Intercreditor Agreement



  
 Exhibit 4.6

 INTERCREDITOR AGREEMENT 
 dated as of May 7, 2010, 
 among 

C.P. ATLAS ACQUISITION CORP. 
 (to be merged with and into AMERICAN RENAL HOLDINGS INC.), 
 the other GRANTORS
party hereto, 
 BANK OF AMERICA, N.A., 
 as Credit Agreement Administrative Agent, 
 and 

WILMINGTON TRUST FSB, 
 as Senior Secured Notes Collateral Agent, 
 and 

each ADDITIONAL COLLATERAL AGENT from time to time party hereto, 







  
 INTERCREDITOR
AGREEMENT dated as of May 7, 2010 (as amended, supplemented or otherwise modified from time to time, this “Agreement”), among C.P. ATLAS ACQUISITION CORP., a Delaware corporation (which on the Closing Date shall be merged with
and into AMERICAN RENAL HOLDINGS INC., a Delaware corporation (the “Company”), with the Company surviving such merger as the borrower, the “Borrower”), the other GRANTORS (as defined below) party hereto, BANK OF
AMERICA, N.A., as collateral agent for the Credit Agreement Secured Parties (as defined below) (in such capacity, the “Credit Agreement Administrative Agent”), WILMINGTON TRUST FSB, as collateral agent for the Senior Secured Notes
Secured Parties (as defined below) (in such capacity, the “Senior Secured Notes Collateral Agent”) and each ADDITIONAL COLLATERAL AGENT from time to time party hereto as collateral agent for any First Lien Obligations (as defined
below) of any other Class (as defined below). 
 The parties hereto agree as follows: 

ARTICLE I  

Definitions 
 SECTION 1.01. Certain Defined Terms. As used in this Agreement, the following terms have the meanings specified below: 
 “Additional Collateral Agent” has the meaning assigned to the term in Article VII. 
 “Additional First Lien Obligations” means all obligations of the Borrower and the other Grantors that shall have been designated as such pursuant to Article VII. 

“Additional First Lien Obligations Documents” means the indentures or other agreements under which Additional First Lien
Obligations of any Series are issued or incurred and all other instruments, agreements and other documents evidencing or governing Additional First Lien Obligations of such Series or providing any guarantee, Lien or other right in respect thereof.

 “Additional Secured Parties” means the holders of any Additional First Lien Obligations. 

“Affiliate” means, with respect to any Person, another Person that directly, or indirectly through one or more
intermediaries, Controls or is Controlled by or is under common Control with the Person specified. “Control” means the possession, directly or indirectly, of the power to direct or cause the direction of the management or policies
of a Person, whether through the ability to exercise voting power, by contract or otherwise. “Controlling” and “Controlled” have meanings correlative thereto. 

“Agreement” has the meaning assigned to such term in the preamble hereto. 







  

“Amend” means, in respect of any agreement, to amend, restate, supplement, waive or otherwise modify such agreement, in
whole or in part. The terms “Amended” and “Amendment” shall have correlative meanings. 

“Authorized Officer” means, with respect to any Person, the chief executive officer, the chief financial officer,
principal accounting officer, any vice president, treasurer, general counsel, secretary or another executive officer of such Person. 
 “Bailee Collateral Agent” has the meaning assigned to such term in Section 4.01(a). 
 “Bankruptcy Code” means Title 11 of the United States Code, as amended. 
 “Bankruptcy Law” means the Bankruptcy Code and any similar Federal, state or foreign law for the relief of debtors. 

“Borrower” has the meaning assigned to such term in the preamble hereto. 

“Business Day” means any day that is not a Saturday, Sunday or other day on which commercial banks in New York City are
authorized or required by law to remain closed. 
 “Class”, when used in reference to (a) any First Lien
Obligations, refers to whether such First Lien Obligations are the Credit Agreement Obligations, the Senior Secured Notes Obligations or the Additional First Lien Obligations of any Series, (b) any Collateral Agent, refers to whether such
Collateral Agent is the Credit Agreement Administrative Agent, the Senior Secured Notes Collateral Agent or the Additional Collateral Agent with respect to the Additional First Lien Obligations of any Series, (c) any Bailee Collateral Agent,
refers to whether such Bailee Collateral Agent is the Credit Agreement Administrative Agent, the Senior Secured Notes Collateral Agent or the Additional Collateral Agent with respect to the Additional First Lien Obligations of any Series,
(d) any Secured Parties, refers to whether such Secured Parties are the Credit Agreement Secured Parties, the Senior Secured Notes Secured Parties or the holders of the Additional First Lien Obligations of any Series, (e) any Secured
Credit Documents, refers to whether such Secured Credit Documents are the Credit Agreement Documents, the Senior Secured Notes Documents or the Additional First Lien Obligations Documents with respect to Additional First Lien Obligations of any
Series, and (f) any Security Documents, refers to whether such Security Documents are part of the Credit Agreement Documents, the Senior Secured Notes Documents or the Additional First Lien Obligations Documents with respect to Additional First
Lien Obligations of any Series. 
 “Collateral” means all assets of the Borrower or any of the Grantors now or
hereafter subject to a Lien securing any First Lien Obligation. 
 “Collateral Agent Joinder Agreement” means a
supplement to this Agreement substantially in the form of Exhibit I. 
 “Collateral Agents” means the Credit
Agreement Administrative Agent, the Senior Secured Notes Collateral Agent and each Additional Collateral Agent. 

  
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“Control” has the meaning assigned thereto in the definition of “Affiliate”. 

“Controlled Shared Collateral” has the meaning assigned to such term in Section 4.01(a). 

“Credit Agreement” means the Credit Agreement dated as of May 7, 2010 by and among the Borrower, the lenders party
thereto in their capacities as lenders thereunder and Bank of America, N.A., as administrative agent, and one or more other financing arrangements (including, without limitation, any guarantee agreements and security documents), in each case as such
agreements may be amended (including any amendment and restatement thereof), supplemented or otherwise modified from time to time, including any agreement extending the maturity of, refinancing, replacing, consolidating or otherwise restructuring
all or any portion of the Indebtedness under any such agreement or any successor or replacement agreement and whether by the same or any other agent, lender or group of lenders and whether or not increasing the amount of Indebtedness that may be
incurred thereunder; provided that any such amendment, supplement, modification, refinancing, consolidating or restructuring of Indebtedness under such agreement may only provide for the making of revolving loans and/or issuance of letters of
credit; provided further that the collateral agent for any such other financing arrangement or agreement becomes a party hereto by executing and delivering a Collateral Agent Joinder Agreement. 

“Credit Agreement Administrative Agent” has the meaning assigned to such term in the preamble hereto. 

“Credit Agreement Collateral Agreement” has the meaning assigned to the term “Security Agreement” in the
Credit Agreement. 
 “Credit Agreement Documents” has the meaning assigned to the term “Loan
Documents” in the Credit Agreement. 
 “Credit Agreement Obligations” has the meaning assigned to the term
“Obligations” in the Credit Agreement. 
 “Credit Agreement Secured Parties” has the meaning assigned
to the term “Secured Parties” in the Credit Agreement. 
 “Discharge” means, with respect to First
Lien Obligations of any Class, (a) payment in full in cash of the principal of and interest on (including interest accruing during the pendency of any Insolvency or Liquidation Proceeding, regardless of whether allowed or allowable in such
Insolvency or Liquidation Proceeding), and premium, if any, on, all Indebtedness outstanding under Secured Credit Documents of such Class, (b) payment in full of all other First Lien Obligations of such Class that are due and payable or
otherwise accrued and owing at or prior to the time such principal and interest are paid, (c) in the case of the Credit Agreement Obligations, cancellation of or the entry into arrangements reasonably satisfactory to the Credit Agreement
Administrative Agent and each applicable issuing lender with respect to all letters of credit issued and outstanding under the Credit Agreement Documents and (d) termination or expiration of all commitments to lend under the Credit Agreement
Documents. 

  
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 “Event of
Default” means an “Event of Default” (or similar event, however denominated) as defined in any Secured Credit Document. 
 “First Lien Obligations” means (a) all the Credit Agreement Obligations, (b) all the Senior Secured Notes Obligations and (c) all the Additional First Lien Obligations.

 “Grantor Joinder Agreement” means a supplement to this Agreement substantially in the form of Exhibit II.

 “Grantors” means, at any time, Holdings, the Borrower and each Subsidiary that, at such time, pursuant to
Security Documents of any Class have granted a Lien on any of its assets to secure any First Lien Obligations of such Class. 

“Holdings” means C.P. Atlas Intermediate Holdings, LLC, a Delaware limited liability company. 

“Indebtedness” has the meaning assigned to such term in the Senior Secured Notes Indenture or in the Credit Agreement,
as applicable. 
 “Impairment” has the meaning assigned to such term in Section 2.02. 

“Insolvency or Liquidation Proceeding” means: 

(a) any case commenced by or against the Borrower or any other Grantor under any Bankruptcy Law, any other proceeding for
the reorganization, receivership, recapitalization or adjustment or marshalling of the assets or liabilities of the Borrower or any other Grantor, any receivership or assignment for the benefit of creditors relating to the Borrower or any other
Grantor or its assets or any similar case or proceeding relative to the Borrower or any other Grantor or its creditors or its assets, as such, in each case whether or not voluntary; 

(b) any liquidation, dissolution, marshalling of assets or liabilities, assignment for the benefit of creditors or other
winding up of or relating to the Borrower or any other Grantor or its assets, in each case whether or not voluntary and whether or not involving bankruptcy or insolvency and whether or not in a court supervised proceeding; or 

(c) any other proceeding of any type or nature in which substantially all claims of creditors of the Borrower or any other
Grantor are determined and any payment or distribution is or may be made on account of such claims. 
 “Intervening
Creditor” has the meaning assigned to such term in Section 2.02. 
 “Intervening Lien” has the
meaning assigned to such term in Section 2.02. 
 “Lien” means, with respect to any asset, any mortgage,
deed of trust, lien, pledge, hypothecation, encumbrance, charge or security interest in, on or of such asset. 

  
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 “Pari Passu
Lien Indebtedness” shall have the meaning assigned to such term in the Senior Secured Notes Indenture. 

“Person” means any natural person, corporation, limited liability company, trust, joint venture, association, company,
partnership, governmental authority or other entity. 
 “Priority Payment Lien Obligations” shall mean
(a) Credit Agreement Obligations secured by Liens permitted by clause (25) of the definition of “Permitted Liens” in the Senior Secured Notes Indenture as in effect on the date hereof (or analogous clause of a successor or
amended agreement permitted by the Credit Agreement) and (b) to the extent secured equally and ratably with the Credit Agreement Obligations referred to in the foregoing clause (a), Credit Agreement Obligations secured by Liens permitted by
clause (18) or clause (21) of the definition of “Permitted Liens” in the Senior Secured Notes Indenture as in effect on the date hereof (or analogous clauses of a successor or amended agreement permitted by the Credit Agreement).

 “Proceeds” has the meaning assigned to such term in Section 2.01(b). 

“Refinance” means, in respect of any Indebtedness, to refinance, extend, renew, refund, repay, prepay, redeem, purchase,
defease, retire, restructure or replace, or to issue other Indebtedness in exchange or replacement for, such Indebtedness, in whole or in part. “Refinanced” and “Refinancing” shall have correlative meanings.

 “Related Secured Credit Documents” means, with respect to the Collateral Agent or Secured Parties of any
Class, the Secured Credit Documents of such Class. 
 “Related Secured Parties” means, with respect to the
Collateral Agent of any Class, the Secured Parties of such Class. 
 “Secured Credit Documents” means,
collectively, (a) the Credit Agreement Documents, (b) the Senior Secured Notes Documents and (c) the Additional First Lien Obligations Documents. 
 “Secured Parties” means (a) the Credit Agreement Secured Parties, (b) the Senior Secured Notes Secured Parties and (c) the Additional Secured Parties. 

“Security Documents” means (a) the Credit Agreement Collateral Agreement and the other Collateral Documents (as
defined in the Credit Agreement), (b) the Senior Secured Notes Collateral Agreement and the other Senior Secured Notes Documents and (c) any other agreement entered into in favor of the Collateral Agent of any other Class for the purpose
of securing the First Lien Obligations of such Class. 
 “Senior Secured Notes Collateral Agent” has the
meaning assigned to such term in the preamble hereto. 
 “Senior Secured Notes Collateral Agreement” has the
meaning assigned to the term “Security Agreement” in the Senior Secured Notes Indenture. 

  
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 “Senior
Secured Notes Documents” means the Senior Secured Notes Indenture, the Senior Secured Notes Collateral Agreement and all other instruments, agreements and other documents evidencing or governing the Senior Secured Notes Obligations or
providing any Guarantee (as defined in the Senior Secured Notes Indenture), Lien (including any mortgage) or other right in respect thereof. 
 “Senior Secured Notes Indenture” means that certain Indenture, dated as of May 7, 2010, among the Borrower, the other Grantors party thereto, as guarantors, and Wilmington Trust FSB,
as trustee and collateral agent, governing the Borrower’s 8.375% Senior Secured Notes due 2018, as the same may be amended, supplemented or otherwise modified from time to time, including any agreement extending the maturity of, refinancing,
replacing, consolidating or otherwise restructuring all or any portion of the Indebtedness under such Senior Secured Notes Indenture or any successor or replacement Senior Secured Notes Indenture and whether by the same or any other Senior Secured
Notes Trustee and whether or not increasing the amount of Indebtedness that may be incurred thereunder; provided that the collateral agent for any such other financing arrangement or Senior Secured Notes Indenture becomes a party hereto by
executing and delivering a Collateral Agent Joinder Agreement. 
 “Senior Secured Notes Obligations” has the
meaning assigned to the term “Notes Obligations” in the Senior Secured Notes Indenture. 
 “Senior Secured
Notes Secured Parties” has the meaning assigned to the term “Secured Parties” in the Senior Secured Notes Indenture. 
 “Senior Secured Notes Trustee” means the trustee under the Senior Secured Notes Indenture. 
 “Series”, when used in reference to Additional First Lien Obligations, refers to such Additional First Lien Obligations as shall have been issued or incurred pursuant to the same
indentures or other agreements and with respect to which the same Person acts as the Additional Collateral Agent. 

“Shared Collateral” means, at any time, Collateral on which Collateral Agents or Secured Parties of any two or more
Classes have at such time a valid and perfected Lien (including as a result of the agreements set forth in Section 4.01). If First Lien Obligations of more than two Classes are outstanding at any time, then any Collateral shall constitute
Shared Collateral with respect to First Lien Obligations of any Class only if the Collateral Agent or Secured Parties of such Class have at such time a valid and perfected Lien on such Collateral. 

“Subsidiary” of a Person means a corporation, partnership, joint venture, limited liability company or other business
entity of which a majority of the shares of securities or other interests having ordinary voting power for the election of directors or other governing body (other than securities or interests having such power only by reason of the happening of a
contingency) are at the time beneficially owned directly, or indirectly through one or more intermediaries, or both, by such Person. Unless otherwise specified, all references herein to a “Subsidiary” or to “Subsidiaries” shall
refer to a Subsidiary or Subsidiaries of the Borrower. 
 SECTION 1.02. Terms Generally. The definitions of terms herein
shall apply 

  
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equally to the singular and plural forms of the terms defined. Whenever the context may require, any pronoun shall include the corresponding masculine, feminine and neuter forms. The words
“include”, “includes” and “including” shall be deemed to be followed by the phrase “without limitation”. The word “will” shall be construed to have the same meaning and effect as the word
“shall”. Unless the context requires otherwise, (a) any definition of or reference to any agreement, instrument, other document, statute or regulation herein shall be construed as referring to such agreement, instrument, other
document, statute or regulation as from time to time amended, supplemented or otherwise modified, (b) any reference herein to any Person shall be construed to include such Person’s successors and assigns, but shall not be deemed to include
the subsidiaries of such Person unless express reference is made to such subsidiaries, (c) the words “herein”, “hereof” and “hereunder”, and words of similar import, shall be construed to refer to this Agreement in
its entirety and not to any particular provision hereof, (d) all references herein to Articles, Sections and Exhibits shall be construed to refer to Articles, and Sections of, and Exhibits to, this Agreement and (e) the words
“asset” and “property” shall be construed to have the same meaning and effect and to refer to any and all tangible and intangible assets and properties, including cash, securities, accounts and contract rights. 

SECTION 1.03. Concerning the Credit Agreement Administrative Agent, the Senior Secured Notes Collateral Agent and Each Additional
Collateral Agent. 
 (a) Each acknowledgement, agreement, consent and waiver (whether express or implied) in this Agreement
made by the Credit Agreement Administrative Agent, whether on behalf of itself or any of its Related Secured Parties, is made in reliance on the authority granted to the Credit Agreement Administrative Agent pursuant to the authorization thereof
under the Credit Agreement. It is understood and agreed that the Credit Agreement Administrative Agent shall not be responsible for or have any duty to ascertain or inquire into whether any of its Related Secured Parties is in compliance with the
terms of this Agreement, and no party hereto or any other Secured Party shall have any right of action whatsoever against the Credit Agreement Administrative Agent for any failure of any of its Related Secured Parties to comply with the terms hereof
or for any of its Related Secured Parties taking any action contrary to the terms hereof. 
 (b) Each acknowledgement,
agreement, consent and waiver (whether express or implied) in this Agreement made by the Senior Secured Notes Collateral Agent, whether on behalf of itself or any of its Related Secured Parties, is made in reliance on the authority granted to the
Senior Secured Notes Collateral Agent pursuant to the authorization thereof under the Senior Secured Notes Indenture. It is understood and agreed that the Senior Secured Notes Collateral Agent shall not be responsible for or have any duty to
ascertain or inquire into whether any of its Related Secured Parties is in compliance with the terms of this Agreement, and no party hereto or any other Secured Party shall have any right of action whatsoever against the Senior Secured Notes
Collateral Agent for any failure of any of its Related Secured Parties to comply with the terms hereof or for any of its Related Secured Parties taking any action contrary to the terms hereof. 

(c) Each acknowledgement, agreement, consent and waiver (whether express or implied) in this Agreement made by any Additional Collateral
Agent, whether on behalf of itself or any of its Related Secured Parties, is made in reliance on the authority granted to such 

  
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Additional Collateral Agent pursuant to the authorization thereof under the Additional First Lien Obligations Documents relating to such Class of First Lien Obligations. It is understood and
agreed that no Additional Collateral Agent shall be responsible for or have any duty to ascertain or inquire into whether any of its Related Secured Parties is in compliance with the terms of this Agreement, and no party hereto or any other Secured
Party shall have any right of action whatsoever against the Additional Collateral Agent for any failure of any of its Related Secured Parties to comply with the terms hereof or for any of its Related Secured Parties taking any action contrary to the
terms hereof. 
 ARTICLE II  
 Lien Priorities; Proceeds 
 SECTION 2.01. Relative Priorities.

 (a) Notwithstanding the date, time, method, manner or order of grant, attachment or perfection of any Lien on any Shared
Collateral securing any First Lien Obligation, and notwithstanding any provision of the Uniform Commercial Code of any jurisdiction, any other applicable law or any Secured Credit Document, or any other circumstance whatsoever (but, in each case,
subject to Section 2.01(b) and Section 2.02), each Collateral Agent, for itself and on behalf of its Related Secured Parties, agrees that valid and perfected Liens on any Shared Collateral securing First Lien Obligations of any Class shall
be of equal priority. 
 (b) Each Collateral Agent, for itself and on behalf of its Related Secured Parties, agrees that,
notwithstanding (x) any provision of any Secured Credit Document to the contrary (but subject to Section 2.02) and (y) the date, time, method, manner or order of grant, attachment or perfection of any Lien on any Shared Collateral
securing any First Lien Obligation, and notwithstanding any provision of the Uniform Commercial Code of any jurisdiction, any other applicable law or any Secured Credit Document, or any other circumstance whatsoever (but, in each case, subject to
Section 2.02), if (i) such Collateral Agent or any of its Related Secured Parties takes any action to enforce rights or exercise remedies in respect of any Shared Collateral (including any such action referred to in Section 3.01(a)),
(ii) any distribution is made in respect of any Shared Collateral in any Insolvency or Liquidation Proceeding of the Borrower or any other Grantor or (iii) such Collateral Agent or any of its Related Secured Parties receives any payment
with respect to any Shared Collateral pursuant to any intercreditor agreement (other than this Agreement), then the proceeds of any sale, collection or other liquidation of any Shared Collateral obtained by such Collateral Agent or any of its
Related Secured Parties on account of such enforcement of rights or exercise of remedies, and any such distributions or payments received by such Collateral Agent or any of its Related Secured Parties (all such proceeds, distributions and payments
being collectively referred to as “Proceeds”), shall be applied as follows: 
 (i) FIRST, to the
payment of all amounts owing to and all costs and expenses incurred by any Collateral Agent, the Credit Agreement Administrative Agent and the Senior Secured Notes Trustee (in their capacities as such), pursuant to the terms of any Secured Credit
Document or in connection with any enforcement of rights or exercise of 

  
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remedies pursuant thereto, including all court costs and the reasonable fees and expenses of agents and legal counsel and, in each case, including all costs and expenses incurred in enforcing its
rights to obtain such payment; 
 (ii) SECOND, to the payment in full of any Priority Payment Lien Obligations
(including any post-petition interest with respect thereto, whether or not allowable in any Insolvency or Liquidation Proceeding) and the termination of any commitments thereunder; 

(iii) THIRD, to the payment in full of all other First Lien Obligations of each Class secured by a valid and perfected
Lien on such Shared Collateral at the time due and payable (the amounts so applied to be distributed, as among such Classes of First Lien Obligations, ratably in accordance with the amounts of the First Lien Obligations of each such Class on the
date of such application); provided that amounts applied under this clause THIRD during any period when the First Lien Obligations of any such Class shall not be due and payable in full (other than contingent obligations not then due) shall
be allocated to the First Lien Obligations of such Class as if such First Lien Obligations were at the time due and payable in full, and any amounts allocated to the payment of the First Lien Obligations of such Class that are not yet due and
payable shall be transferred to, and held by, the Collateral Agent of such Class solely as collateral for the First Lien Obligations of such Class (and shall not constitute Shared Collateral for purposes hereof) until the date on which the First
Lien Obligations of such Class shall have become due and payable in full (at which time such amounts shall be applied to the payment thereof); and 
 (iv) FOURTH, after payment in full of all the First Lien Obligations, to the Borrower and the other Grantors or their successors or assigns, as their interests may appear, or as a court of competent
jurisdiction may direct. 
 (c) For the avoidance of doubt, any amounts to be distributed pursuant to this Section 2.01
shall be distributed by the applicable Collateral Agent to the following agents for further distribution to its Related Secured Parties: (i) in the case of any amount representing payment with respect to a Priority Payment Lien Obligation, to
the Credit Agreement Administrative Agent, (ii) in the case of any amount representing payment with respect to a Credit Agreement Obligation, to the Credit Agreement Administrative Agent, (iii) in the case of any amount representing
payment with respect to a Senior Secured Notes Obligation, to the Senior Secured Notes Trustee, (iv) in the case of any amount representing payment with respect to any Additional First Lien Obligation, to the applicable Additional Collateral
Agent for the corresponding Additional First Lien Obligation Documents. 
 SECTION 2.02. Impairments. It is the intention
of the parties hereto that the Secured Parties of any given Class of Pari Passu Lien Indebtedness (and not the Secured Parties of any other Class of Pari Passu Lien Indebtedness) bear the risk of any determination by a court of competent
jurisdiction that (i) any First Lien Obligations of such Class of Pari Passu Lien Indebtedness are unenforceable under applicable law or are subordinated to any other obligations (other than to any Pari Passu Lien Indebtedness), (ii) the
Secured Parties of such Class of Pari Passu Lien Indebtedness do not have a valid and perfected Lien on any of the Collateral securing 

  
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any First Lien Obligations of any other Class of Pari Passu Lien Indebtedness and/or (iii) any Person (other than any Collateral Agent or Secured Party) has a Lien on any Shared Collateral
that is senior in priority to the Lien on such Shared Collateral securing First Lien Obligations of such Class of Pari Passu Lien Indebtedness, but junior to the Lien on such Shared Collateral securing any other class of Priority Payment Lien
Obligations or Pari Passu Lien Indebtedness (any such Lien being referred to as an “Intervening Lien”, and any such Person being referred to as an “Intervening Creditor”) (any condition with respect to First Lien
Obligations of such Class of Pari Passu Lien Indebtedness being referred to as an “Impairment” of such Class). In the event an Impairment exists with respect to First Lien Obligations of any Class of Pari Passu Lien Indebtedness,
the results of such Impairment shall be borne solely by the Secured Parties of such Class of Pari Passu Lien Indebtedness, and the rights of the Secured Parties of such Class of Pari Passu Lien Indebtedness (including the right to receive
distributions in respect of First Lien Obligations of such Class of Pari Passu Lien Indebtedness pursuant to Section 2.01(b)) set forth herein shall be modified to the extent necessary so that the results of such Impairment are borne solely by
the Secured Parties of such Class. In furtherance of the foregoing, in the event First Lien Obligations of any Class of Pari Passu Lien Indebtedness shall be subject to an Impairment in the form of an Intervening Lien of any Intervening Creditor,
the value of any Shared Collateral or Proceeds that are allocated to such Intervening Creditor shall be deducted solely from the Shared Collateral or Proceeds to be distributed in respect of First Lien Obligations of such Class. 

SECTION 2.03. Payment Over. Each Collateral Agent, on behalf of itself and its Related Secured Parties, agrees that if such
Collateral Agent or any of its Related Secured Parties shall at any time obtain possession of any Shared Collateral or receive any Proceeds (other than as a result of any application of Proceeds pursuant to Section 2.01(b)), (i) such
Collateral Agent or its Related Secured Party, as the case may be, shall promptly inform each other Collateral Agent thereof, (ii) such Collateral Agent or its Related Secured Party shall hold such Shared Collateral or Proceeds in trust for the
benefit of the Secured Parties of any Class entitled thereto pursuant to Section 2.01(b) and, with respect to any Shared Collateral constituting Controlled Shared Collateral, such Collateral Agent shall comply with the provisions of
Section 4.01 and (iii) in the case of any such Proceeds, such Proceeds shall be applied in accordance with Section 2.01(b) as promptly as practicable. 
 SECTION 2.04. Determinations with Respect to Amounts of Obligations and Liens. Whenever the Collateral Agent of any Class shall be required, in connection with the exercise of its rights or the
performance of its obligations hereunder, to determine the existence or amount of any First Lien Obligations of any other Class, or the Shared Collateral subject to any Lien securing the First Lien Obligations of any other Class (and whether such
Lien constitutes a valid and perfected Lien), it may request that such information be furnished to it in writing by the Collateral Agent of such other Class and shall be entitled to make such determination on the basis of the information so
furnished; provided that if, notwithstanding the request of the Collateral Agent of such Class, the Collateral Agent of such other Class shall fail or refuse reasonably promptly to provide the requested information, the Collateral Agent of
such Class shall be entitled to make any such determination by such method as it may, in the exercise of its good faith judgment, determine, including by reliance upon a certificate of an Authorized Officer of the Borrower. Each Collateral Agent may
rely conclusively, and shall be fully protected in so relying, on any determination made by it in accordance with the provisions of the 

  
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preceding sentence (or as otherwise directed by a court of competent jurisdiction) and shall have no liability to any Grantor, any Secured Party or any other Person as a result of such
determination or any action taken or not taken pursuant thereto. 
 ARTICLE III  

Rights and Remedies; Matters Relating to Shared Collateral 

SECTION 3.01. Exercise of Rights and Remedies. 
 (a) Subject to paragraph (b) of this Section and Section 4.01(a), nothing in this Agreement shall affect the ability of any Collateral Agent or any of its Related Secured Parties (i) to
enforce any rights and exercise any remedies with respect to any Shared Collateral available under any Related Secured Credit Documents or applicable law, including any right of set-off and any determinations regarding the release of Liens on, or
any sale, transfer or other disposition of, any Shared Collateral, or any other rights or remedies available to a secured creditor under the Uniform Commercial Code of any jurisdiction, the Bankruptcy Code or any other Bankruptcy Law, or
(ii) to commence any action or proceeding with respect to such rights or remedies (including any foreclosure action or proceeding or any Insolvency or Liquidation Proceeding). Subject to paragraph (b) of this Section and
Section 4.01(a), any such exercise of rights and remedies by any Collateral Agent or any of its Related Secured Parties may be made in such order and in such manner as such Collateral Agent or its Related Secured Parties may, subject to the
provisions of their Related Secured Credit Documents, determine in their sole discretion. 
 (b) Notwithstanding paragraph
(a) of this Section: 
 (i) each Collateral Agent and its Related Secured Parties shall remain subject to,
and bound by, all covenants or agreements made herein by or on behalf of such Collateral Agent or its Related Secured Parties; 
 (ii) each Collateral Agent agrees, on behalf of itself and its Related Secured Parties, that, prior to the commencement of any enforcement of rights or any exercise of remedies with respect to any Shared
Collateral by such Collateral Agent or any of its Related Secured Parties, such Collateral Agent or its Related Secured Party, as the case may be, shall provide prior written notice thereof to each other Collateral Agent, such notice to be provided
as far in advance of such commencement as reasonably practicable, and shall regularly inform each other Collateral Agent of developments in connection with such enforcement or exercise; and 

(iii) subject to the terms and conditions of each Collateral Agent’s Related Secured Credit Documents, each
Collateral Agent agrees, on behalf of itself and its Related Secured Parties, that such Collateral Agent and its Related Secured Parties, to the extent requested by the other Collateral Agent, shall cooperate in a commercially reasonable manner with
each other Collateral Agent and its Related Secured Parties in any enforcement of rights or any exercise of remedies with respect to any Shared Collateral; provided however that nothing in this section shall require any Collateral Agent to
cooperate with any other Collateral Agent if it has not received the appropriate or necessary consents, waivers, direction or indemnity from its Related Secured Parties. 

  
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 SECTION 3.02.
Prohibition on Contesting Liens. Each Collateral Agent agrees, on behalf of itself and its Related Secured Parties, that neither such Collateral Agent nor any of its Related Secured Parties will, and each hereby waives any right to, contest
or support any other Person in contesting, in any proceeding (including any Insolvency or Liquidation Proceeding), the perfection, priority, validity, attachment or enforceability of a Lien held by or on behalf of any other Collateral Agent or any
of its Related Secured Parties in all or any part of the Shared Collateral; provided that nothing in this Agreement shall be construed to prevent or impair the rights of any Collateral Agent or any of its Related Secured Parties to enforce
this Agreement. 
 SECTION 3.03. Prohibition on Challenging this Agreement. Each Collateral Agent agrees, on behalf of
itself and its Related Secured Parties, that neither such Collateral Agent nor any of its Related Secured Parties will attempt, directly or indirectly, whether by judicial proceedings or otherwise, to challenge the enforceability of any provision of
this Agreement; provided that nothing in this Agreement shall be construed to prevent or impair the rights of any Collateral Agent or any of its Related Secured Parties to enforce this Agreement. 

SECTION 3.04. Release of Liens. The parties hereto agree and acknowledge that the release of Liens on any Shared Collateral
securing First Lien Obligations of any Class, whether in connection with a sale, transfer or other disposition of such Shared Collateral or otherwise, shall be governed by and subject to the Secured Credit Documents of such Class, and that nothing
in this Agreement shall be deemed to amend or affect the terms of the Secured Credit Documents of such Class with respect thereto. 
 SECTION 3.05. Insurance and Condemnation Awards. So long as the Discharge of the Credit Agreement Obligations has not occurred, the Credit Agreement Administrative Agent and its Related Secured
Parties shall have the exclusive right, subject to the rights of the Grantors under and solely to the extent provided in the Credit Agreement Documents, to settle and adjust claims in respect of Shared Collateral under policies of insurance covering
Shared Collateral and to approve any award granted in any condemnation or similar proceeding, or any deed in lieu of condemnation, in respect of the Shared Collateral; provided that any Proceeds arising therefrom shall be subject to Article
II. 
 ARTICLE IV  
 Collateral 
 SECTION 4.01. Bailment for Perfection of Security
Interests. 
 (a) Each Collateral Agent agrees that if it shall at any time hold a Lien on any Shared Collateral that can be
perfected by the possession or control of such Shared Collateral or of any deposit, securities or other account in which such Shared Collateral is held, and if such Shared Collateral or any such account is in fact in the possession or under the
control of such Collateral Agent, or of agents or bailees of such Collateral Agent (such Shared Collateral being 

  
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referred to herein as the “Controlled Shared Collateral”), such Collateral Agent shall, solely for the purpose of perfecting the Liens of any other Collateral Agent granted on
such Shared Collateral under its Related Secured Credit Documents and subject to the terms and conditions of this Article, also hold such Controlled Shared Collateral as gratuitous bailee and sub-agent for each such other Collateral Agent (any
Collateral Agent that shall be holding any Controlled Shared Collateral as gratuitous bailee and sub-agent being referred to herein as the “Bailee Collateral Agent”). In furtherance of the foregoing, each Collateral Agent appoints
each Bailee Collateral Agent as such Collateral Agent’s gratuitous bailee and sub-agent hereunder with respect to any Controlled Shared Collateral that such Bailee Collateral Agent possesses or controls at any time solely for the purpose of
perfecting a Lien on such Controlled Shared Collateral. Notwithstanding anything herein to the contrary, it is understood and agreed that as of the date hereof and until such time as the Credit Agreement Obligations are Discharged, the Credit
Agreement Administrative Agent shall have the sole right to give any instructions, directions and entitlement orders (including any blockage or withdrawal instructions) with respect to any deposit, securities or other accounts, or any funds or
property contained thereinto and to exercise any other remedies under any control agreement entered into with respect to a deposit account, a securities account or any other account (whether or not the Senior Secured Notes Collateral Agent is also a
party thereto); provided that any amounts withdrawn therefrom shall be subject to Article II. It is further understood and agreed that as of the date hereof and until such time as the Credit Agreement Obligations are Discharged, the Credit
Agreement Administrative Agent shall be granted possession of all possessory Controlled Shared Collateral and, thereafter, possession shall be determined by Section 4.01(d). 

(b) In furtherance of the foregoing, each Grantor hereby grants a security interest in the Controlled Shared Collateral to each
Collateral Agent that possesses or controls Controlled Shared Collateral as permitted in Section 4.01(a) for the benefit of the Secured Parties under any other Class of First Lien Obligations which have been granted a Lien on the Controlled
Shared Collateral possessed or controlled by such Collateral Agent. 
 (c) Subject to Section 4.01(a), for purposes of this
Section, the Bailee Collateral Agent shall be entitled to deal with the applicable Controlled Shared Collateral in accordance with the terms of its Related Secured Credit Documents as if the Liens thereon of the Collateral Agent or Secured Parties
of any other Class (and the agreements set forth in paragraph (a) of this Section) did not exist; provided that any Proceeds arising from any such Controlled Shared Collateral shall be subject to Article II. The obligations and
responsibilities of any Bailee Collateral Agent to any other Collateral Agent or any of its Related Secured Parties under this Article shall be limited solely to holding or controlling the applicable Controlled Shared Collateral as gratuitous bailee
and sub-agent in accordance with this Article. Without limiting the foregoing, (i) no Bailee Collateral Agent shall have any obligation or responsibility to ensure that any Controlled Shared Collateral is genuine or owned by any of the
Grantors, (ii) no Bailee Collateral Agent shall, by reason of this Agreement, any other Security Document or any other document, have a fiduciary relationship or other implied duties in respect of any other Collateral Agent or any other Secured
Party and (iii) without affecting the agreement of any Bailee Collateral Agent to act as a gratuitous bailee and sub-agent solely for the purpose set forth in paragraph (a) of this Section or the right of any other Collateral Agent to
enforce the rights and exercise the remedies (in each case other than through such Bailee Collateral Agent) as set forth in Section 3.01 and subject to the proviso in Section 4.01(a), each Collateral Agent agrees that


  
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such Collateral Agent shall not issue any instructions to any Bailee Collateral Agent, in its capacity as a gratuitous bailee and sub-agent of such Collateral Agent, with respect to the
Controlled Shared Collateral or otherwise seek to exercise control over any Bailee Collateral Agent. 
 (d) The Bailee
Collateral Agent of any Class shall, upon the Discharge of the First Lien Obligations of such Class, transfer the possession and control of the applicable Controlled Shared Collateral, together with any necessary endorsements but without recourse or
warranty, (i) if First Lien Obligations of any other Class are outstanding at such time, to the Collateral Agent of such other Class (or, if First Lien Obligations of more than one other Class are outstanding at such time, to the Collateral
Agent of the same Class as the Class of the First Lien Obligations the aggregate principal amount of which outstanding at such time exceeds the aggregate principal amount of the First Lien Obligations of any other Class outstanding at such time) and
(ii) if no First Lien Obligations are outstanding at such time, to the applicable Grantor or as directed by a court of competent jurisdiction, in each case so as to allow such Person to obtain possession and control of such Controlled Shared
Collateral. In connection with any transfer under clause (i) above by any Bailee Collateral Agent, such Bailee Collateral Agent agrees to take all actions in its power as shall be necessary or reasonably requested by the transferee Collateral
Agent to permit the transferee Collateral Agent to obtain, for the benefit of its Related Secured Parties, a first priority security interest in the applicable Controlled Shared Collateral. 

SECTION 4.02. Delivery of Documents. Promptly after the execution and delivery to any Collateral Agent by any Grantor of any
Security Document (other than (a) any Security Document in effect on the date hereof and (b) any Additional First Lien Obligations Document referred to in paragraph (b) of Article VII, but including any amendment, amendment and
restatement, waiver or other modification of any such Security Document or Additional First Lien Obligations Document), the Borrower shall deliver to each Collateral Agent party hereto at such time a copy of such Security Document. 

ARTICLE V  

Other Agreements 
 SECTION 5.01. Concerning Secured Credit Documents and Collateral. 
 (a) The
Secured Credit Documents of any Class may be Amended, in whole or in part, in accordance with their terms, in each case without notice to or the consent of the Collateral Agent or any Secured Parties of any other Class; provided that nothing
in this paragraph shall affect any limitation on any such Amendment that is set forth in the Secured Credit Documents of any such other Class. 
 (b) The Grantors agree that each Security Document (other than any Credit Agreement Document executed and delivered prior to the date hereof, without limitation of the applicability of this Agreement
thereto) creating a Lien on any Shared Collateral securing any First Lien Obligations (i) shall contain a legend substantially in the form of Annex I, or similar provisions approved by the Credit Agreement Administrative Agent, which approval
shall not be 

  
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unreasonably withheld, and (ii) shall provide that all powers, rights and remedies under such Security Document with respect to Shared Collateral may be exercised solely by the Collateral
Agent of the applicable Class on behalf of the Secured Parties of such Class in accordance with the terms thereof, and that no other Secured Party of the applicable Class shall have any right individually to realize upon any of the Liens on Shared
Collateral granted thereunder to secure First Lien Obligations of such Class. 
 (c) The Grantors agree that they shall not
grant to any Person any Lien on any Shared Collateral securing First Lien Obligations of any Class other than through the Collateral Agent of such Class (it being understood that the foregoing shall not be deemed to prohibit grants of set-off rights
to Secured Parties of any Class); provided that the foregoing shall not prohibit the granting of any Liens permitted by the terms of the Secured Credit Documents. 
 (d) The Grantors agree that they shall not, and shall not permit any Subsidiary to, grant or permit or suffer to exist any additional Liens on any asset or property to secure any Class of First Lien
Obligations unless it has granted a Lien on such asset or property to secure each other Class of First Lien Obligations; provided that the foregoing shall not prohibit (i) any class of First Lien Obligations from being secured by Equity
Interests (as defined in the Credit Agreement) that do not secure any other class of First Lien Obligations due to the Rule 3-16 Exception (as defined in the Senior Secured Notes Collateral Agreement) or (ii) the granting of any Liens permitted
by the terms of the Secured Credit Documents. 
 SECTION 5.02. Refinancings. The First Lien Obligations of any Class may
be Refinanced, in whole or in part, in each case, without notice to, or the consent of the Collateral Agent or Secured Party of any other Class, all without affecting the priorities provided for herein (including, without limitation, the priority in
right of payment of the Priority Payment Lien Obligations) or the other provisions hereof; provided that nothing in this paragraph shall affect any limitation on any such Refinancing that is set forth in the Secured Credit Documents of any
such other Class; and provided further that, if any obligations of the Grantors in respect of such Refinancing indebtedness shall be secured by Liens on any Shared Collateral, such obligations and the holders thereof shall be subject
to and bound by the provisions of this Agreement and, if not already, the collateral agent under such obligations shall become a party hereto by executing and delivering a Collateral Agent Joinder Agreement. 

SECTION 5.03. Reinstatement. If, in any Insolvency or Liquidation Proceeding or otherwise, all or part of any payment with respect
to the First Lien Obligations of any Class previously made shall be rescinded for any reason whatsoever (including an order or judgment for disgorgement of a preference under the Bankruptcy Code, or any similar law), then the terms and conditions of
Article II shall be fully applicable thereto until all the First Lien Obligations of such Class shall again have been paid in full in cash. 
 SECTION 5.04. Reorganization Modifications. In the event the First Lien Obligations of any Class are modified pursuant to applicable law, including Section 1129 of the Bankruptcy Code, any
reference to the First Lien Obligations of such Class or the Secured Credit Documents of such Class shall refer to such obligations or such documents as so modified. 
 SECTION 5.05. Further Assurances. Each of the Collateral Agents and the 

  
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Grantors agrees that it will execute, or will cause to be executed, such reasonable further documents, agreements and instruments, and take all such reasonable further actions, as may be required
under any applicable law, or which any Collateral Agent may reasonably request, to effectuate the terms of this Agreement. 

ARTICLE VI  
 No Reliance; No Liability 
 SECTION 6.01. No Reliance; Information.
Each Collateral Agent, on behalf of its Related Secured Parties, acknowledges that (a) its Related Secured Parties have, independently and without reliance upon any Collateral Agent or any Related Secured Parties, and based on such documents
and information as they have deemed appropriate, made their own credit analysis and decision to enter into the Secured Credit Documents to which they are party and (b) its Related Secured Parties will, independently and without reliance upon
any Collateral Agent or any of its Related Secured Parties, and based on such documents and information as they shall from time to time deem appropriate, continue to make their own credit decision in taking or not taking any action under this
Agreement or any other Secured Credit Document. The Collateral Agent or Secured Parties of any Class shall have no duty to disclose to any Collateral Agent or any Secured Party of any other Class any information relating to the Borrower or any of
the Grantors or their Subsidiaries, or any other circumstance bearing upon the risk of nonpayment of any of the First Lien Obligations, that is known or becomes known to any of them or any of their Affiliates. If the Collateral Agent or any Secured
Party of any Class, in its sole discretion, undertakes at any time or from time to time to provide any such information to, as the case may be, the Collateral Agent or any Secured Party of any other Class, it shall be under no obligation (i) to
make, and shall not be deemed to have made, any express or implied representation or warranty, including with respect to the accuracy, completeness, truthfulness or validity of the information so provided, (ii) to provide any additional
information or to provide any such information on any subsequent occasion or (iii) to undertake any investigation. 

SECTION 6.02. No Warranties or Liability. 
 (a) Each Collateral Agent, for itself and on behalf of its Related Secured Parties, acknowledges and agrees that no Collateral Agent or Secured Party of any other Class has made any express or implied
representation or warranty, including with respect to the execution, validity, legality, completeness, collectability or enforceability of any of the Secured Credit Documents, the ownership of any Shared Collateral or the perfection or priority of
any Liens thereon. The Collateral Agent and the Secured Parties of any Class will be entitled to manage and supervise their loans and other extensions of credit in the manner set forth in their Related Secured Credit Documents. No Collateral Agent
shall, by reason of this Agreement, any other Security Document or any other document, have a fiduciary relationship or other implied duties in respect of any other Collateral Agent or any other Secured Party. 

(b) No Collateral Agent or Secured Parties of any Class shall have any express or implied duty to the Collateral Agent or any Secured
Party of any other Class to act or refrain from acting in a manner that allows, or results in, the occurrence or continuance of a default or an Event of Default under any Secured Credit Document (other than, in each case, this Agreement), regardless
of any knowledge thereof that they may have or be charged with. 

  
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 SECTION 6.03.
Rights of Senior Secured Notes Collateral Agent. 
 Notwithstanding anything contained herein to the contrary, the Senior
Secured Notes Collateral Agent shall be entitled to the same rights, protections, immunities and indemnities as set forth in the Senior Secured Notes Indenture as if the provisions setting forth those rights, protections, immunities and indemnities
are fully set forth herein. 
 ARTICLE VII  
 Additional First Lien Obligations 
 The Borrower may from time to time,
subject to any limitations contained in any Secured Credit Documents in effect at such time, designate additional indebtedness and related obligations that are, or are to be, secured by Liens on any assets of the Borrower or any of the Grantors that
would, if such Liens were granted, constitute Shared Collateral as Additional First Lien Obligations by delivering to each Collateral Agent party hereto at such time a certificate of an Authorized Officer of the Borrower: 

(a) describing the indebtedness and other obligations being designated as Additional First Lien Obligations, and including
a statement of the maximum aggregate outstanding principal amount of such indebtedness as of the date of such certificate; 
 (b) setting forth the Additional First Lien Obligations Documents under which such Additional First Lien Obligations are issued or incurred or the Guarantees of or Liens securing such Additional First
Lien Obligations are, or are to be, granted or created, and attaching copies of such Additional First Lien Obligations Documents as each Grantor has executed and delivered to the Person that serves as the collateral agent, collateral trustee or a
similar representative for the holders of such Additional First Lien Obligations (such Person being referred to as the “Additional Collateral Agent”) with respect to such Additional First Lien Obligations on the closing date of such
Additional First Lien Obligations, certified as being true and complete by an Authorized Officer of the Borrower; 
 (c) identifying the Person that serves as the Additional Collateral Agent; 
 (d) certifying that the incurrence of such Additional First Lien Obligations, the creation of the Liens securing such Additional First Lien Obligations and the designation of such Additional First Lien
Obligations as “Additional First Lien Obligations” hereunder do not violate or result in a default under any provision of any Secured Credit Document of any Class in effect at such time; 

(e) identifying such Additional First Lien Obligations as either Priority Payment Lien Obligations or Pari Passu Lien
Indebtedness, and if identified as Priority Payment Lien Obligations, certifying that the designation of such Additional First Lien Obligations as Priority Payment Lien Obligations does not violate or result in a default under any provision of any
Secured Credit Document of any Class in effect at such time; 

  
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 (f)
certifying that the Additional First Lien Obligations Documents (A) meet the requirements of Section 5.01(b) and (B) authorize the Additional Collateral Agent to become a party hereto by executing and delivering a Collateral Agent
Joinder Agreement and provide that, upon such execution and delivery, such Additional First Lien Obligations and the holders thereof shall become subject to and bound by the provisions of this Agreement; and 

(g) attaching a fully completed Collateral Agent Joinder Agreement executed and delivered by the Additional Collateral
Agent. 
 Upon the delivery of such certificate and the related attachments as provided above and as so long as the statements made therein are
true and correct as of the date of such certificate, the obligations designated in such notice shall become Additional First Lien Obligations for all purposes of this Agreement. Notwithstanding anything herein contained to the contrary, each
Collateral Agent may conclusively rely on such certificate delivered by the Borrower, and upon its receipt of such certificate, each Collateral Agent shall execute the Collateral Agent Joinder Agreement evidencing its acknowledgment thereof, and
shall incur no liability to any Person for such execution. 
 ARTICLE VIII  

Miscellaneous 
 SECTION 8.01. Notices. All notices and other communications provided for herein shall be in writing and shall be delivered by hand or overnight courier service, mailed by certified or registered
mail or sent by facsimile, as follows: 
 (a) if to any Grantor, to it (or, in the case of any Grantor other than
the Borrower, to it in care of the Borrower) at American Renal Holdings Inc., 66 Cherry Hill Drive, Beverly, MA 01915 (fax: (978) 232-4060); Attention: General Counsel; 

(b) if to the Credit Agreement Administrative Agent, to it at Bank of America, N.A., 101 N. Tryon St., NC1-001-04-39,
Charlotte, NC 28255-0001 (fax: 704-409-0857); Attention: Agency Management; 
 (c) if to the Senior Secured Notes
Collateral Agent, to it at 50 South Sixth Street, Suite 1290, Minneapolis, MN 55402-1544 (fax: (612) 217-5651); Attention: American Renal Holdings Administrator; and 

(d) if to any Additional Collateral Agent, to it at the address set forth in the applicable Collateral Agent Joinder
Agreement. 
 Any party hereto may change its address or facsimile number for notices and other communications hereunder by notice to the other
parties hereto. All notices and other communications given to any party hereto in accordance with the provisions of this Agreement 

  
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shall be deemed to have been given on the date of receipt (if a Business Day) and on the next Business Day thereafter (in all other cases) if delivered by hand or overnight courier service or
sent by facsimile or on the date five Business Days after dispatch by certified or registered mail if mailed, in each case delivered, sent or mailed (properly addressed) to such party as provided in this Section or in accordance with the latest
unrevoked direction from such party given in accordance with this Section. As agreed to in writing by any party hereto from time to time, notices and other communications to such party may also be delivered by e-mail to the e-mail address of a
representative of such party provided from time to time by such party. 
 SECTION 8.02. Waivers; Amendment; Joinder
Agreements. 
 (a) No failure or delay on the part of any party hereto in exercising any right or power hereunder shall
operate as a waiver thereof, nor shall any single or partial exercise of any such right or power, or any abandonment or discontinuance of steps to enforce such a right or power, preclude any other or further exercise thereof or the exercise of any
other right or power. The rights and remedies of the parties hereto are cumulative and are not exclusive of any rights or remedies that they would otherwise have. No waiver of any provision of this Agreement or consent to any departure by any party
therefrom shall in any event be effective unless the same shall be permitted by paragraph (b) of this Section, and then such waiver or consent shall be effective only in the specific instance and for the purpose for which given. No notice or
demand on any party hereto in any case shall entitle such party to any other or further notice or demand in similar or other circumstances. 
 (b) Neither this Agreement nor any provision hereof may be waived, amended or otherwise modified except as contemplated by the Secured Credit Documents and then pursuant to an agreement or agreements in
writing entered into by each Collateral Agent then party hereto; provided that no such agreement shall by its terms amend, modify or otherwise affect the rights or obligations of any Grantor without the Borrower’s prior written consent;
provided further that (i) (A) this Agreement may be supplemented by a Collateral Agent Joinder Agreement, and an Additional Collateral Agent may become a party hereto, in accordance with Article VII and (B) this
Agreement may be supplemented by a Grantor Joinder Agreement, and a Subsidiary may become a party hereto, in accordance with Section 8.12, and (ii) in connection with any Refinancing of First Lien Obligations of any Class, the Collateral
Agents then party hereto shall enter (and are hereby authorized to enter without the consent of any other Secured Party), at the request of any Collateral Agent or the Borrower, into such amendments or modifications of this Agreement as are
reasonably necessary to reflect such Refinancing and are reasonably satisfactory to each such Collateral Agent; provided that such Collateral Agent shall not be required to enter into such amendments or modifications unless it shall have
received a certificate of an Authorized Officer of the Borrower, in form reasonably satisfactory to such Collateral Agent, certifying that such Refinancing and such amendment or modification are permitted hereunder. 

SECTION 8.03. Parties in Interest. This Agreement shall be binding upon and inure to the benefit of the parties hereto and their
respective successors and assigns, as well as the other Secured Parties, all of whom are intended to be bound by, and to be third party beneficiaries of, this Agreement. No other Person shall have or be entitled to assert rights or benefits
hereunder. 

  
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 SECTION 8.04.
Effectiveness; Survival. This Agreement shall become effective when executed and delivered by the parties hereto. All covenants, agreements, representations and warranties made by any party in this Agreement shall be considered to have been
relied upon by the other parties hereto and shall survive the execution and delivery of this Agreement. This Agreement shall continue in full force and effect notwithstanding the commencement of any Insolvency or Liquidation Proceeding against the
Borrower or any of the Subsidiaries. 
 SECTION 8.05. Counterparts. This Agreement may be executed in counterparts, each
of which shall constitute an original but all of which when taken together shall constitute a single contract. Delivery of an executed signature page to this Agreement by facsimile or other electronic transmission shall be as effective as delivery
of a manually signed counterpart of this Agreement. 
 SECTION 8.06. Severability. Any provision of this Agreement held
to be invalid, illegal or unenforceable in any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of such invalidity, illegality or unenforceability without affecting the validity, legality and enforceability of the remaining
provisions hereof; and the invalidity of a particular provision in a particular jurisdiction shall not invalidate such provision in any other jurisdiction. The parties shall endeavor in good-faith negotiations to replace the invalid, illegal or
unenforceable provisions with valid provisions the economic effect of which comes as close as possible to that of the invalid, illegal or unenforceable provisions. 
 SECTION 8.07. Governing Law; Jurisdiction; Consent to Service of Process. 

(a) This Agreement shall be construed in accordance with and governed by the law of the State of New York. 

(b) Each party hereto irrevocably and unconditionally submits, for itself and its property, to the exclusive jurisdiction of the Supreme
Court of the State of New York sitting in the Borough of Manhattan, New York County and of the United States District Court of the Southern District of New York sitting in the Borough of Manhattan, and any appellate court from any thereof, in any
action or proceeding arising out of or relating to this Agreement, or for recognition or enforcement of any judgment, and each of the parties hereto hereby irrevocably and unconditionally agrees that all claims in respect of any such action or
proceeding may be heard and determined in such New York State or, to the extent permitted by law, in such Federal court. Each party hereto agrees that a final judgment in any such action or proceeding shall be conclusive and may be enforced in other
jurisdictions by suit on the judgment or in any other manner provided by law. Nothing in this Agreement shall affect any right that any party hereto or any Secured Party may otherwise have to bring any action or proceeding relating to this Agreement
against any party hereto or its properties in the courts of any jurisdiction. 
 (c) Each party hereto irrevocably and
unconditionally waives, to the fullest extent it may legally and effectively do so, any objection which it may now or hereafter have to the laying of venue of any suit, action or proceeding arising out of or relating to this Agreement in any court
referred to in paragraph (b) of this Section. Each party hereto irrevocably waives, to the fullest extent permitted by law, the defense of an inconvenient forum to the maintenance of such action or proceeding in any such court. 

  
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 (d) Each party hereto
irrevocably consents to service of process in the manner provided for notices in Section 8.01, such service to be effective upon receipt. Nothing in this Agreement will affect the right of any party hereto or any Secured Party to serve process
in any other manner permitted by law. 
 SECTION 8.08. WAIVER OF JURY TRIAL. EACH PARTY HERETO WAIVES, TO THE FULLEST
EXTENT PERMITTED BY APPLICABLE LAW, ANY RIGHT IT MAY HAVE TO A TRIAL BY JURY IN ANY LEGAL PROCEEDING DIRECTLY OR INDIRECTLY ARISING OUT OF OR RELATING TO THIS AGREEMENT (WHETHER BASED ON CONTRACT, TORT OR ANY OTHER THEORY). EACH PARTY HERETO
(A) CERTIFIES THAT NO REPRESENTATIVE, AGENT OR ATTORNEY OF ANY OTHER PARTY HERETO HAS REPRESENTED, EXPRESSLY OR OTHERWISE, THAT SUCH OTHER PARTY WOULD NOT, IN THE EVENT OF LITIGATION, SEEK TO ENFORCE THE FOREGOING WAIVER AND
(B) ACKNOWLEDGES THAT IT AND THE OTHER PARTIES HERETO HAVE BEEN INDUCED TO ENTER INTO THIS AGREEMENT BY, AMONG OTHER THINGS, THE MUTUAL WAIVERS AND CERTIFICATIONS IN THIS SECTION. 

SECTION 8.09. Headings. Article and Section headings used herein are for convenience of reference only, are not part of this
Agreement and are not to affect the construction of, or to be taken into consideration in interpreting, this Agreement. 

SECTION 8.10. Conflicts. In the event of any conflict or inconsistency between the provisions of this Agreement and the provisions
of any other Secured Credit Documents, the provisions of this Agreement shall control. 
 SECTION 8.11. Provisions Solely to
Define Relative Rights. The provisions of this Agreement are and are intended solely for the purpose of defining the relative rights of the Secured Parties in relation to one another. Except as expressly provided in this Agreement, none of the
Borrower, any other Grantor, any other Subsidiary or any other creditor of any of the foregoing shall have any rights or obligations hereunder, and none of the Borrower, any other Grantor or any other Subsidiary may rely on the terms hereof. Nothing
in this Agreement is intended to or shall impair the obligations of the Borrower or any other Grantor, which are absolute and unconditional, to pay the First Lien Obligations as and when the same shall become due and payable in accordance with their
terms. For the avoidance of doubt, nothing contained herein shall be construed to constitute a waiver or an amendment of any covenant of the Borrower or any other Grantor contained in any Secured Credit Document, which restricts the incurrence of
any Indebtedness or the grant of any Lien. 
 SECTION 8.12. Additional Grantors. In the event any Subsidiary shall have
granted a Lien on any of its assets to secure any First Lien Obligations, the Borrower shall cause such Subsidiary, if not already a party hereto, to become a party hereto as a “Grantor”. Upon the execution and delivery by any Subsidiary
of a Grantor Joinder Agreement, any such Subsidiary shall become a party hereto and a Grantor hereunder with the same force and effect as if originally named as such herein. The execution and delivery of any such instrument shall not require the
consent of any other party hereto. The rights and obligations of each party hereto shall remain in full force and effect notwithstanding the addition of any new Grantor as a party to this Agreement. 

  
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 SECTION 8.13.
Specific Performance. Each Collateral Agent, on behalf of itself and its Related Secured Parties, may demand specific performance of this Agreement. Each Collateral Agent, on behalf of itself and its Related Secured Parties, hereby
irrevocably waives any defense based on the adequacy of a remedy at law and any other defense that might be asserted to bar the remedy of specific performance in any action which may be brought by the Secured Parties. 

SECTION 8.14. Integration. This Agreement, together with the other Secured Credit Documents, represents the agreement of each of
the Grantors and the Secured Parties with respect to the subject matter hereof and there are no promises, undertakings, representations or warranties by any Grantor, any Collateral Agent or any other Secured Party relative to the subject matter
hereof not expressly set forth or referred to herein or in the other Secured Credit Documents. 
 [signature page follows]


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

 

					
	C.P. ATLAS ACQUISITION CORP.
	(which on the Closing Date shall be merged with and into AMERICAN RENAL HOLDINGS INC. with AMERICAN RENAL HOLDINGS INC. surviving such merger as the
Borrower)
		
	By:	 	 /s/ Jared S. Hendricks

		 	Name:	 	Jared S. Hendricks
		 	Title:	 	Vice President
	
	C.P. ATLAS INTERMEDIATE HOLDINGS, LLC
		
	By:	 	 /s/ Jared S. Hendricks

		 	Name:	 	Jared S. Hendricks
		 	Title:	 	Co-President
	
	AMERICAN RENAL ASSOCIATES LLC
		
	By:	 	AMERICAN RENAL HOLDINGS INC.
		
	By:	 	 /s/ Joseph A. Carlucci

		 	Name:	 	Joseph A. Carlucci
		 	Title:	 	Chief Executive Officer
	
	 AMERICAN RENAL MANAGEMENT LLC

AKC HOLDING LLC
 JKC HOLDING LLC
 ARA-BOCA RATON HOLDING LLC

ARA-OHIO HOLDINGS LLC

ARA-RHODE ISLAND DIALYSIS II LLC

TEXAS-ARA LLC
 ACUTE DIALYSIS SERVICES-ARA LLC

		
	 By:
	 	 AMERICAN RENAL ASSOCIATES LLC

		
	 By:
	 	 /s/ Joseph A. Carlucci

		 	Name:	 	Joseph A. Carlucci
		 	Title:	 	Chief Executive Officer









  
 
					
	 AMERICAN RENAL TEXAS L.P.
 AMERICAN RENAL TEXAS II, L.P.

		
	By:	 	TEXAS-ARA LLC
		
	By:	 	 /s/ Joseph A. Carlucci

		 	Name:	 	Joseph A. Carlucci
		 	Title:	 	Chief Executive Officer
	
	 BANK OF AMERICA, N.A., as
 Credit Agreement Administrative Agent

		
	By:	 	 /s/ Mollie S. Canup

		 	Name:	 	Mollie S. Canup
		 	Title:	 	Vice President
	
	 WILMINGTON TRUST FSB,
 as Senior Secured Notes Collateral Agent

		
	By:	 	 /s/ Jane Schweiger

		 	Name:	 	Jane Schweiger
		 	Title:	 	Vice President