Document:

First Amendment to Air Rights Lease

 Exhibit 10.144 
 FIRST AMENDMENT TO 
 AIR RIGHTS LEASE 

THIS FIRST AMENDMENT TO AIR RIGHTS LEASE (the “Amendment”) made as of the 8th day of October, 2003 by and between ST. MARY’S HEALTH SYSTEM,
INC., a Tennessee nonprofit corporation (“Landlord”) and JEFFERSON EQUITY PARTNERS, LLC, a Tennessee limited liability company (“Tenant’). 
 WHEREAS, Landlord and Tenant entered into a certain Air Rights Lease as of the 27th day of March, 2003 (the “Air Rights Lease”); and 

WHEREAS, the parties desire to amend certain provisions of the Air Rights Lease. 

NOW THEREFORE, in consideration of the mutual covenants and promises of the parties and other good and valuable consideration, the
parties do hereby agree as follows: 
 1. Description of Easements. Sections 3.1, 3.2, 3.4 and 3.5 are hereby revised in
their entirety to read as follows: 
  

	 	3.1	Elevator Shaft Easements. 

 Landlord hereby grants, conveys and encumbers Landlord’s Facility and the Land with a vertical perpetual non-exclusive easement for construction, installation, maintenance, repair, replacement and
use of elevator shafts for the use and benefit of Tenant’s Facility and the Air Space Parcel. The Elevator Shaft Easements shall be limited to the current locations of the elevator shafts in the Landlord’s Facility. 

 

	 	3.2	Utility Easements. 

 Landlord hereby grants, conveys and encumbers Landlord’s Facility and the Land with perpetual non-exclusive easements for passage, construction, installation, maintenance, repair, replacement and use
of utility lines, pipes, wires, conduits, flues, ducts, lines and other equipment including without limitation, electricity, gas, water, communications, sewer and storm drainage from the surrounding public thoroughfares to Tenant’s Facility and
the Air Space Parcel. 
  

	 	3.4	Fire Stair Easements. 

 Landlord hereby grants, conveys and encumbers Landlord’s Facility and the Land with vertical perpetual non-exclusive easements which shall contain fire stairs to serve Tenant’s Facility and
Landlord’s Facility. The Fire Stair Easements shall be limited to the current locations of the fire stairs in the Landlord’s Facility. Tenant understands and agrees that said easement is a non-exclusive easement and will be used by
Landlord and Tenant. 

  
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	 	3.5	Elevator Shaft Overrun Rooms. 

 Tenant hereby grants, conveys and encumbers Tenants Facility with vertical perpetual non-exclusive easements for location of elevator shaft overrun rooms for the elevators serving Landlord’s
Facility. The Elevator Shaft Overrun Rooms shall be located directly above the current locations of the elevator shafts in the Landlord’s Facility. Landlord shall have a perpetual nonexclusive easement for ingress and egress through
Tenant’s Facility for access to the Elevator Shaft Overrun Rooms. 
 2. Deletion of Exhibits. Exhibits B through E
to the Air Rights Lease are hereby deleted. 
 3. Reimbursement for Use of Other’s Facilities. Article XIII of the
Air Rights Lease is deleted in its entirety. 
 4. Full Force and Effect. All provision of the Air Rights Lease not
expressly amended herein shall remain in full force and effect in accordance with their terms. 
 IN WITNESS WHEREOF, the
parties have executed this Amendment as of the day and date as stated above. 
  

			
	LANDLORD:
	
	ST. MARY’S HEALTH SYSTEM, INC.
		
	By:	 	  

	Title:	 	  

	
	TENANT:
	
	JEFFERSON EQUITY PARTNERS, LLC
		
	By:	 	 /s/ Norman T. Brinkman

	Title:	 	  

		 	Norman Brinkman

  
 2Second Amendment to Air Rights Lease

 Exhibit 10.145 
 SECOND AMENDMENT TO 
 AIR RIGHTS LEASE 

THIS SECOND AMENDMENT TO AIR RIGHTS LEASE (the “Second Amendment”) made as of the 14th day of May, 2008 by and between ST.
MARY’S HEALTH SYSTEM, INC., a Tennessee nonprofit corporation (“Landlord”) and HEALTHCARE EQUITY PARTNERS, LLC, a Tennessee limited liability company (“Tenant”). 

WHEREAS, Landlord and Jefferson Equity Partners, LLC (“Jefferson”) entered into a certain Air Rights Lease as of the 27th day
of March, 2003, as amended by a First Amendment to Air Rights Lease dated as of October 8, 2003 (collectively, the “Air Rights Lease”); and 
 WHEREAS, Jefferson assigned its interest in and to the Air Rights Lease to Tenant pursuant to an Assignment of Air Rights Lease dated October 28, 2003; and 

WHEREAS, Tenant constructed a two-story medical office building (“Tenant’s Facility”) in the air parcel leased by Tenant
pursuant to the Air Rights Lease; and 
 WHEREAS, Landlord currently leases the 5th floor of the Tenant’s Facility pursuant
to a Lease Agreement between Tenant (as landlord) and Landlord (as tenant) dated as of January 16, 2007 (the “Existing SMHS Lease”); and 
 WHEREAS, the parties desire to amend certain provisions of the Air Rights Lease. 

NOW THEREFORE, in consideration of the mutual covenants and promises of the parties and other good and valuable consideration, the
parties do hereby agree as follows: 
 1. Master Lease. Landlord agrees that it will lease any Tenant Space (each such
lease being a “Master Lease”) in Tenant’s Facility that is not then subject to a Space Lease, as and when such Tenant Space becomes available. Each Master Lease shall be upon substantially the same terms as the Existing SMHS Lease,
subject to the following: 
 (a) Term. The initial term of each Master Lease shall be three
(3) years. The term of each Master Lease shall automatically renew for additional terms of three (3) years each, provided that the term of any Master Lease shall not extend beyond the expiration of the Master Lease Term (as defined below).
It is the intent of the parties that Tenant’s Facility remain fully leased during the entire Master Lease Term. 
 (b) Rent. Base Rent and Additional Rent shall be equivalent to the Rent then payable under the Existing SMHS Lease (or which would have been payable under the Existing SMHS Lease assuming that the
Existing SMHS Lease had continued to be renewed through the expiration of the Master Lease Term), determined on a square foot basis. 
 (c) Tenant Improvements. Tenant shall have no obligation to construct tenant improvements in connection with any Master Lease. 

  
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 Landlord’s obligation pursuant to this Section will terminate ten (10) years from
the date of this Second Amendment (the ‘Master Lease Term”). 
 2. Existing SMHS Lease. In the event the
existing SMHS Lease is terminated or expires, Landlord shall thereupon lease the “Premises” (as defined in the Existing SMHS Lease) from Tenant pursuant to a Master Lease for the remainder of the Master Lease Term. 

3. Landlord Option to Purchase. Tenant grants Landlord an option to purchase Tenant’s Facility (the “Landlord Purchase
Option”) during the Master Lease Term at any time (provided that Landlord is not then in default of its obligations under the Air Rights Lease or this Second Amendment) upon the following terms: 

(a) Purchase Price. The purchase price shall be the sum of (i) Five Million Seven Hundred Seventy-Five
Thousand Dollars ($5,775,000) and (ii) the amount of any prepayment fee, yield maintenance premium, defeasance premium or similar payment that Tenant must pay in order to prepay or defease any mortgage loan secured by Tenant’s Facility.
The portion of the purchase price stated in clause (i) above will not adjust over time, but shall remain fixed during the Master Lease Term. 
 (b) Closing Date. The closing of the purchase and sale of Tenant’s Facility (the “Closing”) shall occur upon a date mutually agreed upon by Landlord and Tenant, but not sooner than
sixty (60) days and not more than one hundred twenty (120) days following the Landlord’s delivery of notice to Tenant that it has elected to exercise this option to purchase. 

(c) Conveyance. The conveyance of Tenant’s Facility shall be by special warranty deed of improvements only,
subject to no liens or encumbrances created or suffered by Tenant other than the lien of real property taxes for the year in which the Closing occurs. 
 (d) Assignment and Assumption of Leases. At the Closing Tenant shall assign and Landlord shall assume all Space Leases then in effect. 

4. Landlord Required Purchase of Tenant’s Facility. In the event that Landlord has not exercised the Landlord Purchase Option
during the Master Lease Term, then Landlord shall be obligated to purchase and Tenant shall be obligated to sell Tenant’s Facility upon the same terms as contained in the Landlord Purchase Option, except that the closing of the purchase and
sale shall occur not later than one hundred twenty (120) days following expiration of the Master Lease Term. 
 5.
Defined Terms. Capitalized terms not otherwise defined in this Second Amendment shall have the meanings assigned to such terms in the Air Rights Lease or in the Existing SMHS Lease, as applicable. 

6. Full Force and Effect. All provision of the Air Rights Lease not expressly amended herein shall remain in full force and effect
in accordance with their terms. 

  
 2 

 IN WITNESS WHEREOF, the parties have executed this Amendment as of the day and date as
stated above. 
  

			
	LANDLORD:
	
	ST. MARY’S HEALTH SYSTEM, INC.
		
	By:	 	  

		
	Title:	 	  

	
	TENANT:
	
	HEALTHCARE EQUITY PARTNERS, LLC,
		
	By:	 	 /s/ Norman Brinkman

		
	Title:	 	  

		 	Norman Brinkman,

  
 3Third Amendment to Air Rights Lease

 Exhibit 10.146 
 THIRD AMENDMENT 
 TO AIR RIGHTS LEASE 

THIS THIRD AMENDMENT TO AIR RIGHTS LEASE (this “Third Amendment”) made as of the 10th day of July,
2013, by and between METRO KNOXVILLE HMA, LLC, a Tennessee limited liability company (“Landlord”), and OAK HILLS PARTNERS, LLC, a Tennessee limited liability company (“Tenant”) (Landlord
and Tenant are referred to together as the “Parties”). 
 W I T N E S S E T H: 

WHEREAS, St. Mary’s Health System, Inc. (“SMHS”), as landlord, and Jefferson Equity Partners, LLC
(“JEP”), as tenant, entered into that certain Air Rights Lease dated of March 27, 2003 (the “Original Lease”); 
 WHEREAS, SMHS and Jefferson amended the Original Lease by that First Amendment to Air Rights Lease dated as of October 8, 2003 (the “First Amendment”); 

WHEREAS, JEP assigned its interest in and to the Original Lease, as amended by the First Amendment, to Health Equity Partners, LLC
(“HEP”) pursuant to an Assignment of Air Rights Lease dated October 28, 2003; 
 WHEREAS,
SMHS and HEP further amended the Original Lease by that certain Second Amendment to Air Rights Lease dated as of October 8, 2008 (the “ Second Amendment”) (the Original Lease, as amended by the First Amendment and Second
Amendment, is referred to herein as the “Lease”); 
 WHEREAS, HEP assigned its interest in and to
the Lease to Tenant pursuant to an Assignment of Air Rights Lease dated July 29, 2011; 
 WHEREAS, SMHS assigned its
interest in and to the Lease to Landlord pursuant to an Assignment and Assumption Agreement dated as of October 1, 2011; and 
 WHEREAS, Tenant and Landlord desire to confirm that the Lease is in full force and effect and to amend the Lease only as specifically provided in this Third Amendment. 

NOW, THEREFORE, in consideration of the foregoing and other good and valuable consideration, the receipt and sufficiency of which
are hereby acknowledged, the Parties hereby agree as follows: 
 1. Incorporation of Recitals. The above recitals are
true and correct and are hereby incorporated by this reference. 
 2. Exhibit A. Exhibit A attached to the Lease is
hereby deleted in its entirety and replaced with the Exhibit A attached hereto. 
 3. Vehicular and Pedestrian
Ingress/Egress. The following provision is hereby added to the Lease as Section 3.8, to appear immediately following Section 3.7 of the Lease: 

 “3.8 Vehicular and Pedestrian Ingress/Egress. 

Landlord hereby encumbers the Land for the benefit of, and as an appurtenance to, the Air Space Parcel and Tenant’s Facility, with a
perpetual non-exclusive easement for vehicular access, ingress, and egress on, over and across the road and access ways currently and hereinafter constructed on the Land and Landlord’s Facility. Further, Landlord hereby encumbers the Land and
Landlord’s Facility for the benefit of, and as an appurtenance to, the Air Space Parcel and Tenant’s Facility, with a non-exclusive right, privilege, and easement for pedestrian access, ingress, and egress on, over, and across the Land and
through the Landlord’s Facility for purposes of accessing the Tenant’s Facility.” 
 4. Conflict. In the
event of a conflict between the provisions of this Third Amendment and the provisions of the Lease, the provisions of this Third Amendment shall control. 
 5. Successors and Assigns. This Third Amendment shall be binding upon, and inure to the benefit of, the Parties hereto and their respective successors and assigns. 

6. Ratification. Except as herein expressly amended, each and every other term of the Lease shall remain unchanged and in full
force and effect without modification, and Landlord and Tenant hereby ratify and affirm the same. 
 7. Counterpart
Signatures. This Third Amendment may be executed in counterparts, each of which, when taken together, shall constitute one and the same document. A facsimile signature of either party shall constitute an original signature of such party for all
purposes and is binding on said party. 
 [Signatures appear on the following page] 

 IN WITNESS WHEREOF, Landlord and Tenant have caused this Third Amendment to Lease to
be duly executed on or as of the day and year first above written. 
  

			
	“LANDLORD”
	
	 METRO KNOXVILLE, HMA, LLC,
 a Tennessee limited liability company

		
	By:	 	  

 

			
	Printed Name:	 	 Steven E. Clifton

			
	Title:	 	 Senior Vice President

 Tenant’s Signature Appears on Next Page 

 
			
	“TENANT”
	
	 OAK HILL PARTNERS, LLC,
 a Tennessee limited liability company

		
	By:	 	 /s/ Norman T. Brinkman

	Name:	 	 Norman T. Brinkman

	Title:	 	 Managing Member

 EXHIBIT A 
 DESCRIPTION OF THE AIR SPACE PARCEL 
 [Intentionally Omitted]

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