Document:

EX-10.15

 Exhibit 10.15 

EMPLOYMENT AGREEMENT 

EMPLOYMENT AGREEMENT (this “Agreement”) is made and entered into by and between United Surgical Partners International, Inc.,
a Delaware corporation (the “Company”), with its principal place of business at 15305 Dallas Parkway, Suite 1600, Addison, TX 75001-6491, and Sandra Karrmann of 2408 Hollow Hill Lane, Lewisville, Texas 75056 (the
“Executive”), effective as of January 7, 2013 (the “Effective Date”). 
 In consideration of the
mutual promises, terms, provisions and conditions set forth in this Agreement, the parties hereby agree as follows: 
 1. Employment.
Subject to the terms and conditions set forth in this Agreement, the Company hereby offers and the Executive hereby accepts employment. 

2. Term. The Company hereby agrees to employ Executive as Senior Vice President, Human Resources, and Executive hereby agrees to accept
such employment, on the terms and conditions set forth herein, for the period commencing on the Effective Date and terminating as of and on the first anniversary of the Effective Date (unless sooner terminated as hereinafter set forth) (the
“Term”); provided, however, that commencing on such first anniversary date, and each anniversary of the date hereof thereafter, the Term of this Agreement shall automatically be extended for one additional year unless
at least thirty (30) calendar days prior to each such anniversary date, the Company or Executive shall have given notice that it or she, as applicable, does not wish to extend this Agreement. Following the date on which the Executive’s
employment so terminates (the “Termination Date”), unless specifically otherwise agreed between Executive and the Company, the Executive shall cease to hold any position (whether as an officer, director, manager, employee, trustee,
fiduciary or otherwise) with the Company or any of its Subsidiaries (as defined in Section 13) or Affiliates (as defined in Section 13). 

3. Capacity and Performance. 

(a) During the term of Executive’s employment hereunder, the Executive shall serve the Company as its Senior Vice
President, Human Resources, reporting to the Company’s Chief Executive Officer. In addition, and without further compensation, the Executive shall serve as a director and/or officer of one or more of the Company’s Subsidiaries if so
elected or appointed from time to time. 
 (b) During the term of Executive’s employment hereunder, the Executive shall
be employed by the Company on a full-time basis and shall perform such duties and responsibilities on behalf of the Company and its Subsidiaries as may be designated from time to time by the Chief Executive Officer. 

(c) During the term of Executive’s employment hereunder, the Executive shall devote her full business time to the
advancement of the business and interests of the Company and its Subsidiaries and to the discharge of her duties and responsibilities hereunder. The Executive shall not engage in any other business activity or serve in any industry, trade,
professional, governmental or academic position during the term of this Agreement, except as may be expressly approved in advance by the Chief Executive Officer in writing. Notwithstanding the preceding, the Executive may, without being in violation
of the Executive’s obligations hereunder, (i) serve on corporate, civic or charitable boards, or committees which are not engaged in business competition with the Company and (ii) invest the Executive’s personal assets in such
form or manner as will not require any material services by the Executive in the operation of the entities in which such investments are made; provided that the Executive shall use the Executive’s best efforts to pursue such activities in such
a manner so that such activities shall not prevent the Executive from fulfilling the Executive’s obligations to the Company hereunder. 

4. Compensation and Benefits. During the Term, as compensation for all services performed by the Executive: 

(a) Base Salary. The Company shall pay the Executive a base salary at the rate of Three Hundred Twenty-Five Thousand
Dollars ($325,000) per year, payable in accordance with the payroll practices of the 

  

			
	Confidential		Karrmann

 
Company for its executives and subject to increase from time to time by the Chief Executive Officer, in his sole discretion. Such base salary, as from time to time increased, is hereafter
referred to as the “Base Salary.” 
 (b) Bonus. During the Term, the Company may pay to the Executive
such bonus payments, if any, as may be determined by the Board (as defined in Section 13) in its sole discretion, based upon the Executive’s performance and other criteria as may be established by the Board from time to time. The
“target” for Executive’s annual bonus will be fifty percent (50%) of Base Salary. Notwithstanding the foregoing, Executive is guaranteed a minimum bonus in March 2014 of at least One Hundred Thousand Dollars ($100,000). 

(c) Vacation. The Executive shall be entitled to vacation days as determined in accordance with the Company’s
vacation policy as in effect from time to time; provided, however, that for purposes of accrual under the Company’s vacation policy, Executive will be treated as if she has been employed for ten years. For purposes of this
Section 4(c), weekends shall not count as vacation days and Executive shall also be entitled to all paid holidays given by the Company to its senior executive officers. Vacation shall otherwise be governed by the policies of the Company,
as in effect from time to time. 
 (d) Other Benefits. Subject to any contribution therefor generally required of
executives of the Company, the Executive shall be entitled to participate in any and all employee benefit plans from time to time in effect for executives of the Company generally, except to the extent such plans are in a category of benefit
specifically otherwise provided to the Executive under this Agreement (e.g., severance pay). Such participation shall be subject to the terms of the applicable plan documents and generally applicable Company policies. The Board may alter,
modify, add to or delete employee benefit plans at any time as it, in its sole judgment, determines to be appropriate. 
 (e)
Business Expenses. The Company shall pay or reimburse the Executive for all reasonable and necessary business expenses incurred or paid by the Executive in the performance of her duties and responsibilities hereunder, subject to any maximum
annual limit or other restrictions on such expenses set by the Board and to such reasonable substantiation and documentation as may be specified by the Company from time to time. 

5. Termination of Employment. The Executive’s employment hereunder shall terminate under the following circumstances: 

(a) Death. In the event of the Executive’s death during the Term, the Executive’s employment shall immediately
and automatically terminate. 
 (b) Disability. The Company may terminate the Executive’s employment hereunder,
upon notice to the Executive, in the event that the Executive becomes disabled during the Term through any illness, injury, accident or condition of either a physical or psychological nature and, as a result, is unable to satisfactorily perform her
duties and responsibilities hereunder on a full-time basis, with or without reasonable accommodation, for ninety (90) days during any period of three hundred and sixty-five (365) consecutive calendar days. If any question shall arise as to
whether during any period the Executive is disabled through any illness, injury, accident or condition of either a physical or psychological nature so as to be unable to perform substantially all of his duties and responsibilities hereunder, the
Executive, at the request of the Company, shall submit to a medical examination by a physician selected by the Company to determine whether the Executive is so disabled and such determination shall for the purposes of this Agreement be conclusive of
the issue. If such question shall arise and the Executive shall fail to submit to such medical examination, the Company’s determination of the issue shall be binding on the Executive. 

(c) By the Company for Cause. The Company may terminate the Executive’s employment hereunder for Cause at any time
upon notice to the Executive setting forth the nature of such Cause. The following shall constitute “Cause” for termination (in each case as determined by not less than seventy-five percent (75%) of the members of the Board):
(i) the Executive’s indictment for a felony or other crime involving 

  
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moral turpitude; (ii) the Executive’s fraud, theft or embezzlement committed with respect to the Company or its Subsidiaries; (iii) material breach by the Executive of any of the
provisions of Sections 7, 8 and/or 9 hereof; or (iv) the Executive’s willful and continued failure to perform his material duties to the Company and its Subsidiaries. 

(d) By the Company Other than for Cause. The Company may terminate the Executive’s employment hereunder other than
for Cause at any time upon notice to the Executive. 
 (e) By the Executive for Good Reason. At his option, Executive
may terminate her employment hereunder for Good Reason (defined below). For purposes of this Agreement, the termination of Executive’s employment hereunder by Executive because of the occurrence of any one or more of the following events shall
be deemed to have occurred for “Good Reason”: 
  

	 	(A)	a material change in the nature or scope of Executive’s authorities, status, powers, functions, duties, responsibilities, or reporting relationships that is determined by Executive in good faith to be adverse to
those existing before such change; 

  

	 	(B)	a material reduction in Executive’s Base Salary that is not consented to or approved by Executive; 

  

	 	(C)	a failure by the Company or any Subsidiary or Affiliate to comply with any other material term or provision hereof or of any other written agreement between Executive and the Company or any Subsidiary or Affiliate; or

  

	 	(D)	a refusal by the Executive upon a request by the Company to report for the performance of his services hereunder on a regular or permanent basis at any location or office more than fifty (50) miles from the
Company’s current address as described above in the preamble to this Agreement. 

 (f) By the Executive
Other than for Good Reason. The Executive may terminate her employment hereunder other than for Good Reason pursuant to Section 5(e) above at any time upon the provision of ninety (90) days written notice to the Company. In the
event of termination of the Executive pursuant to this Section 5(f), the Board may elect to waive the period of notice or any portion thereof. 

6. Compensation Upon Termination. 

(a) Death. In the event of a termination of the Executive’s employment hereunder by reason of death as contemplated
by Section 5(a), the Company shall pay in a lump sum within thirty (30) days of such termination to the Executive’s designated beneficiary or, if no beneficiary has been designated by the Executive, to her estate, the Base
Salary earned but not paid through the Termination Date. 
 (b) Disability. In the event of any termination of
Executive’s employment hereunder by reason of disability as contemplated by Section 5(b), the Company shall pay to him her Base Salary earned but not paid through the Termination Date. 

(c) By the Company for Cause. In the event of any termination of Executive’s employment hereunder by the Company
for Cause as contemplated by Section 5(c), the Company shall have no further obligations to the Executive under this Agreement other than payment of Base Salary through the Termination Date. 

(d) By the Company Other than for Cause or Upon Failure to Renew; By the Executive for Good Reason. In the event of any
termination of Executive’s employment hereunder by the Company other than for Cause pursuant to Section 5(d) or pursuant to Section 2 following notice that the Company does not wish to extend this Agreement for an
additional one (l) year period, or by the Executive for Good Reason pursuant to Section 5(e), the Company shall (i) continue to pay the Executive the Base Salary at the rate in effect on the Termination Date for twelve
(12) months, (ii) continue the Executive’s health insurance benefits for twelve (12) months following the Termination Date (at a cost no less favorable than that paid by the Executive immediately prior to the Termination Date) or
the economic equivalent thereof if such 

  
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continuation is not permissible under the terms of the Company’s health insurance plan, and (iii) pay to the Executive a good faith estimate of the bonus the Executive would have
received had the Executive remained employed by the Company through the end of the fiscal year in which the Termination Date occurred, as determined by the Company in its sole and absolute discretion. Any such estimated bonus compensation shall be
payable at such time or times as bonuses are payable to the other executives of the Company. Any obligation of the Company to the Executive pursuant to this Section 6(d) is conditioned upon (i) the Executive signing a release of
claims in the form appended hereto as Attachment A (the “Employee Release”) within twenty-one (21) days (or such greater period as the Company may specify) following the Termination Date and upon the Executive’s not
revoking the Employee Release in a timely manner thereafter and (ii) the Executive’s continued full performance of his obligations hereunder, including those under Sections 7, 8 and/or 9 hereof. Base Salary to which
the Executive is entitled under this Section 6(d) shall be payable in accordance with the normal payroll practices of the Company and will begin at the Company’s next regular payroll period which is at least five business days
following the effective date of the Employee Release, but shall be retroactive to the next business day following the Termination Date. 

(e) By the Executive Other than for Good Reason. If the Executive shall terminate her employment pursuant to
Section 5(f), the Company shall continue to pay Executive her Base Salary through the Termination Date (it being understood that if, in accordance with Section 5(f), the Board elects to waive the period of notice, or any
portion thereof, the payment of Base Salary under this Section 6(e) shall continue through the notice period or any portion thereof so waived). 

7. Restricted Activities. The Executive agrees that some restrictions on her activities during and after her employment are necessary
to protect the goodwill, Confidential Information (as defined in Section 13) and other legitimate interests of the Company and its Subsidiaries: 

(a) While the Executive is employed by the Company and for one (l) year from the later of the Termination Date or the last
date on which the Executive receives a severance payment from the Company (in the aggregate, the “Non-Competition Period”), the Executive shall not, directly or indirectly, whether as owner, partner, investor, consultant, agent,
employee, co-venturer or otherwise (other than through ownership of publicly-traded capital stock of a corporation which represents less than one percent (l%) of the outstanding capital stock of such corporation), (i) compete with the Company
or any Subsidiary in any business activities, in the United States or in any other country, which the Company or any Subsidiary shall conduct or intend to conduct as of the Termination Date, or (ii) undertake any planning for any business
competitive with the Company or any of its Subsidiaries. Specifically, but without limiting the foregoing, the Executive agrees not to engage in any manner in any activity that is directly or indirectly competitive or potentially competitive with
the business of the Company or any of its Subsidiaries as conducted or under consideration at any time during the Executive’s employment with the Company (including prior to the date hereof). 

(b) The Executive agrees that, during her employment with the Company, she will not undertake any outside activity, whether or
not competitive with the business of the Company or its Subsidiaries, that could reasonably give rise to a conflict of interest or otherwise interfere with her duties and obligations to the Company or any of its Subsidiaries. 

(c) The Executive further agrees that while she is employed by the Company and during the Non-Competition Period, the Executive
will not, directly or indirectly, (i) hire or attempt to hire any employee of the Company or any of its Subsidiaries or anyone who was such an employee within the six (6) months preceding such hire or attempt to hire, (ii) hire or attempt
to hire any independent contractor providing services to the Company or any of its Subsidiaries or anyone who was such an independent contractor within six (6) months preceding such hire or attempt to hire, (iii) assist in hiring or any
attempt to hire of anyone identified in clauses (i) or (ii) of this sentence by any other Person (as defined in Section 13), (iv) encourage any employee or independent contractor of the Company or any of its Subsidiaries
to terminate his relationship with the Company or any of its Subsidiaries, or (v) solicit or encourage any customer or vendor of the Company or any of its Subsidiaries (including physicians holding clinical

  
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privileges at any surgical facility in which the Company has a direct or indirect ownership interest or with which a Subsidiary has a management agreement) to terminate or diminish its
relationship with any of them, or, in the case of a customer, to conduct with any Person any business or activity which such customer conducts or could conduct with the Company or any of its Subsidiaries. 

8. Confidential Information. 

(a) The Executive acknowledges that the Company and its Subsidiaries continually develop Confidential Information, that the
Executive may in the future develop Confidential Information for the Company or its Subsidiaries and that the Executive may in the future learn of Confidential Information during the course of employment with the Company. The Executive will comply
with the policies and procedures of the Company and its Subsidiaries for protecting Confidential Information and shall never use or disclose to any Person (except as required by applicable law or for the proper performance of his duties and
responsibilities to the Company and its Subsidiaries), any Confidential Information obtained by the Executive incident to her employment or other association with the Company or any of its Subsidiaries. The Executive understands that this
restriction shall continue to apply after her employment terminates, regardless of the reason for such termination. 
 (b)
All documents, records, tapes and other media of every kind and description relating to the business, present or otherwise, of the Company or its Subsidiaries and any copies, in whole or in part, thereof (the “Documents”), whether
or not prepared by the Executive, shall be the sole and exclusive property of the Company and its Subsidiaries. The Executive shall safeguard all Documents and shall surrender to the Company at the time his employment terminates, or at such earlier
time or times as the Board or its designee may specify, all Documents then in the Executive’s possession or control. 
 9.
Assignment of Rights to Intellectual Property. The Executive shall promptly and fully disclose all Intellectual Property (as defined in Section 13) to the Company. The Executive hereby assigns and agrees to assign to the Company
(or as otherwise directed by the Company) the Executive’s full right, title and interest in and to all Intellectual Property. The Executive agrees to execute any and all applications for domestic and foreign patents, copyrights or other
proprietary rights and to do such other acts (including without limitation the execution and delivery of instruments of further assurance or confirmation) requested by the Company to assign the Intellectual Property to the Company and to permit the
Company to enforce any patents, copyrights or other proprietary rights to the Intellectual Property. The Executive will not charge the Company for time spent in complying with these obligations. All copyrightable works that the Executive creates
shall be considered “work made for hire.” 
 10. Notification Requirement. Until the conclusion of the Non-Competition
Period, the Executive shall give notice to the Company of each new business activity that she plans to undertake at least thirty (30) days prior to beginning any such activity. Such notice shall state the name and address of the Person for whom
such activity is undertaken and the nature of the Executive’s business relationship(s) and position(s) with such Person. The Executive shall provide the Company with such other pertinent information concerning such business activity as the
Company may reasonably request in order to determine the Executive’s continued compliance with his obligations under Sections 7, 8 and/or 9 hereof. 

11. Enforcement of Covenants. The Executive acknowledges that she has carefully read and considered all the terms and conditions of
this Agreement, including the restraints imposed upon her pursuant to Sections 7, 8 and/or 9 hereof. The Executive agrees that said restraints are necessary for the reasonable and proper protection of the Company and its
Subsidiaries and that each and every one of the restraints is reasonable in respect to subject matter, length of time and geographic area. The Executive further acknowledges that, were she to breach any of the covenants contained in Sections
7, 8 and/or 9 hereof, the damage to the Company would be irreparable. The Executive therefore agrees that the Company, in addition to any other remedies available to it, shall be entitled to preliminary and permanent injunctive
relief against any breach or threatened breach by the 

  
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Executive of any of said covenants, without having to post bond. The parties further agree that, in the event that any provision of Sections 7, 8 and/or 9 hereof shall be
determined by any court of competent jurisdiction to be unenforceable by reason of its being extended over too great a time, too large a geographic area or too great a range of activities, such provision shall be deemed to be modified to permit its
enforcement to the maximum extent permitted by law. 
 12. Conflicting Agreements. The Executive hereby represents and warrants that
the execution of this Agreement and the performance of his obligations hereunder will not breach or be in conflict with any other agreement to which the Executive is a party or is bound and that the Executive is not now subject to any covenants
against competition or similar covenants or any court order or other legal obligation that would affect the performance of his obligations hereunder. The Executive will not disclose to or use on behalf of the Company any proprietary information of a
third party without such party’s consent. 
 13. Definitions. Words or phrases which are initially capitalized or are within
quotation marks shall have the meanings provided in this Section 13 and as provided elsewhere herein. For purposes of this Agreement, the following definitions apply: 

(a) “Affiliate” means, with respect to the Company or any other specified Person, any other Person directly or
indirectly controlling, controlled by or under common control with the Company or such other specified Person, where control may be by management authority, equity interest or other means. 

(b) “Board” means the board of directors of the Company. 

(c) “Confidential Information” means any and all information of the Company and its Subsidiaries that is not
generally known by others with whom they compete or do business, or with whom they plan to compete or do business and any and all information which, if disclosed by the Company or its Subsidiaries, would assist in competition against them.
Confidential Information includes without limitation such information relating to (i) the development, research, testing, manufacturing, marketing and financial activities of the Company and its Subsidiaries, (ii) the Products,
(iii) the costs, sources of supply, financial performance and strategic plans of the Company and its Subsidiaries, (iv) the identity and special needs of the customers of the Company and its Subsidiaries and (v) the people and
organizations with whom the Company and its Subsidiaries have business relationships and those relationships. Confidential Information also includes any information that the Company or any of its Subsidiaries have received, or may receive hereafter,
from others which was received by the Company or any of its Subsidiaries with any understanding, express or implied, that the information would not be disclosed. 

(d) “Intellectual Property” means inventions, discoveries, developments, methods, processes, compositions,
works, concepts and ideas (whether or not patentable or copyrightable or constituting trade secrets) conceived, made, created, developed or reduced to practice by the Executive (whether alone or with others and whether or not during normal business
hours or on or off the premises of the Company or any of its Subsidiaries) during the Executive’s employment with the Company or any of its Subsidiaries (including prior to the Effective Date) that relate to either the Products or any
prospective activity of the Company or any of its Subsidiaries or that make use of Confidential Information or any of the equipment or facilities of the Company or any of its Subsidiaries. 

(e) “Person” means an individual, a corporation, a limited liability company, an association, a partnership,
an estate, a trust and any other entity or organization. 
 (f) “Products” mean all products planned,
researched, developed, tested, manufactured, sold, licensed, leased or otherwise distributed or put into use by the Company or any of its Subsidiaries, together with all services provided or planned by the Company or any of its Subsidiaries, during
the Executive’s employment with the Company or any of its Subsidiaries (including prior to the Effective Date). 
 (g)
“Subsidiary” shall mean any Person of which the Company (or other specified Person) shall, directly or indirectly, own beneficially or control the voting of at least a majority of the outstanding capital stock (or other shares of
beneficial interest) entitled to vote generally or at least a majority of the 

  
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partnership, membership, joint venture or similar interests, or in which the Company (or other specified Person) or a Subsidiary thereof shall be a general partner or joint venturer without
limited liability. 
 14. Survival. The provisions of this Agreement shall survive following the Termination Date if so provided
herein or desirable to accomplish the purposes of other surviving provisions, including without limitation the provisions of Sections 6, 7, 8 and 9 hereof. 

15. Withholding. All payments made by the Company under this Agreement shall be reduced by any tax or other amounts required to be
withheld by the Company under applicable law. 
 16. Assignment. Neither the Company nor the Executive may make any assignment of
this Agreement or any interest herein, by operation of law or otherwise, without the prior written consent of the other; provided, however, that the Company may assign its rights and obligations under this Agreement without the consent of the
Executive in the event that the Company shall hereafter effect a reorganization, consolidation or merger or in the event the Company transfers all or substantially all of its properties or assets. This Agreement shall inure to the benefit of and be
binding upon the Company and the Executive, their respective successors, executors, administrators, heirs and permitted assigns. 
 17.
Severability. If any portion or provision of this Agreement shall to any extent be declared illegal or unenforceable by a court of competent jurisdiction, then the remainder of this Agreement, or the application of such portion or provision
in circumstances other than those as to which it is so declared illegal or unenforceable, shall not be affected thereby, and each portion and provision of this Agreement shall be valid and enforceable to the fullest extent permitted by law. 

18. Waiver. No waiver of any provision hereof shall be effective unless made in writing and signed by the waiving party. The failure of
either party to require the performance of any term or obligation of this Agreement, or the waiver by either party of any breach of this Agreement, shall not prevent any subsequent enforcement of such term or obligation or be deemed a waiver of any
subsequent breach. 
 19. Notices. Any and all notices, requests, demands and other communications provided for by this Agreement
shall be in writing and shall be effective when delivered in person, when delivered by courier at the Executive’s last known address on the books of the Company, or three business days following deposit in the United States mail, postage
prepaid, registered or certified, and addressed to the Executive at his last known address on the books of the Company or, in the case of the Company, at its principal place of business, attention of the Chairman of the Board, or to such other
address as either party may specify by notice to the other actually received. 
 20. Entire Agreement. This Agreement and the other
plans and documents specifically referred to herein constitute the entire agreement between the parties regarding the subject matter of this Agreement and such other plans and documents and supersede all prior communications, agreements and
understandings, written or oral, with respect to such subject matter. 
 21. Amendment. This Agreement may be amended or modified
only by a written instrument signed by the Executive and by an expressly authorized representative of the Company. 
 22. Headings.
The headings and captions in this Agreement are for convenience only and in no way define or describe the scope or content of any provision of this Agreement. 

23. Counterparts. This Agreement may be executed in two or more counterparts, each of which shall be an original and all of which
together shall constitute one and the same instrument. 
 24. Governing Law. This contract and shall be construed and enforced under
and be governed in all respects by the laws of Texas, without regard to the conflict of laws principles thereof. 

  
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 IN WITNESS WHEREOF, this Agreement has been executed as of the date first above written. 

 

							
	THE EXECUTIVE:				UNITED SURGICAL PARTNERS INTERNATIONAL, INC.
				
	 

				By:		 

	Sandra Karrmann				Name:		William H. Wilcox
					Title:		CEO

  
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 Attachment A 

RELEASE OF CLAIMS 

FOR AND IN CONSIDERATION OF the special payments and benefits to be provided in connection with the termination of my employment in accordance
with the terms of the Employment Agreement between me and UNITED SURGICAL PARTNERS INTERNATIONAL, INC., a Delaware corporation (the “Company”) dated as of January 7, 2013 (the “Employment Agreement”), I, on my
own behalf and on behalf of my personal or legal representatives, executors, administrators, successors, heirs, distributees, devisees and legatees and all others connected with me, hereby release and forever discharge, the Company, its Subsidiaries
and Affiliates and all of their respective past and present officers, directors, stockholders, members, partners, managers, controlling persons, employees, agents, representatives, successors and assigns and all others connected with any of them
(all collectively, the “Released”), both individually and in their official capacities, from any and all rights, liabilities, claims, demands and causes of action of any type (all collectively “Claims”) which I have
had in the past, now have, or might now have, through the date of my signing of this Release of Claims, in any way resulting from, arising out of or connected with my employment or its termination or pursuant to any federal, state, foreign or local
employment law, regulation or other requirement (including without limitation Title VII of the Civil Rights Act of 1964, the Age Discrimination in Employment Act, the Americans with Disabilities Act, and the fair employment practices laws of the
state or states in which I have been employed pursuant to the Employment Agreement, each as amended from time to time); provided, however, that the foregoing release shall not apply to any right or benefit that Section 6 of the
Employment Agreement explicitly provides shall survive the termination of my employment. Capitalized terms used in this Release of Claims that are defined in the Employment Agreement are used herein with the meanings so defined. 

In signing this Release of Claims, I acknowledge that I have had at least twenty-one (21) days from the date of notice of termination of
my employment to consider the terms of this Release of Claims and that such time has been sufficient, that I am encouraged by the Company to seek the advice of an attorney prior to signing this Release of Claims and that I am signing this Release of
Claims voluntarily and with a full understanding of its terms. 
 I understand that I may revoke this Release of Claims at any time within
seven (7) days of the date of my signing by written notice to the Company and that this Release of Claims will take effect only upon the expiration of such seven-day revocation period and only if I have not timely revoked it. 

Intending to be legally bound, I have signed this Release of Claims as of the date written below. 

 

			
	Signature:		  

			Sandra Karrmann
		
	Date:EX-10.20

 Exhibit 10.20 

FOURTH AMENDMENT TO THE 

USPI GROUP HOLDINGS, INC. 

2007 EQUITY INCENTIVE PLAN 

This Fourth Amendment (this “Amendment”) is entered into to be effective as of July 15, 2014 (the “Effective
Date”). All capitalized terms used but not defined herein shall have the meaning ascribed to such terms in the USPI Group Holdings, Inc. 2007 Equity Incentive Plan (as amended, the “Plan”). 

W I T N E S S E T H: 

WHEREAS, USPI Group Holdings, Inc., a Delaware corporation (the “Company”), has adopted the Plan to advance the
interests of the Company by providing for the grant to Participants of Awards. 
 WHEREAS, pursuant to Section 9 of the Plan,
the Administrator may amend the Plan; 
 WHEREAS, Section 4(a) of the Plan initially provided that a maximum of
20,145,458 shares of Stock may delivered in satisfaction of Awards under the Plan; 
 WHEREAS, the First Amendment to the Plan
increased the maximum shares of Stock that may be delivered in satisfaction of Awards under the Plan to 20,726,523; 
 WHEREAS,
the Second Amendment to the Plan increased the maximum shares of Stock that may be delivered in satisfaction of Awards under the Plan to 26,630,457; 

WHEREAS, the Third Amendment to the Plan increased the maximum shares of Stock that may be delivered in satisfaction of Awards
under the Plan to 27,070,457; and 
 WHEREAS, the Administrator again desires to amend Section 4(a) of the Plan as set
forth in this Amendment. 
 NOW, THEREFORE, the Plan is hereby amended, effective as of the Effective Date, as follows: 

1. The first sentence of Section 4(a) of the Plan is hereby amended in its entirety to read as follows: “A maximum of 31,816,215 shares
of Stock may be delivered in satisfaction of Awards under the Plan.” 
 2. Except as modified by this Amendment, the Plan shall
continue to read in its current state. 
 IN WITNESS WHEREOF, the undersigned, being the duly elected Secretary of the
Company, hereby certifies that this Amendment was adopted by the Administrator on the Effective Date. 
  

			
	USPI GROUP HOLDINGS, INC.
		
	By:		 

	Name:		Jason B. Cagle
	Title:		Chief Financial Officer

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