EX-10.21


 Exhibit 10.21 

FOURTH AMENDMENT TO LOAN AGREEMENT 

THIS FOURTH AMENDMENT TO LOAN AGREEMENT (this “Amendment”) is effective as of July 5, 2015, among Southern Health
Corporation of Houston, Inc., a Georgia corporation (“Borrower”), Crown Healthcare Investments, LLC, a Georgia limited liability company (f/k/a MedCare South, LLC) (“Crown”), SunLink Health Systems, Inc., an Ohio
corporation (“SunLink” and, together with Crown, “Guarantors”) and Bank SNB (successor by conversion to Bank SNB, National Association) (“Lender”). 

PRELIMINARY STATEMENTS 

A. Borrower and Lender are parties to the Working Capital Loan Agreement, dated July 5, 2012 (as amended from time to time, the
“Loan Agreement”). 
 B. Capitalized terms used in this Amendment have the meanings given to them in the Loan Agreement.

 C. Borrower has requested that Lender amend the Loan Agreement as more particularly described in this Amendment. 

D. Lender has agreed to such amendment, subject to the satisfaction of certain conditions, all as more particularly described in this
Amendment. 
 E. Each of the Guarantors is party to a Guaranty Agreement, dated the date of the Loan Agreement (each, a “Guaranty
Agreement”), pursuant to which such Guarantor has guaranteed the obligations of Borrower under the Loan Agreement. 
 F. Each of
the Guarantors desires to ratify and reaffirm the Guaranty Agreement to which it is a party. 
 AGREEMENT 

NOW, THEREFORE, in consideration of the premises and the mutual covenants contained herein, and for other good and valuable consideration, the
receipt and sufficiency of which is hereby acknowledged, the parties hereto, intending to be legally bound, hereby agree as follows. 
 1.
Amendment to Loan Agreement. Subject to the terms and conditions of this Amendment, Section 2.3 of the Loan Agreement is hereby amended by deleting the reference to “July 5, 2015” and replacing it with a reference to “July
5, 2016.” 
 2. Conditions Precedent. 

a. Representations and Warranties. Each of the representations and warranties of Borrower and the Guarantors in the Loan
Documents shall be true and correct as of the date of this Amendment except for any representation or warranty made as of a date certain, in which event such representation or warranty shall be true as of such date. 






 b. Documents. Lender shall have received (i) this Amendment, duly
executed by the parties hereto, (ii) the duly executed Second Amended and Restated Promissory Note, and (iii) any other document, certificate or instrument that Lender reasonably requires in connection herewith. 

3. Ratification and Release. 

a. Confirmation and Ratification. Borrower and Guarantors confirm and agree that each pledge, assignment, security
interest, lien or other encumbrance made by Borrower and Guarantors in favor of Lender under any Loan Document is hereby ratified and confirmed in all respects. Borrower and each Guarantor each acknowledges and confirms the validity and
enforceability of all Loan Documents to which it is a party. Borrower and each Guarantor represents and warrants to Lender that such party has no right of offset, defense or counterclaim to the payment or performance of the Loans or any of its other
obligations under any of the Loan Documents to which it is a party. 
 b. Release. In consideration of the
accommodations granted by Lender in this Amendment, each Borrower and Guarantor hereby forever waives, releases and discharges Lender and its successors, assigns, directors, officers, members, managers, employees, agents, attorneys and other
representatives (the “Lender Parties”), and indemnifies and holds harmless Lender and the Lender Parties from, any and all claims (including, without limitation, cross-claims, counterclaims, rights of setoff and recoupment), causes
of action, demands, suits, costs, expenses and damages that it now has or hereafter may have, of whatsoever nature and kind, whether known or unknown, whether now existing or hereafter arising, whether arising at law or in equity, including all
actions that arise under or relate to the Loan Documents, this Amendment, any document, instrument or certificate executed in connection with the foregoing, any action or omission of Lender or any of the Lender Parties in connection with the
foregoing, or any person’s rights or obligations thereunder based in whole or in part on facts, whether or not known, existing on or prior to the date of this Amendment. Borrower acknowledges and agrees that all actions of Lender with respect
to the Loan Documents and the transactions contemplated thereby on or prior to the date of this Amendment have been in good faith and in accordance with the Loan Documents and applicable law. 

4. Representations and Warranties. The Borrower and Guarantors, jointly and severally, represent and warrant to Lender as follows: 

a. This Amendment is not being made or entered into with the actual intent to hinder, delay or defraud any entity or person.

 b. No action or proceeding, including, without limitation, a voluntary or involuntary petition for bankruptcy, has been
instituted by or against Borrower or either Guarantor. 






 c. Borrower and each Guarantor each has full power and authority to enter into,
execute, deliver, and perform this Amendment, and the foregoing does not violate any contractual or other obligation by which such person is bound. The execution, delivery and performance of this Amendment have been authorized by all requisite
organizational action of each such person. 
 d. This Amendment constitutes the valid and legally binding obligation of
Borrower and each Guarantor, enforceable in accordance with its terms, subject to the effects of bankruptcy, insolvency, fraudulent conveyance and other laws affecting creditors’ rights generally and to general equitable principles. 

e. The representations and warranties of Borrower and each Guarantor in the Loan Agreement and the other Loan Documents are
true and correct as of the date hereof, except to the extent that such representations and warranties expressly relate to an earlier date, in which case such representations and warranties were true and correct as of such date. 

5. Miscellaneous. 

a. Effect on Loan Documents. Except as set forth in this Amendment, the Loan Agreement and the Loan Documents shall not
be deemed amended, waived or otherwise modified by this agreement and shall remain in full force and effect. 
 b. Fees
and Expenses. Borrower shall pay, as and when billed by Lender, all fees, costs, and expenses (including, without limitation, fees and expenses for Lender’s legal counsel, and for appraisers, engineering consultants, and environmental and
other consultants) paid or incurred by Lender in connection with the negotiation of this Amendment, or in connection with the actions contemplated by this Amendment. 

c. Voluntary Agreement. Borrower and each Guarantor jointly and severally represent and warrant to Lender that
(a) Borrower and each Guarantor has had the opportunity to be represented by legal counsel of their choice and to consult with such counsel regarding this Amendment, (b) Borrower and each Guarantor are fully aware of the terms and
provisions contained herein and of their effect, and (c) Borrower and each Guarantor have voluntarily and without coercion or duress of any kind entered into this Amendment. 

d. Integration. This Amendment constitutes the entire agreement concerning the subject matter hereof, and it supersedes
any prior or contemporaneous oral or written representations, statements, understandings, or agreements concerning the subject matter of this Amendment. 

e. Successors and Assigns. This Amendment shall be binding upon and inure to the benefit of the parties hereto and their
respective successors and assigns. 
 f. Governing Law. This Amendment shall be governed by and construed in
accordance with the laws of the State of Oklahoma, without giving effect to the principles of conflicts of law. 






 g. Headings. All headings in this Amendment are for convenience only and
shall not be used to interpret any term or provision of this Amendment. 
 h. Counterparts. This Amendment may be
executed in one or more counterparts, each of which shall constitute an original and all of which taken together shall constitute one agreement. The parties hereto agree that their electronically transmitted signatures on this Amendment shall have
the same effect as manually transmitted signatures. 
 i. WAIVER OF JURY TRIAL. EACH PARTY HERETO HEREBY KNOWINGLY,
VOLUNTARILY, AND INTENTIONALLY WAIVES ANY RIGHT THAT IT MAY HAVE TO A TRIAL BY JURY IN ANY ACTION OR PROCEEDING TO ENFORCE OR DEFEND ANY RIGHTS UNDER OR RELATING TO THIS AMENDMENT, ANY LOAN DOCUMENTS OR ANY AMENDMENT, INSTRUMENT, DOCUMENT, OR
AGREEMENT DELIVERED OR THAT MAY IN THE FUTURE BE DELIVERED IN CONNECTION HEREWITH OR THEREWITH OR ARISING FROM ANY COURSE OF CONDUCT, COURSE OF DEALING, STATEMENTS (WHETHER VERBAL OR WRITTEN), ACTIONS OF ANY OF THE PARTIES HERETO, OR ANY OTHER
RELATIONSHIP EXISTING IN CONNECTION WITH THIS AMENDMENT OR ANY LOAN DOCUMENTS, AND AGREES THAT ANY SUCH ACTION OR PROCEEDING SHALL BE TRIED BEFORE A COURT AND NOT BEFORE A JURY. EACH PARTY HERETO ACKNOWLEDGES THAT IT HAS BEEN, OR HAS HAD THE
OPPORTUNITY TO BE, REPRESENTED IN THE SIGNING OF THIS AMENDMENT AND IN THE MAKING OF THIS WAIVER BY INDEPENDENT LEGAL COUNSEL SELECTED OF ITS OWN FREE WILL, AND THAT IT HAS DISCUSSED THIS WAIVER WITH SUCH LEGAL COUNSEL. EACH PARTY HERETO FURTHER
ACKNOWLEDGES THAT IT HAS READ AND UNDERSTANDS THE MEANING OF THIS WAIVER. 






 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be duly executed and
delivered as of the date first written above. 
  

					
	BORROWER:	 	 SOUTHERN HEALTH CORPORATION OF

HOUSTON, INC.

			
		 	By:	  	 
		 	Name:	  	 
		 	Title:	  	 
		
	GUARANTORS:	 	CROWN HEALTHCARE INVESTMENTS, LLC
			
		 	By:	  	 
		 	Name:	  	 
		 	Title:	  	 
		
		 	SUNLINK HEALTH SYSTEMS, INC.
			
		 	By:	  	 
		 	Name:	  	 
		 	Title:	  	 
		
	LENDER:	 	BANK SNB
			
		 	By:	  	 
		 	Name:	  	 
		 	Title: