Document:

Exhibit
10.52

 

ADDENDUM
TO ADMINISTRATIVE SERVICES AGREEMENT

 

This Addendum (the “Addendum”)
is entered into as of January 1, 2010, by and among MARYLAND RADIATION THERAPY
MANAGEMENT SERVICES, INC., a Maryland corporation (“MANAGEMENT SERVICES”) and
KATIN RADIATION THERAPY, P.A., a Maryland professional corporation (the “PA”).
This Addendum amends Section 3.1 of the Administrative Services Agreement dated
October 31, 1998 between the parties (the “Agreement”) to adjust the monthly
Service Fee of $4,333.33 paid in 2009 to a monthly Service Fee of $3,666.67,
and replaces the Addendum of that same Section dated January 1, 2009. From and
after the date hereof, Section 3.1 shall read as follows:

 

3.1.
Service Fee. For the services to be provided hereunder by MANAGEMENT
SERVICES, the PA shall pay to MANAGEMENT SERVICES a monthly Service Fee of
$3,666.67 The parties agree that the Service Fee represents the fair market
value of the services provided by MANAGEMENT SERVICES hereunder and that the
parties shall meet annually to reevaluate the value of services provided by
MANAGEMENT SERVICES and shall establish the fair market value thereof for
purposes of this Section 3.1.

 

 

	
  Accepted:

  	
  MARYLAND RADIATION THERAPY
  MANAGEMENT SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Brian J. Carey

  
	
   

  	
   

  	
  Brian J. Carey

  
	
   

  	
   

  	
  Vice President & CFO

  
	
   

  	
   

  	
   

  
	
  Accepted:

  	
  KATIN RADIATION THERAPY,
  P.A.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Daniel E. Dosoretz

  
	
   

  	
   

  	
  Daniel E. Dosoretz, M.D.

  
	
   

  	
   

  	
  Vice President

  

 

 

ADDENDUM
TO ADMINISTRATIVE SERVICES AGREEMENT

 

This Addendum (the “Addendum”)
is entered into as of January 1, 2009, by and among MARYLAND RADIATION THERAPY
MANAGEMENT SERVICES, INC., a Maryland corporation (“MANAGEMENT SERVICES”) and
KATIN RADIATION THERAPY, P.A., a Maryland professional corporation (the “PA”).
This Addendum amends Section 3.1 of the Administrative Services Agreement dated
October 31, 1998 between the parties (the “Agreement”) to adjust the monthly
Service Fee of $5,166.67 paid in 2008 to a monthly Service Fee of $4,333.33,
and replaces the Addendum of that same Section dated January 1, 2008. From and after the date hereof, Section
3.1 shall read as follows:

 

3.1.
Service Fee. For the services to be provided hereunder by MANAGEMENT
SERVICES, the PA shall pay to MANAGEMENT SERVICES a monthly Service Fee of
$4,333.33. The parties agree that the Service Fee represents the fair market
value of the services provided by MANAGEMENT SERVICES hereunder and that the
parties shall meet annually to reevaluate the value of services provided by
MANAGEMENT SERVICES and shall establish the fair market value thereof for
purposes of this Section 3.1.

 

 

	
  Accepted:

  	
  MARYLAND RADIATION THERAPY
  MANAGEMENT SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ David NT Watson

  
	
   

  	
   

  	
  David NT Watson

  
	
   

  	
   

  	
  Vice President & CFO

  
	
   

  	
   

  	
   

  
	
  Accepted:

  	
  KATIN RADIATION THERAPY,
  P.A.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Daniel E. Dosoretz

  
	
   

  	
   

  	
  Daniel E. Dosoretz, M.D.

  
	
   

  	
   

  	
  Vice President

  

 

 

ADDENDUM
TO ADMINISTRATIVE SERVICES AGREEMENT

 

This Addendum (the “Addendum”)
is entered into as of January 1, 2008, by and among MARYLAND RADIATION THERAPY
MANAGEMENT SERVICES, INC., a Maryland corporation (“MANAGEMENT SERVICES”) and
KATIN RADIATION THERAPY, P.A,, a Maryland professional corporation (the “PA”),
This Addendum amends Section 3.1 of the Administrative Services Agreement dated
October 31, 1998 between the parties (the “Agreement”) to adjust the monthly
Service Fee of $16,667.67 paid in 2007 to a monthly Service Fee of $5,166.67,
and replaces the Addendum of that same Section dated January 1, 2007. From and
after the date hereof Section 3.1 shall read as follows:

 

3.1.
Service Fee. For the services to be provided hereunder by MANAGEMENT
SERVICES, the PA shall pay to MANAGEMENT SERVICES a monthly Service Fee of
$5,166.67. The parties agree that the Service Fee represents the fair market
value of the services provided by MANAGEMENT SERVICES hereunder and that the
parties shall meet annually to reevaluate the value of services provided by
MANAGEMENT SERVICES and shall establish the fair market value thereof for
purposes of this Section 3.1.

 

 

	
  Accepted:

  	
  MARYLAND RADIATION THERAPY
  MANAGEMENT SERVICES, INC.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ David NT Watson

  
	
   

  	
   

  	
  David NT Watson

  
	
   

  	
   

  	
  Vice President & CFO

  
	
   

  	
   

  	
   

  
	
  Accepted:

  	
  KATIN RADIATION THERAPY,
  P.A.

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Daniel E. Dosoretz

  
	
   

  	
   

  	
  Daniel E. Dosoretz, M.D.

  
	
   

  	
   

  	
  Vice President

  

 

 

ADMINISTRATIVE
SERVICES AGREEMENT

“Maryland”

 

This Administrative Services
Agreement (“Agreement”) is entered into as of October 31, 1998 (“Effective Date”)
by and among MARYLAND RADIATION THERAPY MANAGEMENT SERVICES, INC., a Maryland
corporation (“MANAGEMENT SERVICES”) and KATIN RADIATION THERAPY, PA., a
Maryland professional corporation (the “PC”).

 

RECITALS

 

A. The PC is a Maryland
professional corporation that engages in the business of providing or arranging
for the provision of health care services (the “Practice”). The PC has entered
into and throughout the term of this Agreement may (if MANAGEMENT SERVICES does
not do so itself as provided herein) continue to enter into arrangements with
insurers, HMOs and other third-party payors (“Payors”) to provide or arrange
for the provision of health care services to persons covered by those Payors (“Enrollees”).

 

B. The PC has entered into
written employment agreements with physicians and other health care providers
and health care professionals (“Employed Providers”) licensed to practice in
the State of Maryland. The PC may also enter into independent contractor
agreements with various physicians and other health care providers and health
care professionals (“Contracting Providers”) to assist the PC in providing or
arranging for the provision of health care services to Enrollees and other
patients of the PC (collectively, “Patients”).

 

C. MANAGEMENT SERVICES
engages in the business of providing certain administrative and support
services concerning the day-to-day affairs of radiation therapy office (the “Offices”),
both in their startup and established phases, and in providing space in the
Offices, equipment, furnishings, supplies, inventory, personnel and working
capital to Offices and facilities management in connection therewith.

 

D. The PC desires to secure
certain administrative services from MANAGEMENT SERVICES in connection with its
operation of the Practice in the Offices, and to lease from MANAGEMENT SERVICES
certain space, equipment, furnishings, supplies and inventory in connection
therewith.

 

E. The PC and MANAGEMENT
SERVICES desire to enter into a written agreement for the provision by
MANAGEMENT SERVICES, on an exclusive basis, of administrative services to the
PC with respect to the Practice, and for the provision of space, furnishings,
supplies, inventory, non-medical personnel and management services to the
Practice, so as to permit the PC to devote its efforts on a concentrated and
continuous basis to the rendering of medical services to its Patients.

 

NOW, THEREFORE, in
consideration of the mutual covenants and conditions contained herein, the
parties agree as follows:

 

 

I. RESPONSIBILITIES OF THE PC

 

1.1. Sole Responsibility
for All Medical and Professional Matters. All medical and professional
matters relating to the provision of radiation therapy or oncology services at
the Offices shall be the sole responsibility of the PC. The PC shall use and
occupy the facilities provided by MANAGEMENT SERVICES hereunder exclusively for
the practice of medicine. The PC expressly acknowledges that the medical
practice or practices conducted at these facilities shall be conducted solely
by Employed Providers and Contracting Providers.

 

1.2. Employed Providers
and Contracting Providers. The PC shall have complete control of and
responsibility for the hiring, engagement, compensation, supervision
evaluation, and termination of all Employed Providers and Contracting
Providers, including nurses, physician assistants and other licensed healthcare
professionals, With respect to physicians, the PC shall only employ and
contract with licensed physicians meeting applicable credentialing guidelines
established by the PC. The PC shall be responsible for the payment of salaries
and wages, compensation, payroll taxes, employee benefits, and all other taxes
and charges now or hereafter applicable to Employed Providers and Contracting
Providers. Prior to making any changes with respect to any of the Employed
Providers or Contracting Providers, the PC shall consult with MANAGEMENT
SERVICES, although MANAGEMENT SERVICES shall provide input only and shall not
conclude whether an Employed Provider should be hired or terminated. The PC
shall also consult with MANAGEMENT SERVICES with regard to the terms of
contracts entered into between the PC and Employed Providers and Contracting
Providers and the terms and conditions of their employment or engagement as
independent contractors, as applicable.

 

1.3. Fees, Charges and
Payor Agreements. The PC shall, after consultation with MANAGEMENT
SERVICES, determine the fees, charges, premiums, or other amounts due in
connection with its delivery of health care services to Patients. Such fees,
charges, premiums, or other amounts, regardless of whether determined on a
fee-for-service, capitated, prepaid, or other basis, shall be reasonable and
consistent with the fees, charges, premiums and other amounts due to health
care providers for similar services within the community under the type of
reimbursement program involved. MANAGEMENT SERVICES shall provide input
relating to the foregoing but shall not conclude the level of fees, charges,
premiums, or other amounts the PC should establish.

 

1.4. Compliance with Law.
The PC shall require all of its Employed Providers and Contracting Providers to
comply with all laws, regulations, and ethical and professional standards
applicable to the practice of medicine. Employed Providers and Contracting
Providers who are physicians shall at all times be licensed, to practice
medicine in the State of Maryland and all other states in which an Office at which
such physician provides patients medical services is located.

 

2

 

1.5. Offices; Hours of
Operation; Staffing. The PC shall conduct the Practice from the current
Office located in Maryland at                                           , as well as
such hospitals and other facilities as may be agreed upon by MANAGEMENT
SERVICES and the PC from time to time. Any additional or substitute Office
shall be deemed to be part of the Practice for the purposes of this Agreement.
The hours of operation and the medical staffing of the Offices shall be
established by the agreement of the PC and MANAGEMENT SERVICES from time to
time hereafter.

 

1.6. Quality Assurance.
The PC shall rigorously monitor utilization and quality of services provided by
Employed Providers and Contracting Providers, shall develop, maintain, and
administer quality assurance programs and performance standards and shall take
all steps necessary to remedy any and all deficiencies in the efficiency or the
quality of medical care provided.

 

1.7. Patient Referrals.
The parties agree that the benefits to the PC hereunder do not require, are not
payment for, and are not in any way contingent upon the admission, referral or
any other arrangements for the provision of any item or service offered by
MANAGEMENT SERVICES or any Affiliate, as defined in Section 8.21 of this
Agreement, of MANAGEMENT SERVICES to any of the PC’s Patients in any facility
or laboratory controlled, managed or operated by MANAGEMENT SERVICES or any
Affiliate of MANAGEMENT SERVICES.

 

1.8. Professional Dues
and Education Expenses. The PC and its Employed Providers and Contracting
Providers shall be solely responsible for the cost of membership in
professional associations, and continuing professional education. The PC shall
ensure that each of its Employed Providers and Contracting Providers
participates in such continuing medical education as is necessary for such
provider to remain current with professional licensure and community standards.

 

1.9. Professional
Insurance Eligibility. The PC shall cooperate with MANAGEMENT SERVICES in
the obtaining and retaining of professional liability insurance by assuring
that either its Employed Providers and Contracting Providers are insurable or
instituting proceedings to terminate any Employed Provider of Contracting
Provider who is not insurable or loses Ms or her insurance eligibility.
Termination shall be effective no more than thirty (30) days from such
determination. The PC shall require all Employed Providers and Contracting
Providers to participate in an on-going risk management program.

 

1.10. Fees for
Professional Services. MANAGEMENT SERVICES shall be solely responsible for
legal, accounting and other professional services incurred by the PC in
operating the Practice absent a violation by the PC of any provisions of this
Agreement.

 

3

 

II.
RESPONSIBILITIES OF MANAGEMENT SERVICES

 

2.1.
General Responsibility. MANAGEMENT SERVICES shall
have general responsibility for providing fiscal services, administrative
services, and other strategic and tactical support services to the PC with
respect to the Practice, except as otherwise provided in this Agreement.
MANAGEMENT SERVICES shall perform all required functions in accordance with
sound management techniques. Notwithstanding MANAGEMENT SERVICES’s general and
specific rights and responsibilities set forth in this Agreement, the PC shall
have full authority and control with respect to all medical, professional and
ethical determinations over the PC’s Practice to the extent required by
federal, state and local laws, rules and regulations, MANAGEMENT SERVICES shall
not engage in activities which constitute the practice of medicine under
applicable laws. MANAGEMENT SERVICES shall neither exercise control over nor
interfere with the physician-patient relationship, which shall be maintained
strictly between the physicians employed by or contracting with the PC and the
PC’s Patients.

 

2.2. Responsibilities with
Regard to Selected Patient- Related Matters.

 

(a) Patient Relations.
Scheduling. Etc. MANAGEMENT SERVICES shall assist the PC in maintaining
positive Patient relations by, among other things, in conjunction with and at
the direction of the PC: scheduling Patient appointments; responding to Patient
grievances and complaints in matters other than medical evaluation, diagnosis,
and treatment; and establishing and maintaining in the PC’s name and on its
behalf Patient transfer arrangements to expedite referrals where medically
necessary; as determined and requested by the attending physician.

 

(b) Recordkeeping.
MANAGEMENT SERVICES shall assist the PC in maintaining Patient medical records
in accordance with applicable laws concerning their confidentiality and
retention, and promptly making such records available to the PC’s Employed
Providers, Contracting Providers and other appropriate recipients.
Notwithstanding the foregoing sentence, Patient medical records shall be and
shall remain the property of the PC, and the content thereof shall be solely
the responsibility of the PC.

 

(c) Quality Assurance.

 

(i) In General.
MANAGEMENT SERVICES shall assist the PC, in accordance with criteria
established by the PC, in the development and implementation of appropriate
quality assurance programs, including development of performance and
utilization standards, sampling techniques for case review, and preparation of
appropriately documented studies. Notwithstanding the foregoing, MANAGEMENT
SERVICES shall not perform any duties that constitute the corporate practice of
medicine in Maryland and all other states in which an Office at which the PC
provides patient medical services is located.

 

(ii) Periodic Independent
Review. On behalf of the PC,

 

4

 

MANAGEMENT SERVICES may
periodically perform quality assurance and utilization reviews through nurses
employed by it; provided, however, that MANAGEMENT SERVICES shall not
engage in activities which constitute the practice of medicine under applicable
law. Alternatively, MANAGEMENT SERVICES may periodically arrange for an
independent quality assurance and utilization review to be performed by persons
who are unrelated to the PC or MANAGEMENT SERVICES, or to any Affiliate of the
PC or MANAGEMENT SERVICES, which has expertise in such areas, and which has
been approved in advance by the PC. Such review shall include a random sampling
of medical records (consistent with laws regarding the confidentiality of
medical records), an analysis of the PC’s quality assurance utilization review
procedures, and an analysis of the appropriateness of costs associated with
operating the PC’s medical practice at the Practice.

 

2.3. Responsibilities
with Regard to Selected Financial Matters.

 

(a) Billing.
MANAGEMENT SERVICES shall submit on a timely basis all bills and necessary
documentation required by Patients and Payors in order to obtain payment in
connection with the PC’s delivery of health’ care services at the Practice or
its arrangement for the delivery of such services. In seeking such payment,
MANAGEMENT SERVICES shall act as the PC’s exclusive agent in billing and
collecting professional fees, charges and other amounts owed to the PC. In this
connection, the PC hereby appoints MANAGEMENT SERVICES, during the term of this
Agreement, as the PC’s true and lawful attorney-in-fact, with power of
substitution, for the following purposes relating to the Practice:

 

(i) To bill the PC’s
Patients on the PC’s behalf.

 

(ii) To collect accounts
receivable generated by such billings on the PC’s behalf, including, where
deemed appropriate by MANAGEMENT SERVICES and approved in advance by the PC,
settling and compromising claims, assigning such accounts receivable to a
collection agency or the bringing of legal action against a Patient or Payor on
the PC’s behalf.

 

(iii) To receive payments on
behalf of the PC from Patients and Payors, to cause such payments to be
deposited into appropriate depository accounts (each such depository account, a
“Collections Account”) arid to write checks against or otherwise withdraw such
payments to pay the PC Expenses (as hereinafter defined).

 

(b) Accounting.
MANAGEMENT SERVICES shall direct and maintain the operation of an appropriate
accounting system with respect to the PC’s operation of the Practice which
shall perform all bookkeeping and accounting services required for the
operation of the Practice, including the maintenance, custody and supervision
of business records, ledgers and reports; the establishment, administration and
implementation of accounting procedures, controls and systems. Such accounting
system shall allow MANAGEMENT SERVICES to prepare the reports specified in Section
2.3(c).

 

5

 

(c) Reporting.
MANAGEMENT SERVICES shall present to the PC reports on the financial condition
of the PC on the basis set forth below in clauses (i) and (ii) and such other
reports that the PC may reasonably request, including daily activity reports,
weekly analyses, alternative delivery system reports, backlog reports and the
like, MANAGEMENT SERVICES also shall provide such reports as may be required by
any regulatory agency having jurisdiction over the operations of the PC.

 

The reports initially
required to be delivered to the PC under this Section 2.3(c) with respect to
the Practice are as follows:

 

(i) As soon as possible
after the close of each month, a balance sheet and a related statement of
revenues and expenses showing the results of the PC’s operations for the
preceding month of the fiscal year and the year to date.

 

(ii) As soon as possible
after the close of each fiscal year, a balance sheet and related statement of
revenues and expenses showing the results of the PC’s operations during that
fiscal year.

 

2.4. Responsibilities
with Respect to Facilities Management.

 

(a) Office Management
Services. MANAGEMENT SERVICES shall provide, supervise and direct the
development of appropriate and efficient office management services with
respect to the PC’s operation of the Practice.

 

(b) Offices.
MANAGEMENT SERVICES shall provide, manage and maintain the real property
comprising the Offices and reasonable improvements during the term of this
Agreement. In consultation with the PC} MANAGEMENT
SERVICES shall oversee all management, maintenance and other decisions
pertaining to the Offices consistent with the terms of this Agreement.
MANAGEMENT SERVICES shall maintain the Offices in good condition and repair,
reasonable wear and tear excepted. MANAGEMENT SERVICES shall provide such
additional and/or replacement facilities as the PC and MANAGEMENT SERVICES
agree, from time to time. MANAGEMENT SERVICES shall provide the PC with all
utilities (including water, gas and electricity), heat, air conditioning,
telephone, janitorial services and disposal services (including the disposal of
medical wastes) required in connection with the operation of the Offices.

 

(c) Use of Assets.

 

(i) MANAGEMENT SERVICES
shall lease or purchase and, when necessary, replace equipment and furnishings
needed for the delivery of health care services by the PC at the Offices and
for the delivery of services provided by MANAGEMENT SERVICES pursuant to this
Agreement. MANAGEMENT SERVICES shall consult with the PC with respect to the
suppliers, prices and specifications of such equipment and furnishings.
MANAGEMENT SERVICES shall use its best efforts to keep and maintain the
equipment and

 

6

 

furnishings used by the PC
at the Offices in good working order and condition.

 

(ii) All assets provided or
purchased under this Agreement by MANAGEMENT SERVICES, including any management
information systems, shall remain the property of MANAGEMENT SERVICES and the
PC shall have the right to use such assets only during the term of this Agreement.

 

(iii) Nothing in this
Agreement shall be construed to affect or limit in any way the professional
discretion of the PC to select and use equipment, furnishings, inventory and
supplies purchased by MANAGEMENT SERVICES in accordance with the terms of this
Agreement insofar as such selection or use constitutes or might constitute the
practice of medicine.

 

(d) Supplies and
Inventory. MANAGEMENT SERVICES shall provide and replenish, as necessary
and as may be permitted by applicable law, the inventory and supplies needed
for the delivery of medical services by the PC, and for the delivery of
services by MANAGEMENT SERVICES pursuant to this Agreement. MANAGEMENT SERVICES
shall consult with the PC with respect to the suppliers, prices and
specifications of such inventory and supplies.

 

(e) No Warranties.
THE PC ACKNOWLEDGES THAT MANAGEMENT SERVICES MAKES NO WARRANTIES OR
REPRESENTATIONS, EXPRESS OR IMPLIED, AS TO THE SUITABILITY OR ADEQUACY OF ANY
FACILITIES, EQUIPMENT, FURNISHINGS, INVENTORY OR SUPPLIES PROVIDED PURSUANT TO
THIS AGREEMENT FOR THE CONDUCT OF A MEDICAL PRACTICE OR FOR ANY OTHER
PARTICULAR PURPOSE.

 

2.5. Other
Responsibilities.

 

(a) Public Relations.
MANAGEMENT SERVICES shall provide services reasonably necessary for enhancing
public relations for the PC’s health care services and shall submit any public
relations programs for prior review and revision, if necessary, and approval by
the PC. Such public relations shall comply with applicable laws and regulations
governing the use of promotional activities by the medical profession and with
applicable standards of medical ethics.

 

(b) Insurance.

 

(i) Property and
Liability Insurance. MANAGEMENT SERVICES shall obtain and maintain during
the term of this Agreement, if available on commercially reasonable terms, (a) property
damage insurance protecting the Practice premises and the personal property
located therein against such hazards and in such amounts as MANAGEMENT SERVICES
determines are reasonably prudent; and (b) general liability insurance in such
amounts as MANAGEMENT SERVICES determines are reasonably prudent.

 

7

 

(ii) General Liability
Insurance. The PC shall obtain and maintain during the term of this
Agreement general liability insurance in such amounts as the PC determines are
reasonably prudent. The PC shall name MANAGEMENT SERVICES as an additional
insured on such policies.

 

(iii) Malpractice
Insurance. It is understood that the PC and its Employed Providers shall,
at the PC’s cost, at all times be covered by malpractice insurance with
coverage in usual and customary amounts for practitioners of the same profession
and specialties in Maryland and, if applicable, other slates. The PC shall
ensure that its written agreements with Contracting Providers who are
physicians require such Contracting Providers to at all times be covered by
malpractice insurance in amounts that are usual and customary for practitioners
of the same profession and specialty in Maryland and, if applicable, other
states. Such malpractice policies shall name MANAGEMENT SERVICES as an
additional insured.

 

(iv) Copies of Insurance
Policies. MANAGEMENT SERVICES or the PC shall, upon request by the PC or
MANAGEMENT SERVICES, as the case may be, promptly provide the PC or MANAGEMENT
SERVICES, as the case may be, with copies of all policies of insurance that it
procures under this Agreement. Each such policy shall provide that it cannot be
modified or terminated except after thirty (30) days written notice to
MANAGEMENT SERVICES.

 

(c) Personnel.
MANAGEMENT SERVICES shall furnish the services of all personnel other than
physicians, nurses, physician assistants or other licensed healthcare
professionals required for the operation of the Practice. Except as
specifically provided in this Section 2.5(c), MANAGEMENT SERVICES has
the power to recruit, hire, train, promote, assign, set the compensation level for,
and discharge all personnel other than physicians, nurses, physician assistants
or other licensed healthcare professionals. Any personnel employed by
MANAGEMENT SERVICES who perform patient care services shall perform such
services under the exclusive direction, supervision and control of the PC,
while all other services of MANAGEMENT SERVICES personnel shall be performed
under the exclusive direction, supervision and control of MANAGEMENT SERVICES.
If the PC is dissatisfied with the services of any personnel employed by
MANAGEMENT SERVICES, the PC shall consult with MANAGEMENT SERVICES. MANAGEMENT
SERVICES shall in good faith determine whether the performance of that employee
could be brought to acceptable levels through counsel and assistance, or whether,
if requested by the PC (provided that such employee is not an officer or senior
manager of MANAGEMENT SERVICES), such employee should be removed from providing
services for the PC. Employee assignments shall be made with the intention of
assuring consistent and continued rendering of quality services and to ensure
prompt availability and accessibility of personnel to physicians in order to
develop constant, familiar and routine working relationships between the
Employed Providers, Contracting Providers and MANAGEMENT SERVICES personnel.

 

(d) Employed Providers.
MANAGEMENT SERVICES shall assist the PC

 

8

 

in the administration of any
employee benefit plans established by the PC in compliance with the provisions
of Section 1.10 hereof.

 

(e) Managed Care
Agreements. MANAGEMENT SERVICES shall negotiate and administer all managed
care agreements on behalf of the PC and shall consult with the PC on all
professional and clinical matters relating thereto.

 

III. FINANCIAL
ARRANGEMENTS

 

3.1. Service Fee. For
the services to be provided hereunder by MANAGEMENT SERVICES, the PC shall pay
to MANAGEMENT SERVICES a monthly Service Fee of $124,000. The parties agree
that the Service Fee represents the fair market value of the services provided
by MANAGEMENT SERVICES hereunder and that the parties shall meet annually to
reevaluate the value of services provided by MANAGEMENT SERVICES and shall
establish the fair market value thereof for purposes of this Section 3.1.

 

3.2. Security Agreement;
the PC Expenses. To secure the PC’s payment obligations hereunder, the PC
is concurrently herewith entering into a security agreement, in form acceptable
to MANAGEMENT SERVICES, to grant to MANAGEMENT SERVICES a security interest in
the accounts receivable of the PC and all of the PC’s rights to receive
payments under managed care contracts. The PC shall cooperate with MANAGEMENT
SERVICES and execute all reasonably necessary documents in connection with the
granting of such security interest.

 

All payments on behalf of
the PC from Patients and Payors shall be deposited into one or more Collection
Accounts. To the extent the PC receives any such payments, the PC shall direct
such payments to MANAGEMENT SERVICES for deposit in one or more Collection
Accounts.

 

3.3. Arbitration. Any
controversy or claim arising out of or relating to this Agreement or the
transactions contemplated hereby, including any controversy or claim arising
out of or relating to the parties’ decision to enter into tin’s Agreement or
the transactions contemplated hereby, shall be settled by binding arbitration.
Each party shall select an arbitrator who has at least three (3) years
experience in health care or medical practice management or in health care or
medical practice dispute resolution. The arbitration proceedings shall be
confidential and the arbitrators may issue appropriate protective orders to
safeguard each party’s confidential information. Such protective orders shall
be enforceable by any court of competent jurisdiction. Except as specifically
provided in this section, the arbitration shall be conducted in accordance with
the rules of conciliation and arbitration of the American Arbitration
Association. The two arbitrators shall agree upon any issue no later than
thirty (30) days after the date the second arbitrator has been engaged, and
shall take into account the principles and objectives set forth in paragraph
(b) below. If the two arbitrators cannot agree on a determination, then within
five (5) days thereafter the two arbitrators shall select a third arbitrator,
who shall have the same qualifications required for the first two arbitrators.
No later than thirty (30) days after the date the third arbitrator is engaged,
he or she shall determine which of the two positions best satisfies

 

9

 

the provisions of the
contract and the intent of the parties, taking into account the principles and
objectives set forth in paragraph (b) below. The third arbitrator shall have no
right to propose a middle ground between the two or to make any modification of
the proposals of either party. The third arbitrator’s determination shall be
final and binding on all parties. The cost and expense of the third arbitrator
shall be shared equally between the parties. If either party fails to engage an
arbitrator as required hereunder, the arbitrator selected by the other party
shall conduct the arbitration and make the final decision in accordance with
this Section 3.4.

 

(b) The arbitration shall be
conducted at the offices of MANAGEMENT SERVICES or such other mutually
acceptable site. In conducting the arbitration, the arbitrators) shall consider
the following principles and objectives of the parties in entering into this
Agreement:

 

(i) The parties contemplate
that the PC shall pay MANAGEMENT SERVICES a flat fee for the fair market value
of MANAGEMENT SERVICES’ hereunder.

 

(ii) The parties agree that
MANAGEMENT SERVICES shall in no way provide medical services to Patients.

 

(iii) The parties
contemplate an expansion of the Practice by acquisition or purchase of other
Offices and by expansion of the variety of specialty medical services provided
and/or ancillary services provided.

 

IV.
REPRESENTATIONS AND WARRANTIES; COVENANTS

 

4.1. Representations and
Warranties and Covenants of the PC.

 

(a) The PC hereby represents
and warrants to MANAGEMENT SERVICES as follows:

 

(i) The PC is and shall
remain during the term of this Agreement a professional corporation duly
organized, validly existing and in good standing under the laws of the State of
Maryland, actively engaged in the practice of medicine, and possessing full
corporate power and authority to own its properties and to conduct the business
in which it engages.

 

(ii) The PC has full
corporate power and authority to execute and deliver this Agreement and to
engage in the transactions and obligations contemplated by this Agreement. Upon
its execution, this Agreement shall constitute a valid and binding obligation
of the PC, enforceable in accordance with its terms, except as limited by
applicable bankruptcy, insolvency, moratorium, or other similar laws affecting
generally the rights of creditors and by principles of equity. The party
executing this Agreement on behalf of the PC is duly authorized to do so.

 

10

 

(iii) The consummation of
the transactions contemplated by this Agreement will not: result in a breach of
the terms, provisions, or conditions of or constitute a default under the
Articles of Incorporation, By-Laws or other enabling or governing instruments
of the PC or any agreement to which the PC is a party or by which it is bound;
or, to the best knowledge of the PC, constitute a violation of any applicable
law or regulation.

 

(b) The PC hereby covenants
to MANAGEMENT SERVICES that it shall not, without the prior written consent of
MANAGEMENT SERVICES, take any action to terminate or nullify, or release any
Employed Provider from, the terms of any noncompetition covenant set forth in
any employment agreement between the PC and such Employed Provider.

 

4.2. Covenants and
Warranties of MANAGEMENT SERVICES. MANAGEMENT SERVICES hereby represents
and warrants to the PC as follows:

 

(a) MANAGEMENT SERVICES is
and shall remain during the term of this Agreement a corporation which is duly
organized, validly existing and in good standing under the laws of the State of
Maryland, possessing full corporate power and authority to own its properties
and to conduct the business in which it engages.

 

(b) MANAGEMENT SERVICES has
full corporate power and authority to execute and deliver this Agreement and to
engage in the transactions and obligations contemplated by this Agreement. Upon
its execution, this Agreement shall constitute a valid and binding obligation
of MANAGEMENT SERVICES, enforceable in accordance with its terms, except as
limited by applicable bankruptcy, insolvency, moratorium, or other similar laws
affecting generally the rights of creditors and by principles of equity. The
party executing this Agreement on behalf of MANAGEMENT SERVICES is duly
authorized to do so.

 

(c) The consummation of the
transactions contemplated by this Agreement will not: result in any breach of
the terms, provisions or conditions of or constitute a default under the Certificate
of Incorporation, Bylaws or other enabling or governing instruments of
MANAGEMENT SERVICES or any agreement to which MANAGEMENT SERVICES is a party or
by which it is bound; or, to the best knowledge of MANAGEMENT SERVICES,
constitute a violation of any applicable law or regulation.

 

V. TERM
AND TERMINATION

 

5.1 Initial and Renewal
Term. The term of this Agreement will be for an initial period of
twenty-five (25) years after the Effective Date, and shall be automatically
renewed for successive five (5) year periods thereafter (collectively, the “Term”),
provided that neither MANAGEMENT SERVICES nor the PC shall have given notice of
termination of this Agreement at least one hundred twenty (120) days before the  end of the initial term or any renewal term,
or unless otherwise terminated as provided in Section 5.2 of this Agreement.

 

11

 

5.2 Termination.

 

(a) Termination by the PC.
The PC may immediately terminate this Agreement at its discretion, upon written
notice as follows:

 

(i) If MANAGEMENT SERVICES
becomes insolvent by reason of its inability to pay its debts as they mature;
is adjudicated bankrupt or insolvent; files a petition in bankruptcy,
reorganization or similar proceeding under the bankruptcy laws of the United
States or shall have such a petition filed against it which is not discharged
within thirty (30) days; has a receiver or other custodian, permanent or
temporary, appointed for its business, assets or property; makes a general
assignment for the benefit of creditors; has its bank accounts, property or
accounts attached; has execution levied against its business or property; or
voluntarily dissolved or liquidates or has a petition filed for corporate
dissolution and such petition is not dismissed with thirty (30) days;

 

(ii) If the MANAGEMENT
SERVICES fails to comply with any material provision of this Agreement, or any
other agreement with the PC, and does not correct such failure within sixty
(60) days after written notice of such failure to comply is delivered by the PC
specifying the nature of the breach in reasonable detail.

 

(b) Termination by
MANAGEMENT SERVICES. MANAGEMENT SERVICES may immediately terminate this
Agreement at its discretion, upon written notice as follows:

 

(i) If the PC becomes
insolvent by reason of its inability to pay its debts as they mature; is
adjudicated bankrupt or insolvent; files a petition in bankruptcy,
reorganization or similar proceeding under the bankruptcy laws of the United
States or shall have such a petition filed against it which is not discharged
within thirty (30) days; has a receiver or other custodian, permanent or
temporary, appointed for its business, assets or property; makes a general
assignment for the benefit of creditors; has its bank accounts, property or
accounts attached; has execution levied against its business or property; or
voluntarily dissolves or liquidates or has a petition filed for corporate
dissolution and such petition is not dismissed with thirty (30) days; or

 

(ii) If the PC fails to
comply with any material provision of this Agreement with MANAGEMENT SERVICES,
and does not correct such failure within sixty (60) days after written notice
of such failure to comply is delivered by MANAGEMENT SERVICES specifying the
nature of the breach in reasonable detail.

 

(c) Termination by
Agreement. In the event the PC and MANAGEMENT SERVICES shall mutually agree
in writing, this Agreement may be terminated on the date specified in such
written agreement.

 

(d) Legislative,
Regulatory or Administrative Change. In the event there shall be a change
in the Medicare or Medicaid statutes, federal statutes, state statutes, case
laws,

 

12

 

administrative
interpretations, regulations or general instructions, the adoption of new
federal or state legislation, or a change in any third-party reimbursement
system, any of which are reasonably likely to materially and adversely affect
the manner in which either party may perform or be compensated for its services
under this Agreement or which shall make this Agreement or any related
agreements unlawful or unenforceable, or which would be reasonably likely to
subject either party to this Agreement, or any member, shareholder, officer,
director, employee, agent or affiliated organization to any civil or criminal
penalties or administrative sanctions, the parties shall immediately use their
best efforts to enter into a new service arrangement or basis for compensation
for the services furnished pursuant to this Agreement that complies with the
law, regulation, or policy, or which minimizes the possibility of such
penalties, sanctions or unenforceability, and that approximates as closely as
possible the economic position of the parties prior to the change. If the parties
are unable to reach a new agreement within a reasonable time, then either party
may submit the issue to arbitration pursuant to Section 3.3 for the purpose of
reaching an alternative arrangement that is equitable under the circumstances.

 

5.3 Effects of
Termination. Upon termination of this Agreement, as provided in this
Article V, neither party shall have any further obligations hereunder except
for (i) obligations accruing prior to the date of termination, including,
without limitation, payment of the Service Fee relating to services provided
prior to the termination of this Agreement, (ii) obligations, promises, or
covenants set forth herein that are expressly made to extend beyond the Term,
including, without limitation, insurance, indemnities and non-competition
provisions, which provisions shall survive the expiration or termination of
this Agreement. In effectuating the provisions of this Section 5.3, the PC
specifically acknowledges and agrees that if this Agreement terminates pursuant
to Sections 5.2(b) or (d), MANAGEMENT SERVICES shall continue for a period not
to exceed ninety (90) days to collect and receive on behalf of the PC on an
exclusive basis all cash collections from accounts receivable in existence at
the time this Agreement is terminated, it being understood that (a) such cash
collections may be used to compensate MANAGEMENT SERVICES for services rendered
prior to the termination of this Agreement, (b) MANAGEMENT SERVICES shall not
be entitled to collect accounts receivable after the termination date of this
Agreement is terminated pursuant to Section 5.2(a), and (c) the MANAGEMENT
SERVICES shall deduct for such cash collections any other amounts owed to
MANAGEMENT SERVICES under this Agreement, including, without limitation, any reasonable
costs incurred by MANAGEMENT SERVICES in carrying out the post-termination
procedures and transactions contemplated herein. MANAGEMENT SERVICES shall
remit remaining amounts from such collection activities, if any, to the PC.
Upon the expiration or termination of this Agreement for any reason or cause
whatsoever, MANAGEMENT SERVICES shall surrender to the PC all books and records
pertaining to the PC’s Patient medical records and PC Records (as defined in
Section 7.2).

 

13

 

VI.
RESTRICTIVE COVENANTS

 

6.1. Covenant Regarding
Proprietary Information. In the course of the relationship created pursuant
to this Agreement, the PC will have access to certain methods, tirade secrets,
processes, ideas, systems, procedures, invention’s, discoveries, concepts,
software in various stages of development, designs, drawings, specifications,
models, data, documents, diagrams, flow charts, research, economic and
financial analysis, developments, procedures, know-how, policy manuals,
financial data, form contracts, marketing ad other techniques, plans,
materials, forms, copyrightable materials and trade information regarding the
operations of MANAGEMENT SERVICES and/or of its Affiliates (collectively, the “Protected
Parties”). The foregoing, together with the existence and terms of this
Agreement, are referred to in this Agreement as “Proprietary Information”. The
PC shall maintain all such Proprietary Information in strict secrecy and shall
not divulge such information to any third parties, except as may be necessary
for the discharge of its obligations under this Agreement. The PC shall take
all necessary and proper precautions against disclosure of any Proprietary
Information to unauthorized persons by any of its officers, directors,
employees or agents. All officers, directors, employees and agents of the PC
who will have access to all or any part of the Proprietary Information may be
required to execute an agreement, at the reasonable request of MANAGEMENT
SERVICES, valid under the law of the jurisdiction in which such agreement is
executed, and in a form acceptable to MANAGEMENT SERVICES and its counsel,
committing themselves to maintain the Proprietary Information in strict
confidence and not to disclose it to any unauthorized person or entity. The
Protected Parties not party to this Agreement are hereby specifically made
third party beneficiaries of this Section 6.1, with the power to enforce the
provisions hereof. Upon termination of this Agreement for any reason, the PC
and each of its Employed Providers and Contracting Providers shall cease all
use of any of the Proprietary Information and, at the request of MANAGEMENT
SERVICES, shall execute such documents as may be necessary to evidence the PC’s
abandonment of any claim thereto. The parties recognize that a breach of this
Section 6.1 cannot be adequately compensated in money damages and therefore
agree that injunctive relief shall be available to the Protected Parties as their
respective interests may appear.

 

The obligations of the PC
under this Section 6.1 shall not apply to information: (i) which is a matter of
public knowledge on or becomes a matter of public knowledge after the Effective
Date of this Agreement, other than as a breach of the confidentiality terms of
this Agreement or as a breach of the confidentiality terms of any other
agreement between the PC and MANAGEMENT SERVICES or its Affiliates; or (ii) was
lawfully obtained by the PC on a nonconfidential basis other than in the course
of performance under this Agreement and from some entity other than MANAGEMENT
SERVICES or its Affiliates or from some person other than one employed or
engaged by MANAGEMENT SERVICES or its Affiliates, which entity or person has no
obligation of confidentiality to MANAGEMENT SERVICES or its Affiliates.

 

6.2. Covenants Not to
Compete During the Term. The parties recognize that the services to be
provided by MANAGEMENT SERVICES shall be feasible only if the PC operates an
active medical practice to which the PC and Employed Providers devote full time

 

14

 

and attention. To that end:

 

(a) Restrictive Covenants
by the PC. During the term of this Agreement, the PC shall not establish,
operate or provide physician or other health care services at any medical
office, clinic or other health care facility providing services substantially
similar to those provided by the PC pursuant to this Agreement anywhere other
than at the Offices and as may be approved in writing by MANAGEMENT SERVICES. The
PC shall also not enter into any management or administrative services
agreement or arrangement with any person or entity other than MANAGEMENT
SERVICES without MANAGEMENT SERVICES’s prior written approval.

 

(b) Restrictive Covenants
by Employed Providers. All employment contracts between the PC and its
Employed Providers shall name MANAGEMENT SERVICES as a third-party beneficiary
to the contract and shall not be revised without the prior written consent of
MANAGEMENT SERVICES. The contracts shall include noncompetition agreements with
its Employed Providers who are physicians, the substance and form of which is
set forth as Exhibit A hereto, and which the PC will enforce.

 

6.3. Covenant Not to
Compete Following Termination. For three (3) years following the
termination of this Agreement by MANAGEMENT SERVICES pursuant to Section 5.2,
the PC shall not enter into any management or administrative services agreement
or any similar arrangement with any person or entity for the provision of the
same or similar services as MANAGEMENT SERVICES provides to the PC under this
Agreement.

 

6.4. Covenant Not to
Solicit. During the term of this Agreement and for three (3) years
following the termination of this Agreement, the PC shall not:

 

(a) Directly or indirectly
solicit, recruit or hire, or induce any party to solicit, recruit or hire any
person who is an employee of, or who has entered into an independent contractor
arrangement with, MANAGEMENT SERVICES or any Affiliate of MANAGEMENT SERVICES
(excluding any person who performs patient services);

 

(b) Directly or indirectly,
whether for itself or for any other person or entity, call upon, solicit,
divert or take away, or attempt to solicit, call upon, divert or take away any
of MANAGEMENT SERVICES’s customers, business, or clients; or

 

(c) Disrupt, damage, impair
or interfere with the business of MANAGEMENT SERVICES.

 

6.5. Enforcement.
MANAGEMENT SERVICES and the PC acknowledge and agree that since a remedy at law
for any breach or attempted breach of the provisions of this Article VI or of
Article VII shall be inadequate, either party shall be entitled to specific
performance and injunctive or other equitable relief in case of any such breach
or attempted breach, in addition to whatever other remedies may exist by law.
All parties hereto also waive

 

15

 

any requirement for the
securing or posting of any bond in connection with the obtaining of any such
injunctive or other equitable relief. If any provision of Article VI or Article
VII relating to the restrictive period, scope of activity restricted and/or
other provisions described therein shall be declared by a court of competent
jurisdiction to exceed the maximum time period, scope of activity restricted or
geographical area such court deems reasonable and enforceable under applicable
law, the time period, scope of activity restricted and/or area of restriction
held reasonable and enforceable by the court shall thereafter be the
restrictive period, scope of activity restricted and/or the territory
applicable to the restrictive covenant provisions in this Article VI or Article
VII. The invalidity or non-enforceability of this Article VI or Article VII in
any respect shall not affect the validity or enforceability of the remainder of
this Article VI or Article VII or of any other provisions of this Agreement.

 

VII.
INFORMATION AND RECORDS

 

7.1. Ownership of Records.
At all times during and after the term of this Agreement, including any
extensions or renewals hereof, all business records, including but not limited
to, business agreements, books of account, general administrative records and
all information generated under or contained in the management information
system pertaining to MANAGEMENT SERVICES’s obligations hereunder, and other
business information of any kind or nature, except for Patient medical records
and the PC’s Records (as defined in Section 7.2), shall be and remain the sole
property of MANAGEMENT SERVICES; provided that after termination of this
Agreement the PC shall be entitled to reasonable access to such records and
information, including the right to obtain copies thereof, for any purpose
related to patient care or the defense of any claim relating to patient care or
the business of MANAGEMENT SERVICES or the PC.

 

7.2. The PC’s Business
and Financial Records. At all times during and after the term of this
Agreement, the financial, corporate and personnel records and information
relating exclusively to the business and activities of the PC, as distinguished
from the business and activity of MANAGEMENT SERVI.CES, hereinafter referred to
as “the PC’s Records,” shall be and remain the sole property of the PC.

 

7.3. Access to Records.
Each party shall be entitled, upon request and with reasonable advance notice,
to obtain access to all records of the other party directly related to the
performance of such party’s obligations pursuant to this Agreement; provided,
however, that such right shall not allow for access to records that must
necessarily be kept confidential. Either party, at its expense, shall have the
right to make copies of any records to which it has access pursuant to this
Section.

 

7.4. Confidentiality of
Records. MANAGEMENT SERVICES and the PC shall adopt procedures for
maintaining the confidentiality of the records relating to the operations of
MANAGEMENT SERVICES and the PC which do not constitute Proprietary Information,
which information is not otherwise available to third parties publicly or by
law, and shall comply with all applicable federal and state statutes and
regulations relating to such records. Patient

 

16

 

medical records and other
privileged Patient information shall not be disclosed or utilized by the PC or
MANAGEMENT SERVICES or their agents or employees except as required or
permitted by applicable laws and regulations.

 

VIII.
MISCELLANEOUS

 

8.1. Independent
Contractor Status of Parties. In the performance of the work, duties and
obligations under this Agreement, it is mutually understood and agreed that
each party is at all times acting and performing as an independent contractor
with respect to the other and that no relationship of partnership joint venture
or employment is created by this Agreement. Neither party, nor any other person
performing services on behalf of such party pursuant to this Agreement, shall
have any right or claim against the other party for Social Security benefits,
workers’ compensation benefits, disability benefits, unemployment insurance
benefits, health benefits, vacation pay, sick leave or any other employee
benefits of any kind.

 

8.2. No Waiver. The
waiver by any party to this Agreement of any breach of any term or condition of
this Agreement shall not constitute a waiver of subsequent breaches. No waiver
by any party of any provision of this Agreement shall be deemed to constitute a
waiver of any other provision.

 

8.3. Notices. If, at
any time after the execution of this Agreement, it shall become necessary or
convenient for one of the parties to serve any notice, demand or communication
upon the other party, such notice, demand, or communication shall be in writing
and shall be served personally, by nationally recognized overnight courier
which provides confirmation of delivery, or by depositing the same in the
United States mail, registered or certified, return receipt requested, postage
prepaid and to such address as either party may have furnished to the other
party in writing as the place for the service of notice. Any notice so mailed
shall be deemed to have been given three (3) days after the same has been
deposited in the United States mall; when delivered if the same has been given
personally; or the next business day if the same has been delivered to a
nationally recognized overnight courier service.

 

8.4. Assignment.
Neither party may sell, transfer, assign, or otherwise convey its rights or
obligations under this Agreement without the prior written consent of the
other, which consent shall not be unreasonably withheld. Notwithstanding the
foregoing, MANAGEMENT SERVICES shall have the right to (a) assign its rights
and/or delegate all or any of its obligations to any of its Affiliates; and/or
(b) subcontract some portion of its obligations hereunder to a third party
which is not an Affiliate of MANAGEMENT SERVICES, in each case without the
consent of the PC.

 

8.5. Successors and
Assigns. Subject to the provisions of this Agreement respecting assignment,
the terms, covenants and conditions contained herein shall be binding upon and
inure to the benefit of the successors and permitted assigns of the parties
hereto.

 

8.6. Severability.
Nothing contained in this Agreement shall be construed to require

 

17

 

the commission of an act
contrary to law, and whenever there is any conflict between any provision of
this Agreement and any statute, law, ordinance or regulation, the latter shall
prevail. In such event, and in any case in which any provision of this Agreement
is determined to be in violation of a statute, law, ordinance or regulation,
the affected provision(s) shall be limited only to the extent necessary to
bring it within the requirements of the law and, insofar as possible under the
circumstances, to carry out the purposes of this Agreement. The other
provisions of this Agreement shall remain in full force and effect, and the
invalidity or unenforceability of any provision hereof shall not affect the
validity and enforceability of the other provisions of this Agreement; nor the
availability of all remedies in law or equity to the parties with respect to
such other provisions.

 

8.7. Third Parties.
Except as provided in Article VII, nothing in this Agreement shall be construed
to create any duty to, any standard of care with reference to or any liability
to anyone not a party to this Agreement.

 

8.8. Headings. The
headings used in this Agreement are for convenience of reference only and shall
have no force or effect in the construction or interpretation of the provisions
of this Agreement.

 

8.9. Time of the Essence.
Time is of the very essence of each and all of the agreements, covenants and
conditions of this Agreement.

 

8.10. Governing Law.
This Agreement shall be deemed made, executed and entered into and shall be
governed by and construed in accordance with the internal laws of the State of
Florida.

 

8.11. Language
Construction. The language in all parts of this Agreement shall be
construed, in all cases, according to its fair meaning, and not for or against
either party hereto. The parties acknowledge that each party and its counsel
have reviewed and revised this Agreement and that the normal rule of
construction to the effect that any ambiguities are to be resolved against the
drafting party shall not be employed in the interpretation of this Agreement.

 

8.12. Indemnification.
The PC shall indemnify, hold harmless and defend MANAGEMENT SERVICES, its
officers, directors, shareholders, employees, agents and independent
contractors (the “MANAGEMENT SERVICES Group”) from and against any and all
liabilities, losses, damages, claims, causes of action, and expenses (including
reasonable attorneys’ fees and disbursements (a “MANAGEMENT SERVICES Loss”)),
caused or asserted to have been caused, directly or indirectly, by or as a
result of the performance of medical services or any other acts or omissions by
MANAGEMENT SERVICES and/or its partners, agents, employees and/or
subcontractors (other than MANAGEMENT SERVICES) during the term hereof except
with respect to any MANAGEMENT SERVICES Loss which is the result of any gross
negligence or willful misconduct by a member of the MANAGEMENT SERVICES Group,
MANAGEMENT SERVICES shall indemnify, hold harmless and defend the PC, its

 

18

 

officers, directors,
partners employees, agents and independent contractors (the “the PC Group”)
from and against any and all liabilities, losses, damages, claims, causes of
action, and expenses (including reasonable judgment attorneys’ fees and
disbursements) (a “the PC Loss”), caused or asserted to have been caused,
directly or indirectly, by or as a result of the performance of any acts of
omissions by MANAGEMENT SERVICES and/or its shareholders, agents, employees
and/or subcontractors during the term hereof except with respect to any the PC
Loss which is the result of any gross negligence or willful misconduct by a
member of the PC Group.

 

8.13. Entire Agreement.
This Agreement constitutes the entire agreement between the parties with respect
to the subject matter hereof and supersedes all prior and contemporaneous
agreements, understandings, negotiations and discussions, whether written or
oral, between or among parties regarding the subject matter of this Agreement.

 

8.14. Incorporation by
Reference. All exhibits and other attachments to this Agreement are
incorporated by reference into this Agreement by such reference.

 

8.15. Amendments Only in
Writing. This Agreement may not be amended or modified in any respect
whatsoever, except by an instrument in writing signed by the parties hereto.

 

8.16. Counterparts.
This Agreement may be executed in one or more counterparts, each of which shall
be considered an original and all of which shall constitute one and the same
agreement. This Agreement shall not become effective until it has been executed
by all of the parties hereto.

 

8.17. Commercial
Impracticability. No party to this Agreement shall be liable for any
failure to perform its obligations hereunder where such failure results from
any cause beyond that party’s reasonable control, including, for example, an
act of God, labor disturbance such as a strike or walkout, war, riot, fire,
storm, accident, government regulation or interference, or mechanical,
electronic or communications failure.

 

8.18. Election of
Remedies. The respective rights of the parties to this Agreement shall be
cumulative. Each party shall have all other rights and remedies consistent with
this Agreement as law and equity may provide. No exercise by any party of one
right or remedy shall he deemed to be an exclusive election of rights or
remedies.

 

8.19. Survival. The
provisions of Articles III, IV, V, VI, VII and VIII shall survive any
termination of this Agreement.

 

8.20. Third Party
Beneficiaries. Except with respect to Affiliates of MANAGEMENT SERVICES,
nothing in this Agreement shall be construed to create any duty to, any
standard of care with reference to, or any liability to any Person not a party
to this Agreement. The Affiliates of MANAGEMENT SERVICES are intended third
party beneficiaries of this Agreement.

 

19

 

8.21 Affiliate. An “Affiliate”
of an entity means (i) any person or entity directly or indirectly controlled
by such entity; (ii) any person or entity directly or indirectly controlling
such entity; (iii) any subsidiary of such entity if the entity has a fifty
percent (50%) or greater ownership interest in the subsidiary; or (iv) such
entity’s parent entity if the parent has a fifty percent (50%) or greater ownership
interest in the entity. For purposes of this Agreement, the PC is not an
Affiliate of MANAGEMENT SERVICES.

 

IN WITNESS WHEREOF,
MANAGEMENT SERVICES and the PC have caused this Agreement to be executed by
their duly authorized respective officers as of the Effective Date.

 

Signed and sealed in the
presence of:

 

	
  /s/
  Authorized
  Signatory

  	
   

  	
  MARYLAND RADIATION THERAPY
  MANAGEMENT SERVICES, INC. 

  
	
  Printed name:

  	
  /s/ Authorized Signatory

  	
   

  	
   

  	
   

  
	
  (witness 1)

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ Daniel E. Dosoretz

  
	
  /s/
  Authorized Signatory

  	
   

  	
   

  	
  Daniel E. Dosoretz, M.D.

  
	
  Printed name:

  	
  /s/ Authorized Signatory

  	
   

  	
   

  	
  President

  
	
  (witness 2)

  	
   

  	
   

  	
   

  	
   

  

 

20

 

	
  /s/ Authorized Signatory

  	
   

  	
  KATIN RADIATION THERAPY,
  P.A.

  
	
  Printed name: 

  	
  /s/ Authorized Signatory

  	
   

  	
   

  	
   

  
	
  (witness 1)

  	
   

  	
   

  	
   

  	
   

  
	
   

  	
   

  	
   

  	
  By:

  	
  /s/ Michael J. Katin

  
	
   

  	
   

  	
   

  	
   

  	
  Michael J. Katin, M.D.

  
	
   

  	
   

  	
   

  	
   

  	
  President

  
	
  /s/
  Authorized
  Signatory

  	
   

  	
   

  	
   

  
	
  Printed name:

  	
  /s/ Authorized Signatory

  	
   

  	
   

  	
   

  
	
  (witness 2)

  	
   

  	
   

  	
   

  	
   

  

 

 

	
  STATE OF FLORIDA    )

  	
   

  	
   

  
	
   

  	
  )

  	
   

  
	
  COUNTY OF LEE

  	
  )

  	
   

  

 

The foregoing instrument was
acknowledged before me this 13th day of April,
1999, by Daniel E. Dosoretz, M.D., the President of Maryland Radiation Therapy
Management Services, Inc., a Maryland corporation organized under the laws of
the State of Maryland, on behalf of the corporation.

 

	
  [SEAL]

  	
   

  	
  Signature:

  	
  /s/ Authorized Signatory

  
	
   

  	
   

  	
   

  
	
   

  	
  Printed name:

  	
  /s/ Authorized Signatory

  
	
   

  	
  Notary Public

  

 

	
  STATE
  OF FLORIDA    )

  	
   

  	
   

  
	
   

  	
  )

  	
   

  
	
  COUNTY
  OF LEE

  	
  )

  	
   

  

 

The foregoing instrument was
acknowledged before me this 13th day of April,
1999, by Michael J. Katin, M.D., the President of Katin Radiation Therapy,
P.A., a Maryland professional corporation organized under the laws of the State
of Maryland, on behalf of the corporation.

 

	
  [SEAL]

  	
   

  	
  Signature: 

  	
  /s/ Authorized Signatory

  
	
   

  	
   

  	
   

  
	
   

  	
  Printed name: 

  	
  /s/ Authorized Signatory

  
	
   

  	
  Notary Public

  

 

21

 

EXHIBIT
A

 

NONCOMPETITION
AGREEMENT

 

NON-COMPETITIVE
AND RESTRICTIVE AGREEMENTS.

 

A. During the term of this
Agreement and any renewal period, Physician shall not undertake any
professional service except as directed and authorized by [Employer] and shall
not engage in any profession other than the rendition of the professional
services as directed by [Employer].

 

B. In the event of the
termination of this Agreement for any reason, Physician agrees not to directly
or indirectly engage in the practice of radiation therapy or oncology, or
otherwise compete with [Employer], or any of its physician providers, by
practicing as a radiation therapist or oncologist (i) at any hospital in which
physician providers of [Employer] regularly admit patients, or (ii) within any
county in which [Employer] or any of its Affiliates operate an Office for a
period of two (2) years after the date of such actual termination of this
Agreement. The purpose of this covenant is to protect [Employer] from the
irreparable harm it will suffer if Physician competes with [Employer] after
having been introduced to [Employee’s personnel and patients and after learning
special medical procedures used by [Employer]’s physician providers, [Employer]’s
business procedures, office and practice policies, and the special and
confidential professional procedures developed by [Employer].

 

C. The parties agree that in
the event of any breach or attempted breach of any of the covenants set out in
section B (the “Covenant Not to Compete”), [Employer] will be entitled to
equitable relief by way of injunction or otherwise, in addition to any remedy
at law which may be available. The parties agree that any violation or
threatened violation by Physician of the Covenant Not to Compete will cause
[Employer] to suffer irreparable harm. The parties agree that [Employer]’s
remedy of an injunction is not the exclusive remedy for breach of the Covenant
Not to Compete and that a court may grant such additional relief as is
reasonable.

 

D. In the event Physician
breaches the Covenant Not to Compete in addition to the injunctive relief to
which [Employer] shall be entitled under the law, Physician shall immediately
repay to [Employer] any amounts paid by [Employer] pursuant to section 3.B
hereof after the termination of this Agreement, and all severance or
termination pay, if any, paid pursuant to this Agreement. [Employer] may offset
against any amounts owed Physician pursuant to this Agreement any amounts
Physician owes [Employer] pursuant to paragraph E below for breach of the
Covenant Not to Compete.

 

E. In addition to the
injunctive relief to which [Employer] is entitled under the law and in addition
to the payments provided for in paragraph D above and in order to compensate
[Employer] for the damages it will incur in recruiting and compensating a

 

22

 

replacement radiation
oncologist and for the lost business it will suffer, in the event of a breach
by Physician of the Covenant Not to Compete, Physician shall also pay to
[Employer], as liquidated damages, a sum equal to a percentage of the gross
billings of [Employer] for the twelve month period immediately preceding the
termination of this Agreement. The percentage shall be that formed by dividing
the number one by the number equal to the total number of physician providers
of [Employer], including Physician, on the date of termination of this
Agreement. The parties agree that, in the event of the breach by Physician of
the Covenant Not to Compete, the actual amount of damages which would be
incurred by [Employer] would be difficult to ascertain and prove, and that
therefore the liquidated damages sum set forth herein would be reasonable and
appropriate.

 

F. In the event the Covenant
Not to Compete shall be determined by a court of competent jurisdiction to be
unenforceable by reason of its geographic or temporal restrictions being too
great, or by reason that the range of activities covered is too great, or for
any other reason, section B shall be interpreted to extend over the maximum
geographic area, period of time, range of activities or other restrictions as
to which it may be enforceable.

 

23Exhibit 10.53

 

PROFESSIONAL SERVICES AGREEMENT

 

This Professional Services
Agreement (the “Agreement”) is made and entered into as of the first of
January, 2005, by and between Berlin Radiation Therapy Treatment Center, LLC, a
Maryland limited liability company (“BRT”) and Katin Radiation Therapy, P.A,, a
Maryland professional corporation (the “P.A.”).

 

INTRODUCTION

 

1.         BRT operates a radiation
oncology facility, located at 314 Franklin Avenue, Berlin, Maryland 21811 (the “Cancer
Center”).

 

2.         The P.A. has substantial
expertise in the provision of professional radiation oncology services.

 

3.         BRT desires to engage the
P.A., on an independent contractor basis, to be the exclusive provider of
professional medical radiation oncology services for and on behalf of BRT, and
the P. A. desires to accept such engagement, subject to the terms of this
Agreement.

 

THEREFORE, the parties
hereto agree as follows:

 

ARTICLE I - DUTIES AND RESPONSIBILITIES OF THE P.A.

 

1.1       General Description of
Services. Subject to the terms and conditions of this
Agreement, BRT hereby engages the P.A. on an independent contractor basis as
the exclusive provider of the services described below.

 

1.2       Specific Duties and
Responsibilities. The services provided by the P.A. will include the
following:

 

(a)         Licensed Radiation
Oncologist. The P.A, shall, at its cost, provide to BRT one or
more radiation oncologists, licensed in the State of Maryland and board
certified in radiation oncology (the “Physician”), each of whom shall be
participating providers in the Medicare and Maryland Medicaid programs, to
provide professional services to patients at the Cancer Center. BRT shall have
the right to approve the Physician assigned to this position. Further, if BRT
is dissatisfied with the services of the Physician hereunder, BRT shall notify
the P.A. of such dissatisfaction in writing. BRT and the P.A. shall then
consult with each other in good faith to determine whether the performance of
the Physician is capable of being brought to acceptable levels through counsel
and assistance, or whether the Physician should be replaced. Notwithstanding
the foregoing, BRT shall have the ultimate authority to determine whether the
Physician should be replaced; and if BRT makes a request to have the Physician
replaced, the P.A. shall promptly replace the Physician with another duly
licensed radiation oncologist who shall be reasonably satisfactory to BRT. A
list of the Physicians currently engaged by the P.A. is attached hereto as Exhibit A
and shall be periodically updated as necessary.

 

(b)         Licensed Registered Nurse. In addition,
the P.A. shall, at its cost, provide to BRT one or more registered nurses,
licensed in the State of Maryland (the “R.N.”), to provide professional
services to patients at the Cancer Center. BRT shall have the right to approve
the

 

 

R.N. assigned to this
position. Further, if BRT is dissatisfied with the services of the R.N.
hereunder, BRT shall notify the P.A. of such dissatisfaction in writing. BRT
and the P.A. shall then consult with each other in good faith to determine
whether the performance of the R.N. is capable of being brought to acceptable
levels through counsel and assistance, or whether the R.N. should be replaced.
Notwithstanding the foregoing, BRT shall have the ultimate authority to
determine whether the R.N. should be replaced; and if BRT makes a request to
have the R.N. replaced, the P.A. shall promptly replace the R.N. with another
duly licensed registered nurse who shall be reasonably satisfactory to BRT.

 

(c)         Coordination. The P.A. will
coordinate with BRT the scheduling needs of the Cancer Center so that the work
needs are met in a timely manner satisfactory to BRT. Without limiting the
generality of the foregoing, it is anticipated that the Physician and R.N.
shall during the Term (as hereinafter defined) of this Agreement be physically
present at the Cancer Center to provide radiation oncology services hereunder
on a full-time basis, Monday through Friday, between the hours of 8:00 a.m and
5:00 p.m.

 

(d)         Medical Devices and Supplies. The P.A.
shall be responsible for providing all treatment devices and medical supplies
necessary for the performance of its services required to be performed by it or
its employees under the terms of this Agreement. All sales taxes incurred in
connection with acquiring such equipment and supplies shall be borne by the PA.

 

(e)         Compliance with BRT Policies
and Procedures. The P.A. in providing services hereunder shall
comply with the rules, regulation and policies of BRT, Each Physician shall
make any and all decisions pertaining or related to the practice of medicine
and the care and treatment of patients under such Physician’s care.
Notwithstanding any provision herein to the contrary, each Physician shall
perform all services with respect to the diagnosis and treatment of patients in
such manner as such Physician, in the independent exercise of his or her
medical judgment, deems to be in the best interests of the patients.

 

(f)          Billing and Collection. All fees and
charges for services performed by the P.A, or its employees hereunder, shall be
billed by BRT in BRT’s name and shall be deposited in a bank account maintained
by BRT. The P.A. shall not bill any patient or third party payor any amount for
services performed or provided by the P.A. hereunder. The P.A. hereby
irrevocably assigns and grants to BRT the right to bill all patients and third
party payors for, and to collect all fees and charges payable in connection
with, all services personally performed or provided by the P.A. hereunder. The P.A.
shall take such actions and shall execute and deliver to BRT all such documents
and instruments as BRT may deem necessary or advisable to carry out the
provisions of this Section.

 

The P.A. hereby appoints BRT
to be its true and lawful attorney-in-fact to execute, deliver or endorse
checks, applications for payment, insurance claim forms, or other documents and
instruments, and to take such other action, as BRT shall reasonably determine,
to fully collect, secure, or realize all sums lawfully due to BRT, for services
personally performed or provided by the P.A. hereunder.

 

2

 

(g)         Exclusivity. The parties
agree and acknowledge that the P.A. shall be the exclusive provider of
professional radiation therapy services to the LLC. In no event during the Term
of this Agreement shall the LLC engage any other party to provide professional
radiation therapy services on its behalf.

 

ARTICLE II - RELATIONSHIP OF PARTIES; MALPRACTICE
INSURANCE

 

2.1       P.A. Control. BRT shall
neither have nor exercise any control or direction over the methods by which
the P.A., any Physician or its other professional employees shall perform their
respective professional functions. The P.A. shall have the exclusive authority
to assign its Physician and other professional and non-professional employees
to perform specific duties and to assign cases and responsibilities. BRT shall
have no control over, or right to interfere with, the means employed by P.A,
and its Physician in the performance of their medical duties under this
Agreement.

 

2.2       Independent Contractor
Relationship, The relationship between BRT and the P.A. is an
independent contractor relationship. Neither BRT nor its officers, directors,
shareholders, employees, or agents are employees or agents of the P.A., and
neither the P.A. nor its officers, directors, shareholders, employees, or
agents are employees or agents of BRT. None of the provisions of this Agreement
shall be construed to create a relationship of agency, representation, joint
venture, partnership, association, ownership, control, or employment, or other
affiliation or like relationship, between the parties hereto other than that of
independent parties contracting solely for the purpose of effectuating this
Agreement. Each party hereto agrees and acknowledges that such party has no
right or authorization, express or implied, to act for the other party or to
incur, assume, or create any obligation or liability on behalf of the other
party or make any representations or warranties concerning the other party, or
bind the other party in any manner, whatsoever.

 

2.3       Employment Taxes and
Benefits. Each party hereto shall be solely responsible for
and shall comply with all state and federal laws pertaining to employment
taxes, income tax withholding, unemployment compensation contributions, and
other employment related statutes applicable to that party. Neither BRT, its
employees, or independent contractors, nor the P.A,, its employees, or
independent contractors, shall claim against the other for worker’s
compensation, sick leave, vacation pay, retirement benefits, social security
benefits, or any other employee benefits, all of which will be the respective
and sole responsibility of the respective parties. Without limiting the generality
of the foregoing, the P.A. shall be responsible for the actual cost of all
benefits, including base salary and overtime, fringe benefits, business, health
and disability insurance and worker’s compensation insurance relative to the
Physician.

 

2.4       Medical Malpractice
Insurance. During the Term of this Agreement, the P.A. shall
obtain and maintain, at its expense, medical malpractice liability insurance
for the P.A. and the Physician with a carrier licensed to do business in the
State of Maryland and with limits not less than $1,000,000 per occurrence and
$3,000,000 in the aggregate. The P.A. shall provide BRT with certificates of
insurance evidencing the insurance coverage required under this Section 2.5
upon execution of this Agreement. The P.A. shall promptly notify BRT of any
cancellation, reduction, or other material changes in the amount or scope of
any coverage required under this Section 2,5. If this Agreement terminates
for any reason, the P.A. shall, at its

 

3

 

cost and expense, continue
to maintain such medical malpractice liability insurance coverage for the
applicable statute of limitations for personal injury relative to the services
provided hereunder; or if this Agreement terminates for any reason, or if such
medical malpractice liability insurance coverage terminates for any reason, the
P.A. shall, at its cost and expense, purchase, or arrange to purchase, either (a) an
extended reporting endorsement with respect to such medical malpractice
liability insurance (i.e., tail insurance) for the maximum period that may be
purchased from its insurer, or (b) “prior acts” coverage from a new
insurer reasonably acceptable to BRT with a retroactive date on or prior to the
date the P.A. or the Physician began providing services hereunder, and the P.A.
shall maintain such “prior acts” coverage for the applicable statute of
limitations for personal injury relative to the services provided hereunder.

 

2.5       Third Party Contracts. The P.A.
agrees to use best efforts to become credentialed in connection with third
party payor contracts, including but not limited to contracts with governmental
payors, insurers, and managed care organization such as health maintenance
organizations (“HMOs”), preferred provider organizations (“PPOs”) or
independent practice associations (“IPAs”) with which the LLC contracts.

 

ARTICLE III - COMPENSATION

 

3.1       Fees. Subject to
the provisions of Section 3.3 hereof, the P.A. shall be entitled to
receive, for each year of this Agreement, compensation for its services under
this Agreement equal to twenty-four percent (24%) of BRT’s annual “Net Global
Collections.”

 

For purposes of this
Agreement, “Net Global Collections” means the fees and charges actually
collected by BRT during the applicable year that are attributable to radiation
oncology services performed or provided by the P.A. hereunder at the Cancer
Center, less refunds to patients and third party payors, and offsets,
overpayments, recoupments, and re-application of revenues in order to address
adjustments by third party payors, including, without limitation, Medicare or
Medicaid.

 

3.2       Annual Evaluation. BRT and the
P.A. shall meet within thirty (30) days of the expiration of each twelve (12)
month period of the term of this Agreement for purposes of discussing the
adequacy of the fees payable hereunder.

 

ARTICLE IV - COMPLIANCE WITH LAWS

 

Each party hereto shall,
during the Term of this Agreement, comply with all applicable federal, state,
and local laws, rules, and regulations, in connection with the performance of
its obligation hereunder and the conduct of its business, including, without
limitation, federal and state statutes, rules, and regulations which prohibit
presenting or causing to be presented a false claim for payment, making a false
statement or using a false record in order to obtain any benefit or payment,
soliciting or receiving any remuneration (including any kickback, bribe, or
rebate), directly or indirectly, in cash or in kind, or offering to pay or
receive such remuneration, in return for referring an individual to any person
or entity for the furnishing or arranging for the furnishing of any item or
service for which payment may be made in whole or in part by a state or federal
healthcare program or any other person or entity, including, without
limitation, the Medicare and Medicaid programs, or in return for purchasing,
leasing, or ordering or arranging

 

4

 

for, or recommending,
purchasing, leasing, or ordering any good, facility, service, or item for which
payment may be made in whole or in part by a state or federal healthcare
program or any other person or entity, including, without limitation, the
Medicare and Medicaid programs, or referring a patient for “designated health
services” (as defined in 42 U.S.C. § 1395nn, as the same may be amended from
time to time (or any corresponding provisions of succeeding law)) to a person
or entity with which the referring physician has a financial relationship.

 

ARTICLE V - TERM AND TERMINATION

 

5.1       Term. The term of
this Agreement shall commence on April 1, 2005 and shall continue in
effect for an initial term of thirty-six (36) months. Unless sooner terminated
in accordance with the provisions of this Article V, this Agreement shall
be renewed for successive twelve (12) month terms thereafter unless either
party gives notice to the other in writing at least ninety (90) days in advance
of the then expiring term of its intention not to renew the Agreement.

 

5.2       Termination by Either Party. This
Agreement may be terminated by either party upon written notice to the other
party (the “Other Party”) for any of the following reasons:

 

(a)         upon the filing of a
petition in an involuntary action by, or upon the entry of an order or decree
in an involuntary action against, the Other Party, under the Bankruptcy Code or
any successor statute thereto;

 

(b)         institution by the Other
Party of proceedings, other than under the Bankruptcy Code, of any nature under
any laws of the United States or of any state, whether a now existing or
subsequently enacted or amended, for the relief of debtors wherein such Other
Party is seeking relief as a debtor;

 

(c)         a general assignment of all
or substantially all of its assets by the Other Party for the benefit of
creditors;

 

(d)         a proposed plan or
arrangement or other action by the Other Party’s creditors taken as a result of
a general meeting of the creditors of such Other Party;

 

(e)         upon the issuance of a final
order or decree of any court or governmental agency having jurisdiction over
the parties which order or decree requires the termination of this Agreement;
or

 

(f)          In the event that the Other
Party or any of its officers, directors or Physicians providing services under
this Agreement becomes ineligible to participate or is barred from
participation in the Medicare or Medicaid programs.

 

5.3       Termination by BRT.

 

(a)         BRT may terminate this
Agreement upon the failure by the P.A. to observe or perform any of its
covenants, agreements, warranties, or representations contained in this
Agreement if such failure shall remain uncured for a period of thirty (30)
calendar days after written notice thereof specifying such failure has been
given to the P.A.

 

5

 

(b)         BRT may immediately
terminate this Agreement in the event Michael Katin, M.D. is no longer the sole
shareholder of the P.A.

 

5.4       Termination by the P.A. The P.A. may
terminate this Agreement upon failure by BRT to observe or perform any of its
agreements, covenants, warranties, or representations contained in this
Agreement if such failure shall remain uncured for a period of thirty (30) days
after written notice thereof, specifying such failure, has been given to BRT.

 

5.5       Prospective Legal Events. Notwithstanding
anything to the contrary contained in this Agreement, if: (a) the
performance by either party hereto of any term, covenant, condition or
provision of this Agreement could in the reasonable opinion of counsel for BRT
or the P.A., be deemed to jeopardize (i) the license of BRT, or (ii) participation
by either party in the Medicare Program, the Medicaid Program, or any other
government sponsored health care program, or any other health care program; or (iii) for
any other reason such performance should be deemed, in the reasonable opinion
of counsel for BRT or the P.A., to be in violation of any federal or state law,
rule, regulation, or ordinance, or otherwise deemed to be actually illegal or
likely illegal, BRT and the P.A, will promptly meet and attempt to
re-negotiate, in good faith, an amendment to this Agreement so as to bring this
Agreement into compliance with such law, rule or regulation, or otherwise
remove the alleged violation. To the maximum extent possible, any such
amendment shall preserve the underlying economic and financial arrangements
between the parties hereto.

 

If within thirty (30)
calendar days of the commencement of such negotiations (the “Negotiation Period”),
BRT and the P.A. have been unable to reach an agreement regarding an amendment
which shall bring this Agreement into compliance with such law, rule, or
regulation, or otherwise remove such violation, and preserve the underlying
economic and financial arrangements between the parties hereto, then either
party may, within thirty (30) calendar days after the expiration of the
Negotiation Period, elect to terminate this Agreement by giving written notice
to the other which notice shall specify a termination date which shall be on
the last day of a month. This Agreement shall automatically terminate upon the
termination date specified in such notice, with all obligations and
responsibilities of each party to the other hereunder terminating, except that
each party shall be fully liable and responsible for any obligations which have
accrued prior to the effective date of such termination.

 

5.6       Rights and Remedies.

 

(a)         Upon expiration or sooner
termination of this Agreement, all obligations of each party to the other under
this Agreement shall cease, except such termination shall not relieve either
party of any obligation to the other in accordance with this Agreement with
respect to services performed prior to such termination.

 

(b)         In the event of any breach
by either party of this Agreement and the failure to cure it within the requisite
grace period, the non-breaching party shall be entitled to any relief to which
it may be entitled at law or in equity.

 

5.7       Medical Records. All medical
records, case records, case histories, notes, plans of care, financial records,
and all other records and information relating in any way to any patient

 

6

 

who receives services at the
Cancer Center shall at all times belong to and remain the property of BRT, and
shall be located at the Cancer Center, and BRT shall be the records owner
thereof. If this Agreement terminates for any reason, the P.A. shall, and shall
cause the Physician, to promptly return to BRT all such records that the P.A.
or the Physician may then have, or at any time thereafter discover to be, in
their possession. During the Term of this Agreement and thereafter, the P.A. or
its representative shall on reasonable advance notice have reasonable access
during normal business hours to review and copy, at its expense, the medical
records of all patients of the Cancer Center who have received services from
the Physician.

 

5.8       Access to Books and Records. Upon the
written request of the Secretary of the Department of Health and Human Services
or the Comptroller General or any other duly authorized representative thereof,
the P.A. shall make available for inspection those contracts, books, documents,
and records necessary to verify the nature and extent of the cost of providing
its services hereunder. Such inspection shall be available for up to four (4) years
after such services are rendered. If the P.A. carries out any of its duties
hereunder through subcontract with a value of Ten Thousand Dollars ($10,000.00)
or more over a twelve (12) month period with a related individual or
organization, the P.A. agrees to include this requirement in such subcontract.
If a written request for inspection from the Secretary of the Department of
Health and Human Services or the Comptroller General or any other duly
authorized representative thereof is served on the P.A., the P.A. will use its
reasonable best efforts to notify the Center in writing prior to responding to
the request.

 

ARTICLE VI - COVENANT NOT-TO-COMPETE

 

6.1       (a)      The
P.A. covenants and agrees that during the term of this Agreement and for a
period of twenty-four (24) months following the expiration or other termination
of this Agreement (or any renewal thereof), neither it nor any of its employees
or shareholders shall: (i) engage in the practice of radiation oncology or
engage in the ownership, operation or management of a radiation oncology
practice or facility (a “Competing Business”) within 25 miles of the Cancer
Center (the “Service Area”); (ii) whether as owner, stockholder, partner,
member, director or consultant in any Competing Business in the Service Area; (iii) for
its or their own account or the account of others, induce any patient of the
Cancer Center to patronize any Competing Business; (iv) canvass or solicit
any business relationship from any patients of the Cancer Center; (v) directly
or indirectly request or advise any patients of the Cancer Center to withdraw,
curtail, or cancel such patient’s business with the Cancer Center; or (vi) urge,
induce, entice or in any manner whatsoever solicit the employees of BRT to
leave BRT’s employ or engage (or cause a third party to engage any individual
who was an employee of BRT within the twelve month (12) period preceding the
termination of this Agreement; provided however, the foregoing shall not be
deemed to prohibit or restrict the P.A., its shareholders or employees from
providing services where currently under agreement to do so with Peninsula
Regional Medical Center in Salisbury, Maryland and Naticoke Health Services in
Seaford, Delaware.

 

(a)         BRT shall also be entitled
to an injunction restraining the P.A. from violating the terms of the
restrictive covenant set forth herein (without the necessity of securing a
bond) and any other legal or equitable remedies available for such breach or
threatened breach.

 

7

 

(b)         If the P.A. violates this
restrictive covenant and BRT brings legal action for injunctive or other
relief, BRT shall not, as a result of the time involved in obtaining the
relief, be deprived of the benefit of the full period of the restrictive
covenant. Accordingly, the restrictive covenant shall be deemed to have the
duration specified herein, computed from the date the relief is granted, but
reduced by the time between the period when the restriction began to run and
the date of your first violation of the covenant.

 

(c)         The P. A. acknowledges that
the provisions of this paragraph are necessary and reasonable in order to
protect BRT in the conduct of its business, particularly in light of the
difficultly in ascertaining damages in the event of a breach.

 

(d)    If any court or tribunal of
competent jurisdiction determines that the duration, geographical limit or any
other aspect of the above restrictive covenants is unenforceable in accordance
with its terms in a particular jurisdiction, such covenant shall not terminate;
instead, such covenant shall be deemed amended to the extent required to render
it valid and enforceable in such jurisdiction and such court or tribunal is
hereby authorized and directed to amend the non-competition covenant contained
herein only to the extent that such court or tribunal determines such an
amendment is necessary to make it valid and enforceable in said jurisdiction
(with as minimal a change from the covenant as drafted as is legally
permissible).

 

ARTICLE VII - INDEMNIFICATION

 

7.1       BRT’s Obligation. BRT shall,
and does hereby agree to, hold harmless and indemnify the P.A. and its
officers, directors, employees, agents, and shareholders from all liabilities,
costs or expenses, including legal fees and court costs, arising from (i) its
negligent acts or omissions and those of its employees including, but not
limited to, claims of professional malpractice, (ii) services performed by
BRT under this Agreement, or (iii) BRT’s failure to observe or perform any
of covenants, warranties, representations or requirements contained in this
Agreement.

 

7.2       The P.A.’s Obligation. The P.A. shall,
and does hereby agree to, hold harmless and indemnify BRT, its officers,
directors, employees, agents and shareholders from all liabilities, costs, or
expenses, including legal fees and court costs, arising or resulting from (i) its
negligent acts or omissions and those of its employees including, but not
limited to, claims of professional malpractice, (ii) services performed by
the P.A. under this Agreement, or (iii) the P.A.’s failure to observe or
perform any of its covenants, warranties, representations, or requirements
contained in this Agreement.

 

ARTICLE VIII - GENERAL TERMS

 

8.1       Notices. All notices
or other communications that are required or may be given or made pursuant to
this Agreement shall be in writing and shall be: (a) delivered personally,
by hand, or by telefax, or (b) delivered by registered or certified mail,
return receipt requested, through the United States mail, postage prepaid, or (c) delivered
through or by Federal Express, Express Mail, or other expedited mail or package
service, addressed to the parties as follows:

 

8

 

	
  If to BRT:

  	
  Berlin Radiation Therapy

  
	
   

  	
  Treatment Center, LLC

  
	
   

  	
  2234 Colonial Boulevard

  
	
   

  	
  Fort Myers, Florida 33907

  
	
   

  	
  Attention: David Koeninger

  
	
   

  	
   

  
	
  with a copy to:

  	
  Peninsula Health
  Ventures, Inc.

  
	
   

  	
  100 East Carroll Street

  
	
   

  	
  Salisbury, Maryland 21804

  
	
   

  	
   

  
	
  If to the P.A.:

  	
  Katin Radiation Therapy,
  P.A.

  
	
   

  	
  2234 Colonial Boulevard

  
	
   

  	
  Fort Myers, Florida 33907

  
	
   

  	
  Attention: Michael Katin,
  M.D.

  

 

Any notice or other
communications to be given or that may be given pursuant to this Agreement
shall be deemed to have been given: (a) five (5) calendar days after
the deposit of such notice or communication in the United States mail,
certified, return receipt requested, with proper postage affixed thereto; (b) upon
the first business day after depositing such notice or other communication with
Federal Express, Express Mail, or other expedited mail or package delivery
service guaranteeing delivery no later than the next business day if next day
delivery service has been requested and paid for; or (c) upon delivery if
hand delivered or telefaxed to the appropriate address.

 

8.2       Entire Agreement. This
Agreement between BRT and the P.A. contains the entire agreement between the
parties hereto and supersedes all prior agreements between the parties hereto,
whether written or oral, as of the date of this Agreement. The parties
acknowledge and agree that neither of them has made any representations with
respect to the subject matter of such agreements, or any representation
inducing the execution and delivery hereof except such representations as are
specifically set forth herein or therein, and each of the parties hereto
acknowledges that it has relied on its or his own judgment in entering into the
same.

 

8.3       Modification and Waiver. No provision
of this Agreement may be amended, modified, waived, or discharged unless such
amendment, modification, waiver, or discharge is agreed to in writing and
signed by authorized representatives of BRT and the P.A, No waiver by BRT or
the P.A. of any default or breach of any provision of this Agreement by the
other shall be deemed to extent to or operate as a waiver of any prior or
subsequent default or breach of any provision of this Agreement or affect in
any way any right arising by virtue of any prior or subsequent occurrence. No
delay or omission on the part of BRT or the P.A. in exercising any right or
remedy that such party may know or hereafter have hereunder or otherwise at law
or in equity shall operate as a waiver thereof, and no single or partial
exercise by such party of any such right to remedy shall preclude any other
future exercised thereof or the exercise of any other right or remedy.

 

8.4       Binding Effect; Benefit. This
Agreement shall be binding upon, and inure to the benefit of, the parties
hereto and their successors and permitted assigns.

 

9

 

8.5       No Third-Party Beneficiaries. Except as
otherwise provided herein, this Agreement shall not confer any rights or
remedies upon any Person other than the parties hereto and their respective
successors and permitted assigns.

 

8.6       Severability. Except as
otherwise provided in Article VI hereof, in the event any provision of
this Agreement is rendered invalid or unenforceable by the enactment of any
applicable statute or ordinance or by any regulation duly promulgated by
officers of the United States, or of the State of Maryland acting in accordance
with law, or is declared null and void by any court of competent jurisdiction,
the remainder of the provisions of this Agreement will remain in full force and
effect.

 

8.7       Waiver of Breach. Waiver of a
breach of any provision of this Agreement will not be deemed a waiver of any
other breach of either the same or any different provision of this Agreement.

 

8.8       Assignment. Neither of
the parties may assign this Agreement without the consent of the other party.

 

8.9       Plural. Whenever the
singular is used, it shall include the plural and wherever the plural is used
it shall include the singular.

 

8.10     Approval. Except as
otherwise provided herein, whenever this Agreement requires the approval,
consent or permission of any party hereto, such approval, consent or permission
by such party shall not be unreasonably withheld or delayed and shall be given
in writing and within thirty (30) calendar days of the request (unless a
different time period is specified), specifying the reasons therefor or the
same is approved, consented to, or permitted, as the case may be. In the event
of an emergency requiring approval, such approval request shall be responded to
within twenty-four (24) hours of delivery of the request to the designated
representative of the appropriate party or at the earliest possible time
thereafter. Further, once a consent, approval, etc., has been given, it
may not be rescinded in later submissions covering such matters unless approved
items are materially modified.

 

8.11     Applicable Law. This
Agreement shall be construed under and in accordance with the laws of the State
of Maryland.

 

8.12     Costs of Enforcement. If any action
at law or in equity (including any arbitration or appellate proceeding) is
brought to enforce or interpret the terms of this Agreement, the prevailing
party shall be entitled to all costs and reasonable legal and accounting fees,
expenses, costs, and disbursements, at all levels of arbitration, litigation,
or appeal, as the case may be, in addition to any other relief to which such
party may be entitled.

 

8.13     Counterparts. This
Agreement may be executed in counterparts, each of which will be deemed to be
an original.

 

10

 

IN WITNESS WHEREOF, the
parties have caused this Agreement to be made and entered into on the date last
below written with the intent to be legally bound.

 

 

	
   

  	
  BERLIN RADIATION THERAPY
  TREATMENT CENTER, LLC

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ David M. Koeninger

  
	
   

  	
   

  	
  Name:

  	
  David M. Koeninger

  
	
   

  	
   

  	
  Title:

  	
  Vice President

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  KATIN RADIATION THERAPY,
  P.A.

  
	
   

  	
   

  
	
   

  	
   

  
	
   

  	
  By:

  	
  /s/ Michael J. Katin, M.D.

  
	
   

  	
   

  	
  Name:

  	
  Michael J. Katin, M.D.

  
	
   

  	
   

  	
  Title:

  	
  President

  

 

11

 

EXHIBIT A

 

Licensed
Radiation Oncologists - December 31, 2004

 

Michael J. Katin, M.D.

 

Mark L. Sobczak, M.D.

 

Manoj Jain, M.D.

 

Edward Kiggundu, M.D.

 

12

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