EX-10.1



 Exhibit 10.1 

FIRST LIEN INCREMENTAL AMENDMENT 

This FIRST LIEN INCREMENTAL AMENDMENT (this “Amendment”), dated as of October 7, 2015, by and among Surgery Center
Holdings, Inc., a Delaware corporation (the “Borrower”), SP Holdco I, Inc. (“Holdings”), the other Guarantors party hereto, the Lenders party hereto (the “Incremental Lenders”), Jefferies Finance
LLC, as administrative agent for the Lenders (in such capacity, the “Administrative Agent”) and as collateral agent for the Secured Parties (in such capacity, the “Collateral Agent” or, as Administrative Agent or
Collateral Agent, “Agent”), and Jefferies Finance LLC, as Issuing Bank. 

W I T N E S S E T H: 

WHEREAS, the Borrower, Holdings, Guarantors, Lenders and Agent, among others, are parties to that certain First Lien Credit Agreement,
dated as of November 3, 2014 (as the same may be amended, restated, amended and restated, supplemented or otherwise modified from time to time, the “Credit Agreement”); 

WHEREAS, pursuant to Section 2.19 of the Credit Agreement, the Borrower has requested a Revolving Commitment Increase in an
aggregate amount of $70,000,000; 
 WHEREAS, each Incremental Lender has agreed to provide Incremental Revolving Commitments in the
amount set forth opposite such Incremental Lender’s name on Exhibit A attached hereto, and such Incremental Revolving Commitments shall be on terms and conditions identical to the Revolving Commitments made on the Closing Date (except as
such terms and conditions are amended or modified by this Amendment); and 
 WHEREAS, Agent and the Incremental Lenders are willing,
on the terms and subject to the conditions set forth below, to enter into the amendments, modifications and agreements set forth in this Amendment. 

NOW, THEREFORE, in consideration of the premises and the mutual agreements herein contained and other good and valuable consideration,
the sufficiency and receipt of which are hereby acknowledged, the parties hereto, intending to be legally bound hereby, agree as follows: 

1. Defined Terms. Unless otherwise defined herein, capitalized terms used herein shall have the respective meanings ascribed thereto in
the Credit Agreement (as amended hereby). 
 2. Amendments. Subject to the satisfaction of the conditions precedent set forth in
Section 7 below, the Borrower, Holdings, the Incremental Lenders and Agent hereby agree as follows: 
 a)
Section 1.01 of the Credit Agreement is hereby amended by amending and restating the definition of “Revolving Commitment” in its entirety to read as follows: 

“Revolving Commitment” shall mean, with respect to each Lender, the commitment, if any, of such Lender to make
Revolving Loans hereunder up to the 







 
amount set forth on Schedule 2.01 under the caption “Revolving Loan Commitment” or in the Assignment and Acceptance or Refinancing Amendment pursuant to which such Lender assumed its
Revolving Commitment, as applicable, as the same may be (a) reduced from time to time pursuant to Section 2.09 and (b) reduced or increased from time to time pursuant to (i) assignments by or to such Lender pursuant to an
Assignment and Acceptance, (ii) a Refinancing Amendment, (iii) an Extension Amendment or (iv) an Incremental Amendment. The aggregate principal amount of the Lenders’ Revolving Commitments on the Closing Date is $80,000,000. The
aggregate principal amount of the Lenders’ Revolving Commitments on the First Incremental Amendment Date is $150,000,000. 

b) Section 1.01 of the Credit Agreement is hereby amended by adding the following defined term in correct alphabetical
order: 
 “First Incremental Amendment Date” shall mean October 7, 2015. 

c) Schedule 2.01 of the Credit Agreement is hereby amended by amending and restating the table under the heading
“Revolving Loan Commitment” in its entirety to read as follows: 
  

					
	 Lender
	  	Commitment	 
	 Jefferies Finance LLC
	  	$	30,000,000.00	  
	 Jefferies Group LLC
	  	$	42,600,000.00	  
	 KKR Asset Management
	  	$	20,000,000.00	  
	 Bank of America, N.A.
	  	$	16,800,000.00	  
	 Goldman Sachs Bank USA
	  	$	12,600,000.00	  
	 Citibank, N.A.
	  	$	5,600,000.00	  
	 Credit Suisse AG, Cayman Islands Branch
	  	$	5,600,000.00	  
	 Morgan Stanley Senior Funding, Inc.
	  	$	5,600,000.00	  
	 Raymond James Bank, N.A.
	  	$	4,200,000.00	  
	 Royal Bank of Canada
	  	$	3,500,000.00	  
	 Stifel Financial Corp.
	  	$	3,500,000.00	  
		  	  
	  
	 
	 Total:
	  	$	150,000,000.00	  
		  	  
	  
	 


  
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 3. Revolving Loans. From and after the Effective Date (as defined below), the Incremental
Revolving Commitments made pursuant to this Amendment shall for all purposes of the Loan Documents be deemed to be “Revolving Commitments.” From and after the Effective Date, any loans extended utilizing the Incremental Revolving
Commitments made pursuant to this Amendment shall be designated as, and for all purposes of the Loan Documents shall be deemed to be, “Revolving Loans” and “Loans”. The Incremental Revolving Commitments (including any Revolving
Loans extended utilizing the Incremental Revolving Commitments) shall have terms and provisions (and be subject to documentation) (including with respect to security interests and guarantees, but excluding upfront fees, original issue discount or
similar fees) that are identical to those of the existing Revolving Commitments (including any Revolving Loans extended utilizing the existing Revolving Commitments) prior to giving effect to this Amendment. 

4. Joinder. Each Incremental Lender acknowledges and agrees that, from and after the Effective Date, such Incremental Lender commits to
provide its Incremental Revolving Commitment, as set forth on Exhibit A annexed hereto on the terms and subject to the conditions set forth herein, shall be a “Revolving Lender” and “Lender” under, and for all purposes of,
the Credit Agreement and the other Loan Documents, and shall be subject to and bound by the terms thereof, and shall perform all the obligations of and shall have all the rights of a Lender thereunder. 

5. Reallocation. On the Effective Date, each of the Revolving Lenders holding Revolving Commitments immediately prior to the Revolving
Commitment Increase given effect pursuant to this Amendment is hereby deemed to assign to each of the Incremental Lenders pursuant to Section 10.04 of the Credit Agreement notwithstanding that no Assignment and Acceptance will be executed and
delivered to the Agent, and each of the Incremental Lenders is hereby deemed to purchase from each of the Revolving Lenders holding Revolving Commitments immediately prior to such Revolving Commitment Increase, at the principal amount thereof, such
interests in the Revolving Loans outstanding on the Effective Date as shall be necessary in order that, after giving effect to all such assignments and purchases, such Revolving Loans are held by the Revolving Lenders ratably in accordance with
their Revolving Commitments after giving effect to the addition of such Incremental Revolving Commitments to the Revolving Commitments. 

6. Representations and Warranties. In order to induce the other parties hereto to enter into this Amendment in the manner provided
herein, each of Holdings, the Borrower and each Guarantor represents and warrants to the other parties hereto that the following statements are true and correct in all material respects (provided that any representation and warranty that is
qualified by “materiality,” “material adverse effect” or similar language shall be true and correct in all respects (after giving effect to any such qualification therein)): 

a) each of the representations and warranties contained in Article 5 of the Credit Agreement and in each other Loan Document
are true and correct in all material respects (provided that any representation and warranty that is qualified by “materiality,” “material adverse effect” or similar language is true and correct in all respects (after giving
effect to any such qualification therein)) on and as of the Effective Date (as defined below) with the same effect as though made on and as of the Effective Date, 

  
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except to the extent such representations and warranties expressly relate to an earlier date (in which case such representations and warranties are true and correct in all material respects (or
if any such representation and warranty is qualified by “materiality,” “material adverse effect” or similar language, such representation and warranty is true and correct in all respects (after giving effect to any such
qualification therein)) on and as of such earlier date); and 
 b) as of the date hereof and immediately after giving effect
to this Amendment, no Default or Event of Default has occurred and is continuing. 
 7. Conditions to Effectiveness. The
effectiveness of this Amendment is subject to the satisfaction of the following conditions (the time at which all such conditions are so satisfied is referred to herein as the “Effective Date”): 

a) the Agent shall have received a certificate executed by a Responsible Officer of the Borrower, certifying that as of the
Effective Date, (i) each of the representations and warranties made by the Loan Parties set forth in this Amendment, in Article 5 of the Credit Agreement and in all other Loan Documents shall be true and correct in all material respects
(provided that any representation and warranty that is qualified by “materiality,” “material adverse effect” or similar language shall be true and correct in all respects (after giving effect to any such qualification therein))
on and as of the Effective Date with the same effect as though made on and as of the Effective Date, except to the extent such representations and warranties expressly relate to an earlier date (in which case such representations and warranties
shall be true and correct in all material respects (or if any such representation and warranty is qualified by “materiality,” “material adverse effect” or similar language, shall be true and correct in all respects (after giving
effect to any such qualification therein)) on and as of such earlier date); (ii) no Default exists or would result from the incurrence of the Incremental Revolving Commitments contemplated by this Amendment and (iii) this Amendment is
effected in accordance with the terms of Section 2.19 of the Credit Agreement; 
 b) Holdings and the Borrower shall
have paid to the Agent (i) all applicable fees and other amounts due and payable on or prior to the Effective Date and (ii) all costs and expenses due and payable under Section 12 of this Amendment; 

c) the Agent shall have received, on behalf of itself, the Collateral Agent and the Incremental Lenders, an opinion of
(i) Ropes & Gray LLP, counsel for the Loan Parties, and (ii) each local counsel for the Loan Parties listed on Schedule 4.02(d) to the Credit Agreement, in each case, dated the Effective Date and addressed to the Agent, the
Collateral Agent, each Issuing Bank and the Incremental Lenders substantially in the form previously provided to the Agent; 

d) the Agent shall have received (i) a certificate as to the good standing of each Loan Party as of a recent date;
(ii) a certificate of the Secretary or Assistant Secretary of each Loan Party dated the Effective Date and certifying (A) that attached thereto is a copy of the certificate or articles of incorporation or organization or certificate of
formation, including all amendments thereto, of each Loan Party, certified as of a 

  
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recent date by the Secretary of State of the state of its organization, or in the alternative, certifying that such certificate or articles of incorporation or organization or certificate of
formation has not been amended since the Closing Date, (B) that attached thereto is a true and complete copy of the by-laws or operating (or limited liability company) agreement of such Loan Party as in effect on the Effective Date and at all
times since a date prior to the date of the resolutions described in clause (C) below (or that the by-laws or operating (or limited liability company) agreement of such Loan Party has not been amended or otherwise modified since the delivery of
such documents on the Closing Date), (C) that attached thereto is a true and complete copy of resolutions duly adopted by the board of directors (or equivalent governing body) of such Loan Party authorizing the execution, delivery and
performance of the Amendment and, in the case of the Borrower, the borrowings and/or incurrence of the Incremental Revolving Commitments hereunder, and that such resolutions have not been modified, rescinded or amended and are in full force and
effect and (D) as to the incumbency and specimen signature of each officer executing any Loan Document or any other document delivered in connection herewith on behalf of such Loan Party; and (iii) a certificate of another officer as to
the incumbency and specimen signature of the Secretary or Assistant Secretary executing the certificate pursuant to clause (ii) above; 

e) the Agent shall have received counterparts of this Amendment duly executed by Holdings, the Borrower, each other Guarantor,
the Administrative Agent, the Collateral Agent, each Issuing Bank and the Incremental Lenders; 
 f) the Agent shall have
received a Note executed by the Borrower in favor of each Incremental Lender that has requested a Note at least three Business Days in advance of the Effective Date; 

g) the Agent shall have received a solvency certificate, substantially in the form set forth in Exhibit H to the Credit
Agreement, from the chief financial officer or other officer with equivalent duties of Holdings, or in lieu thereof at the option of the Borrower, an opinion of a nationally recognized valuation firm as to the solvency (on a consolidated basis) of
Holdings and its respective Subsidiaries as of the Effective Date 
 h) the Agent shall have received, at least three days
prior to the Effective Date, all documentation and other information about the Borrower and the Guarantors required under applicable “know your customer” and anti-money laundering rules and regulations, including the USA PATRIOT Act, that
has been reasonably requested in writing at least five days prior to the Effective Date; and 
 i) the Agent shall have
received evidence reasonably satisfactory to it that (i) a Qualified IPO has been completed on or prior to October 31, 2015, (ii) the Loan Parties have received no less than $271,415,000 in gross cash proceeds therefrom and
(iii) the Loan Parties have used all of the net proceeds of such Qualified IPO to prepay a portion of the Second Lien Term Loans, pay any call premium applicable thereto and to pay fees and expenses associated with such Qualified IPO. 

  
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 8. Acknowledgement. 

a) The Borrower and each Guarantor hereby confirm that each Loan Document to which it is a party or otherwise bound and all
Collateral encumbered thereby will continue to guarantee or secure, as the case may be, to the fullest extent possible in accordance with the Loan Documents the payment and performance of all Obligations and Secured Obligations under each of the
Loan Documents to which it is a party (in each case as such terms are defined in the applicable Loan Document). 
 b) The
Borrower and each Guarantor acknowledge and agree that any of the Loan Documents to which it is a party or otherwise bound shall continue in full force and effect and that all of its obligations thereunder shall be valid and enforceable and shall
not be impaired or limited by the execution or effectiveness of this Amendment. 
 c) Each of the Borrower and each Guarantor
hereby acknowledges that it has reviewed the terms and provisions of this Amendment and consents to the amendment of the Credit Agreement effected pursuant to this Amendment (including the Incremental Revolving Commitments made by the Incremental
Lenders) and acknowledges and agrees that the Incremental Lenders (and any assignee thereof) is a “Lender” and a “Secured Party” for all purposes under the Loan Documents to which the Borrower or such Guarantor is a party. 

d) Each Guarantor acknowledges and agrees that (i) notwithstanding the conditions to effectiveness set forth in this
Amendment, such Guarantor is not required by the terms of the Credit Agreement or any other Loan Document to consent to the amendments to the Credit Agreement effected pursuant to this Amendment and (ii) nothing in the Credit Agreement, this
Amendment or any other Loan Document shall be deemed to require the consent of such Guarantor to any future amendments to the Credit Agreement. 

e) The parties hereto agree and acknowledge that, for all purposes under the Credit Agreement and the other Loan Documents,
this Amendment constitutes an Incremental Amendment contemplated by Section 2.19 of the Credit Agreement. 
 9. GOVERNING LAW AND
WAIVER OF JURY TRIAL. 
 a) THIS AMENDMENT AND ANY CLAIMS, CONTROVERSY, DISPUTE OR CAUSE OF ACTION (WHETHER SOUNDING IN
CONTRACT, TORT OR OTHERWISE) BASED UPON, ARISING OUT OF OR RELATING TO THIS AMENDMENT AND THE TRANSACTIONS CONTEMPLATED HEREBY SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK WITHOUT GIVING EFFECT TO ANY
CHOICE OF LAW PRINCIPLES THAT WOULD APPLY THE LAWS OF ANOTHER JURISDICTION. 
 b) EACH PARTY HERETO HEREBY 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 

  
 6 








 
ARISING OUT OF OR RELATING TO THIS AMENDMENT AND THE TRANSACTIONS CONTEMPLATED HEREBY (WHETHER BASED ON CONTRACT, TORT OR OTHERWISE). EACH PARTY HERETO (A) CERTIFIES THAT NO REPRESENTATIVE,
AGENT OR ATTORNEY OF ANY OTHER PARTY 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 AMENDMENT, BY, AMONG OTHER THINGS, THE MUTUAL WAIVERS AND CERTIFICATIONS IN THIS SECTION 9(B). 
 10.
Counterparts. This Amendment may be executed in counterparts (and by different parties hereto on different counterparts), each of which shall constitute an original, but all of which when taken together shall constitute a single contract.
Delivery of an executed counterpart of a signature page to this Amendment by facsimile or other electronic imaging transmission shall be as effective as delivery of a manually executed counterpart of this Amendment. 

11. Reference to and Limited Effect on the Credit Agreement and the Other Loan Documents. 

a) On and after the Effective Date, (x) each reference in the Credit Agreement to “this Agreement”,
“hereunder”, “hereof”, “herein” or words of like import referring to the Credit Agreement, and (B) each reference in the other Loan Documents to the “Credit Agreement”, “thereunder”,
“thereof”, “therein” or words of like import referring to the Credit Agreement shall mean and be a reference to the Credit Agreement after giving effect to this Amendment. 

b) Except as specifically amended by this Amendment, the Credit Agreement and each of the other Loan Documents shall remain in
full force and effect and are hereby ratified and confirmed. 
 c) The execution, delivery and performance of this Amendment
shall not constitute a waiver of any provision of, or operate as a waiver of any right, power or remedy of the Agent or Lender under, the Credit Agreement or any of the other Loan Documents. 

d) Each of Holdings, the Borrower and each other Guarantor hereby (i) ratifies, confirms and reaffirms its liabilities,
its payment and performance obligations (contingent or otherwise) and its agreements under the Credit Agreement and the other Loan Documents and (ii) acknowledges, ratifies and confirms that such liabilities, obligations and agreements
constitute valid and existing Obligations under the Credit Agreement, in each case, to the extent Holdings, the Borrower or such Guarantor, as applicable, is a party thereto. In addition, each of Holdings, the Borrower and each Guarantor hereby
ratifies, confirms and reaffirms (i) the liens and security interests granted, created and perfected under the Collateral Documents and any other Loan Documents and (ii) that each of the Collateral Documents to which it is a party remain
in 

  
 7 








 
full force and effect notwithstanding the effectiveness of this Amendment. Without limiting the generality of the foregoing, each of Holdings, the Borrower and each other Guarantor further agrees
(A) that any reference to “Obligations” contained in any Collateral Documents shall include, without limitation, the “Obligations” as such term is defined in the Credit Agreement (as amended by this Amendment) and
(B) that the related guarantees and grants of security contained in such Collateral Documents shall include and extend to such Obligations. This Amendment shall not constitute a modification of the Credit Agreement, except as specified under
Section 2 hereto, or a course of dealing with Agent or any Lender at variance with the Credit Agreement such as to require further notice by Agent or any Lender to require strict compliance with the terms of the Credit Agreement and the other
Loan Documents in the future, except as expressly set forth herein. This Amendment contains the entire agreement among Holdings, the Borrower, the other Guarantors, each Issuing Bank and Incremental Lenders contemplated by this Amendment. Neither
Holdings nor the Borrower nor any other Guarantor has any knowledge of any challenge to Agent’s or any Lender’s claims arising under the Loan Documents or the effectiveness of the Loan Documents. Agent and Lenders reserve all rights,
privileges and remedies under the Loan Documents. Nothing in this Amendment is intended, or shall be construed, to constitute a novation or an accord and satisfaction of any of the Obligations or to modify, affect or impair the perfection, priority
or continuation of the security interests in, security titles to or other Liens on any Collateral for the Obligations. 
 12.
Expenses. The Borrower and Holdings agree, jointly and severally, to pay on demand all reasonable out-of-pocket costs and expenses incurred in connection with the preparation, negotiation and execution of this Amendment, including, without
limitation, all Attorney Costs. 
 13. Severability. In the event any one or more of the provisions contained in this Amendment
should be held invalid, illegal or unenforceable in any respect, the validity, legality and enforceability of the remaining provisions contained herein and therein shall not in any way be affected or impaired thereby (it being understood that the
invalidity of a particular provision in a particular jurisdiction shall not in and of itself affect the validity of 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. 

14. Headings. Section headings used herein are for convenience of reference only, are not part of this Amendment and shall not affect
the construction of, or to be taken into consideration in interpreting, this Amendment. 
 15. Conflicts. In the event of any
conflict between the terms of this Amendment and the terms of the Credit Agreement or any of the other Loan Documents, the terms of this Amendment shall govern. 

[SIGNATURE PAGES FOLLOW] 

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

			
	SURGERY CENTER HOLDINGS, INC.,
	as Borrower
		
	By:	 	 /s/ Michael T. Doyle

	Name:	 	Michael T. Doyle
	Title:	 	President and Chief Executive Officer
	
	SP HOLDCO I, INC.,
	as Holdings
		
	By:	 	 /s/ Michael T. Doyle

	Name:	 	Michael T. Doyle
	Title:	 	President and Chief Executive Officer



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 








 SUBSIDIARY GUARANTORS: 

 

			
	AMBULATORY RESOURCE CENTRES INVESTMENT COMPANY, LLC
	AMBULATORY RESOURCE CENTRES OF WASHINGTON, INC.
	AMBULATORY RESOURCE CENTRES OF WILMINGTON, INC.
	ANESTHESIOLOGY PROFESSIONAL SERVICES, INC.
	APS OF BRADENTON, LLC
	APS OF MERRITT ISLAND, LLC
	ARC DEVELOPMENT CORPORATION
	ARC FINANCIAL SERVICES CORPORATION
	ASC OF NEW ALBANY, LLC
	AUSTIN SURGICAL HOLDINGS, LLC
	BUSINESS IT SOLUTIONS OF TAMPA, INC.
	LOGAN LABORATORIES, LLC
	LUBBOCK SURGICENTER, INC.
	MEDICAL BILLING SOLUTIONS, LLC
	MIDWEST UNCUTS, INC.
	NEOSPINE SURGERY OF PUYALLUP, LLC
	NEOSPINE SURGERY, LLC
	NOVAMED ACQUISITION COMPANY, INC.
	NOVAMED ALLIANCE, INC.
	NOVAMED MANAGEMENT OF KANSAS CITY, INC.
	NOVAMED MANAGEMENT SERVICES, LLC
	NOVAMED OF BETHLEHEM, INC.
	NOVAMED OF DALLAS, INC.
	NOVAMED OF LEBANON, INC.
	NOVAMED OF SAN ANTONIO, INC.
	NOVAMED OF TEXAS, INC.
		
	By:	 	 /s/ Teresa F. Sparks

	Name:	 	Teresa F. Sparks
	Title:	 	Chief Financial Officer and Executive Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	NOVAMED OF WISCONSIN, INC.
	NOVAMED, INC.
	PATIENT EDUCATION CONCEPTS INC.
	PHYSICIANS SURGICAL CARE, INC.
	PSC DEVELOPMENT COMPANY, LLC
	PSC OPERATING COMPANY, LLC
	REHABILITATION MEDICAL GROUP, INC.
	SAINT THOMAS COMPOUNDING LLC
	SARASOTA ANESTHESIA SERVICES, LLC
	SARC/ASHEVILLE, INC.
	SARC/CIRCLEVILLE, INC.
	SARC/FT. MYERS, INC.
	SARC/GEORGIA, INC.
	SARC/JACKSONVILLE, INC.
	SARC/KENT, LLC
	SARC/LARGO ENDOSCOPY, INC.
	SARC/LARGO, INC.
	SARC/PROVIDENCE, LLC
	SARC/ST. CHARLES, INC.
	SARC/VINCENNES, INC.
	SMBI DOCS, LLC
	SMBI GREAT FALLS, LLC
	SMBI HAVERTOWN, LLC
	SMBI IDAHO, LLC
	SMBI JACKSON, LLC
	SMBI LHH, LLC
	SMBI PORTSMOUTH, LLC
	SMBI STLWSC, LLC
	SMBIMS BIRMINGHAM, INC.
	SMBIMS DURANGO, LLC
	SMBIMS FLORIDA I, LLC
		
	By:	 	 /s/ Teresa F. Sparks

	Name:	 	Teresa F. Sparks
	Title:	 	Chief Financial Officer and Executive Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	SMBIMS GREENVILLE, LLC
	SMBIMS KIRKWOOD, LLC
	SMBIMS ORANGE CITY, LLC
	SMBIMS STEUBENVILLE, INC.
	SMBIMS WICHITA, LLC
	SMBISS BEVERLY HILLS, LLC
	SMBISS CHESTERFIELD, LLC
	SMBISS ENCINO, LLC
	SMBISS IRVINE, LLC
	SMBISS THOUSAND OAKS, LLC
	SURGERY PARTNERS ACQUISITION COMPANY, INC.
	SURGERY PARTNERS OF CORAL GABLES, LLC
	SURGERY PARTNERS OF LAKE MARY, LLC
	SURGERY PARTNERS OF LAKE WORTH, LLC
	SURGERY PARTNERS OF MERRITT ISLAND, LLC
	SURGERY PARTNERS OF MILLENIA, LLC
	SURGERY PARTNERS OF NEW TAMPA, LLC
	SURGERY PARTNERS OF PARK PLACE, LLC
	SURGERY PARTNERS OF SARASOTA, LLC
	SURGERY PARTNERS OF SUNCOAST, LLC
	SURGERY PARTNERS OF WEST KENDALL, L.L.C.
	SURGERY PARTNERS OF WESTCHASE, LLC
	SURGERY PARTNERS, LLC
	SYMBION AMBULATORY RESOURCE CENTRES, INC.
	SYMBION ANESTHESIA SERVICES, LLC
	SYMBION HOLDINGS CORPORATION
	SYMBION, INC.
	  
 By:
	 	 /s/ Teresa F. Sparks

	Name:	 	Teresa F. Sparks
	Title:	 	Chief Financial Officer and Executive Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	SYMBIONARC MANAGEMENT SERVICES, INC.
	TAMPA PAIN RELIEF CENTER, INC.
	TEXARKANA SURGERY CENTER GP, INC.
	UNIPHY HEALTHCARE OF JOHNSON CITY VI, LLC
	UNIPHY HEALTHCARE OF MAINE I, INC.
	VASC, INC.
	VILLAGE SURGICENTER, INC.
	  
 By:
	 	 /s/ Teresa F. Sparks

	Name:	 	Teresa F. Sparks
	Title:	 	Chief Financial Officer and Executive Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	JEFFERIES FINANCE LLC,
	as Administrative Agent and Collateral Agent
	  
 By:
	 	 /s/ J. Paul McDonnell

	Name:	 	J. Paul McDonnell
	Title:	 	Managing Director



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	JEFFERIES FINANCE LLC,
	as Issuing Bank
	  
 By:
	 	 /s/ J. Paul McDonnell

	Name:	 	J. Paul McDonnell
	Title:	 	Managing Director



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









					
	JEFFERIES GROUP, LLC,
	as an Incremental Lender
		
	By:	 	 /s/ Mark Sahler

		 	Name:	 	Mark Sahler
		 	Title:	 	Managing Director



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









					
	BANK OF AMERICA, N.A.,
	as an Incremental Lender
		
	By:	 	 /s/ Justin Smiley

		 	Name:	 	Justin Smiley
		 	Title:	 	Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









					
	GOLDMAN SACHS BANK USA,
	as an Incremental Lender
		
	By:	 	 /s/ Rebecca Kratz

		 	Name:	 	Rebecca Kratz
		 	Title:	 	Authorized Signatory



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









					
	Citibank, N.A.,
	as an Incremental Lender
		
	By:	 	 /s/ Brian Rolli

		 	Name:	 	Brian Rolli
		 	Title:	 	Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	CREDIT SUISSE AG, Cayman Islands Branch,
	as an Incremental Lender
	  
 By:
	 	 /s/ Nupur Kumar

	Name:	 	Nupur Kumar
	Title:	 	Authorized Signatory
	  
 By:
	 	 /s/ Whitney Gaston

	Name:	 	Whitney Gaston
	Title:	 	Authorized Signatory



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	Morgan Stanley Senior Funding, Inc.,
	as an Incremental Lender
	  
 By:
	 	 /s/ Michael King

	Name:	 	Michael King
	Title:	 	Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









			
	RAYMOND JAMES BANK, N.A.,
	as an Incremental Lender
	  
 By:
	 	 /s/ Alexander L. Rody

	Name:	 	Alexander L. Rody
	Title:	 	Senior Vice President



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









					
	Royal Bank of Canada,
	as an Incremental Lender
		
	By:	 	 /s/ Steven T. Bachman

		 	Name:	 	Steven T. Bachman
		 	Title:	 	Authorized Signatory



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 









					
	Stifel Financial Corp.,
	as an Incremental Lender
		
	By:	 	 /s/ Jeffrey M. Jones

		 	Name:	 	Jeffrey M. Jones
		 	Title:	 	Managing Director



  
 [SIGNATURE PAGE TO
INCREMENTAL AMENDMENT] 








 Exhibit A 
  


					
	 Lender
	  	 Commitment
	 
	 Jefferies Group LLC
	  	$	12,600,000.00	  
	 Bank of America, N.A.
	  	$	16,800,000.00	  
	 Goldman Sachs Bank USA
	  	$	12,600,000.00	  
	 Citibank, N.A.
	  	$	5,600,000.00	  
	 Credit Suisse AG, Cayman Islands Branch
	  	$	5,600,000.00	  
	 Morgan Stanley Senior Funding, Inc.
	  	$	5,600,000.00	  
	 Raymond James Bank, N.A.
	  	$	4,200,000.00	  
	 Royal Bank of Canada
	  	$	3,500,000.00	  
	 Stifel Financial Corp.
	  	$	3,500,000.00	  
		  	  
	  
	 
	 Total:
	  	$	70,000,000.00