----

----

----

----

----

|   | If to HEALTHSMART: |   |   |
|--------|--------------------|--------|--------|

|   | 2002 W. Loop 289, Suite 103 |
|--------|-----------------------------|

|   | Lubbock, TX  79407 |
|--------|------------------------------|

|   | If to ACS: | Mark Bodnar, President |
|--------|------------|------------------------|

|   | 8080 Tristar Drive, Suite 100 |
|--------|-------------------------------|

|   | Irving, TX  75063 |
|--------|-----------------------------|

----

----

| · | Bone Growth Stimulators |
|--------|-------------------------|

| · | Chiropractic Services |
|--------|-----------------------|

| · | Dialysis Services |
|--------|-------------------|

| · | Durable Medical Equipment |
|--------|---------------------------|

| · | Home Health Services |
|--------|----------------------|

|   | · | Aides |
|--------|--------|-------|

|   | · | IV Infusion Therapy |
|--------|--------|---------------------|

|   | · | Medical Social Worker Services |
|--------|--------|--------------------------------|

|   | · | Therapies |
|--------|--------|-----------|

|   | · | Wound Care |
|--------|--------|------------|

| · | Hospice Services |
|--------|------------------|

| · | Laboratory Services |
|--------|---------------------|

| · | Orthotics and Prosthetics |
|--------|---------------------------|

| · | Outpatient Therapies |
|--------|----------------------|

|   | · | Occupational Therapy |
|--------|--------|----------------------|

|   | · | Physical Therapy |
|--------|--------|------------------|

|   | · | Speech Therapy |
|--------|--------|----------------|

| · | Perinatal Monitoring |
|--------|----------------------|

| · | Rehabilitation Services |
|--------|-------------------------|

|   | · | Functional Capacity Evaluations |
|--------|--------|---------------------------------|

|   | · | Work Hardening/Work Conditioning |
|--------|--------|----------------------------------|

| · | Sub-Acute and Skilled Nursing Facilities |
|--------|------------------------------------------|

| · | Surgery Centers |
|--------|-----------------|

----

| · | [***] of National Medicare Ceiling rates for Ancillary Services priced by Medicare |
|--------|------------------------------------------------------------------------------------|

| · | Extrapolation of [***] of National Medicare Ceiling rates when Ancillary Services are not priced by Medicare but there is adequate UCR to estimate what [***] of National Medicare Ceiling rates would be if it had priced.  “UCR” means the fees for Ancillary Services which are representative of the average and prevailing charge for the same service in the same or similar geographic communities where services are rendered. |
|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| · | [***] off billed charges for remaining Ancillary Services that are not priced by Medicare and no extrapolation of Medicare is possible. |
|--------|-----------------------------------------------------------------------------------------------------------------------------------------|

----

----

----

----

----

| If to ACS: | Wayne Schellhammer, President & CEO8080 Tristar Drive, Suite 100Irving, TX  75063 |
|------------|-------------------------------------------------------------------------------------------------|

----

| AMERICAN CARESOURCEHOLDINGS, INC. |   |   | HEALTHSMART PREFERREDCARE II, LP |   |
|-----------------------------------|--------|--------|----------------------------------|--------|
|                              |   |   |                             |   |
|                              |   |   |                             |   |
| /s/ Wayne A. Schellhammer         |   |   | /s/ David Adams                  |   |
| Signature                         |   |   | Signature                        |   |
|                              |   |   |                             |   |
|                              |   |   |                             |   |
| Wayne A. Schellhammer             |   |   | David Adams                      |   |
| Printed Name                      |   |   | Printed Name                     |   |
|                              |   |   |                             |   |
|                              |   |   |                             |   |
| December 13, 2005                 |   |   | January 19, 2006                 |   |
| Date                              |   |   | Date                        |   |

----

----

----

----

| 1) | ACS agrees to allow HealthSmart to outsource the access to and electronic routing of ACS provider claims, through HealthSmart to ACS for the benefit of their respective client base.  Affiliated Entities will be identified on the attached Exhibit A as they are approved and implemented by both parties. |
|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 2) | ACS agrees to develop and maintain an ancillary provider service solution for HealthSmart and the Affiliated Entities identified in Exhibit A for the benefit of their clients. |
|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | a) | ACS has the obligation to maintain an ancillary service solution as required by HealthSmart and become the primary point of contact for ACS providers. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------------|

----

|   | b) | In addition, as ACS expands its ancillary service solution, ACS providers will be made available to HealthSmart. |
|--------|----|------------------------------------------------------------------------------------------------------------------|

| 3) | ACS will pay HealthSmart an Administrative Services Fee as compensation for the data processing, administration and management of the claims transfer and payment processes associated with administrating the electronic and manual claims transfer to ACS. |
|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | a) | ACS agrees to pay HealthSmart an Administrative Services Fee based on a total of [***] of the ACS provider payments received by ACS on the existing ACS/ HealthSmart provider payments and any future HealthSmart’s client claims, as set forth below. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | i) | This incremental [***] increase in Administrative Services Fee is predicated on HealthSmart claims flow being fully implemented by the agreed upon terms, timetable and agreements as set forth in the Exhibit B attached to this Amendment. |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | ii) | This additional payment will be calculated, applied with current payments retroactively to December 1, 2006, continuing thereafter, subject to fulfillment of items in Exhibit B. |
|--------|-----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | b) | The increase in the existing HealthSmart Administrative Services Fee does not apply if the terms and agreements included in Exhibit B are not fulfilled. |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | c) | Effective March 1, 2007, ACS agrees to pay HealthSmart an Administrative Services Fee based on [***] of the ACS provider payments received by ACS from HealthSmart clients’ claims. |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | d) | The Administrative Services Fee shall not exceed [***] per annum.  (the “Capped Amount”). |
|--------|----|-----------------------------------------------------------------------------------------------------------------|

|   | e) | The Capped Amount shall be reviewed annually and adjusted based on increased processing and data management requirements of HealthSmart and ACS. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------|

|   | f) | The total Administrative Service Fees paid for a specific book of business will not exceed [***] of collected revenue, in total.  This includes payments to HealthSmart, its Affiliated Entities, or any other third party. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

| 4) | Administrative Services Fees will be estimated by ACS monthly based on claims paid during the immediately preceding month. |
|----|----------------------------------------------------------------------------------------------------------------------------|

|   | a) | Monthly payments will be made within 30 days following the end of each calendar month of the year under this Agreement.  Within 60 days following the end of each quarter under this Agreement |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | (1) | ACS shall reconcile the monthly payments made during the previous quarter and calculate the final payment for that previous quarter based on actual receipts. |
|--------|-----|---------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | (2) | All adjustments will be made in conjunction with the next scheduled payment. |
|--------|-----|------------------------------------------------------------------------------|

|   | b) | ACS will provide the existing HealthSmart approved monthly Financial Report with monthly payments. |
|--------|----|----------------------------------------------------------------------------------------------------|

| 5) | ACS and HealthSmart agree to work together on a continuing basis to establish, enhance, and modify their respective electronic interfaces and claims processing/repricing requirements for the benefit of HealthSmart.  ACS and HealthSmart agree to create a process to identify, route, reprice and distribute ACS provider claims from HealthSmart, as outlined in Exhibit B. |
|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 6) | ACS Appeals Policy – ACS will require ACS providers to follow an established appeals process if they disagree with the payment of services and/or explanation of benefits received.  An appeal is warranted when there is a dispute between the ACS provider and Ancillary Care Services, Inc. for reason(s) including, but not limited to:  contractual issues, timely filing, authorization, and notification of payment issues.  Providers will not be penalized for filing an appeal. |
|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

| 7) | The Agreement and any amendments to the Agreement will automatically renew for three years unless either party provides one hundred and twenty (120) days notice of its intent to modify or terminate the Agreement prior to the contract term.  However, either party may, except as otherwise set forth in the Agreement or amendments to the Agreement, terminate the Agreement and any amendments to the Agreement for good cause upon no less than sixty (60) days prior written notice to the other party.  These amended provisions supersede the language of the underlying agreement regarding modification or termination. |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

| AMERICAN CARESOURCE |   | HEALTHSMART PREFERRED |
|---------------------|--------|-----------------------|
| HOLDINGS, INC.      |   | CARE II, LP           |
|                |   |                  |
| /s/ David S. Boone  |   | /s/ Reagan Bruce      |
| Signature           |   | Signature             |
|                |   |                  |
| David S. Boone      |   | Reagan Bruce          |
| Printed Name        |   | Printed Name          |
|                |   |                  |
| May 1, 2007         |   | July 1, 2007          |
| Date                |   | Date                  |

----

|   | 1. | American Administrative Group, Inc. (AAG) |
|--------|----|-------------------------------------------|

|   | 2. | CareVu Corporation |
|--------|----|--------------------|

----

| 1. | HealthSmart/CareVu – an implementation of a two-way electronic exchange of UB92 claims to ACS for repricing, to be completed by February 28, 2007. |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------|

| 2. | AAG/CareVu – AAG to use ACS for non-HealthSmart clients wherever possible.  AAG may implement this on a staggered timetable for its clients.  This project includes the following sub-projects: |
|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | a. | AAG Network Setup |
|--------|----|-------------------|

|   | b. | AAG PMA Load |
|--------|----|--------------|

|   | c. | AAG Provider Load |
|--------|----|-------------------|

|   | d. | AAG/CareVu – two-way electronic exchange of claims to ACS for repricing. |
|--------|----|--------------------------------------------------------------------------------|

| 3. | AAG will develop a detailed project plan by February 2, 2007, which includes specific tasks to be completed by AAG, ACS and CareVu, as well as projected completion dates. |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 4. | AAG and ACS agree to hold regularly scheduled meetings during the entire implementation process.  AAG and ACS agree to diligently strive to follow and meet completion dates reflected in the project plan. |
|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

| 1) | HSPC agrees to use ACS as the Primary ancillary benefits manager for HSPC Customers.  Primary Ancillary benefits manager means that ACS will have primary responsibility and priority in providing Ancillary Care Services, including network development, contracting and provider maintenance, to HSPC Customers, subject to Customer’s agreement.  ACS and HSPC will work together to communicate the benefits of ACS’ provider network to these customers.  ACS provider contracts will be placed in priority, first tier position for HSPC Covered Persons’ access.  ACS will be responsible for properly and accurately repricing all submitted claims that match an ACS provider TIN file.  Upon mutual development of targeted ancillary providers (as provided for in Section 15, below), HSPC contracting staff will use commercially reasonable efforts to assist ACS in obtaining contracts with identified ancillary providers.  Notwithstanding, HSPC may contract directly for ancillary care providers as part of HSPC’s routine hospital and physician contracting, and/or with specific ancillary providers. |
|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 2) | HSPC agrees to devote necessary internal contracting resources to the joint strategic contracting plan as described in Section 15, below.  The initial phase of joint strategic contracting plan will be defined and implemented by HSPC and ACS no later then August 1, 2007. |
|----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 3) | HSPC agrees to maintain the confidential nature of the service fee paid under this arrangement and will not disclose it to outside parties |
|----|--------------------------------------------------------------------------------------------------------------------------------------------|

----

| 4) | HSPC agrees that no HSPC contracted providers will be excluded from the primary claims sort process that identifies that provider as an ACS contracted provider unless a more beneficial rate adjustment may be obtained by accessing an existing HSPC ancillary provider agreement. |
|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 5) | HSPC agrees that no ACS providers will be excluded by HSPC, HSPC customers, or its Affiliated Entities unless ACS cannot provide at least equivalent specific provider average savings compared to savings currently being achieved through alternative cost reduction mechanisms.  Current average savings are calculated using a minimum (90) day time frame and a minimum of ten (10) claims. |
|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 6) | HSPC will maintain the confidentiality and proprietary nature of the ACS provider discounts.  During the term of this Agreement, except as otherwise provided herein, HSPC agrees not to contract with any third-party vendors to receive services substantially similar to those provided by ACS hereunder. |
|----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 7) | HSPC and ACS agree to develop a joint communication plan that will communicate this relationship to providers and payors.  Both parties will work together to determine the written and oral communication used to describe and sell this arrangement to the various parties. |
|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 8) | HSPC will communicate, as a follow up to communications sent by ACS, as necessary, to the providers included under this agreement, that they have contracted with ACS to manage the agreed upon ancillary service categories. |
|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 9) | HSPC will communicate, as necessary to its Customers, that they have contracted ACS to manage the agreed upon ancillary service categories with the ACS Network Providers. |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 10) | HSPC will dedicate staff to support the communication and conversion of providers to the ACS network as well as support communication with Customers to ensure timely implementation. |
|-----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 11) | HSPC agrees to allow a press release by ACS announcing this expanded relationship.  HSPC and ACS will jointly develop the copy for the press release and such release must be preagreed upon, in writing, prior to release.  Approval will not be unreasonably withheld. |
|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 12) | HSPC agrees that if they engage in any merger, acquisition or partnership with an organization that processes, produces or has access to ancillary claims that match TINs in the ACS provider network, that commercially reasonable efforts will be made to assure that such claims be included with and subject to the same process and terms of this agreement, provided that both HSPC and ACS agree at the time that such action will be mutually beneficial to the parties. |
|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 13) | ACS will provide HealthSmart with a complete ACS provider network download no later than July 15, 2007.  Effective August 1, 2007 HSPC will have downloaded the ACS provider network directory into the HSPC claims system as HealthSmart’s primary ancillary network. |
|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

| 14) | Effective August 1, 2007, HSPC will:  (1) receive claims from HSPC Customers and/or providers, as applicable, with ACS provider TIN’s and (2) submit all such claims that match the ACS provider TIN’s directly to ACS for repricing in accordance with the Client Fee Schedule without exclusion (except as otherwise provided herein). |
|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 15) | The parties will jointly develop a strategic contracting plan that will define targeted providers and timetables for ACS/HSPC contracting efforts.  This project plan will be mutually agreed upon and incorporated into the Provider Service Agreement by subsequent amendment. |
|-----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 16) | HSPC and ACS agree to work diligently to complete and execute a new contract updating all terms, conditions and language within one-hundred-eighty (180) days from August 1, 2007. |
|-----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 17) | Non-Solicitation; Non-Interference.  While this Agreement is in effect, and for a period of one (1) year following the termination of this Agreement, neither party shall, directly or indirectly, (i) solicit or attempt to induce any individual who then is, or at anytime during the preceding six (6) month period was, an employee of the other party to become employed by or otherwise render services to the other party or (ii) employ any such individual. |
|-----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 18) | ACS represents and warrants that the ASC established Client Fee Schedule for HSPC and their Affiliates will demonstrate superior overall savings for their Customers and equivalent or superior savings per specific provider.  The specific benchmarks to demonstrate and document those savings will be jointly developed and incorporated into the Provider Service Agreement by subsequent amendment. |
|-----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 19) | Section 3 of the January 1, 2007 Client Amendment is deleted in its entirety and replaced with the following: |
|-----|---------------------------------------------------------------------------------------------------------------|

----

|   | · | From [***] in ACS billed charge claim volume the Service Fee will be jointly reviewed and operational plans to deliver [***] will be jointly developed.  The time frame to achieve [***] in ACS monthly billed charges will be extended by 120 days, which could be extended upon mutual agreement thereafter. |
|--------|--------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | · | From [***] in ACS billed charge claim volume the on-going Service Fee will be reduced to [***] until the threshold of [***] is achieved and then the Service Fee will revert to [***]. |
|--------|--------|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | · | From [***] in ACS billed charge claim volume the on-going Service Fee will revert to [***]. |
|--------|--------|---------------------------------------------------------------------------------------------|

|   | · | Below [***] in ACS billed charge claim volume the Service Fee will revert to [***] and ACS has the right to recoup the incremental [***] paid from August to December over the next twelve months as an adjustment to the monthly Service Fee owed to the HSPC. |
|--------|--------|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

| AMERICAN CARESOURCEHOLDINGS, INC. |   |   | HEALTHSMART PREFERREDCARE II, LP |   |
|-----------------------------------|--------|--------|----------------------------------|--------|
|                              |   |   |                             |   |
|                              |   |   |                             |   |
| /s/ David S. Boone                |   |   | /s/ David Adams                  |   |
| Signature                         |   |   | Signature                        |   |
|                              |   |   |                             |   |
|                              |   |   |                             |   |
| David S. Boone                    |   |   | David Adams                      |   |
| Printed Name                      |   |   | Printed Name                     |   |
|                              |   |   |                             |   |
|                              |   |   |                             |   |
| 8/01/07                           |   |   | 8-1-07                           |   |
| Date                              |   |   | Date                        |   |

----

|   | 1. | American Administrative Group, Inc. (AAG) |
|--------|----|-------------------------------------------|

|   | 2. | CareVu Corporation |
|--------|----|--------------------|

----

| 1) | In order to assist HSPC in coordinating and integrating access to the ACS network by members of the IHG network, ACS agrees to pay to HSPC one million dollars ($1,000,000) to offset integration costs incurred in connection therewith including, but not limited to, costs associated with salaries, benefits, and third party contract costs.  The payment shall be made by ACS to HSPC within ninety (90) days of the execution of this Amendment.  Both ACS and the HealthSmart Entities will maintain the confidentiality and proprietary nature of the payment and other terms described herein, to the extent public disclosure is not required by applicable law. |
|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 2) | The term of the Provider Service Agreement is hereby extended through December 31, 2012. |
|----|-----------------------------------------------------------------------------------------------|

|   | a) | The Provider Service Agreement, as amended, may not be terminated or amended by either party without the prior written consent of the other party other than upon any default by the other party, which default remains uncured for a period of 60 days following notice in writing thereof. |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

|   | b) | The Provider Service Agreement, as amended, shall apply to and bind each and all of the HealthSmart Entities.  By executing this Amendment, Parent accepts and ratifies such agreement, as amended, on behalf of itself and all Affiliated Entities, as defined in Exhibit A. |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | c) | This agreement shall survive a change in control of Parent or HSPC or its operating divisions subject to the Provider Service Agreement, as amended, and shall be binding upon any successor in interest thereto and no such change in control shall be effective without the express assumption of the terms of all agreements between the parties by the acquiror. |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 3)     | Section 3 of the First Amendment is deleted in its entirety and replaced with the following:  |
|--------|----------------------------------------------------------------------------------------------------|
|   | a)                                                                                                 | A fee (the “Service Fee”) payable to HSPC is designed to reimburse and compensate HSPC for the work that it is required to perform to support the ACS program.  This includes, but is not limited to marketing support, electronic claims conversion for the benefit of this program, the transmission of those claims to ACS, the receipt of those claims from ACS, and the transmission and tracking of the claims to the HSPC client payors. |

|   | b) | “Paid Claim Volume” is defined as the aggregate claims paid each calendar quarter to ACS that were derived from HSPC or its clients. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------|

|   | c) | When calculating Paid Claim Volume for purposes of the Service Fee, ACS may exclude paid claims in those cases where the amount paid to ACS is less than the sum of (i) the corresponding provider cost and (ii) any administrative fee paid to HealthSmart.  However, such claims will also be excluded for purposes of calculating the targets established in the table provided in Subsection d below. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | d) | The Service Fee, which is calculated based on paid claims, will be reset annually beginning with the twelve months beginning June 30, 2009 (hereinafter, the “Reset Date”, which date may change in accordance with Section 3h of this Agreement), according to the following schedule: |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| If the paid claim volume for the quarter ended June 30 is... | The Service Fee rate shall be... |
|------------------------------------------------------------------|--------------------------------------|
| At [***] or greater                                              | [***]                                |
| From [***] to [***]                                              | [***]                                |
| From [***] to [***]                                              | [***]                                |
| Less than [***]                                                  | [***]                                |

|   | e) | If there is a significant reduction in HSPC covered or managed lives, the fees will be revisited by both parties. |
|--------|----|-------------------------------------------------------------------------------------------------------------------|

----

|   | f) | If this arrangement is found in any way to violate any federal or state regulations, both parties agree that they will use their best efforts to negotiate a revision that is acceptable to each party. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | g) | The Service Fee shall not exceed [***] per annum (the “Capped Amount”). |
|--------|----|-------------------------------------------------------------------------------------|

|   | (h) | The Reset Date shall become March 31, 2009 immediately (and retroactively in arrears if appropriate) and the relevant Service Fee shall adjust downward as of March 31, 2009 in accordance with the above schedule as if June 30 were March 31 upon either of the following: |
|--------|-----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | i)   | Any failure to satisfy any covenant, condition or warranty in any agreement relating to Indebtedness of HSPC or any HSPC Entity, whether or not such failure results in an event of default; or                                                                                                                                                                                                                                                                                                                                                                                 |
|--------|------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
|   | ii)  | If the Paid Claim Volume is less than [***] for the quarter ending-March 31, 2009.                                                                                                                                                                                                                                                                                                                                                                                                                                                                                              |
|   | iii) | In documenting compliance with 3)(h)(i) above, HSPC shall provide to ACS within 45 days following the end of the stated quarter quarter a copy of the certified compliance certificate submitted to its lenders and accompanying financial statements for the quarters ended December 31, 2008, March 31, 2009, June 30, 2009, September 30, 2009 and December, 31, 2009.  In addition, HSPC shall provide a copy of its annual audit report for each year of the remainder of the contract term within 30 days of its issuance by HSPC’s independent auditors. |

| 4) | ACS warrants that it will provide the same level of discounts to HealthSmart Entities that it provides other clients for similar products and levels of support. |
|----|------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 5) | Each of HSPC and Parent represents and warrants to ACS that it does not control, is not controlled by and is not under common control with (in each case directly or indirectly through one or more intermediaries) any person other than the Affiliated Entities, as defined in Exhibit A. |
|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 6) | The parties will jointly develop a strategic contracting plan (the “Project Plan”) that will define a list of targeted providers and timetables for ACS/HSPC contracting efforts pursuant to the Provider Service Agreement, as amended.  The Project Plan will be mutually agreed upon no later than January 15, 2009.  HSPC agrees to devote necessary internal contracting resources to the development of the Project Plan.  In addition, each of ACS and HSPC will dedicate a named point person who will devote substantially all of their time to the ACS/HSPC contracting efforts and the ongoing management of the relationship between ACS and HSPC by January 15, 2009. The Project Plan will also include the following provisions: |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | a) | ACS will be the outsourced ancillary contracting and network management provider for HealthSmart’s group health clients, any Third Party Administrators (“TPAs”) currently owned by or affiliated with HealthSmart (including American Administrative Group |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

|   |   | (AAG)) and any entities, including any primary PPO networks and any TPAs, that may be controlled by (in each case directly or indirectly whether or not through one or more intermediaries) HSPC at any time in the future and with respect to which the ACS model could be deployed; provided, however, that HealthSmart payors who are not accessing a HealthSmart network as their primary PPO shall not be covered by this provision. |
|--------|--------|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | i) | HealthSmart will give ACS the rights of first refusal to add ancillary providers to the network. |
|--------|----|--------------------------------------------------------------------------------------------------|

|   | ii) | HealthSmart will not pursue ancillary contracts for its group health business and TPAs, except through the Provider Services Agreement, as amended, and the Project Plan. |
|--------|-----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|    | iii) | ACS and HealthSmart will jointly develop network service standards, and hereby agree to be bound by such standards, that will define the coverage and response necessary to meet the demands of HealthSmart. |
|--------------|------|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | iv) | The provisions of this Amendment will have no binding effect on HealthSmart’s routine hospital and physician contracting. |
|--------|-----|---------------------------------------------------------------------------------------------------------------------------------|

|   | b) | HSPC contracting staff will notify targeted contracted ancillary providers that HSPC has engaged ACS to be the contracted ancillary management vendor for HealthSmart Entities.  Access to the HealthSmart group health lines of business can only occur through a direct contract with ACS, provided that the ACS discounts are equal to or greater than HSPC network discounts currently in force. |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | i) | HSPC will support the ACS contracting efforts through both written and verbal confirmation that ACS is the outsourced group health ancillary network for HealthSmart Entities. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | ii) | HSPC will stop using a non-participating provider for any HealthSmart Entity if the ACS network is able to provide substitute coverage for the same service with quality standards and economics that satisfy either the same standards applied to the current providers or substantially similar standards actually applied to the current providers within the same geographic area. |
|--------|-----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | c) | HSPC and the HealthSmart Entities will support the ACS ancillary network with its payors through joint sales efforts and communication to these payors about the benefits of the ACS network. |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | i) | If a HealthSmart Payor is not participating with the ACS program, they can be excluded on a case by case basis from the ACS network requirement. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------|

|   | ii) | ACS and HSPC will work together to develop a consistent provider and payor notification plan to support the contracting efforts. |
|--------|-----|----------------------------------------------------------------------------------------------------------------------------------|

----

| 7) | HSPC agrees to include the ACS logo on all cards issued by it or any other HealthSmart Entity to members that are or could be eligible for the ACS network.  In addition, HSPC agrees to re-issue, by June 30, 2009 all cards previously issued to members that are eligible for the ACS network with replacement cards including the ACS logo. |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | a) | The ACS logo will be displayed in a mutually agreeable fashion, subordinated to the Health Smart and/or payor logos, as applicable. |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------|

|   | b) | This will only apply where HealthSmart is responsible for producing the cards. |
|--------|----|--------------------------------------------------------------------------------|

|    | c) | The program will be initiated no later than March 31, 2009, with cards being issued by June 30, 2009. |
|--------------|----|-----------------------------------------------------------------------------------------------------------------|

|   | d) | HSPC will be responsible for the reasonable incremental cost of issuing and reissuing cards as described above.  This includes the cost of adding the logo to the card and printing and mailing the card. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 8) | The ACS logo will also be included in the member directories, with the providers identified as an ACS provider.  This will be done in a mutually agreeable fashion, subordinated to the Health Smart logos as appropriate. |
|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | a) | The directory will include any web based or internet accessed directories prepared for participating HSPC members or companies. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------|

|   | b) | HSPC will be responsible for the reasonable incremental cost of preparing the member directories as described above.  This includes the cost of adding the logo to the directories and printing and mailing the directories, if applicable. |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 9) | The parties further agree to use good faith efforts to cooperate on a number of projects the parties have identified to be mutually beneficial.  Such projects include but are not limited to the Anci-Select,  Anci-Concierge, and Anci-Card programs currently under development by ACS. |
|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

| 10) | In the case of any disputes or issues that may arise in connection with the respective rights and/or obligations of the parties under the Agreement, arbitration will be entered into in Dallas, Texas.  Each party will notify the other, in writing, of the name of its representative(s) who will have primary responsibility for communications with the other party.  If such representatives are unable to resolve the dispute within 60 days of a party’s written notice of a dispute, either party may demand submission of the issue to arbitration before a single arbitrator in accordance with the Alternative Dispute Resolution Service Rules of Procedure for Arbitration, as published by the American Health Lawyers Association.  The party requesting such arbitration shall pay the arbitrator’s fee.  The |
|-----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

|   11) | decision of the representatives or, if applicable, the arbitrator, shall be final and binding upon the parties. Except as otherwise stated herein, all remaining terms of the Service Provider Agreement, as previously amended, shall remain unmodified and in full force and effect. |
|-----------------|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

----

| AMERICAN CARESOURCEHOLDINGS, INC.                                          |   | HEALTHSMART PREFERREDCARE II, L.P. |
|----------------------------------------------------------------------------|--------|------------------------------------|
|   /s/ David S. Boone                                             |   |   Illegible              |
| Signature                                                                  |   | Signature                          |
|  David S. Boone                                                       |   |  Illegible                    |
| Printed Name                                                               |   | Printed Name                       |
|  12/31/08                                                             |   |  12/31/08                     |
| Date                                                                       |   | Date                               |
|                                                                       |   |                               |
| HEALTHSMART HOLDINGS, INC.,on behalf of itself and the Affiliated Entities |   |                               |
|   Illegible                                                      |   |                               |
| Signature                                                                  |   |                               |
|  Illegible                                                            |   |                               |
| Printed Name                                                               |   |                               |
|  12/31/08                                                             |   |                               |
| Date                                                                       |   |                               |

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