exv10w49



 






Exhibit 10.49




EQUIPMENT LEASE AGREEMENT




     THIS EQUIPMENT LEASE AGREEMENT (“Agreement”) is made and entered into on May 28, 2004, by and
between GK FINANCING, LLC, a California limited liability company (“GKF”), and Mercy Health Center,
an Oklahoma not for profit corporation (“Hospital”), with reference to the following facts:



R E C I T A L S




     WHEREAS, Hospital wants to lease a Leksell Stereotactic Gamma Unit, model C with Automatic
Positioning System, manufactured by Elekta Instruments, Inc., as specified in Exhibit A of the LGK
Agreement (hereinafter referred to as the “Equipment”); and



     WHEREAS, GKF is willing to lease the Equipment which GKF has acquired from Elekta Instruments,
Inc., a Georgia corporation (hereinafter referred to as “Elekta”), to Hospital, pursuant to the
terms and conditions of this Agreement.



A G R E E M E N T




     NOW, THEREFORE, in consideration of the mutual covenants, conditions and agreements set forth
herein, and for such other good and valuable consideration, the receipt and sufficiency of which
are hereby acknowledged, the parties hereto agree as follows:



     1. Lease. Subject to and in accordance with the covenants and conditions set forth in
this Agreement, GKF hereby leases to Hospital, and Hospital hereby leases from GKF, the Equipment.
The Equipment to be leased to Hospital pursuant to this Agreement shall include the latest approved
Gamma Knife technology available as of the date of this Agreement (i.e., model C with Automatic
Positioning System), including all standard hardware and software related thereto.



     2. LGK Agreement. Simultaneously with the execution of this Agreement, Hospital and
Elekta shall enter into that certain LGK Agreement (the “LGK Agreement”), a copy of which is
attached hereto as Exhibit A. Hospital shall perform, satisfy and fulfill all of its obligations
arising under the LGK Agreement when and as required thereunder. Hospital acknowledges that GKF is
a third party beneficiary of the LGK Agreement and, in that capacity, GKF shall be entitled to
enforce Hospital’s performance, satisfaction and fulfillment of its obligations thereunder.



     3. Term of the Agreement. The initial term of this Agreement (the “Term”) shall
commence as of the date hereof and, unless earlier terminated or extended in accordance with the
provisions of this Agreement, shall continue for a period of ten (10) years following the date of
the performance of the first clinical Gamma Knife procedure (the “First Procedure Date”) at the



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Site. Hospital’s obligation to make the payments to GKF for the Equipment described in
Section 8 below shall commence as of the First Procedure Date.




     4. User License.



          4.1 Hospital shall apply for and obtain in a timely manner a User License from the Nuclear
Regulatory Commission and, if necessary, from the applicable state agency authorizing it to take
possession of and maintain the Cobalt supply required in connection with the use of the Equipment
during the term of this Agreement. Hospital also shall apply for and obtain in a timely manner all
other licenses, permits, approvals, consents and authorizations which may be required by state or
local governmental or other regulatory agencies for the development, construction and preparation
of the Site, the charging of the Equipment with its Cobalt supply, the conduct of acceptance tests
with respect to the Equipment, and the use of the Equipment during the Term, as more fully set
forth in Article 2.1 of the LGK Agreement. GKF shall reimburse Hospital for its direct costs to
obtain a User License and any other licenses, permits, approvals, consents and authorizations
required by this Section 4 upon presentation of invoices. In the event Hospital’s application to
obtain a User License and any other licenses, permits, approvals, consents and authorizations
required to operate the Equipment is denied after Hospital has used its best efforts, this
Agreement shall automatically terminate and all parties shall be released from the further
performance of any obligations or duties arising under this Agreement. Costs under this Section 4
shall be defined as “Startup Costs”.




     5. Delivery of Equipment; Site.



          5.1 GKF shall coordinate with Elekta and Hospital to have the Equipment delivered to Hospital
at (the “Site”) on or prior to the delivery date agreed upon by Hospital and Elekta in the LGK
Agreement. GKF makes no representations or warranties concerning delivery of the Equipment to the
Site or the actual date thereof.




          5.2 Subject to Section 6 below, Hospital at its cost and expense, shall provide a safe,
convenient Site for the Equipment. The location of the Site shall be subject to the prior approval
of GKF.




     6. Site Preparation and Installation of Equipment.



          6.1 GKF, at its cost and expense, shall prepare all plans and specifications required to
prepare, construct and improve the Site for the installation, use and operation of the Equipment
during the Term. The plans and specifications (i) shall be approved by Hospital, which approval
shall not be unreasonably withheld or delayed; (ii) shall comply in all respects with the Site
Planning Criteria attached as Exhibit E to the LGK Agreement (collectively the “Site Planning
Criteria”); and (iii) to the extent required by applicable law, shall be submitted to all state and
federal agencies for their review and approval. GKF, at its cost and expense, shall obtain all
permits, certifications, approvals or authorizations required by applicable federal, state




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or local laws, rules or regulations necessary to prepare, construct and improve the Site as
provided above.




          6.2 GKF, at its cost and expense, shall prepare, construct and improve the Site as necessary
for the installation, use and operation of the Equipment during the Term, including, without
limitation, providing all temporary or permanent shielding required for the charging of the
Equipment with the Cobalt supply and for its subsequent use, selecting and constructing a proper
foundation for the Equipment and the temporary or permanent shielding, aligning the Site for the
Equipment, and installing all electrical systems and other wiring required for the Equipment. In
connection with the construction of the Site, GKF, at its cost and expense, shall select, purchase
and install all radiation monitoring equipment, devices, safety circuits and radiation warning
signs required at the Site in connection with the use and operation of the Equipment. GKF shall be
responsible for the shipment, storage, placement and removal of all Cobalt and depleted Cobalt in
accordance with all State and Federal regulations. Any depleted Cobalt supply shall be properly
disposed of by GKF at such time as GKF shall deem necessary, in GKF’s sole and absolute judgment.




          6.3 In addition to construction and improvement of the Site, GKF, at its cost and expense,
shall be responsible for the installation of the Equipment at the Site, including the positioning
of the Equipment on its foundation at the Site in compliance with the Site Planning Criteria.




          6.4 During the Term, GKF, at its cost and expense, shall maintain the Site in a good working
order, condition and repair, reasonable wear and tear excepted.




     7. Marketing Support. Not less than ninety (90) days prior to the First Procedure
Date and the commencement of each succeeding twelve (12) month period during the Term, GKF and
Hospital shall jointly develop an annual marketing plan, budget and timeline, which shall be
implemented by Hospital with the support of GKF, based on the approved budget and timeline.
Hospital’s approval of such plan, budget and timeline shall not be unreasonably withheld or
delayed. If Hospital has not approved or disapproved the same within thirty (30) days following
its receipt, Hospital shall be deemed to have approved the same. GKF shall be * responsible for
any out-of-pocket marketing expenses paid to unrelated third parties that are included in the
marketing plan budget. Any marketing efforts conducted independently by Hospital shall be at
Hospital’s expense, and subject to coordination with GKF. Hospital’s approval of such plan, budget
and timeline shall not unreasonably withheld or delayed.



     8. Lease Payments.



          8.1 In consideration for and as compensation to GKF for (i) the lease of the Equipment by GKF
to Hospital pursuant to this Agreement; (ii) payment of Startup Costs; (iii) the preparation by GKF
of all plans and specifications required to prepare, construct and improve the Site for the
installation, use and operation of the Equipment; (iv) the preparation, construction and
improvement of the Site as necessary for the installation, use and operation of




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the Equipment; (v) the installation by GKF of the Equipment at the Site; (vi) the marketing of
the services to be provided using the Equipment; (vii) the cost of the individual referenced in
Section 11.3 below; and (viii) the maintenance by GKF of the Site in a good working order,
condition and repair, on a monthly basis, Hospital shall pay the “Lease Payment” to GKF for each
“Procedure” that is performed on any and all patients admitted to Hospital, on an inpatient or
outpatient basis, irrespective of whether (a) the Procedure is performed on the Equipment or using
any other equipment or devices; or (b) the Procedure is performed by Hospital, its representatives
or affiliates or by any other person or entity.





          (1) The “Lease Payment” shall be equal to (a) * of the “Technical Component
Collections” relating to each Procedure, less (b) Hospital’s aggregate “Additional Cost
Component,” if any, relating to those Procedures performed using the Equipment during the
corresponding month.




          (2) “Technical Component Collections” means (a) the total amount actually collected by
Hospital or its representatives or affiliates during each month from any and all payor
sources, including, without limitation, patients, insurance companies, state or federal
government programs or any other third party payors, as reimbursement for the technical
component of each Procedure performed on the Equipment or using any other equipment or
devices, plus (b) any and all other amounts actually collected by Hospital or its
representatives or affiliates during such month from any and all payor sources, including,
without limitation, patients, insurance companies, state or federal government programs or
any other third party payors, which amounts are related to “Extended Inpatient Days” (as
defined below) following a Procedure that is performed using the Equipment or using any
other equipment or devices, including, without limitation, any outlier payments. The
technical fees to be billed for Procedures performed utilizing the Equipment during the Term
of this Agreement shall be an amount which is economically justifiable based upon GKF’s
direct operating expenses and its total project costs, together with a return thereon.
Hospital shall consult and mutually agree with GKF from time to time regarding the amount of
the technical fees to be billed by Hospital for Procedures that are performed utilizing the
Equipment and any revisions thereto. Subject to compliance with the standard described in
the preceding sentence, Hospital and GKF shall mutually agree on the setting or revision of
the amount of the technical fees on no less than an annual basis, and the acceptance of the
technical fee component amounts with third party payors prior to their implementation.




          (3) An Additional Cost Component shall apply and be calculated if (a) unexpected
complications arise (e.g., stroke, heart attack) during the performance of a
Procedure using the Equipment such that the patient remains hospitalized for Extended
Inpatient Days; and (b) the Extended Inpatient Days and the Procedure are included as part
of the same reimbursement claim. Where applicable, the “Additional Cost Component” relating
to a Procedure utilizing the Equipment shall be equal to (i) the number of covered (by third
party payor) Extended Inpatient Days for that Procedure, multiplied by (ii) the
“Additional Cost Per Diem.” Notwithstanding anything to the contrary contained herein,
there shall be no deduction from the Lease Payment for any



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Additional Cost Component incurred where the Procedure is performed using any equipment
or devices other than the Equipment.




          (4) The “Additional Cost Per Diem” shall be equal to the quotient of (i) fifty percent
(50%) of the Technical Component Collections from the subject Procedure performed on the
Equipment that results in Extended Inpatient Days, divided by (ii) the then-current Medicare
Geometric Mean Length of Stay for the Diagnostic Related Group (DRG) under which such
discharge was billed (or could have been billed to Medicare), as such Geometric Mean Length
of Stay is set forth in the Federal Register.




          (5) “Procedure” shall mean any treatment, whether performed on an inpatient or
outpatient basis, that involves stereotactic, external, single fraction, conformal
radiation, commonly called Radiosurgery, that may include one or more isocenters during the
patient treatment session, delivered to any site(s) superior to the foramen magnum.




          (6) “Extended Inpatient Days” shall mean the number of days after the date of Procedure
during which the patient was properly classified as an inpatient, where all services
performed during such period are included as part of the same reimbursement claim. The date
of discharge shall not be included in the number of Extended Inpatient Days.


No Lease Payment for any Procedure shall be payable by Hospital to GKF unless and until the
Technical Component Collections corresponding to such Procedure have been actually collected by the
Hospital and/or its representatives or affiliates. On a monthly basis and by the 25th of the
following month, Hospital shall remit GKF’s aggregate Lease Payment for the preceding month.



It is acknowledged that the portion comprised of * of the Technical Component Collections relating
to each Procedure that is not paid as part of the Lease Payment is a good faith estimate of the
costs and expenses that will be incurred by Hospital during the corresponding month for services
and personnel associated with the performance of Procedures, including, without limitation, costs
and expenses for registered nurses, radiation technicians, recovery room, Hospital daily charges,
ventilator daily charges, MRI procedures, CT procedures, angiography procedures, the physicist,
laboratory services, pharmacy items, billing and collection services, other direct operating costs,
and physical space. Such costs and expenses shall not include (i) Lease Payments, (ii) physician
and other professional fees, and/or (iii) direct or indirect administrative overhead expenses.
Such percentage shall not be increased, reduced or otherwise modified regardless of whether
Hospital’s actual costs and expenses are higher or lower than the amount estimated.



Notwithstanding the foregoing, on each anniversary date of this Agreement, the parties shall meet
to review the percentage of the Technical Component Collections that are payable as part of the
Lease Payment, and any adjustments thereto must be mutually agreed upon by the parties in writing.
Upon request by GKF, Hospital shall promptly furnish GKF with written documentation substantiating
Hospital’s costs.




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     8.2 Within thirty (30) days following the end of each month (or portion thereof) during the
term of this Agreement, Hospital shall pay the Lease Payments to GKF and shall concurrently inform
GKF in writing as to the number of Procedures performed during that month utilizing the Equipment
and any other equipment or devices. To facilitate Hospital’s billing and collection for Procedures
performed, within three (3) business days after any Procedure using the Equipment is performed, the
administrative support individual referenced in Section 11.3 below shall provide Hospital with
written confirmation of the names of the patients treated. Hospital shall submit claims for
reimbursement to the appropriate payors for each Procedure within thirty (30) days after the
patient receiving the treatment is discharged. Such claims shall be submitted under Hospital’s
provider numbers and license, Hospital shall also diligently follow up any unpaid or denied claims
and re-bill and/or contest the same where appropriate so as to maximize Technical Component
Collections. All or any portion of any Lease Payment which is not paid in full within sixty (60)
days after its due date shall bear interest at the annual rate of five percent (5%) in excess of
the Federal Reserve Discount Rate then in effect as published in the Wall Street Journal or similar
publication (or the maximum monthly interest rate permitted to be charged by law between an
unrelated, commercial borrower and lender, if less) until the unpaid Lease Payment, together with
all accrued interest thereon is paid in full. If GKF shall at any time accept a Lease Payment from
Hospital after it shall become due, such acceptance shall not constitute or be construed as a
waiver of any or all of GKF’s rights under this Agreement, including the rights of GKF set forth in
Section 20 hereof.



          8.3 Within thirty (30) days after the close of each month, Hospital shall provide GKF with a
written report indicating the status of billings and collections for each Procedure performed
during that month, including, without limitation, the amount of the claim submitted, the amount
received or denied for each such procedure, and copies of the corresponding Explanation of Benefits
(“EOB”). Upon request by GKF, Hospital shall furnish to GKF information regarding reimbursement
rates from any or all payor sources for Procedures (applicable to Procedures performed either on an
inpatient or outpatient basis). If such reimbursement rates should change at any time or from time
to time after the date hereof, in each instance, Hospital shall provide written notice thereof to
GKF within five (5) days of Hospital receiving notice thereof. Prior to entering into or renewing
any third party payor contracts for the provision of Procedures utilizing the Equipment, Hospital
shall consult with GKF regarding the terms and provisions thereof, including the technical
component reimbursement rates. GKF shall maintain the confidentiality of all information provided
to GKF by Hospital with regard to Procedure charges, billing and reimbursement rates.




          8.4 The parties acknowledge that the Lease Payments payable to GKF and Hospital’s Cost
Component reflect their respective fair market value and are not determined in a manner that takes
into account the volume or the value of any referral or other business generated between the
parties.




          8.5 Within ten (10) days after Hospital’s receipt of written request from GKF, GKF shall have
the right to audit Hopsital’s books and records (including, without limitation, the

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books and records pertaining to any other Radiosurgery equipment and devices) during normal
business hours to verify the Technical Component Collections and Hopsital’s Cost Component, and
Hospital shall provide GKF with access to such books and records.




          8.6 New Technology. Notwithstanding anything to the contrary set forth in Section 8
of this Agreement, if, at any time during the term of this Agreement, Hospital purchases or leases
“New Technology,” then, from and after the “New Technology Effective Date,” no Lease Payment shall
be payable by Hospital to GKF for any Procedures performed using the New Technology;
provided that Hospital shall continue to be responsible for making Lease Payments to GKF
for all other Procedures performed on the Equipment or using any other equipment or devices as set
forth in this Section 8. Hospital shall provide GKF with not less than one hundred and eighty
(180) days prior written notice of Hospital’s intention to purchase or lease New Technology, which
written notice shall include any and all documentation evidencing compliance with the definition of
New Technology, and which documentation shall be subject to the prior written approval of GKF in
its sole but reasonable judgment. As used herein:




               (a) “New Technology” shall mean a treatment modality for performing Procedures which (a) uses
medical technology not commercially available as of the date of this Agreement; (b) consists of a
single device and not a combination of different types of equipment; and (c) has been documented in
at least (3) articles published in peer-reviewed journals in the United States, using five-year
minimum follow-up studies, to be more medically appropriate than the Equipment to perform
Procedures in treating 65% or greater of the currently treatable Gamma Knife indications.



               (b) “New Technology Effective Date” shall mean the later to occur of (a) the date that is
seven (7) years after the First Procedure Date, or (b) the date on which the first clinical
Procedure is performed using the New Technology on a patient admitted to Hospital on an inpatient
or outpatient basis.



     9. Use of the Equipment.



          9.1 The Equipment shall be used by Hospital only at the Site and shall not be removed
therefrom. Hospital shall use the Equipment only in the regular and ordinary course of Hospital’s
business operations and only within the capacity of the Equipment as determined by Elekta’s
specifications. Hospital shall not use nor permit the Equipment to be used in any manner nor for
any purpose which, in the opinion of Elekta or GKF, the Equipment is not designed or reasonably
suitable.




          9.2 This is an agreement of lease only. Nothing herein shall be construed as conveying to
Hospital any right, title or interest in or to the Equipment, except for the express leasehold
interest granted to Hospital for the Term. All Equipment shall remain personal property (even
though said Equipment may hereafter become attached or affixed to real property) and the title
thereto shall at all times remain exclusively in GKF.





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          9.3 During the Term, upon the request of GKF, Hospital shall promptly affix to the
Equipment in a prominent place, or as otherwise directed by GKF, labels, plates, insignia,
lettering or other markings supplied by GKF indicating GKF’s ownership of the Equipment, and shall
keep the same affixed for the entire Term. Hospital hereby authorizes GKF to cause this Lease or
any statement or other instrument showing the interest of GKF in the Equipment to be filed or
recorded, or refiled or re-recorded, with all governmental agencies considered appropriate by GKF,
at GKF’s cost and expense. Hospital also shall promptly execute and deliver, or cause to be
executed and delivered, to GKF any statement or instrument requested by GKF for the purpose of
evidencing GKF’s interest in the Equipment, including financing statements and waivers with
respect to rights in the Equipment from any owners or mortgagees of any real estate where the
Equipment may be located.




          9.4 At Hospital’s cost and expense, Hospital shall (a) protect and defend GKF’s ownership of
and title to the Equipment from and against all persons claiming against or through Hospital, (b)
at all times keep the Equipment free from any and all liens, encumbrances, attachments, levies,
executions, burdens, charges or legal processes imposed against Hospital, and (c) give GKF
immediate written notice of any matter described in clause (b).




     10. Additional Covenants of Hospital. In addition to the other covenants of Hospital
contained in this Agreement, Hospital shall, at its cost and expense:



          10.1 Provide properly trained professional, technical and support personnel and supplies
required for the proper performance of Gamma Knife procedures utilizing the Equipment. In this
regard, Hospital shall maintain on staff a minimum of two (2) Gamma Knife trained teams comprised
of neurosurgeons, radiation oncologists and physicists. Hospital shall be provided with six (6)
one week Elekta Gamma Knife training sessions for the training of its two (2) Gamma Knife teams.
GKF shall also be responsible for the reasonable travel related expenses for the physicians and/or
physicists associated with the six (6) Gamma Knife training sessions.




          10.2 Direct, supervise and administer the diagnosis, treatment and care of all patients who
receive Gamma Knife procedures.




          10.3 In consultation with GKF, provide reasonable and customary marketing support in terms of
administrative and physician support for the Gamma Knife service to be operated by the Hospital.




          10.4 Keep and maintain the Equipment and the Site fully protected, secure and free from
unauthorized access or use by any person.




     11. Additional Covenants of GKF. In addition to the other covenants of GKF contained
in this Agreement, GKF, at its cost and expense, shall:



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          11.1 Use its best efforts to require Elekta to meets its contractual obligations to GKF and
Hospital upon delivery of the Equipment and put the Equipment, as soon as reasonably possible, into
good, safe and serviceable condition and fit for its intended use in accordance with the
manufacturer’s specifications, guidelines and field modification instructions.




          11.2 Ensure Hospital’s quite enjoyment and use of the Equipment, free of the rights of any
other persons except for those rights reserved by GKF or granted to Elekta under the LGK Agreement
or the Purchase Agreement.




          11.3 GKF and Hospital shall mutually select an individual to be located at the Site to provide
Gamma Knife administrative and marketing support services. The individual’s duties shall include
but not be limited to scheduling Gamma Knife patients and coordinating professional and technical
personnel and support services to perform said Gamma Knife treatment. This individual shall also
verify patient insurance. The individual shall also assist with marketing activities on an as
needed basis. This individual is provided by the Hospital and GKF shall reimburse Hospital for the
cost of the individual and payment made by GKF to Hospital by the end of the following month. GKF
and Hospital shall mutually agree on individual.




     12. Maintenance of Equipment; Damage or Destruction of Equipment.



          12.1 During the Term and except as otherwise provided in this Agreement, GKF, at its cost and
expense, shall (a) maintain the Equipment in good operating condition and repair, reasonable wear
and tear excepted, (b) subject to Hospital’s compliance with its obligations under the LGK
Agreement and under Sections 4, 5, 9, 10, 12, 13, and 16 hereunder, cause the equipment to be in
compliance with all applicable state and federal regulations, and (c) maintain in full force and
effect a Service Agreement with Elekta and any other service or other agreements required to
fulfill GKF’s obligation to repair and maintain the Equipment under this Section 12. Hospital
shall promptly notify GKF in the event of any damage or destruction to the Equipment or of any
required maintenance or repairs to the Equipment, regardless of whether such repairs or maintenance
are covered or not covered by the Service Agreement. GKF shall pursue all remedies available to it
under the Service Agreement and under any warranties made by Elekta with respect to the Equipment
so that the Equipment will be free from defects in design, materials and workmanship and will
conform to Elekta’s technical specifications concerning the Equipment.




          12.2 GKF and Elekta shall have the right to access the Equipment for the purpose of inspection
and the performance of repairs at all reasonable times, upon reasonable advance notice and with a
minimum of interference or disruptions to Hospital’s regular business operations.




          12.3 Hospital shall be liable for, and in the manner described in Section 22 below shall
indemnify GKF from and against, any damage to or destruction of the Equipment caused by the misuse,
improper use, or other intentional and wrongful or negligent acts or

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omissions of Hospital’s officers, employees, agents, contractors and physicians. In the event
the Equipment is damaged as a result of the misuse, improper use, or other intentional and wrongful
or negligent acts or omissions of Hospital’s officers, employees, agents, contractors (other than
GKF and Elekta) and physicians, to the extent such damage is not covered by the Service Agreement
or any warranties or insurance, GKF may service or repair the Equipment as needed and the cost
thereof shall be paid by Hospital to GKF immediately upon written request together with interest
thereon at the rate of one and one-half percent (1.50%) per month (or the maximum monthly interest
rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less)
and reasonable attorneys’ fees and costs incurred by GKF in collecting such amount from Hospital.
Any work so performed by GKF shall not deprive GKF of any of its rights, remedies or actions
against Hospital for such damages.




          12.4 If the Equipment is rendered unusable as a result of any physical damage to or
destruction of the Equipment, Hospital shall give GKF written notice thereof. GKF shall determine,
within thirty (30) days after it is given written notice of such damage or destruction, whether the
Equipment can be repaired. Subject to Section 12.3 above, in the event GKF determines that the
Equipment cannot be repaired, at the election of GKF in GKF’s sole and absolute discretion, (a)
GKF, at its cost and expense, may replace the Equipment as soon as reasonably possible taking into
account the availability of replacement equipment from Elekta, Elekta’s other then existing orders
for equipment, and the then existing limitations on Elekta’s manufacturing capabilities, and (b) in
such event, this Agreement shall continue in full force and effect as though such damage or
destruction had not occurred. If GKF elects not to replace the Equipment, GKF shall provide
written notice of such election to Hospital, and this Agreement shall terminate on the date that is
ninety (90) days following the date of such notice. In the event GKF determines that the Equipment
can be repaired, GKF shall cause the Equipment to be repaired as soon as reasonably possible
thereafter. Hospital shall fully cooperate with GKF to effect the replacement of the Equipment or
the repair of the Equipment (including, without limitation, providing full access to the Site)
following the damage or destruction thereof.




     13. Alterations and Upgrades to Equipment. Hospital shall not make any modifications,
alterations or additions to the Equipment (other than normal operating accessories or controls)
without the prior written consent of GKF. Hospital shall not, and shall not permit any person
other than representatives of Elekta or any other person authorized by GKF to, effect any
inspection, adjustment, preventative or remedial maintenance, or repair to the Equipment without
the prior written consent of GKF. All modifications, alterations, additions, accessories or
operating controls incorporated in or affixed to the Equipment (herein collectively called
“additions” and included in the definition of “Equipment”) shall become the property of the GKF
upon termination of this Agreement. The parties agree that the necessity for the reloading of the
cobalt-60 source, shall be discussed and mutually decided by GKF and Hospital. If GKF reloads the
Equipment at its cost, the initial Term of the Agreement shall be extended for * years from a
duration of 10 to * years.



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     14. Financing of Equipment by GKF. GKF, in its sole discretion, may finance the
Equipment. Financing may be in the form of an installment loan, a capitalized lease or other
commercially available debt or financing instrument. If GKF finances the Equipment through an
installment loan, GKF shall be required to provide the Equipment as collateral for the loan. If
GKF finances the Equipment through a capitalized lease, title shall vest with the lessor until such
time as GKF exercises its buy-out option under the lease, if any. If required by the lender,
lessor or other financing entity (the “Lender”), GKF may assign its interest under this Agreement
as security for the financing. Hospital’s interest under this Agreement shall be subject to the
interests of the Lender and Hospital shall execute such documentation as the Lender shall
reasonably require in furtherance of this Section 14.



     15. Equipment Operational Costs. GKF shall be responsible for all costs and expenses
for the operation and use of the Equipment. Significant costs and expenses are enumerated in
Exhibit 8.1. Between Hospital and GKF, Hospital shall be fully liable for all negligent,
intentional or wrongful acts or omissions of Hospital, its officers, directors, employees and
agents.



     16. Taxes. GKF shall pay all sales or use taxes imposed or assessed in connection
with the purchase of the Equipment and all personal property taxes imposed, levied or assessed on
the ownership and possession of the Equipment during the Term. All other taxes, assessments,
licenses or other charges imposed, levied or assessed on the Equipment during the Term shall be
paid by Hospital before the same shall become delinquent, whether such taxes are assessed or would
ordinarily be assessed against GKF or Hospital; provided, however, Hospital shall not be required
to pay any federal, state or local income, franchise, corporation or excise taxes imposed upon
GKF’s net income realized from the lease of the Equipment. In case of a failure by Hospital to pay
any taxes, assessments, licenses or other charges when and as required under this Section, GKF may
pay all or any part of such taxes, in which event the amount paid by GKF shall be immediately
payable by Hospital to GKF upon written request together with interest thereon at the rate of at
the rate of one and one-half percent (1.50%) per month (or the maximum monthly interest rate
permitted to be charged by law between an unrelated, commercial borrower and lender, if less) and
reasonable attorneys’ fees and costs incurred by GKF in collecting such amount from Hospital.



     17. No Warranties by GKF. Hospital warrants that as of the First Procedure Date, it
shall have (a) thoroughly inspected the Equipment, (b) determined that the Equipment is consistent
with the size, design, capacity and manufacture selected by it, and (c) satisfied itself that to
the best of its knowledge the Equipment is suitable for Hospital’s intended purposes and is good
working order, condition and repair. GKF SUPPLIES THE EQUIPMENT UNDER THIS AGREEMENT IN ITS “AS
IS” CONDITION. GKF, NOT BEING THE MANUFACTURER OF THE EQUIPMENT OR THE MANUFACTURER’S AGENT, MAKES
NO WARRANTY OR REPRESENTATION, EITHER EXPRESSED OR IMPLIED, AS TO THE EQUIPMENT’S MERCHANTABILITY,
FITNESS FOR A PARTICULAR PURPOSE OR USE, DESIGN, CONDITION, DURABILITY, CAPACITY, MATERIAL OR



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WORKMANSHIP OR AS TO PATENT INFRINGEMENT OR THE LIKE. As between GKF and Hospital, Hospital
shall bear all risks with respect to the foregoing warranties. GKF shall not be liable for any
direct, indirect and consequential losses or damages suffered by Hospital or by any other person,
and Hospital expressly waives any right to hold GKF liable hereunder for, any claims, demands and
liabilities arising out of or in connection with the design, manufacture, possession or operation
of the Equipment, including injury to persons or property resulting from the failure of, defective
or faulty design, operation, condition, suitability or use of the Equipment, or with the accuracy,
completeness or suitability of the Site Planning Criteria, including GKF’s good faith compliance
therewith. All warranty or other similar claims with respect to the Equipment or the Site Planning
Criteria shall be made by Hospital solely and exclusively against persons other than GKF, including
Elekta or any other manufacturers or suppliers. In this regard and with prior written approval of
GKF, Hospital may, in GKF’s name, but at Hospital’s sole cost and expense, enforce all warranties,
agreements or representations, if any, which may have been made by Elekta or manufacturers,
suppliers or other third parties regarding the Equipment to GKF or Hospital. GKF shall not be
responsible for the operation of the Equipment. However, it shall be GKF’s responsibility that the
Equipment be properly maintained.



     18. Termination for Economic Justification.



          18.1 If, following the initial twenty-four (24) months after the First Procedure Date and
following each subsequent 12 month period thereafter during the Term, based upon the utilization of
the Equipment and other factors considered relevant by GKF in the exercise of its discretion,
within a reasonable period of time after GKF’s written request, Hospital does not provide GKF with
a reasonable economic justification to continue this Agreement and the provision of Gamma Knife
services at the Hospital, then and in that event, GKF shall have the option to terminate this
Agreement by giving a written notice thereof to Hospital not less than ninety (90) days prior to
the effective date of the termination designated in GKF’s written notice.




          18.2 Notwithstanding the provisions of Section 18.1, if at any time during the term of this
Agreement, Hospital is suspended or terminated from participation in the Medicare program, GKF
shall have the option to terminate this Agreement immediately by giving written notice thereof to
Hospital.




          18.3 As a result of any termination of this Agreement pursuant to this Section 18, GKF may
enter upon the Site and remove the Equipment and any improvements made by GKF to the Site without
liability of any kind or nature for so doing or GKF may demand that Hospital remove and return the
Equipment and such improvements to GKF, all at GKF’s sole cost and expense. GKF shall restore the
Site to a similar pre-deinstallation appearance and condition.




     19. Options to Extend Agreement. As of the end of the Term, Hospital shall have the
option either to:



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          19.1 Extend the Term of this Agreement for a specified period of time and upon such other
terms and conditions in writing as may be agreed upon by GKF and Hospital taking into account the
use (e.g., number of Gamma Knife procedures, etc.) of the Equipment at the Site during the initial
Term and other factors deemed relevant by the parties;




          19.2 Terminate this Agreement as of the expiration of the Term.




          Hospital shall exercise one (1) of the two (2) options referred to above by giving an irrevocable
written notice thereof to GKF at least nine (9) months prior to the expiration of the initial Term.
Any such notice shall be sufficient if it states in substance that Hospital elects to exercise its
option and states which of the two (2) options referred to above Hospital is exercising. If
Hospital fails to exercise the option granted herein at least nine (9) months prior to the
expiration of the initial Term, the option shall lapse and this Agreement shall expire as of the
end of the initial Term. Further, if Hospital exercises the option specified in Section 19.1 above
and the parties are unable to mutually agree upon the length of the extension of the Term or any
other terms or conditions applicable to such extension prior to the expiration of the Term, this
Agreement shall expire as of the end of the initial Term.




     20. Events of Default by Hospital and Remedies.



          20.1 The occurrence of any one of the following shall constitute an event of default under
this Agreement (an “Event of Default”):





               20.1.1 Hospital fails to pay any Lease Payment when due pursuant to Paragraph 8 above and such
failure continues for a period of thirty (30) days after written notice thereof is given by GKF or
its assignee to Hospital; however, if Hospital cures the payment default within the applicable
thirty (30) day period, such default shall not constitute an Event of Default.




               20.1.2 Hospital attempts to remove, sell, transfer, encumber, assign, sublet or part with
possession of the Equipment or any items thereof, except as expressly permitted herein.




               20.1.3 Hospital fails to observe or perform any of its covenants, duties or obligations
arising under this Agreement or the LGK Agreement and such failure continues for a period of thirty
(30) days after written notice thereof by GKF to Hospital; however, if Hospital cures the default
within the applicable thirty (30) day period or if the default reasonably requires more than thirty
(30) days to cure, Hospital commences to cure the default during the initial thirty (30) day period
and Hospital diligently completes the cure as soon as reasonably possible following the end of the
thirty (30) day period, such default shall not constitute an Event of Default.




               20.1.4 Hospital ceases doing business as a going concern, makes an assignment for the benefit
of creditors, admits in writing its inability to pay its debts as they



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become due, files a voluntary petition in bankruptcy, is adjudicated a bankrupt or an
insolvent, files a petition seeking for itself any reorganization, arrangement, composition,
readjustment, liquidation, dissolution or similar arrangement under any present or future statute,
law or regulation or files an answer admitting the material allegations of a petition filed against
it in any such proceeding, consents to or acquiesces in the appointment of a trustee, receiver, or
liquidator of it or of all or any substantial part of its assets or properties, or it or its
shareholders shall take any action looking to its dissolution or liquidation





               20.1.5 Within sixty (60) days after the commencement of any proceedings against Hospital
seeking reorganization, arrangement, readjustment, liquidation, dissolution or similar relief under
any present or future statute, law or regulation, such proceedings shall not have been dismissed,
or if within thirty (30) days after the appointment without Hospital’s consent or acquiescence of
any trustee, receiver or liquidator of it or of all or any substantial part of its assets and
properties, such appointment shall not be vacated.



     20.2 Upon the occurrence of an Event of Default with respect to Hospital, GKF may at its
option do any or all of the following:





               20.2.1 By written notice to Hospital, immediately terminate this Agreement as to the
Equipment, wherever situated. As a result of the termination, GKF may enter upon the Site and
remove the Equipment and any improvements made by GKF to the Site without liability of any kind or
nature for so doing or GKF may demand that Hospital remove and return the Equipment and such
improvements to GKF, all at Hospital’s sole cost and expense. GKF shall restore the Site to a
similar pre-deinstallation appearance and condition.




               20.2.2 Recover damages from Hospital as may be awarded by a court of competent jurisdiction
for the loss of the bargain represented by this Agreement. For purposes of determining such
damages, the parties agree that the following methodology shall be used: (a) the amount of such
damages shall be equal to the present value of the unpaid estimated future Lease Payments to be
made by Hospital to GKF through the end of the Term discounted at the rate of nine percent (9%);
and (b) the unpaid estimated future Lease Payments shall be based on the historical trend of
payments made by Hospital to GKF hereunder taking into account known factors which could impact the
historical trend through the end of the Term. Hospital and GKF acknowledge that the methodology
set forth in this Section 20.2.2 constitutes a reasonable method to calculate GKF’s damages
resulting from an Event of Default under the circumstances existing as of the date of this
Agreement. GKF shall use reasonable commercial efforts to mitigate its damages by attempting to
sell or lease the Equipment; provided that (i) GKF shall not be obligated to give
preference to the sale or lease of the Equipment over the sale, lease or other disposition of
similar equipment or improvements owned or leased by GKF, (ii) GKF shall have no obligation to sell
or lease any improvements made by GKF to the Site, and (iii) GKF’s inability in good faith to
mitigate damages shall not limit or otherwise affect the foregoing methodology for determining
damages as set forth in this Section.



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               20.2.3 Sell, dispose of, hold, use or lease the Equipment or any improvements made by GKF to
the Site, as GKF in its sole and absolute discretion may determine (and GKF shall not be obligated
to give preference to the sale, lease or other disposition of the Equipment or improvements over
the sale, lease or other disposition of similar Equipment or improvements owned or leased by GKF).




               20.2.4 Exercise any other right or remedy which may be available to GKF under the Uniform
Commercial Code or any other applicable law or proceed by appropriate court action, without
affecting GKF’s title or right to possession of the Equipment or improvements, to enforce the terms
hereof or to recover damages for the breach hereof or to cancel this Agreement as to the Equipment.


In addition to the foregoing remedies, Hospital shall be liable to GKF for all costs and expenses
incurred by GKF as a result of the Event of Default or the exercise of GKF’s remedies.




          20.3 Upon termination of this Agreement or the exercise of any other rights or remedies under
this Agreement or available under applicable law following an Event of Default, Hospital shall,
without further request or demand, pay to GKF all Lease Payments and other sums owing under this
Agreement. Hospital shall in any event remain fully liable for all damages as may be provided by
law and for all costs and expenses incurred by GKF on account of such default, including but not
limited to, all court costs. The rights and remedies afforded GKF under this Agreement shall be
deemed cumulative and not exclusive, and shall be in addition to any other rights or remedies to
GKF provided by law or in equity.




     21. Events of Default by GKF and Remedies.



          21.1 The occurrence of any one of the following shall constitute an Event of Default
hereunder:





               21.1.1 GKF shall fail to observe or perform any of its covenants, duties or obligations
arising under this Agreement and such failure shall continue for a period of thirty (30) days after
written notice thereof is given by Hospital to GKF; however, if GKF cures the default within the
applicable thirty (30) day period or if the default reasonably requires more than thirty (30) days
to cure, GKF commences to cure the default during the initial thirty (30) day period and GKF
diligently completes the cure as soon as reasonably possible following the end of the thirty (30)
day period, such default shall not constitute an Event of Default.




               21.1.2 GKF ceases doing business as a going concern, makes an assignment for the benefit of
creditors, admits in writing its inability to pay its debts as they become due, files a voluntary
petition in bankruptcy, is adjudicated a bankrupt or an insolvent, files a petition seeking for
itself any reorganization, arrangement, composition, readjustment, liquidation, dissolution or
similar arrangement under any present or future statute, law or regulation or files an answer
admitting the material allegations of a petition filed against it in any such proceeding, consents
to or acquiesces in the appointment of a trustee, receiver, or liquidator




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of it or of all or any substantial part of its assets or properties, or it or its shareholders
shall take any action looking to its dissolution or liquidation.




               21.1.3 Within sixty (60) days after the commencement of any proceedings against GKF seeking
reorganization, arrangement, readjustment, liquidation, dissolution or similar relief under any
present or future statute, law or regulation, such proceedings shall not have been dismissed, or if
within thirty (30) days after the appointment without GKF’s consent or acquiescence of any trustee,
receiver or liquidator of it or of all or any substantial part of its assets and properties, such
appointment shall not be vacated.



          21.2 Upon the occurrence of an Event of Default involving GKF, Hospital may at its option do
any or all of the following:




               21.2.1 By written notice to GKF, immediately terminate this Agreement as to the Equipment and,
in such event, GKF shall remove the Equipment, the Cobalt and any improvements made by GKF to the
Site, at GKF’s sole cost and expense or, in the absence of removal by GKF within a reasonable
period of time after a written request therefore, Hospital may remove the Equipment, the Cobalt and
such improvements with all due care and store the same at GKF’s sole cost and expense.



               21.2.2 Seek to recover from GKF such loss as may be realized by Hospital in the ordinary
course of events as a result of the Event of Default.



          21.3 GKF shall in any event remain fully liable for reasonable damages as provided by law and
for all costs and expenses incurred by GKF on account of such default, including but not limited
to, all court costs (other than attorneys’ fees). However, GKF shall not in any manner be or
become liable to Hospital for any consequential or incidental damages that may be suffered by
Hospital which arise out of or result from the Event of Default.




          21.4 Notwithstanding the occurrence of an Event of Default with respect to GKF (including any
claim which would otherwise be in the nature of a set-off), Hospital shall fully perform and pay
its obligations hereunder (including payment of all Lease Payments) without set-off or defense of
any kind. Upon termination of this Agreement or the exercise of any other rights or remedies under
this Agreement or applicable law following an Event of Default, Hospital shall, without further
request or demand, pay to GKF all Lease Payments and other sums owing under this Agreement when and
as due.




     22. Removal of Equipment. Upon expiration of the Term, GKF, at its cost and expense,
shall remove the Equipment from the Site not more than ninety (90) days following the last day of
the Term; provided that all of GKF’s right, title and interest in and to the improvements
made by GKF to the Site pursuant to Section 6 above shall thereupon transfer to Hospital.



     23. Insurance.



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          23.1 During the Term, GKF shall, at its cost and expense, purchase and maintain in effect an
all risk property and casualty insurance policy covering the Equipment. The all risk property and
casualty insurance policy shall be for an amount not less than the replacement cost of the
Equipment. The all risk property and casualty insurance policy maintained by GKF shall be
evidenced by a certificate of insurance or other reasonable documentation which shall be delivered
by GKF to Hospital upon request following the commencement of this Agreement and as of each annual
renewal of such policy during the Term.




          23.2 During the Term, Hospital shall, at its cost and expense, purchase and maintain in effect
general liability and professional liability insurance policies (or self-insurance coverage)
covering the Site (together with all premises where the Site is located) and the use or operation
of the Equipment by Hospital or its officers, directors, agents, employees, contractors or
physicians. The general liability and professional liability insurance policies shall provide
coverage (or self-insurance coverage) in amounts not less than One Million Dollars ($1,000,000.00)
per occurrence and Five Million Dollars ($5,000,000.00) annual aggregate. GKF shall be named as
additional insured party on the general liability and professional liability insurance policies to
be maintained hereunder by Hospital. The policies to be maintained by Hospital hereunder shall be
evidenced by a certificate of insurance or other reasonable documentation which shall be delivered
by Hospital to GKF no later than the First Procedure Date and as of each annual renewal of such
policies during the Term.




          23.3 During the construction of the Site and prior to the First Procedure Date, GKF, at its
cost and expense, shall purchase and maintain a general liability insurance policy which conforms
with the coverage amounts and other requirements described in Section 23.2 above and which names
Hospital as an additional insured party. The policy to be maintained by GKF hereunder shall be
evidenced by a certificate of insurance or other reasonable documentation which shall be delivered
by GKF to Hospital prior to the commencement of any construction at the Site.




          23.4 During the Term, Hospital shall maintain all workers compensation insurance as required
by applicable law.




     24. Indemnification



          24.1 Hospital and GKF each hereby covenants and agrees that it will defend, indemnify and hold
the other party and the other party’s officers, directors, members, employees and agents at all
times harmless from and against any loss, damage, and expense (including reasonable attorneys’ fees
and other costs of defense) caused by or arising out of: (i) any liability or obligation related
to the business of the indemnifying party prior to the date hereof; (ii) any obligation or
liability arising from services provided under this Agreement by the indemnifying party to the
extent any such liability or obligation directly results from the negligence or intentional
misconduct of the indemnifying party, it’s employees or agents; or (iii) any obligation or
liability resulting from a breach of any provision of this Agreement by the

17









 








indemnifying party, it’s employees or agents. The obligations of the parties under this
Section shall survive the expiration or earlier termination of this Agreement.




          24.2 Any party that intends to enforce an indemnity obligation shall give the indemnifying
party notice of any claim as soon as possible, but the failure to give such notice shall not
constitute a waiver or release of the indemnifying party and shall not affect the rights of the
indemnified party to recover under this indemnity, except to the extent the indemnifying party is
materially prejudiced thereby. In connection with any claim giving rise to indemnity under this
Section resulting from or arising out of any claim or legal proceeding by a person who is not a
party to this Agreement, the indemnifying party, at its sole cost and expense, may, upon written
notice to the indemnified party, assume control of the defense of such claim or legal proceeding,
to the extent that the indemnifying party admits in writing its indemnification liability to the
indemnified party with respect to all material elements thereof. If the indemnifying party assumes
the defense of any such claim or legal proceeding, the obligation of the indemnifying party
hereunder as to such claim or legal proceeding shall be to take all steps necessary in the defense
or settlement thereof and to hold the indemnified party harmless from and against any losses,
damages, expenses or liability caused by or arising out of any settlement approved by the
indemnifying party and the indemnified party or any judgment in connection with such claim or legal
proceeding. Each indemnified party shall cooperate with the indemnifying party in the defense of
any such action, the defense of which is assumed by the indemnifying party. Except with the
consent of the indemnified party, which consent may be withheld at the indemnified party’s sole
discretion, the indemnifying party shall not consent to any settlement or the entry of any judgment
arising from any such claim or legal proceeding which, in each case, does not include as an
unconditional term thereof the delivery by the claimant or the plaintiff to the indemnified party
of a release from all liability in respect thereof. If the indemnifying party does not assume the
defense of any claim or litigation, any indemnified party may defend against such claim or
litigation in such manner as it may deem appropriate, including but not limited to settling such
claim or litigation, after giving notice of the same to the indemnifying party, on such terms as
the indemnified party may deem appropriate. The indemnifying party will, promptly after any of the
same is incurred, reimburse the indemnified party in accordance with the provisions hereof for all
damages, losses, liabilities, costs and expenses incurred by the indemnified party.




          24.3 The indemnity obligations under this Section shall survive the termination of this
Agreement with respect to events occurring during or relating to the Term.




     25. Miscellaneous.



          25.1 Binding Effect. This Agreement shall be binding upon and inure to the benefit of
the parties hereto and their respective successors and assigns. Neither party shall assign this
Agreement nor any of its respective rights hereunder and Hospital shall not sublease the Equipment
without the prior written consent of the other party, which consent shall not be unreasonably
withheld. An assignment or sublease shall not relieve the assigning party or

18









 








sublessor of any liability for performance of this Agreement during the remainder of the Term.
Any purported assignment or sublease made without the other party’s prior written consent shall be
null, void and of no force or effect.




          25.2 Agreement to Perform Necessary Acts. Each party agrees to perform any further
acts and execute and deliver any further documents which may be reasonably necessary or otherwise
reasonably required to carry out the provisions of this Agreement.




          25.3 Validity. If for any reason any clause or provision of this Agreement, or the
application of any such clause or provision in a particular context or to a particular situation,
circumstance or person, should be held unenforceable, invalid or in violation of law by any court
or other tribunal of competent jurisdiction, then the application of such clause or provision in
contexts or to situations, circumstances or persons other than that in or to which it is held
unenforceable, invalid or in violation of law shall not be affected thereby, and the remaining
clauses and provisions hereof shall nevertheless remain in full force and effect.




          25.4 Attorney’s Fees and Costs. In the event of any action, mediation or other
proceedings between or among the parties hereto with respect to this Agreement, each party shall
pay for their own attorneys’ fees and related costs and expenses, irrespective of which party is
deemed to be the prevailing party.




          25.5 Entire Agreement; Amendment. This Agreement together with the Exhibits attached
hereto constitutes the full and complete agreement and understanding between the parties hereto
concerning the subject matter hereof and shall supersede any and all prior written and oral
agreements with regard to such subject matter. This Agreement may be modified or amended only by a
written instrument executed by all of the parties hereto.




          25.6 Number and Gender. Words in the singular shall include the plural, and words in
a particular gender shall include either or both additional genders, when the context in which such
words are used indicates that such is the intent.




          25.7 Effect of Headings. The titles or headings of the various paragraphs hereof are
intended solely for convenience or reference and are not intended and shall not be deemed to
modify, explain or place any construction upon any of the provisions of this Agreement.




          25.8 Counterparts. This Agreement may be executed in one or more counterparts by the
parties hereto. All counterparts shall be construed together and shall constitute one agreement.




          25.9 Governing Law. This Agreement shall be interpreted and enforced in accordance
with the internal laws, and not the law of conflicts, of the State of Oklahoma applicable to
agreements made and to be performed in that State.





19










 






          25.10 Exhibits. All exhibits attached hereto and referred to in this Agreement
are hereby incorporated by reference herein as though fully set forth at length.




          25.11 Ambiguities. The general rule that ambiguities are to be construed against the
drafter shall not apply to this Agreement. In the event that any provision of this Agreement is
found to be ambiguous, each party shall have an opportunity to present evidence as to the actual
intent of the parties with respect to such ambiguous provision.




          25.12 Representations. Each of the parties hereto represents (a) that no
representation or promise not expressly contained in this Agreement has been made by any other
party hereto or by any of its agents, employees, representatives or attorneys; (b) that this
Agreement is not being entered into on the basis of, or in reliance on, any promise or
representation, expressed or implied, other than such as are set forth expressly in this Agreement;
(c) that it has been represented by counsel of its own choice in this matter or has affirmatively
elected not to be represented by counsel; (d) it is duly organized, validly existing and in good
standing under the laws of the jurisdiction of its organization, (e) it has full power and
authority to execute, deliver and perform this Agreement, and (f) the execution, delivery and
performance of this Agreement has been duly authorized by all necessary corporate or other similar
action.




          25.13 Non-Waiver. No failure or delay by a party to insist upon the strict
performance of any term, condition, covenant or agreement of this Agreement, or to exercise any
right, power or remedy hereunder or under law or consequent upon a breach hereof or thereof shall
constitute a waiver of any such term, condition, covenant, agreement, right, power or remedy or of
any such breach or preclude such party from exercising any such right, power or remedy at any later
time or times.




          25.14 Notices. All notices, requests, demands or other communications required or
permitted to be given under this Agreement shall be in writing and shall be delivered to the party
to whom notice is to be given either (a) by personal delivery (in which case such notice shall be
deemed to have been duly given on the date of delivery), (b) by next business day air courier
service (e.g., Federal Express or other similar service) (in which case such notice shall be deemed
given on the business day following deposit with the air courier service), or (c) by United States
mail, first class, postage prepaid, registered or certified, return receipt requested (in which
case such notice shall be deemed given on the third (3rd) day following the date of mailing), and
properly addressed as follows:




	 	 	 	 	 
	To GKF:

	 	Craig K. Tagawa
	 	 
	 

	 	Chief Executive Officer	 	 
	 

	 	GK Financing, LLC	 	 
	 

	 	Four Embarcadero Center, Suite 3700	 	 
	 

	 	San Francisco, CA 94111	 	 






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	To Hospital:

	 	Mark Nafziger
	 	 
	 

	 	Senior VP & CFO	 	 
	 

	 	Mercy Health Center	 	 
	 

	 	4120 W Memorial Road	 	 
	 

	 	Oklahoma City, OK 73120	 	 





A party to this Agreement may change his, her or its address for purposes of this Section by giving
written notice to the other parties in the manner specified herein.




          25.15 Special Provisions Respecting Medicare and Medicaid Patients




               25.15.1 Hospital and GKF shall generate such records and make such disclosures as may be
required, from time to time, by the Medicare, Medicaid and other third party payment programs with
respect to this Agreement in order to meet all requirements for participation and payment
associated with such programs, including but not limited to the matters covered by Section
1861(v)(1)(I) of the Social Security Act.



               25.15.2 For the purpose of compliance with Section 1861(v)(1)(I) of the Social Security Act,
as amended, and any regulations promulgated pursuant thereto, both parties agree to comply with the
following statutory requirements (a) Until the expiration of four (4) years after the termination
of this Agreement, both parties shall make available, upon written request to the Secretary of
Health and Human Services or, upon request, to the Comptroller General of the United States, or any
of their duly authorized representatives, the contract, and books, documents and records of such
party that are necessary to certify the nature and extent of such costs, and (b) if either party
carries out any of the duties of the contract through a subcontract with a value or cost of $10,000
or more over a twelve month period, with a related organization, such subcontract shall contain a
clause to the effect that until the expiration of four (4) years after the furnishing of such
services pursuant to such subcontract, the related organization shall make available, upon written
request to the Secretary, or upon request to the Comptroller General, or any of their duly
authorized representatives the subcontract, and books, documents and records of such organization
that are necessary to verify the nature and extent of such costs.



          25.16 Force Majeure. Failure to perform by either party will be excused in the event
of any delay or inability to perform its duties under this Agreement directly or indirectly caused
by conditions beyond its reasonable control, including, without limitation, fires, floods,
earthquakes, snow, ice, disasters, acts of God, accidents, riots, wars, operation of law, strikes,
governmental action or regulations, shortages of labor, fuel, power, materials, manufacturer delays
or transportation problems. Notwithstanding the foregoing, all parties shall make good faith
efforts to perform under this Agreement in the event of any such circumstance. Further, once such
an event is resolved, the parties shall again perform their respective obligations under this
Agreement.




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          25.17 Independent Contractor Status. With respect to the performance of the duties
and obligations arising under this Agreement, nothing in this Agreement is intended nor shall be
construed to create a partnership, an employer/employee relationship, a joint venture relationship,
or a lease or landlord/tenant relationship between GKF and Hospital.




          25.18 Mediation. Except as provided herein, no civil action with respect to any
dispute, claim or controversy arising out of or relating to this Agreement may be commenced until
the matter has been submitted for non-binding mediation to the Judicial Arbitration and Mediation
Services, Inc. (“JAMS”), except that if JAMS is no longer in existence or is otherwise unable to
appoint a neutral mediator, the parties shall submit the matter for non-binding mediation to the
American Arbitration Association (“AAA”), subject to the provisions in this section. Either party
may commence mediation by providing to the other party a written request for mediation, setting
forth the subject of the dispute and the relief requested. The parties will cooperate with one
another in selecting a mediator and in scheduling the mediation proceedings. The parties covenant
that they will participate in the mediation in good faith, and that they will share equally in its
costs. All offers, promises, conduct and statements, whether oral or written, made in the course
of the mediation by any of the parties, their agents, employees, experts and attorneys, and by the
mediator, are confidential, privileged and inadmissible for any purpose, including impeachment, in
any litigation or other proceeding involving the parties, provided that evidence that is
otherwise admissible or discoverable shall not be rendered inadmissible or non-discoverable as a
result of its use in the mediation. Either party may seek equitable relief prior to the mediation
to preserve the status quo pending the completion of that process. Except for such an action to
obtain equitable relief, neither party may commence a civil action with respect to the matters
submitted to mediation until after the completion of the initial mediation session, or 45 days
after the date of filing the written request for mediation, whichever occurs first. Mediation may
continue after the commencement of a civil action, if the parties so desire. The provisions of
this Section may be enforced by any court of competent jurisdiction, and the party seeking
enforcement shall be entitled to an award of all costs, fees and expenses, including attorney’s
fees, to be paid by the party against whom enforcement is ordered.




     IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed as of the
date first set forth above.



	 	 	 	 	 	 	 
	“GKF”

	 	“Hospital”
	 
	GK FINANCING, LLC,

	 	MERCY HEALTH CENTER,
	a California limited liability company

	 	an Oklahoma not for profit corporation
	 
	 
	By:	 	
/s/ Craig K. Tagawa
 

Craig Tagawa

Chief Executive Officer
	 	By:
 
	 	/s/ Mark Nafziger
 

Mark Nafziger

Senior VP & CFO
	 	 







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