Document:

EX-10.33

 Exhibit 10.33 

PROMISSORY NOTE 

(NOTE NO. 3) 
  

			
	$1,000,000.00	  	Effective December 30, 2011

 FOR VALUE RECEIVED, FOUNDATION SURGERY AFFILIATES, LLC, a Nevada limited liability company
(“FSA”), FOUNDATION SURGERY HOLDINGS, L.L.C., a Delaware limited liability company (“FSH”) and FOUNDATION SURGERY MANAGEMENT, LLC, a Delaware limited liability company (“FSM”) (hereinafter collectively
referred to as the “Borrowers”), jointly and severally, unconditionally promise to pay to the order of LEGACY BANK (“Lender”), at 2801 W. Memorial Road, Oklahoma City, OK 73134, or at such other place as may be designated
in writing by the holder of this promissory note, the principal sum of not to exceed ONE MILLION AND 00/100 DOLLARS ($1,000,000.00), together with interest thereon at the rate hereinafter specified: 

INTEREST RATE. Interest shall accrue on the outstanding principal balance of this loan at the rate of Wall Street Journal Prime
Rate plus two and one-half percent (2.5%) per annum, adjusted on date of change. Interest on this Note shall be computed on the basis of a 365/360 day year. The Wall Street Journal Prime Rate (WSJP) means that annual rate of interest published
on the Wall Street Journal and is defined herein as the base rate on corporate loans posted by at least 75% of the nations thirty (30) largest banks or a similar substitute rate determined by the Lender in its sole discretion as most nearly
approximating that rate in the case this prime rate is no longer published. Each change in the WSJP shall become effective without notice (which notice is hereby waived) on the date of change. In no event shall the interest rate be less than six and
three quarters percent (6.75%) per annum. 
 PAYMENT TERMS. Beginning January 31, 2012, and on the last day of each
month through December 30, 2016, Borrowers shall pay Lender monthly installment payments of principle and interest based upon a sixty (60) month amortization. On the Maturity Date of December 30, 2016, all accrued interest and unpaid
principal shall be due and payable in full. The payments may be adjusted as needed to maintain the sixty (60) month amortization. 

DEFAULT INTEREST: Any sum not paid when due shall bear interest at a rate of six percent (6%) per annum greater than the
per annum interest rate prevailing on this Note at the time the unpaid amount came due, but in no event at a rate less than twelve percent (12%) per annum. 

PREPAYMENTS: Prepayments are permitted without penalty. 

On February 5, 2010, Borrowers and Lender entered into that certain Third Modification to Third Amended and Restated Loan and Security
Agreement (“Agreement”). This Promissory Note is defined in the Agreement as “Note No. 3”. Unless otherwise defined herein, all words and phrases with their initial letter capitalized shall be afforded the meaning given in
the Agreement. 
 The Lender’s records of advances and repayments will be prima facie evidence of the amount owed by the Borrowers to
the Lender with respect to this Note, in the absence of manifest error. 

 All payments made upon this Note shall be applied first to the outstanding accrued interest, if
any, through the date of payment and the balance, if any, to the principal balance due and owing under this Note. 
 Borrowers and each of
them hereby waive any and all suretyship type defenses to payment of this Note. 
 Borrowers agree that if, and as often as, this Note is
placed in the hands of an attorney for collection or to defend or enforce any of the Lender’s rights hereunder or under any instrument securing payment of this Note, Borrowers shall pay the Lender its reasonable attorneys’ fees and all
court costs and other expenses incurred in connection therewith. 
 It is expressly understood that time is of the essence of this Note, and
if the Borrowers shall fail to pay, when due, any amount payable under the provisions of this Note or fail to perform any other obligation to the Lender, or upon the occurrence of an Event of Default under the Agreement such event shall constitute a
default hereunder (any of the foregoing being hereinafter referred to as “Default”). Upon Default (i) this Note and all other liabilities together with all accrued but unpaid interest hereon and thereon, at the option of the Lender,
and without notice, demand or presentment, or notice of intent to accelerate to the Borrowers or any other person or party, may be declared, and thereupon immediately shall become, due and payable; and (ii) the Lender may exercise, from time to
time, any and all other rights, remedies and recourses now or hereafter existing in equity, at law, herein or under the Agreements, any other Loan Documents between Borrowers and Lender, by virtue of statute or otherwise, including but not limited
to, all rights and remedies available to it under the Uniform Commercial Code as in effect from time to time in the State of Oklahoma, and the right to foreclose any and all liens and security interests securing this Note. Notwithstanding anything
herein or in the Agreement to the contrary, this Note and all other liabilities of Borrowers to Lender, at the option of Lender, may be accelerated, without notice or demand of any kind in the event Borrowers fail to make when due any payments to
Lender as required herein or in the Agreement, 
 At any time additional payments may be made to be credited to principal. Monthly payments
shall not be reduced as a result of any prepayments. 
 The invalidity, or unenforceability in particular circumstances, of any provision of
this Note shall not extend beyond such provision or circumstances, and no other provision of this instrument shall be affected thereby. 

Borrowers expressly stipulate and agree that ii is the intent of Borrowers and Lender at all times to comply with applicable state law or
applicable United States federal law (to the extent that it permits Lender to contract for, charge, take, reserve, or receive a greater amount of interest than under state law) and that this section shall control every other covenant and agreement
in this Note and the other Loan Documents. If the applicable law (state or federal) is ever judicially interpreted so as to render usurious any amount called for under the 

  
 -2- 

 
Note or under any of the other Loan Documents, or contracted for, charged, taken, reserved, or received with respect to the Note, or if Lender’s exercise of the option to accelerate the
maturity of the Note, or if any prepayment by Borrowers result in Borrowers having paid any interest in excess of that permitted by applicable law, then it is Borrowers’ and Lender’s express intent that all excess amounts theretofore
collected by Lender shall be credited on the principal balance of the Note (or, if the Note has been or would thereby be paid in full, refunded to Borrowers), and the provisions of the Note and the other Loan Documents immediately shall be deemed
reformed and the amounts thereafter collectible hereunder and thereunder reduced, without the necessity of the execution of any new documents, so as to comply with the applicable law, but so as to permit the recovery of the fullest amount otherwise
called for hereunder or thereunder. All sums paid or agreed to be paid to Lender for the use, forbearance, or detention of the loan proceeds evidenced by the Note shall, to the extent permitted by applicable law, be amortized, prorated, allocated,
and spread throughout the full stated term of the Note until payment in full so that the rate or amount of interest on account of the Note does not exceed the maximum rate permitted under applicable law from time to time in effect and applicable to
the Note for so long as the Note is outstanding. Notwithstanding anything to the contrary contained herein or in any of the other Loan Documents, it is not the intention of Lender to accelerate the maturity of any interest that has not accrued at
the time of such acceleration or to collect unearned interest at the time of such acceleration. 
 This Note, to the extent of the full face
amount hereof, evidences indebtedness of Borrowers to Lender. This Note is issued by the Borrowers as part of a commercial transaction and no part of this loan is for a personal use. 

Borrowers hereby consent to the jurisdiction and/or venue of any state district court or federal district court within the State of Oklahoma,
as Lender may elect with respect to any action involving this Note. 
 BORROWERS HEREBY VOLUNTARILY, AND KNOWINGLY, IRREVOCABLY, AND
UNCONDITIONALLY WAIVES ANY RIGHT TO HAVE A JURY PARTICIPATE IN RESOLVING ANY DISPUTE (WHETHER BASED UPON CONTRACT, TORT OR OTHERWISE) BETWEEN THE BORROWERS AND LENDER ARISING OUT OF OR IN ANY WAY RELATED TO THIS NOTE OR ANY RELATED LOAN DOCUMENT.

 Borrowers stipulate and agree that the Lender may, at its sole discretion, assign this Note to any such person it may select, upon
such terms and conditions as it may deem appropriate, and that such assignee shall thereafter become the holder of this Note and shall be entitled to enforce all rights, remedies, and other benefits which shall or may inure to the benefit of the
Lender. 
 Borrowers further stipulate, represent and agree that this instrument evidences the valid, enforceable, and binding obligation of
the Borrowers to the Lender in accordance with the terms and provisions hereof, without any defense (as of the date of this Note) to the enforcement thereof, whether denominated as affirmative defense, offset, counterclaim, or otherwise, and whether
at Saw or in equity. Borrowers hereby waive all defenses (existing as of the date of this Note and/or based upon acts or omissions occurring prior to the date of this Note) to the enforcement of this Note. 

  
 -3- 

 IN WITNESS WHEREOF, Borrowers have executed this instrument this 30th day of December, 2011, and
made effective as of the date first above appearing. 
  

							
	 “BORROWERS”
	 		 		 	FOUNDATION SURGERY AFFILIATES, LLC, a Nevada limited liability company
				
		 		 	By:	 	

		 		 		 	ROBERT M. BYERS, Manager
				
		 		 		 	FOUNDATION SURGERY HOLDINGS, L.L.C., a Delaware limited liability company
				
		 		 	By:	 	

		 		 		 	ROBERT M. BYERS, Manager
				
		 		 		 	FOUNDATION SURGERY MANAGEMENT, LLC, a Delaware limited liability company
				
		 		 	By:	 	

		 		 		 	ROBERT M. BYERS, Manager

  
 -4-EX-10.34

  
 Exhibit 10.34 

 
 

 
 CHANGE IN TERMS AGREEMENT 
  

															
	Principal
$327,490 62	 	 Loan Date

09-07-2006
	 	 Maturity

02-17-2016
	 	Loan No
10228482	 	 Call / Coll

4a/3
	 	Account	 	 Officer

RUSSN
	 	Initials
	 References in the
boxes above are for Lender’s use only and do not limit the applicability of this document to any particular loan or item Any item above containing “***” has been omitted due to text length limitations

  

									
	Borrower:	  	 Foundation Surgical Hospital Affiliates, LLC

(TIN 80-0322730)
 14000 N PORTLAND AVE STE 205

OKLAHOMA CITY, OK 73134-4004
	  	Lender	  	 Legacy Bank
 OKC May

2801 W Memorial
 Oklahoma City, OK
73134

  

			
	 Principal Amount: $327,490.62
	  	Date of Agreement. 02/17/2013

 DESCRIPTION OF EXISTING INDEBTEDNESS Legacy Bank Note No 10228482 dated 09/07/2006 with an original principal amount of
$650 500 00 and an Assumption Agreement dated 06/19/2012 
 DESCRIPTION OF COLLATERAL All Collateral previously granted to Lender 

DESCRIPTION OF CHANGE IN TERMS Adjusting payment terms, interest terms and maturity date Re-amortizing the remaining balance of the Note A ClT fee of
$750. interest of $1,682 32 and principal of $7,230 81 will be paid in cash with this Change in Terms 
 PROMISE TO PAY Foundation Surgical Hospital
Affiliates, LLC (“Borrower”) promises to pay to Legacy Bank (“Lender”), or order, in lawful money of the United States of America, the principal amount of Three Hundred Twenty-seven Thousand Four Hundred Ninety & 62/100
Dollars ($327,490 62), together with interest on the unpaid principal balance from March 17, 2013, until paid in full 
 PAYMENT Subject to any
payment changes resulting from changes in the index, Borrower will pay this loan in 35 payments of $10,161 73 each payment Borrower’s first payment is due April 17, 2013, and all subsequent payments are due on the same day of each month
after that Borrower’s final payment will be due on February 17, 2016, and will be for all principal and all accrued interest not yet paid Payments include principal and interest Unless otherwise agreed or required by applicable law,
payments will be applied first to any unpaid collection costs, then to any late charges, then to any accrued unpaid interest, and then to principal Borrower will pay Lender at Lender’s address shown above or at such other place as Lender may
designate in writing 
 VARIABLE INTEREST RATE The interest rate on this loan is subject to change from time to time based on changes in an
independent index which is the minimum prime lending rate for large U S Money Center Commercial banks as published in the Money Rate Section of the Wall Street Journal (the “Index”) The Index is not necessarily the lowest rate charged by
Lender on its loans If the Index becomes unavailable during the term of this loan Lender may designate a substitute index after notifying Borrower Lender will tell Borrower the current Index rate upon Borrower’s request The interest rate change
will not occur more often than each day Borrower understands that Lender may make loans based on other rates as well The index currently is 3 250% per annum Prior to adding or subtracting any margin to the index, the index is rounded up to the
nearest 0 001 percent, resulting in a current rounded Index of 3 250% Interest on the unpaid principal balance of this loan will be calculated as described in the “INTEREST CALCULATION METHOD” paragraph using a rate of 1 000 percentage
point over the Index, rounded up to the nearest 0 001 percent, adjusted if necessary for any minimum and maximum rate limitations described below, resulting in an initial rate of 5 500% per annum based on a year of 360 days NOTICE Under
no circumstances will the Interest rate on this loan be less than 5 500% per annum or more than the maximum rate allowed by applicable law Whenever increases occur in the interest rate. Lender, at its option, may do one or more of the following
(A) increase Borrower’s payments to ensure Borrower’s loan will pay off by its original final maturity date, (B) increase Borrower’s payments to cover accruing interest, (C) increase the number of Borrower’s
payments, and (D) continue Borrower’s payments at the same amount and increase Borrower’s final payment 
 INTEREST CALCULATION METHOD
Interest on this loan is computed on a 365/360 basis, that is, by applying the ratio of the Interest rate over a year of 360 days, multiplied by the outstanding principal balance, multiplied by the actual number of days the principal balance is
outstanding All Interest payable under this loan is computed using this method 
 PREPAYMENT Borrower agrees that all loan fees and other prepaid
finance charges are earned fully as of the date of the loan and will not be subject to refund upon early payment (whether voluntary or as a result of default), except as otherwise required by law Except for the foregoing, Borrower may pay without
penalty all or a portion of the amount owed earlier than it is due Early payments will not, unless agreed to by Lender in writing, relieve Borrower of Borrower’s obligation to continue to make payments under the payment schedule Rather, early
payments will reduce the principal balance due and may result in Borrower’s making fewer payments Borrower agrees not to send Lender payments marked “paid in full”, “without recourse”, or similar language If Borrower sends
such a payment. Lender may accept it without losing any of Lender’s rights under this Agreement, and Borrower will remain obligated to pay any further amount owed to Lender All written communications concerning disputed amounts, including any
check or other payment instrument that indicates that the payment constitutes “payment in full” of the amount owed or that is tendered with other conditions or limitations or as full satisfaction of a disputed amount must be mailed or
delivered to Legacy Bank, OKC May, 2801 W Memorial, Oklahoma City, OK 73134 
 LATE CHARGE If a payment is 11 days or more late, Borrower will be charged
5 000% of the unpaid portion of the regularly scheduled payment or $20 00, whichever is greater 
 INTEREST AFTER DEFAULT Upon default, including
failure to pay upon final maturity, the Interest rate on this loan shall be increased by adding an additional 5 000 percentage point margin (“Default Rate Margin”) The Default Rate Margin shall also apply to each succeeding interest rate
change that would have applied had there been no default However, in no event will the interest rate exceed the maximum interest rate limitations under applicable law 

DEFAULT Each of the following shall constitute an Event of Default under this Agreement 

Payment Default Borrower fails to make any payment when due under the Indebtedness 

Other Defaults Borrower fails to comply with or to perform any other term, obligation, covenant or condition contained in this Agreement
or in any of the Related Documents or to comply with or to perform any term, obligation, covenant or condition contained in any other agreement between Lender and Borrower 

Default in Favor of Third Parties Any guarantor or Borrower defaults under any loan, extension of credit, security agreement, purchase
or sales agreement, or any other agreement, in favor of any other creditor or person that may materially affect any of any guarantor’s or Borrower’s property or ability to perform their respective obligations under this Agreement or any of
the Related Documents 
 False Statements Any warranty, representation or statement made or furnished to Lender by Borrower or on
Borrower’s behalf under this Agreement or the Related Documents is false or misleading in any material respect, either now or at the time made or furnished or becomes false or misleading at any time thereafter 

Death or Insolvency The dissolution of Borrower (regardless of whether election to continue is made), any member withdraws from
Borrower, or any other termination of Borrower’s existence as a going business or the death of any member, the Insolvency of Borrower, the appointment of a receiver for any part of Borrower’s property, any assignment for the benefit of
creditors, any type of creditor workout, or the commencement of any proceeding under any bankruptcy or insolvency laws by or against Borrower 

Creditor or Forfeiture Proceedings Commencement of foreclosure or forfeiture proceedings, whether by judicial proceeding, self-help,
repossession or any other method by any creditor of Borrower or by any governmental agency against any collateral securing the Indebtedness This includes a garnishment of any of Borrower’s accounts, including deposit accounts, with Lender
However, this Event of Default shall not apply if there is a good faith dispute by Borrower as to the validity or reasonableness of the claim which is the basis of the creditor or forfeiture proceeding and if Borrower gives Lender written notice of
the creditor or forfeiture proceeding and deposits with Lender monies or a surety bond for the creditor or forfeiture proceeding, in an amount determined by Lender, in its sole discretion, as being an adequate reserve or bond for the dispute 

Events Affecting Guarantor Any of the preceding events occurs with respect to any Guarantor of any of the Indebtedness or any Guarantor
dies or becomes incompetent, or revokes or disputes the validity of, or liability under, any Guaranty of the Indebtedness evidenced by this Note 

Adverse Change A material adverse change occurs in Borrower’s financial condition, or Lender believes the prospect of payment or
performance of the Indebtedness is impaired 
 Insecurity Lender in good faith believes itself insecure 

					
	Loan No: 10228482	  	 CHANGE IN TERMS AGREEMENT

(Continued)
	  	Page 2

  

 Cure Provisions If any default, other than a default in payment is curable and if
Borrower has not been given a notice of a breach of the same provision of this Agreement within the preceding twelve (12) months, it may be cured if Borrower after Lender sends written notice to Borrower demanding cure of such default
(1) cures the default within ten (10) days, or (2) if the cure requires more than ten (10) days immediately initiates steps which Lender deems in Lender’s sole discretion to be sufficient to cure the default and thereafter
continues and completes all reasonable and necessary steps sufficient to produce compliance as soon as reasonably practical 
 LENDER’S RIGHTS
Upon default, Lender may declare the entire unpaid principal balance under this Agreement and all accrued unpaid interest immediately due, and then Borrower will pay that amount 

ATTORNEYS’ FEES, EXPENSES Lender may hire or pay someone else to help collect this Agreement if Borrower does not pay Borrower will pay Lender
that amount This includes, subject to any limits under applicable law. Lender’s attorneys’ fees and Lender’s legal expenses, whether or not there is a lawsuit, including without limitation all attorneys’ fees and legal expenses
for bankruptcy proceedings (including efforts to modify or vacate any automatic stay or injunction) and appeals If not prohibited by applicable law. Borrower also will pay any court costs, in addition to all other sums provided by law 

GOVERNING LAW This Agreement will be governed by federal law applicable to Lender and, to the extent not preempted by federal law, the laws of the
State of Oklahoma without regard to its conflicts of law provisions This Agreement has been accepted by Lender in the State of Oklahoma 
 DISHONORED
ITEM FEE Borrower will pay a fee to Lender of $20 00 if Borrower makes a payment on Borrower’s loan and the check or other payment order including any preauthorized charge with which Borrower pays is later dishonored 

RIGHT OF SETOFF To the extent permitted by applicable law, Lender reserves a right of setoff in all Borrower’s accounts with Lender (whether
checking, savings, or some other account) This includes all accounts Borrower holds jointly with someone else and all accounts Borrower may open in the future However, this does not include any IRA or Keogh accounts, or any trust accounts for which
setoff would be prohibited by law Borrower authorizes Lender to the extent permitted by applicable law, to charge or setoff all sums owing on the indebtedness against any and all such accounts, and, at Lender’s option, to administratively
freeze all such accounts to allow Lender to protect Lender’s charge and setoff rights provided in this paragraph 
 COLLATERAL Borrower
acknowledges this Agreement is secured by Collateral securing other loans with Lender may also secure this loan To the extent collateral previously has been given to Lender by any person which may secure this Indebtedness, whether directly or
Indirectly it is specifically agreed that to the extent prohibited by law all such collateral consisting of household goods will not secured this Indebtedness In addition, if any collateral requires the giving of a right of rescission under Truth in
Lending for this Indebtedness such collateral also will not secure this Indebtedness unless and until all required notices of that right have been given 

CONTINUING VALIDITY Except as expressly changed by this Agreement, the terms of the original obligation or obligations, including all agreements
evidenced or securing the obligation(s), remain unchanged and in full force and effect Consent by Lender to this Agreement does not waive Lender’s right to strict performance of the obligation(s) as changed, nor obligate Lender to make any
future change in terms Nothing in this Agreement will constitute a satisfaction of the obligation(s) It is the intention of Lender to retain as liable parties all makers and endorsers of the original obligation(s), including accommodation parties,
unless a party is expressly released by Lender in writing Any maker or endorser, including accommodation makers, will not be released by virtue of this Agreement If any person who signed the original obligation does not sign this Agreement below,
then all persons signing below acknowledge that this Agreement is given conditionally based on the representation to Lender that the non-signing party consents to the changes and provisions of this Agreement or otherwise will not be released by it
This waiver applies not only to any initial extension modification or release, but also to all such subsequent actions 
 DOCUMENTATION/INFORMATION
FEE Lender may require additional documentation or information related to this Indebtedness from the Borrower for loan security or file documentation as deemed appropriate and at the sole discretion of Lender or in accordance with covenants
described in the Business Loan Agreement In the event Borrower fails to provide requested documentation or Information within 60 days from written request by Lender, a fee may be assessed for each incidence in an amount which is the greater of $100
00 or 03% ( 0003) of the outstanding principal balance of the Indebtedness for each incidence Said fee, if not paid when incurred, will be added to the principal of this Indebtedness 

SUCCESSORS AND ASSIGNS Subject to any limitations stated in this Agreement on transfer of Borrower’s interest, this Agreement shall be binding
upon and inure to the benefit of the parties, their successors and assigns If ownership of the Collateral becomes vested in a person other than Borrower, Lender, without notice to Borrower, may deal with Borrower’s successors with reference to
this Agreement and the indebtedness by way of forbearance or extension without releasing Borrower from the obligations of this Agreement or liability under the Indebtedness 

NOTIFY US OF INACCURATE INFORMATION WE REPORT TO CONSUMER REPORTING AGENCIES Please notify us if we report any inaccurate information
about your account(s) to a consumer reporting agency Your written notice describing the specific inaccuracy(ies) should be sent to us at the following address Legacy Bank, OKC May, 2801 W Memorial, Oklahoma City, OK 73134 

MISCELLANEOUS PROVISIONS If any part of this Agreement cannot be enforced, this fact will not affect the rest of the Agreement Lender may delay or
forgo enforcing any of its rights or remedies under this Agreement without losing them Borrower and any other person who signs, guarantees or endorses this Agreement, to the extent allowed by law, waive presentment, demand for payment, and notice of
dishonor Upon any change in the terms of this Agreement, and unless otherwise expressly stated in writing, no party who signs this Agreement whether as maker, guarantor, accommodation maker or endorser, shall be released from liability All such
parties agree that Lender may renew or extend (repeatedly and for any length of time) this loan or release any party or guarantor or collateral, or impair, fail to realize upon or perfect Lender’s security interest in the collateral, and take
any other action deemed necessary by Lender without the consent of or notice to anyone All such parties also agree that Lender may modify this loan without the consent of or notice to anyone other than the party with whom the modification is made
The obligations under this Agreement are joint and several 
 PRIOR TO SIGNING THIS AGREEMENT, BORROWER READ AND UNDERSTOOD ALL THE PROVISIONS OF THIS
AGREEMENT, INCLUDING THE VARIABLE INTEREST RATE PROVISIONS BORROWER AGREES TO THE TERMS OF THE AGREEMENT 
 BORROWER 

FOUNDATION SURGICAL HOSPITAL AFFILIATES, LLC 
  

			
	
		
	By	 	/s/ Robert M Byers
		 	Robert M Byers, Manager of Foundation Surgical Hospital Affiliates, LLC

 LENDER 
 LEGACY BANK

  

	
	 /s/ Russ Nation

	Authorized Signer

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