governmental authorities; and all proceedings of the Borrower
relating to the matters provided for herein shall be satisfactory to the
Administrative Agent and its counsel.

          10.      Entire Agreement.  This Amendment Agreement sets forth the
entire understanding and agreement of the parties hereto in relation to the
subject matter hereof and supersedes any prior negotiations and agreements among
the parties relative to such subject matter.  None of the terms or conditions of
this Amendment Agreement may be changed, modified, waived or canceled orally or
otherwise, except as provided in the Credit Agreement.

          11.      Ratification.  Except as hereby specifically amended,
modified or supplemented, the Agreement and all of the other Loan Documents are
hereby confirmed and ratified in all respects and shall remain in full force and
effect according to their respective terms.

          12.      Consent of the Subsidiary Guarantors.  Each Subsidiary
Guarantor hereby consents, acknowledges and agrees to the amendments set forth
herein and hereby confirms, reaffirms and ratifies in all respects the
Subsidiary Guaranty to which such Subsidiary Guarantor is a party (including
without limitation the continuation of such Subsidiary Guarantor’s payment and
performance obligations thereunder upon and after the effectiveness of this
Agreement and the amendments contemplated hereby) and the enforceability of the
Subsidiary Guaranty against such Subsidiary Guarantor in accordance with its
terms.

[Remainder of page intentionally left blank.]

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

 

BORROWER:

 

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RADIATION THERAPY SERVICES, INC.

 

 

 

 

 

 

 

By:

/s/ David M. Koeninger

 

 

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Name:

David M. Koeninger

 

Title:

Executive Vice President – Chief Financial Officer

 

GUARANTORS:

 

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21ST  CENTURY ONCOLOGY, INC.

 

21ST  CENTURY ONCOLOGY OF NEW JERSEY, INC.

 

21ST  CENTURY ONCOLOGY OF KENTUCKY, LLC

 

21ST  CENTURY ONCOLOGY OF ALABAMA, INC.

 

NEW YORK RADIATION THERAPY

 

  MANAGEMENT SERVICES, INCORPORATED

 

NEVADA RADIATION THERAPY

 

  MANAGEMENT SERVICES, INC.

 

FINANCIAL SERVICES OF SOUTHWEST

 

  FLORIDA, LLC.

 

RADIATION THERAPY SCHOOL FOR

 

  RADIATION THERAPY TECHNOLOGY, INC.

 

MARYLAND RADIATION THERAPY

 

  MANAGEMENT SERVICES, INC.

 

NORTH CAROLINA RADIATION THERAPY

 

  MANAGEMENT SERVICES, INC.

 

CALIFORNIA RADIATION THERAPY

 

  MANAGEMENT SERVICES, INC.

 

21ST CENTURY ONCOLOGY OF HARFORD

 

  COUNTY, MARYLAND LLC

 

21ST CENTURY ONCOLOGY OF PENNSYLVANIA, INC.

 

NEW ENGLAND RADIATION THERAPY

 

  MANAGEMENT SERVICES, INC.

 

ARIZONA RADIATION THERAPY MANAGEMENT

 

  SERVICES, INC.

 

 

 

 

 

 

 

By:

/s/ David M. Koeninger

 

 

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Name:

David M. Koeninger

 

Title:

See ATTACHMENT A for title for each Guarantor.

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

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ATTACHMENT A TO SIGNATURE PAGE

David M. Koeninger is the Vice President of each of the following Guarantors:

 

•

21st  Century Oncology, Inc.

 

•

21st  Century Oncology of New Jersey, Inc.

 

•

21st  Century Oncology of Alabama, Inc.

 

•

New York Radiation Therapy Management Services, Incorporated

 

•

Nevada Radiation Therapy Management Services, Inc.

 

•

Financial Services of Southwest Florida, LLC

 

•

Radiation Therapy School For Radiation Therapy Technology, Inc.

 

•

Maryland Radiation Therapy Management Services, Inc.

 

•

North Carolina Radiation Therapy Management Services, Inc.

 

•

21st Century Oncology of Harford County, Maryland LLC

 

•

21st Century Oncology of Pennsylvania, Inc.

 

•

New England Radiation Therapy Management Services, Inc.

 

•

Arizona Radiation Therapy Management Services, Inc.

David M. Koeninger is the Chief Financial Officer of each of the following
Guarantors:

 

•

21st  Century Oncology of Kentucky, LLC

 

•

California Radiation Therapy Management Services, Inc.

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

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BANK OF AMERICA, N.A., as Administrative Agent

 

 

 

 

 

 

 

By:

/s/ Kristine Thennes

 

 

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Name:

Kristine Thennes

 

Title:

Vice President

 

 

 

 

 

 

 

BANK OF AMERICA, N.A., as a Lender, as Swingline Lender and as Issuing Bank

 

 

 

 

 

 

 

By:

/s/ Alexander L. Rody

 

 

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Name:

Alexander L. Rody

 

Title:

Senior Vice President

 

 

 

 

 

 

 

FIFTH THIRD BANK

 

 

 

 

 

 

 

By:

 

 

 

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Name:

 

 

Title

 

 

 

 

 

 

 

 

SUNTRUST BANK

 

 

 

 

 

 

 

By:

/s/ Pamela W. Peters

 

 

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Name:

Pamela W. Peters

 

Title:

Senior Vice President

 

 

 

 

 

 

 

WACHOVIA BANK, NATIONAL ASSOCIATION

 

 

 

 

 

 

 

By:

/s/ Kirk Tesch

 

 

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Name:

Kirk Tesch

 

Title:

Vice President

 

 

 

 

 

 

 

REGIONS BANK

 

 

 

 

 

 

 

By:

 

 

 

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Name:

 

 

Title:

 

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

9

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NATIONAL CITY BANK OF KENTUCKY

 

 

 

 

 

 

 

By:

/s/ Deroy Scott

 

 

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Name:

Deroy Scott

 

Title:

Senior Vice President

 

 

 

 

 

 

 

CAROLINA FIRST BANK

 

 

 

 

 

 

 

By:

/s/ Kevin M. Short

 

 

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Name:

Kevin M. Short

 

Title:

Senior Vice President

 

 

 

 

 

 

 

THE INTERNATIONAL BANK OF MIAMI, N.A.

 

 

 

 

 

 

 

By:

/s/ Panayiotis Ch. Zotos

 

 

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Name:

Panayiotis Ch. Zotos

 

Title:

Senior Vice President

 

 

 

 

 

 

 

LASALLE BANK, NATIONAL ASSOCIATION

 

 

 

 

 

 

By:

/s/ Whitney M. Black

 

 

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Name:

Whitney M. Black

 

Title:

Assistant Vice President

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

10

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U.S. BANK, NATIONAL ASSOCIATION

 

 

 

 

 

 

 

By:

/s/ Thomas A. Heckman

 

 

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Name:

Thomas A. Heckman

 

Title:

Vice President

 

 

 

 

 

 

 

DENALI CAPITAL LLC, managing member of DC Funding Partners LLC, portfolio
manager for DENALI CAPITAL CLO V, LTD., or an affiliate

 

 

 

 

 

 

 

By:

/s/ Nicole D. Kouba

 

 

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Name:

Nicole D. Kouba

 

Title:

Vice President

 

 

 

 

 

 

 

DENALI CAPITAL LLC, managing member of DC Funding Partners LLC, portfolio
manager for DENALI CAPITAL CLO VI, LTD., or an affiliate

 

 

 

 

 

 

 

By:

/s/ Nicole D. Kouba

 

 

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Name:

Nicole D. Kouba

 

Title:

Vice President

 

 

 

 

 

 

 

DENALI CAPITAL LLC, managing member of DC Funding Partners, portfolio manager
for DENALI CAPITAL CREDIT OPPORTUNITY FUND FINANCING, LTD., or an affiliate

 

 

 

 

 

 

 

By:

/s/ Nicole D. Kouba

 

 

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Name:

Nicole D. Kouba

 

Title:

Vice President

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

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EXHIBIT A

See attached.

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