Exhibit 10.10


 


Bank of
America, N.A.


WA1-501-17-32


800 Fifth
Avenue, Floor 17


Seattle,
WA  98104


 


February 27, 2009


 


Prospect Medical Group, Inc.


1920 East 17th Street, Suite 200


Santa Ana, CA 92705


 


Re:                               Fourth Amendment to Letter Agreement
Regarding Divestiture Plan and Consent (this “Agreement”)


 


Ladies and Gentlemen:


 


Reference is hereby made
to that certain side letter agreement dated as of May 15, 2008 (as
amended, restated, supplemented or otherwise modified from time to time, the “Divestiture
Letter Agreement”) among Prospect Medical Holdings, Inc. (“Holdings”),
Prospect Medical Group, Inc. (“Prospect” and, collectively with
Holdings, the “Borrowers” and each, individually, a “Borrower”),
Bank of America, N.A., as Administrative Agent (in such capacity, the “Second
Lien Administrative Agent”), and the lenders party
thereto (collectively, the “Second Lien Lenders”).  Reference is also hereby made to that certain Second Lien Credit
Agreement dated as of August 8, 2007 (as amended, restated, supplemented or
otherwise modified, the “Second Lien Credit Agreement”), pursuant to
which the Second Lien Lenders have agreed to make the Loans and other
extensions of credit, all upon the terms and conditions set forth in the Second
Lien Credit Agreement.  Terms not otherwise
defined in this Agreement shall have the meaning assigned thereto in the
Divestiture Letter Agreement and the Second Lien Credit Agreement, as
applicable.


 


1.                                       Fourth
Amendment to the Divestiture Letter Agreement:


 


Under
the terms of the Divestiture Letter Agreement, the Borrowers agreed to complete
the sale of the ProMed Entities (as defined in the Divestiture Plan) no later
than February 27, 2009 (the “Sale Deadline”).  The Borrowers have requested that the Second
Lien Administrative Agent and the Second Lien Lenders amend the Divestiture
Letter Agreement to extend the Sale Deadline to March 6, 2009 (the “Extension
Deadline”).  The Second Lien
Administrative Agent and the Second Lien Lenders are willing to grant the
Borrowers’ request subject to the terms and conditions of this Agreement.


 


In
furtherance thereof, the Second Lien Administrative Agent, the Second Lien
Lenders and the Borrowers agree that paragraph (c) of the Divestiture
Letter Agreement is hereby amended and restated in its entirety to read as
follows:


 


“(c)                            The
Borrowers shall complete the sale of (i) the Antelope Valley Entities (as
defined in the Divesture Plan) no later than October 1, 2008 and in 


 

















 


accordance with the terms set forth in the Amendment
and (ii) the ProMed Entities (as defined in the Divesture Plan) no later
than March 6, 2009 on
terms and conditions reasonably satisfactory to the Second Lien Administrative
Agent and the Required Lenders.”


 


2.                                       Consent by the Second Lien Lenders


 


Prospect Hospital Advisory Services, Inc., a
Prospect subsidiary, presently owns a minority interest in Brotman Medical
Center, Inc. (“Brotman”).  In
connection with Brotman’s exit from current bankruptcy proceedings and as part
of a plan of reorganization for Brotman, the Borrowers placed certain amounts
with the U.S. Bankruptcy Court for the Central District of California, Los
Angeles Division, in an attempt to purchase additional equity in Brotman.  Should the Borrowers prevail, the Borrowers’
resulting ownership interest could approach 70% or more.


 


Under the terms of the Credit Agreement, acquiring a
majority interest in Brotman would immediately qualify Brotman as a “Subsidiary”
of the Borrowers and would require joinder of Brotman to the Collateral
Agreement and the Subsidiary Guaranty Agreement within a short period of time
following such acquisition.


 


Accordingly, the Borrowers have requested that, in
the event that any Borrower (or any Subsidiary or Subsidiaries thereof)
acquires a majority interest in Brotman prior to the Extension Deadline, the
Second Lien Administrative Agent and the Second Lien Lenders exclude Brotman as
a “Subsidiary” under the Second Lien Credit Agreement until the expiration of
the Extension Deadline.


 


Subject to the terms and conditions of this
Agreement, the Second Lien Administrative Agent and the Second Lien Lenders
hereby consent and agree that, should any Borrower (or any Subsidiary or
Subsidiaries thereof), acquire a majority ownership interest in Brotman prior
to the expiration of the Extension Deadline, Brotman shall not be deemed or
considered a “Subsidiary” under the terms of the Second Lien Credit Agreement
for any purpose until the expiration of the Extension Deadline.


 


This
Agreement shall become effective as of February 27, 2009, upon (a) execution
and delivery of this Agreement by the Borrowers, the Guarantors, the Second
Lien Administrative Agent and the Required Lenders under the Second Lien Credit
Agreement, (b) execution and delivery by the Borrowers, the Guarantors,
the First Lien Administrative Agent and the “Required” Lenders under the First
Lien Credit Agreement of an agreement substantially similar to this Agreement,
and (c) payment of all professional fees and expenses of the Second Lien
Administrative Agent and the Second Lien Lenders in connection with this
Agreement and the transactions contemplated hereby and thereby (including all
fees and expenses of Winston & Strawn LLP, in its capacity as counsel
to the Second Lien Administrative Agent), pursuant to wire transfer instructions to be provided
by the Second Lien Administrative Agent.


 


Except
for the amendment and consent contained herein, all of the terms and provisions
of the Divestiture Letter Agreement, the Second Lien Credit Agreement and the
other Loan Documents shall remain in full force and effect.  The Borrowers, by their acceptance hereof, hereby acknowledge and agree that
the failure to complete the sale of the ProMed Entities prior to the date
specified in the Divestiture Letter Agreement, as amended hereby, shall result
in an Event of Default in accordance with Section 8.01(b) of
the Second Lien Credit Agreement.  In 


 

















 


addition, the Borrowers
acknowledge and agree that, should the Borrowers (or any Subsidiary
or Subsidiaries thereof) obtain majority ownership of Brotman and unless otherwise addressed
prior to such date in accordance with the terms of the Second Lien Credit
Agreement, upon the expiration of the Extension Deadline, the Borrowers shall
be required to comply with, and Brotman shall be subject to, the terms of the
Second Lien Credit Agreement and the other Loan Documents in all respects.


 


Each of the Guarantors,
by their acknowledgment hereto, agree and consent to this Agreement, to all
prior Loan Documents, and to the documents and agreements referred to herein and
therein, and to all future modifications and amendments thereto, and any
termination thereof, and to any and all other present and future documents and
agreements between or among the Borrowers, the Second Lien Administrative
Agent.  The Guarantors agree to be bound
by all terms of the Loan Documents applicable to “Loan Parties”.  Nothing contained herein shall in any way
expand, limit or diminish any of the obligations of the Guarantors under their
respective guaranty, each such guaranty being hereby ratified and
affirmed.  The signatures of each of the
Guarantors shall be fully effective even if any other Guarantor fails to sign
this Agreement.


 


[Signature Pages Follow]


 

















 


This Agreement shall
constitute a Loan Document and may be executed in one or more
counterparts, each of which shall be deemed an original, but all of which
together shall constitute one and the same instrument.  Delivery of executed counterparts of this Agreement by telecopy or pdf shall be
effective as an original.


 


Very truly yours,


 


	
   

  	
  BANK
  OF AMERICA, N.A., in its capacity as Second Lien Administrative Agent

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Tiffany Shin

  
	
   

  	
  Name:

  	
  Tiffany Shin

  
	
   

  	
  Title:

  	
  Assistant Vice
  President

  



 


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Fourth Amendment to Second Lien Divestiture Letter Agreement and Consent


 

















 


	
   

  	
  FIELD
  POINT I, LTD., as a Second Lien Lender

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Richard Petrilli

  
	
   

  	
  Name:

  	
  Richard Petrilli

  
	
   

  	
  Title:

  	
  Authorized Signatory

  



 


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Fourth Amendment to Second Lien Divestiture Letter Agreement and
Consent


 

















 


	
   

  	
  FIELD
  POINT II, LTD., as a Second Lien Lender

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Richard Petrilli

  
	
   

  	
  Name:

  	
  Richard Petrilli

  
	
   

  	
  Title:

  	
  Authorized Signatory

  



 


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Fourth Amendment to Second Lien Divestiture Letter Agreement and
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  GRAND
  CENTRAL ASSET TRUST, CMF SERIES, CMF SERIES, as a Second Lien Lender

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Adam Kaiser

  
	
   

  	
  Name:

  	
  Adam Kaiser

  
	
   

  	
  Title:

  	
  Attorney-in-fact

  



 


[Signature Pages Continue]


 


Fourth Amendment to Second Lien Divestiture Letter Agreement and
Consent


 

















 


	
  Accepted and Agreed:

  	
   

  
	
   

  	
   

  
	
  PROSPECT MEDICAL
  HOLDINGS, INC.

  	
   

  
	
   

  	
   

  
	
  By:

  	
  /s/ Samuel S. Lee

  	
   

  
	
  Name:

  	
  Samuel S. Lee

  	
   

  
	
  Title:

  	
  Chief Executive Officer

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  PROSPECT MEDICAL GROUP,
  INC.

  	
   

  
	
   

  	
   

  	
   

  
	
  By:

  	
  /s/ Samuel S. Lee

  	
   

  
	
  Name:

  	
  Samuel S. Lee

  	
   

  
	
  Title:

  	
  Senior Vice President

  	
   

  



 


[Guarantor
Signature Pages Follow]


 


Fourth Amendment to Second Lien Divestiture Letter Agreement and
Consent


 

















 


	
  ALTA HOSPITALS SYSTEM,
  LLC, formerly known as PROSPECT HOSPITALS SYSTEM, LLC

  	
   

  	
  NUESTRA FAMILIA MEDICAL
  GROUP, INC.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  By:

  	
  /s/ Samuel S. Lee

  	
   

  	
  By:

  	
  /s/ Samuel S. Lee

  
	
  Name:

  	
  Samuel S. Lee

  	
   

  	
  Name:

  	
  Samuel S. Lee

  
	
  Title:

  	
  Chief Executive Officer

  	
   

  	
  Title:

  	
  Vice President

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  PROMED HEALTH CARE
  ADMINISTRATORS

  	
   

  	
  PROSPECT ADVANTAGE
  NETWORK, INC.

  
	
  PROMED HEALTH SERVICES
  COMPANY

  	
   

  	
  PINNACLE HEALTH RESOURCES

  
	
   

  	
   

  	
  PROSPECT HOSPITAL ADVISORY
  SERVICES, INC.

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ Samuel S. Lee

  
	
  By:

  	
  /s/ Samuel S. Lee

  	
   

  	
  Name:

  	
  Samuel S. Lee

  
	
  Name:

  	
  Samuel S. Lee

  	
   

  	
  Title:

  	
  President and Chief Executive Officer

  
	
  Title:

  	
  Vice President

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  POMONA VALLEY MEDICAL
  GROUP, INC.

  	
   

  	
  ARTHUR E. LIPPER, solely
  in his capacity as

  
	
  UPLAND MEDICAL GROUP, A
  PROFESSIONAL MEDICAL CORPORATION

  	
   

  	
  Pledgor

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  By:

  	
  /s/ Samuel S. Lee

  	
   

  	
   

  
	
  Name:

  	
  Samuel S. Lee

  	
   

  	
  /s/ Arthur E. Lipper

  
	
  Title:

  	
  Vice President

  	
   

  	
   

  



 


[Signature Pages Continue]


 


Fourth Amendment to Second Lien Divestiture Letter Agreement and
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  ALTA LOS ANGELES
  HOSPITALS, INC.

  	
   

  	
  PROSPECT MEDICAL SYSTEMS,
  INC.

  
	
  ALTA HOLLYWOOD HOSPITALS,
  INC.

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
  By:

  	
  /s/ Samuel S. Lee

  
	
  By:

  	
  /s/ Ellen J. Shin

  	
   

  	
  Name:

  	
  Samuel S. Lee

  
	
  Name:

  	
  Ellen J. Shin

  	
   

  	
  Title:

  	
  Chairman of the Board

  
	
  Title:

  	
  Secretary

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  SANTA ANA/TUSTIN
  PHYSICIANS GROUP, INC.

  	
   

  	
   

  
	
  PROSPECT HEALTH SOURCE
  MEDICAL GROUP, INC.

  	
   

  	
   

  
	
  PROSPECT PROFESSIONAL CARE
  MEDICAL GROUP, INC.

  	
   

  	
   

  
	
  PROSPECT NWOC MEDICAL
  GROUP, INC.

  	
   

  	
   

  
	
  APAC MEDICAL GROUPS, INC.

  	
   

  	
   

  
	
  STARCARE MEDICAL GROUP,
  INC.

  	
   

  	
   

  
	
  GENESIS HEALTHCARE OF
  SOUTHERN CALIFORNIA, INC., A MEDICAL GROUP

  	
   

  	
   

  
	
  PROSPECT PHYSICIANS
  ASSOCIATES, INC.

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  
	
  By:

  	
  /s/ Samuel S. Lee

  	
   

  	
   

  
	
  Name:

  	
  Samuel S. Lee

  	
   

  	
   

  
	
  Title:

  	
  Senior Vice President

  	
   

  	
   

  



 


Fourth Amendment to Second Lien Divestiture Letter Agreement and
Consent