Document:

First Amendment to Second Lien Term Loan Agreement

 Exhibit 4.5 
 EXECUTION COPY 
 FIRST AMENDMENT TO SECOND LIEN TERM LOAN AGREEMENT 
 AND FIRST AMENDMENT TO SECURITY AGREEMENT 
 AND CONSENT TO AMENDMENT TO INTERCREDITOR AGREEMENT 
 This FIRST AMENDMENT TO SECOND LIEN TERM LOAN AGREEMENT AND
FIRST AMENDMENT TO SECURITY AGREEMENT AND CONSENT TO AMENDMENT TO INTERCREDITOR AGREEMENT (this “Amendment”), dated as of July 25, 2007, is among Critical Homecare Solutions, Inc., a Delaware corporation
(“Borrower”), KCHS Holdings, Inc., a Delaware corporation (“Holdings”), the Subsidiary Guarantors, the Lenders party hereto and the Agents (each as defined below). 
 RECITALS 
 WHEREAS, Holdings and
Borrower are parties to that certain Second Lien Term Loan Agreement, dated as of January 8, 2007 (as amended, restated supplemented or otherwise modified from time to time, the “Credit Agreement”), among Holdings, Borrower,
the Subsidiary Guarantors (as defined in the Credit Agreement; unless otherwise defined herein, terms defined in the Credit Agreement and used herein shall have the meanings given to them in the Credit Agreement), the Lenders, Jefferies Finance LLC,
as lead arranger (in such capacity, the “Arranger”), documentation agent (in such capacity, the “Documentation Agent”) and as book manager (in such capacity, the “Book Manager”), Blackstone
Corporate Debt Administration L.L.C., as administrative agent for the Lenders (in such capacity, the “Administrative Agent”) and as collateral agent for the Secured Parties (in such capacity, the “Collateral
Agent”), and Jefferies & Company, Inc., as syndication agent (in such capacity, the “Syndication Agent”); 
 WHEREAS, Holdings and Borrower are parties to that certain Security Agreement, dated as of January 8, 2007 (as amended, restated supplemented or otherwise modified from time to time, the “Security Agreement”), among
Holdings, Borrower, the Subsidiary Guarantors and the Collateral Agent; 
 WHEREAS, Holdings and Borrower are parties to that certain
Intercreditor Agreement, dated as of January 8, 2007 (as amended, restated supplemented or otherwise modified from time to time, the “Intercreditor Agreement”), among Holdings, Borrower, the Collateral Agent and Jefferies
Finance LLC, as first lien collateral agent; 
 WHEREAS, pursuant to Section 11.02(b) of the Credit Agreement, the Loan Parties,
Administrative Agent, the Collateral Agent and the requisite Lenders party hereto desire to amend certain provisions of the Credit Agreement and the Security Agreement as set forth herein, and the requisite Lenders desire to consent to an amendment
to the Intercreditor Agreement as set forth herein. 
 NOW, THEREFORE, in consideration of the premises made hereunder, and for good
and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto, intending to be legally bound, hereby agree as follows: 

 Section 1. Amendments of Section 1.01 of the Credit Agreement. 
 (a) The definition of “Consolidated EBITDA” in Section 1.01 of the Credit Agreement is hereby amended by (X) deleting
“$2,000,000” and “$1,500,000” in the second and third lines of clause (j) thereof and substituting in lieu thereof “$3,000,000” and “$3,000,000”, respectively; (Y) deleting “$2,500,000” and
“$2,000,000” in the second and third lines of clause (k) thereof and substituting in lieu thereof “$3,000,000” and “$3,000,000,” respectively; and (Z) by inserting the following new clause (o): 
 “(o) costs and expenses directly incurred by Holdings in connection with an IPO (not to exceed $2,500,000 in the aggregate for all periods) during
such period, and”. 
 (b) The definition of “Consolidated Indebtedness” in Section 1.01 of the Credit Agreement is
hereby amended by deleting “$1,000,000” in the third line thereof and substituting in lieu thereof “$2,500,000.” 
 (c)
Clause (xi) of the definition of “Permitted Acquisition” in Section 1.01 of the Credit Agreement is hereby amended by (X) inserting the phrase “the East Goshen Acquisition,” in the first line thereof immediately
following the phrase “except for” and (Y) deleting the phrase “Closing Date” in the fifth line thereof and substituting the phrase “First Amendment Effective Date” in lieu thereof. 
 (d) Section 1.01 of the Credit Agreement is hereby amended by adding the following new definitions in appropriate alphabetical order: 

““Applied Health Care” shall mean Applied Health Care, Inc., a Delaware corporation. 
 “Applied Health Care Acquisition Agreement” shall mean that certain partnership interest purchase agreement, dated as of June 27,
2007, among Applied Health Care, Ltd., Applied HC, L.L.C., each of the persons set forth on Schedule A thereto, CHS Applied Healthcare GP, Inc. and CHS Applied Healthcare LP, Inc. 
 “Applied Health Care Earn-Out Obligations” shall mean all obligations required to be paid by Applied Health Care, as
successor-in-interest to Applied Health Care, Ltd., to Applied HC, L.L.C. and each of the persons set forth on Schedule A to the Applied Health Care Acquisition Agreement in accordance with the earn-out provision set forth in Section 3.1(b) of
the Applied Health Care Acquisition Agreement, as in effect on June 27, 2007, up to a maximum of $1,400,000, based on Gross Profit from treatment of two patients under the Cerazyme Business (as such terms are defined in the Applied Health Care
Acquisition Agreement, as in effect on the June 27, 2007). 
 “East Goshen” shall mean East Goshen Pharmacy, Inc., a
Pennsylvania corporation. 
 “East Goshen Acquisition” shall mean the acquisition by Borrower of all of the outstanding
capital stock of East Goshen. 
 “East Goshen Acquisition Agreement” shall mean that certain stock purchase agreement, to be
dated on or before September 14, 2007, among East Goshen, each of the persons set forth on Schedule A thereto and Borrower. 
  

 2 

 “East Goshen Earn-Out Obligations” shall mean all obligations required to be paid by
East Goshen to each of the persons set forth on Schedule A to the East Goshen Acquisition Agreement in accordance with the earn-out provision set forth in Section 3.1(b) of the East Goshen Acquisition Agreement up to a maximum of $900,000,
based on East Goshen’s EBITDA and Gross Profits for the Earn-Out Period (as such terms are defined in the East Goshen Acquisition Agreement). 
 “First Amendment Effective Date” shall mean July 25, 2007. 
 “New England Sellers” shall mean
the holders of all of the issued and outstanding common stock of New England set forth on Schedule A to the New England Acquisition Agreement, as in effect on September 8, 2006.” 
 Section 2. Amendments of Section 5.01 of the Credit Agreement. 
 (a) Section 5.01(a) of the Credit Agreement is hereby amended by deleting the parenthetical phrase “(including a note with an
unaudited consolidating statement of income separating out Borrower and its Subsidiaries)” in the fifth and sixth lines thereof and substituting the parenthetical phrase “(including a note with a statement of income for such period for
Borrower’s segments, as determined and prepared in accordance with GAAP, the Securities Act, the Exchange Act and the rules and regulations thereunder)” in lieu thereof. 
 (b) Section 5.01(b) of the Credit Agreement is hereby amended by deleting the parenthetical phrase “(including a note with a
consolidating statement of income separating out Borrower and its Subsidiaries)” in the sixth and seventh lines thereof and substituting the parenthetical phrase “(including a note with a statement of income for such quarterly period for
Borrower’s segments, as determined and prepared in accordance with GAAP, the Securities Act, the Exchange Act and the rules and regulations thereunder)” in lieu thereof. 
 Section 3. Amendment of Section 6.01(l) of the Credit Agreement. Section 6.01(l) of the Credit Agreement is hereby amended by
inserting the phrase “, the Applied Health Care Earn-Out Obligations and the East Goshen Earn-Out Obligations” immediately following the phrase “the New England Earn-Out Obligations.” 
 Section 4. Amendments of Section 6.10 of the Credit Agreement. 
 (a) Section 6.10(a) of the Credit Agreement is hereby amended by deleting the minimum Consolidated EBITDA covenant level chart in its
entirety and substituting in lieu thereof a replacement minimum Consolidated EBITDA covenant level chart in the form attached as Exhibit A hereto. 
 (b) Section 6.10(b) of the Credit Agreement is hereby amended by deleting the maximum Total Leverage Ratio covenant level chart in its entirety and substituting in lieu thereof a replacement maximum Total
Leverage Ratio covenant level chart in the form attached as Exhibit B hereto. 
 (c) Section 6.10(d) of the Credit
Agreement is hereby amended by deleting the maximum Capital Expenditures covenant level chart in its entirety and substituting in lieu thereof a replacement maximum Capital Expenditures covenant level chart in the form attached as Exhibit C
hereto. 
  

 3 

 Section 5. Amendments of Security Agreement. 
 (a) Section 3.4(c) of the Security Agreement is hereby amended by (X) inserting the following proviso immediately after clause
(ii) in the third to last sentence thereof: “provided that aggregate amount on deposit in Deposit Accounts excluded from the requirements of this Section 3.4(c) by virtue of this clause (ii) may not at any time
exceed $100,000,” and (Y) by inserting the following new sentence at the end thereof: 
 “Notwithstanding the foregoing, in
connection with the consummation of a Permitted Acquisition, Borrower shall cause each Deposit Account or Lockbox Account of the new Pledgor acquired in such Permitted Acquisition to become subject to a Deposit Account Control Agreement or Lockbox
Agreement, as applicable, as soon as reasonably practicable following consummation of such Permitted Acquisition, but in no event later than 90 days following the consummation of such Permitted Acquisition or such later date (but, in no event, to
exceed an additional 60 days) as is acceptable to the Collateral Agent in its sole discretion.” 
 (b)
Section 3.4(e) of the Security Agreement is hereby amended by inserting the following new sentence at the end thereof: 
 “Notwithstanding the foregoing, in connection with the consummation of a Permitted Acquisition, Borrower shall cause each Securities Account or Commodity Account of the new Pledgor acquired in such Permitted Acquisition to become
subject to a Control Agreement as soon as reasonably practicable following consummation of such Permitted Acquisition, but in no event later than 90 days following the consummation of such Permitted Acquisition or such later date (but, in no event,
to exceed an additional 60 days) as is acceptable to the Collateral Agent in its sole discretion.” 
 Section 6. Consent to
Amendment of Intercreditor Agreement. The requisite Lenders party hereto hereby consent to the following amendment to the Intercreditor Agreement and authorize the Collateral Agent to enter into such documentation as the Collateral Agent shall
deem necessary to give effect to such amendment. Section 1.1 of the Intercreditor Agreement shall be amended by deleting the definition of “First Lien Cap Amount” in its entirety and substituting in lieu thereof the following:

 ““First Lien Cap Amount” means (I) $149,600,000, plus (II) the principal amount of Loans (not to
exceed $6,000,000) made pursuant to the First Lien Credit Agreement the proceeds of which are applied to make Permitted Acquisitions, minus (III) the sum of (A) the amount of all repayments and prepayments applied to the principal amount
of any term loans under the First Lien Loan Documents and (B) the amount of all repayments and prepayments of the principal amount of any revolving loan under the First Lien Loan Documents, to the extent accompanied by a corresponding reduction
in the applicable commitment amount (other than reductions in sub-facility commitment amounts where not accompanied by a reduction in the related facility commitment amounts) (excluding, in all events, any such repayments and prepayments to the
extent (and only to the extent) Refinanced at the time of such repayment or prepayment, as the case may be, with a principal (or equivalent) amount of Indebtedness).” 
 Section 7. Conditions Precedent. This Amendment shall become effective upon satisfaction of each of the following conditions precedent:

  

 4 

 (a) The Administrative Agent and the Collateral Agent shall have received all of the following, in form
and substance satisfactory to the Administrative Agent and the Collateral Agent: 
 (i) Amendment. This Amendment and each other
instrument, document or certificate required by the Administrative Agent or the Collateral Agent, duly executed and delivered by Holdings, Borrower, the requisite Lenders and any other person in connection with this Amendment; and 
 (ii) Additional Information. Such additional documents, instruments and information as the Administrative Agent or the Collateral Agent may
reasonably request to effect the transactions contemplated hereby. 
 (b) The representations and warranties contained herein and in the
Loan Documents shall be true and correct in all material respects as of the date hereof as if made on the date hereof (except for those which by their terms specifically refer to an earlier date, in which case such representations and warranties
shall have been true and correct in all material respects as of such earlier date). 
 (c) All corporate proceedings taken in connection
with the execution and delivery of this Amendment and all other agreements, documents and instruments executed and/or delivered pursuant thereto, and all legal matters incident thereto, shall be satisfactory to the Administrative Agent and the
Collateral Agent. 
 (d) No Default or Event of Default shall have occurred and be continuing after giving effect to this Amendment.

 (e) Borrower shall have paid all outstanding costs and expenses of the Agents (including, without limitation, the fees, costs and
expenses of counsel to the Agents) incurred from and after the Closing Date through the date of this Amendment. 
 Section 8.
Representations and Warranties. Each Loan Party hereby represents and warrants to the Agents and the Lenders that, as of the date hereof and after giving effect to this Amendment, (a) all representations and warranties set forth in the
Credit Agreement, the Security Agreement and in any other Loan Document are true and correct in all material respects as if made again on and as of such date (except those, if any, which by their terms specifically relate only to an earlier date, in
which case such representations and warranties shall have been true and correct in all material respects as of such earlier date), (b) no Default or Event of Default has occurred and is continuing, and (c) the Credit Agreement (as amended
by this Amendment), the Security Agreement (as amended by this Amendment) and all other Loan Documents are and remain legal, valid, binding and enforceable obligations of the Loan Parties in accordance with the terms thereof except as may be limited
by bankruptcy, insolvency, reorganization, moratorium or similar laws relating to or limiting creditors’ rights generally or by equitable principles (regardless of whether enforcement is sought in equity or at law). 
 Section 9. Survival of Representations and Warranties. All representations and warranties made in this Amendment or any other Loan Document
shall survive the execution and delivery of this Amendment, and no investigation by any Agent or any Lender shall affect the representations and warranties or the right of the Agents and the Lenders to rely upon them. If any representation or
warranty made in this Amendment is false in any material respect as of the date made or deemed made, then such shall constitute an Event of Default under the Credit Agreement. 
  

 5 

 Section 10. Reference to Agreement. Each of the Loan Documents, including the Credit
Agreement and the Security Agreement, and any and all other agreements, documents or instruments now or hereafter executed and/or delivered pursuant to the terms hereof or pursuant to the terms of the Credit Agreement or the Security Agreement as
amended hereby, are hereby amended so that any reference in such Loan Documents to the Credit Agreement or the Security Agreement, as applicable, whether direct or indirect, shall mean a reference to the Credit Agreement or the Security Agreement,
as applicable, as amended hereby. This Amendment shall constitute a Loan Document under the Credit Agreement. 
 Section 11.
Governing Law. THIS AMENDMENT SHALL BE GOVERNED BY, AND SHALL BE CONSTRUED AND ENFORCED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 
 Section 12. Execution. This Amendment may be executed in any number of counterparts and by different parties hereto in separate counterparts, each of which when so executed shall be deemed to be an
original and all of which taken together shall constitute one and the same agreement. Delivery of an executed counterpart of a signature page to this Amendment by telecopier or other electronic transmission shall be effective as delivery of a
manually executed counterpart of this Amendment. 
 Section 13. Limited Effect. This Amendment relates only to the specific
matters expressly covered herein, shall not be considered to be a waiver of any rights or remedies any Agent or Lender may have under the Credit Agreement or the Security Agreement or under any other Loan Document, and shall not be considered to
create a course of dealing or to otherwise obligate in any respect any Agent or Lender to execute similar or other amendments or grant any waivers under the same or similar or other circumstances in the future. 
 Section 14. Ratification by Guarantors. The Guarantors acknowledge that their respective consents to this Amendment are not required, but the
Guarantors nevertheless hereby agree and consent to this Amendment and to the documents and agreements referred to herein. The Guarantors agree and acknowledge that (i) notwithstanding the effectiveness of this Amendment, the Guarantors’
respective Guarantees shall remain in full force and effect without modification thereto and (ii) nothing herein shall in any way limit any of the terms or provisions of the Guarantors’ respective Guarantees or any other Loan Document
executed by the Guarantors (as the same may be amended from time to time), all of which are hereby ratified, confirmed and affirmed in all respects. The Guarantors hereby agree and acknowledge that no other agreement, instrument, consent or document
shall be required to give effect to this Section 14. The Guarantors hereby further acknowledge that Borrower, the Agents and any Lender may from time to time enter into any further amendments, modifications, terminations and/or waivers
of any provisions of the Loan Documents without notice to or consent from the Guarantors and without affecting the validity or enforceability of the Guarantors’ respective Guarantees or giving rise to any reduction, limitation, impairment,
discharge or termination of the Guarantors’ respective Guarantees. 
 [signature pages follow] 
  

 6 

 IN WITNESS WHEREOF, the parties hereto have caused this First Amendment to Second Lien Term Loan
Agreement and First Amendment to Security Agreement and Consent to Amendment to Intercreditor Agreement to be executed by their respective officers thereunto duly authorized, as of the date first above written. 
  

			
	KCHS HOLDINGS, INC., as Holdings
		
	By:	  	 /s/ Mary Jane Graves

	Name:	  	Mary Jane Graves
	Title:	  	
	
	 CRITICAL HOMECARE SOLUTIONS, INC., as
 Borrower

		
	By:	  	 /s/ Mary Jane Graves

	Name:	  	Mary Jane Graves
	Title:	  	

  

			
	SUBSIDIARY GUARANTORS:
	
	SPECIALTY PHARMA, INC.
	NEW ENGLAND HOME THERAPIES, INC.
	PROFESSIONAL HOME CARE SERVICES, INC.
	DEACONESS ENTERPRISES, INC.
	DEACONESS HOMECARE, INC.
	ELK VALLEY HEALTH SERVICES, INC.
	ELK VALLEY PROFESSIONAL AFFILIATES, INC.
	ELK VALLEY HOME HEALTH CARE AGENCY, INC.
	CEDAR CREEK HOME HEALTH CARE AGENCY, INC.
	GERICARE, INC.
	INFUSION PARTNERS, INC.
	KNOXVILLE HOME THERAPIES, LLC
	REGIONAL AMBULATORY DIAGNOSTICS, INC.
	SOUTH MISSISSIPPI HOME HEALTH, INC.
	SOUTH MISSISSIPPI HOME HEALTH, INC. – REGION I
	SOUTH MISSISSIPPI HOME HEALTH, INC. – REGION II
	SOUTH MISSISSIPPI HOME HEALTH, INC. – REGION III
	INFUSION SOLUTIONS, INC.
	APPLIED HEALTH CARE, INC.
	
	
		
	By:	 	 /s/ Mary Jane Graves

	Title:	 	Mary Jane Graves
	Name:	 	
	
	 JEFFERIES FINANCE LLC,
 as Arranger, Book Manager and Documentation Agent

		
	By:	 	 /s/ E. J. Hess

	Name:	 	E. J. Hess
	Title:	 	Managing Director

  

 First Amendment to Second Lien Term Loan Agreement 
     and First Amendment to Security Agreement and Consent to Amendment to Intercreditor Agreement 

			
	 JEFFERIES & COMPANY, INC.,
 as
Syndication Agent

		
	By:	 	 /s/ Thomas Brady

	Name:	 	Thomas Brady
	Title:	 	Managing Director
	
	 BLACKSTONE CORPORATE DEBT ADMINISTRATION L.L.C.,
 as Administrative Agent and Collateral Agent

		
	By:	 	 /s/ Howard Gilles

	Name:	 	Howard Gilles
	Title:	 	Authorized Signer

  

							
	S.A.C. DOMESTIC INVESTMENTS, LP,
	as a Lender
			
		 	By:	 	 S.A.C. CAPITAL MANAGEMENT, LLC,
 its
General Partner

				
		 		 	By:	 	 /s/ Peter Nussbaum

		 		 	Name:	 	Peter Nussbaum
		 		 	Title:	 	Authorized Signatory

  

									
	 BLACKSTONE MEZZANINE PARTNERS II L.P.,
 as a Lender

			
		 	By:	 	Blackstone Mezzanine Associates II L.P.,
		 		 	its General Partner
				
		 		 	By:	 	 Blackstone Mezzanine Management
 Associates
II L.L.C.,
 its General Partner

					
		 		 		 	By:	 	 /s/ Howard Gellis

		 		 		 	Name:	 	Howard Gellis
		 		 		 	Title:	 	Authorized Signer
	
	 BLACKSTONE MEZZANINE HOLDINGS II L.P.,
 as a Lender

			
		 	By:	 	 Blackstone Mezzanine Associates II L.P.,
 its
General Partner

				
		 		 	By:	 	 Blackstone Mezzanine Management
 Associates
II L.L.C.,
 its General Partner

					
		 		 		 	By:	 	 /s/ Howard Gellis

		 		 		 	Name:	 	Howard Gellis
		 		 		 	Title:	 	Authorized Signer
	
	 BLACKSTONE INTERMEDIATE FUNDING L.P.,
 as a Lender

		
	By:	 	 /s/ Howard Gellis

	Name:	 	Howard Gellis
	Title:	 	Authorized Signer

  

 S-2 
 First
Amendment to Second Lien Term Loan Agreement 
   and First Amendment to Security Agreement and Consent to Amendment to Intercreditor Agreement

 EXHIBIT A TO AMENDMENT1 
  

							
	 Test Period End Date
	  	 (A)
 Consolidated
 EBITDA
Amount
	  	 (B)
 Consolidated
EBITDA
 Amount

	 March 31, 2007
	  	$	19,500,000	  	$	19,500,000
	 June 30, 2007
	  	$	19,700,000	  	$	19,700,000
	 September 30, 2007
	  	$	22,500,000	  	$	21,500,000
	 December 31, 2007
	  	$	23,200,000	  	$	22,100,000
	 March 31, 2008
	  	$	23,600,000	  	$	22,600,000
	 June 30, 2008
	  	$	24,300,000	  	$	23,200,000
	 September 30, 2008
	  	$	24,900,000	  	$	23,900,000
	 December 31, 2008
	  	$	25,600,000	  	$	24,500,000
	 March 31, 2009
	  	$	26,500,000	  	$	25,400,000
	 June 30, 2009
	  	$	26,500,000	  	$	25,400,000
	 September 30, 2009
	  	$	27,300,000	  	$	26,300,000
	 December 31, 2009
	  	$	28,200,000	  	$	27,200,000
	 March 31, 2010
	  	$	30,800,000	  	$	29,800,000
	 June 30, 2010
	  	$	30,800,000	  	$	29,800,000
	 September 30, 2010
	  	$	30,800,000	  	$	29,800,000
	 December 31, 2010
	  	$	30,800,000	  	$	29,800,000
	 March 31, 2011
	  	$	32,600,000	  	$	31,500,000
	 June 30, 2011
	  	$	32,600,000	  	$	31,500,000
	 September 30, 2011
	  	$	32,600,000	  	$	31,500,000
	 December 31, 2011
	  	$	32,600,000	  	$	31,500,000
	 March 31, 2012
	  	$	32,600,000	  	$	31,500,000
	 June 30, 2012
	  	$	32,600,000	  	$	31,500,000
	 September 30, 2012
	  	$	32,600,000	  	$	31,500,000
	 December 30, 2012
	  	$	32,600,000	  	$	31,500,000

	 1
	 The minimum Consolidated EBITDA required under Section 6.10(a) will be
equal to (i) the amounts set forth in Column (A) if the East Goshen Acquisition is completed on or before September 14, 2007 and (ii) the amounts set forth in Column (B) if the East Goshen Acquisition is not completed on or
prior to September 14, 2007, in each case for the respective dates indicated. 

 EXHIBIT B TO AMENDMENT 
  

			
	 Test Period End Date
	  	Total Leverage Ratio
	 March 31, 2007
	  	6.25:1.00
	 June 30, 2007
	  	6.25:1.00
	 September 30, 2007
	  	6.00:1.00
	 December 31, 2007
	  	6.00:1.00
	 March 31, 2008
	  	5.75:1.00
	 June 30, 2008
	  	5.50:1.00
	 September 30, 2008
	  	5.25:1.00
	 December 31, 2008
	  	5.00:1.00
	 March 31, 2009
	  	4.50:1.00
	 June 30, 2009
	  	4.25:1.00
	 September 30, 2009
	  	4.00:1.00
	 December 31, 2009
	  	4.00:1.00
	 March 31, 2010
	  	3.75:1.00
	 June 30, 2010
	  	3.50:1.00
	 September 30, 2010
	  	3.25:1.00
	 December 31, 2010
	  	3.25:1.00
	 March 31, 2011
	  	3.00:1.00
	 June 30, 2011
	  	3.00:1.00
	 September 30, 2011
	  	3.00:1.00
	 December 31, 2011
	  	3.00:1.00
	 March 31, 2012
	  	3.00:1.00
	 June 30, 2012
	  	3.00:1.00
	 September 30, 2012
	  	3.00:1.00
	 December 30, 2012
	  	3.00:1.00

 EXHIBIT C TO AMENDMENT 
  

				
	 Period
	  	Capital
Expenditure
Amount
	 March 31, 2007
	  	$	5,200,000
	 June 30, 2007
	  	$	5,500,000
	 September 30, 2007
	  	$	6,300,000
	 December 31, 2007
	  	$	6,600,000
	 March 31, 2008
	  	$	6,300,000
	 June 30, 2008
	  	$	5,900,000
	 September 30, 2008
	  	$	5,400,000
	 December 31, 2008
	  	$	5,400,000
	 March 31, 2009
	  	$	5,400,000
	 June 30, 2009
	  	$	5,400,000
	 September 30, 2009
	  	$	5,400,000
	 December 31, 2009
	  	$	5,400,000
	 March 31, 2010, and March 31, June 30, September 30 and December 31 of each year thereafter
	  	$	6,100,000Amended and Restated Stockholders Agreement

 Exhibit 10.1 
 EXECUTION COPY 
 AMENDED AND RESTATED STOCKHOLDERS AGREEMENT 
 AMENDED AND RESTATED STOCKHOLDERS AGREEMENT dated as of January 8, 2007 by and among (i) KCHS HOLDINGS, INC., a Delaware corporation (the
“Company”), (ii) Kohlberg Investors V, L.P., a Delaware limited partnership, Kohlberg Partners V, L.P., a Delaware limited partnership, Kohlberg Offshore Investors V, L.P., a Delaware limited partnership, and Kohlberg TE
Investors V, L.P., a Delaware limited partnership, KOCO Investors V, L.P., a Delaware limited partnership (collectively, the “Kohlberg Stockholders”), (iii) Robert Cucuel, Mary Jane Graves, Nitin Patel and the other members of
management of the Company and its subsidiaries who are Stockholders and have executed this Agreement or have otherwise agreed to be bound by the provisions hereof (the “Management Stockholders”), and (iv) BLACKSTONE MEZZANINE
PARTNERS II L.P., a Delaware limited partnership (“Blackstone Partners”), BLACKSTONE MEZZANINE HOLDINGS II L.P., a Delaware limited partnership (“Blackstone Holdings, and, collectively with Blackstone Partners,
“Blackstone”) and S.A.C. DOMESTIC INVESTMENTS, L.P., a [Delaware] limited partnership (“SAC” and, collectively with Blackstone, the “Institutional Stockholders” and, collectively with Blackstone, the
Management Stockholders and the Kohlberg Stockholders, the “Stockholders”). 
 This Amended and Restated Stockholders
Agreement amends, restates and supersedes in its entirety the Stockholder Agreement dated as of December 1, 2006 (the “Original Stockholders Agreement”) by and among the Company, the Kohlberg Stockholders and the Management
Stockholders. 
 The Company and the Stockholders desire to enter into certain agreements with respect to the Shares now owned or hereafter
acquired by them. 
 NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the
parties hereby agree as follows: 
 Section 1. Definitions. For purposes of this Agreement, the following terms have the indicated
meanings: 
 “Affiliate” of a person means any other person controlling, controlled by or under common control with such
person, whether by ownership of voting securities, by contract or otherwise, and, (i) in the case of the Kohlberg Stockholders shall include any partner of any the Kohlberg Stockholders, (ii) in the case of Blackstone, shall include any
partner of Blackstone Partners or Blackstone Holdings or any investment fund or other collective investment vehicle, controlled, administered or managed by any The Blackstone Group or any Person controlled by the Blackstone Group, and (iii) in
the case of SAC shall include any partner of SAC or any investment fund or other collective investment vehicle, controlled, administered or managed by any affiliate of SAC Capital Advisors, L.P. 
 “Board” means the Company’s Board of Directors. 
 “Common Stock” means the Company’s common stock, par value $ .001 per share. 

 “Fair Market Value” of any Shares as of any date means the fair market value of the
Shares (expressed on a per share basis) as of such date, as determined in good faith by the Board based on the consolidated results of operations, financial condition and future prospects of the Company and such other factors as the Company may deem
appropriate. Fair Market Value shall be determined without regard to (i) any restriction on transferability or lack of marketability of the Shares or (ii) any discount for minority position. 
 “Independent Third Party” means any person or entity (i) which does not own in excess of 10% of the Shares on a fully-diluted
basis, (ii) which is not an Affiliate of any such 10% owner of Shares, (iii) which is not the spouse, ancestor or descendant (by birth or adoption) of any such 10% owner of Shares or (iv) which does not otherwise directly or
indirectly control, is not otherwise under the direct or indirect control of, or is not directly or indirectly under common control with, the Company. 
 “Institutional Shares” means the Shares owned by the Institutional Stockholders and their Affiliates and transferees. 
 “Investor Shares” means the Shares owned by the Kohlberg Stockholders and their Affiliates and transferees. 
 “Management Shares” means shares of Common Stock held by the Management Stockholders and their respective Permitted Transferees. 
 “Shares” means all of the issued and outstanding shares of capital stock of the Company. 
 “Securities Act” means the Securities Act of 1933, as amended. 
 “Stockholder Shares” means (i) all Shares acquired by the Stockholders, and (ii) all Shares or other securities issued or
issuable directly or indirectly with respect to the securities referred to in clause (i) by way of stock dividend or stock split or in connection with a combination, recapitalization, merger, consolidation or other reorganization. Stockholder
Shares shall cease to be such when they have been sold (x) pursuant to a registered public offering under the Securities Act, (y) to the public pursuant to Rule 144 under the Securities Act or any successor provision, or (z) pursuant
to Section 2(a)(ii). 
 Section 2. Restrictions on Transfer. 
 (a) Kohlberg Right of First Refusal. 
 (i) Not less than 30 days prior to any proposed transfer of Management Shares, the transferring Management Stockholder shall deliver to the Kohlberg Stockholders a written notice (the “Offer Notice”)
specifying in reasonable detail the number of Shares to be transferred, the identity of the transferee(s), the price (which shall be payable solely in cash) and the other terms and conditions of the proposed transfer. The Kohlberg Stockholders may
elect to purchase all, but not less than all, of the Management Shares proposed to be transferred upon the terms and conditions specified in the Offer Notice by delivering to the transferring Management Stockholder a written notice of such election
within the 20-day period following its receipt of the Offer Notice (the “Election Period”). The Kohlberg Stockholders will be entitled to purchase all (but not less than all) such Management Shares. The purchase of such Shares by
the Kohlberg Stockholders shall be consummated within 30 days following expiration of the Election Period. 
  

 2 

 (ii) In the event that the Kohlberg Stockholders do not elect to purchase the Management
Shares described in the Offer Notice, during the 30-day period following expiration of the Election Period, the transferring Management Stockholder may transfer such Management Shares to the transferee(s) specified in the Offer Notice on terms no
more favorable to such transferee(s) than those specified in the Offer Notice. Any Management Shares so transferred to a transferee who is not an employee of the Company or its subsidiaries shall cease to be Management Shares for purposes of this
Agreement. Any Management Shares not transferred within such 30-day period shall again be subject to Section 2(a)(i) in connection with any proposed transfer thereof. 
 (b) Certain Permitted Transfers. Section 2(a) shall not apply to transfers of Management Shares (i) pursuant to
Section 4, 5, or 7, (ii) by will or pursuant to applicable laws of descent and distribution, or (iii) within a Management Stockholder’s family group; provided that, in connection with any such transfer, each transferee (a
“Permitted Transferee”) agrees in writing to be bound by the provisions of this Agreement. Any Management Shares transferred to a Permitted Transferee shall continue to be Management Shares for purposes of this Agreement. A
Management Stockholder’s “family group” means such Management Stockholder’s spouse and lineal descendants (whether natural or adopted) and any trust formed and maintained solely for the benefit of such Management Stockholder,
such Management Stockholder’s spouse and/or such Management Stockholder’s lineal descendants. 
 Section 3. Additional
Restrictions on Transfer. 
 (a) Legend. The certificates representing the Shares, such certificates shall bear the
following: 
 THE SECURITIES REPRESENTED BY THIS CERTIFICATE WERE ORIGINALLY ISSUED ON
                    , 20__, HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED (THE “ACT”), OR UNDER
ANY STATE SECURITIES LAWS AND MAY NOT BE SOLD OR TRANSFERRED IN THE ABSENCE OF AN EFFECTIVE REGISTRATION STATEMENT UNDER THE ACT AND APPLICABLE STATE SECURITIES LAWS OR AN EXEMPTION FROM REGISTRATION UNDER THE ACT. THE SECURITIES REPRESENTED BY THIS
CERTIFICATE ARE SUBJECT TO ADDITIONAL RESTRICTIONS ON TRANSFER AND CERTAIN OTHER AGREEMENTS SET FORTH IN AN AMENDED AND RESTATED STOCKHOLDERS AGREEMENT DATED AS OF JANUARY         , 2007 AMONG KCHS
HOLDINGS, INC. AND CERTAIN STOCKHOLDERS THEREOF, A COPY OF WHICH MAY BE OBTAINED WITHOUT CHARGE BY THE HOLDER HEREOF AT THE COMPANY’S PRINCIPAL PLACE OF BUSINESS. 
  

 3 

 (b) Opinion of Counsel. No holder of Shares may sell, transfer or dispose of any
such Shares (other than pursuant to an effective registration statement under the Securities Act) without first delivering to the Company an opinion of counsel, if so requested by the Company, reasonably acceptable in form and substance to the
Company that registration under the Securities Act is not required in connection with such transfer. 
 Section 4. Sale of the
Company. If each of the Board and the holders of a majority of the Shares then outstanding approves the sale of the Company to an Independent Third Party, whether by merger, consolidation, sale of all or substantially all of its assets, sale of
all of the outstanding Shares or otherwise (an “Approved Sale”), the Stockholders shall consent to and raise no objections against such Approved Sale (including exercising any rights of appraisal) and shall take all necessary and
desirable actions in their capacities as Stockholders in connection with the consummation of such Approved Sale. Without limiting the foregoing, if the Approved Sale is structured as a sale of Shares of the Company, the Stockholders shall agree to
sell all of their Shares and rights to acquire Shares on the terms and conditions approved by the Board and the holders of a majority of the Shares then outstanding. The obligations of the Stockholders with respect to any Approved Sale are subject
to the condition that, (i) upon the consummation of such Approved Sale, all of the holders of Shares will receive the same form and amount of consideration per Share (giving effect to any priority contained therein and to the exercise of all
option and warrants to the extent such options and warrants are vested or will vest in connection with the Approved Sale), or if any holders are given an option as to the form and amount of consideration to be received, all holders will be given the
same option; (ii) no Stockholder will be required to grant any indemnification rights except indemnification rights which constitute identical indemnification rights (pro rata based upon the consideration received and not joint and several,
other than any such obligations that relate solely to a particular Stockholder, such as indemnification with respect to representations and warranties made by a Stockholder with respect to such Stockholder or covenants made by such Stockholder, in
respect of which only such Stockholder shall be liable); (iii) no Stockholder shall be required to make any representation or warranty that is not made by all other Stockholders; and (iv) no Institutional Stockholder shall be required to
enter into any restrictive covenant, including without limitation, any non-competition or non-solicitation arrangement which survives the closing of such Transfer. 
 Section 5. Participation Rights. Other than in connection with an Approved Sale in which all of the outstanding Shares are being transferred, not less than 15 days prior to any proposed transfer of Shares by
any Kohlberg Stockholder (which term shall include any Affiliate of any Kohlberg Stockholder to which Shares have been transferred pursuant to the last sentence of this Section 5), such Kohlberg Stockholders shall deliver to the Management
Stockholders and the Institutional Stockholders a written notice (the “Sale Notice”) specifying in reasonable detail the identity of the proposed transferee(s) and the terms and conditions of the proposed transfer. Each Management
Stockholder and each Institutional Stockholder may elect to participate in the proposed transfer by delivering to the Kohlberg Stockholders a written notice of such election within the 20-day period following delivery of the Sale Notice, which
notice shall specify the Shares which the Management Stockholder or Institutional Stockholder, as the case may be. elects to sell as part of such transfer. If any Management Stockholders or Institutional Stockholders elect to participate in such
transfer, the Kohlberg Stockholders and each such participating Management Stockholder and Institutional Stockholder will be entitled to sell in 

  

 4 

 
such proposed transfer, at the same price and on the same terms, a number of Shares equal to the product of (i) the quotient determined by dividing the
percentage of the Shares then held by the Kohlberg Stockholders or such participating Management Stockholder or Institutional Stockholder, as the case may be, by the aggregate percentage of the Shares then held by the Kohlberg Stockholders and all
participating Management Stockholders and Institutional Stockholders, multiplied by (ii) the number of Shares to be sold in such proposed transfer. The participating Management Stockholders and Institutional Stockholders shall pay a pro rata
portion of the transaction expenses associated with such transfer that are directly payable by the Stockholders. In connection with such proposed transfer, (i) no Stockholder will be required to grant any indemnification rights except
indemnification rights which constitute identical indemnification rights (pro rata based upon the consideration received and not joint and several, other than any such obligations that relate solely to a particular Stockholder, such as
indemnification with respect to representations and warranties made by a Stockholder with respect to such Stockholder or covenants made by such Stockholder, in respect of which only such Stockholder shall be liable); (ii) no Stockholder shall
be required to make any representation or warranty that is not made by all other Stockholders; and (iii) no Stockholder which is an institutional investor or investment fund shall be required to enter into any restrictive covenant, including
without limitation, any non-competition or non-solicitation arrangement which survives the closing of such Transfer. This Section 5 shall not apply to transfers by the Kohlberg Stockholders or its Affiliates of less than an aggregate of 5%
(together with all prior transfers) of the outstanding Shares or transfers to Affiliates of the Kohlberg Stockholders (provided that such Affiliates shall agree in writing to be bound by the terms hereof). 
 Section 6. Pre-Emptive Rights. After the Closing, the Company shall not issue or sell any capital stock of the Company, or any options, warrants
or other rights to acquire any capital stock of the Company, or any securities convertible into or exchangeable for, directly or indirectly, any capital stock of the Company, to any Kohlberg Stockholder or any Affiliate of a Kohlberg Stockholder
(each a “Pre-Emptive Issuance” of “Securities”), except in compliance with the provisions of this Section 6. 
 (a) Participation Notice. Not fewer than 20 business days prior to the consummation of the Pre-Emptive Issuance, the Company shall provide a written notice to each Institutional Stockholder (the
“Participation Notice”). The Participation Notice shall include the principal terms of the proposed Pre-Emptive Issuance, including (i) the amount and kind of Securities to be included in the Pre-Emptive Issuance, (ii) the
price per share of the Securities (or, if such consideration is not cash, the Fair Market Value thereof), and (iii) the portion of the Pre-Emptive Issuance equal to the aggregate number of Shares held by such Stockholder immediately prior to
such Pre-Emptive Issuance divided by the aggregate number of Shares outstanding immediately prior to the Pre-Emptive Issuance (the “Participation Portion”); 
 (b) Election to Participate. Within 10 business days after the Participation Notice, each Stockholder desiring to accept the offer
pursuant to Section 6(b) shall send an irrevocable commitment (each a “Participation Commitment”) to the Company specifying the amount or proportion of Securities which such holder desires to be issued (each a
“Participating Buyer”). The acceptance of each Participating Buyer shall be irrevocable except as hereinafter provided and so long as no subsequent Participation Notice is required to be delivered pursuant to this Section 6,
and each such Participating Buyer shall be obligated to acquire in the Pre-Emptive 

  

 5 

 
Issuance on the same terms and conditions, with respect to each share of Securities issued, such amount or proportion of Securities as such Participating
Buyer shall have specified in such Participating Buyer’s Participation Commitment. Each Stockholder who does not timely deliver a Participation Commitment shall be deemed to have waived all of such holder’s rights under this Section 6
with respect to the Pre-Emptive Issuance specified in the Participation Notice, and the Company shall thereafter be free to issue the Securities specified in such Participation Notice in such Pre-Emptive Issuance, at a price not less than the price
set forth in the Participation Notice and on other terms not materially more favorable in the aggregate, to the Pre-Emptive Transferees than those set forth in the Participation Notice, provided, however, that if the terms of such proposed
Pre-Emptive Issuance change such that they are materially different in the aggregate than those set forth in the Participation Notice, it shall be necessary for a separate Participation Notice to be furnished, and the terms and provisions of this
Section 6 separately complied with, in order to consummate such Pre-Emptive Issuance. 
 (c) Expiration of
Commitment. If at the end of the 120th day following the date of the effectiveness of the Participation Notice the Company has not completed the Pre-Emptive Issuance on the terms and conditions specified in such Participation Notice, each
Participating Buyer shall be released from its obligations under such Participating Buyer’s Participation Commitment, the Participation Notice shall be null and void, and it shall be necessary for a separate Participation Notice to be
furnished, and the terms and provisions of this Section 6 separately complied with, in order to consummate any Pre-Emptive Issuance subject to this Section 6. 
 (d) Cooperation. Each Participating Buyer shall take or cause to be taken all such commercially reasonable actions, consistent with
the provisions of this Agreement, as may be necessary or appropriate in order expeditiously to consummate each Pre-Emptive Issuance to such Participating Buyer pursuant to this Section 6 and any related transactions. Without limiting the
generality of the foregoing, each Participating Buyer agrees to execute and deliver such customary subscription and other customary agreements specified by the Company to which the Company will be party. 
 (e) Closing. The closing of a Pre-Emptive Issuance pursuant to this Section 6 shall take place at such time and place as the
Company shall specify by notice to each Participating Buyer. At the closing, each Participating Buyer shall be delivered the certificates or other instruments, if any, evidencing the Securities to be issued to such Participating Buyer, against
delivery by such Participating Buyer of the applicable consideration or cash equal to the Fair Market Value pursuant to Section 6(a)(ii). 
 (f) Retroactive Compliance. Notwithstanding the notice requirements of Section 6(a), the Company may proceed with any Pre-Emptive Issuance prior to having complied with the provisions of Section 6;
provided that the Company shall promptly upon the consummation of such Pre-Emptive Issuance (and in any event prior to making any distribution in respect of Securities purchased in connection therewith and prior to consummating any subsequent
Pre-Emptive Issuance) provide to each holder of Shares who would have been entitled to be given a Participation Notice in connection with such Pre-Emptive Issuance (i) with notice of such Pre-Emptive Issuance and (ii) the Participation
Notice described in Section 6(a) in which the actual price per share of Securities shall be set forth, and permit each such holder to exercise such holder’s participation rights under this Section 6 with respect thereto. 

 

 6 

 (g) Exceptions. This Section 6 shall also not apply to any Person which is
not an Accredited Investor. 
 Section 7. Registration Rights. 
 (a) Demand Registration. At any time after the earlier of (i) the fifth anniversary of the date of this Agreement and
(ii) 180 days after the consummation of the Company’s initial public offering of Shares under the Securities Act, the holders of a majority of the then-outstanding Investor Shares shall have the right to require the Company to effect up to
two registrations of their Shares on Form S-1 under the Securities Act and, if available, unlimited registrations on Form S-2 or S-3 under the Securities Act (any such registration, a “Demand Registration”). Upon receipt of any
request for a Demand Registration, the Company shall give prompt written notice of such request to each Stockholder, and shall include in such Demand Registration all Stockholder Shares with respect to which the Company has received written requests
for inclusion therein within 30 days after the delivery of the Company’s notice. If other securities are included in any Demand Registration that is an underwritten offering, and the managing underwriter for such offering advises the Company
that in its opinion the number of securities to be included exceeds the number of securities which can be sold in such offering without adversely affecting the marketability thereof, the Company will include in such registration all Stockholder
Shares requested to be included therein prior to the inclusion of any securities that are not Stockholder Shares. If the number of Stockholder Shares requested to be included in such registration exceeds the number of securities which in the opinion
of such underwriter can be sold without adversely affecting the marketability of such offering, such Stockholder Shares shall be included pro rata among the holders thereof based on the percentage of the outstanding Stockholder Shares held by each
such Stockholder. If other securities are included in any Demand Registration that is not an underwritten offering, all Stockholder Shares included in such Demand Registration shall be sold prior to the sale of any of such other securities. The
Company shall have the right to select the investment banker(s) and manager(s) to administer any Demand Registration that is an underwritten offering, subject to the approval of the holders of a majority of the Investor Shares to be included in such
Demand Registration. If, as a result of inclusion of Stockholder Shares other than Investor Shares in any Demand Registration, the holders of Investor Shares are unable to sell at least 90% of the Investor Shares requested to be included in such
registration, such registration shall not count as one of the Demand Registrations afforded the holders of Investor Shares under this Section 7(a). 
 (b) Company Registration. In the event that the Company proposes to register any Shares under the Securities Act in connection with a public offering (other than a Demand Registration) on any form (other than
Form S-4 or Form S-8) that would legally permit the inclusion of Stockholder Shares, the Company shall give each of the Stockholders written notice thereof as soon as practicable but in no event less than 30 days prior to such registration, and
shall include in such registration all Stockholder Shares requested in writing to be included therein, subject to the limitations set forth in this Section 7(b). If in connection with such proposed registration the managing underwriter for such
offering advises the Company that the number of Stockholder Shares requested to be included therein exceeds the number of shares that 

  

 7 

 
can be sold in such offering without adversely affecting the marketability thereof, any shares to be sold by the Company in such offering shall have priority
over any Stockholder Shares, and the number of Stockholder Shares to be included by a Stockholder in such registration shall be reduced pro rata on the basis of the number of Shares held by such Stockholder and all other holders (other than the
Company) exercising similar registration rights. 
 (c) Costs of Registration. The Company shall bear the costs of each
registration in which Stockholders participate pursuant to this Section 7, including the reasonable fees and expenses of one counsel for the selling Stockholders (to be selected by the holders of a majority of the Stockholder Shares to be
included in such registration) but excluding any underwriting discounts or commissions on the sale of Stockholder Shares or the fees and expenses of any additional counsel retained by the Stockholders. As a condition to the inclusion of Stockholder
Shares in any registration, the participating Stockholder and the Company shall execute a customary underwriting agreement or similar agreement in a form reasonably acceptable to the Company and the underwriter(s), if any, for such offering
containing customary indemnification and holdback provisions. Notwithstanding the foregoing, no Stockholder shall be required to incur indemnification obligations (whether several or joint and several) which are in excess of the net proceeds
received by such Stockholder pursuant to such registration or relates to information not supplied by such Stockholder for inclusion in the registration statement. 
 (d) Initial Public Offering. Notwithstanding any other provision of this Section 7, (i) the Company shall not be required
to include Stockholder Shares in a registration that relates to the Company’s initial public offering of Shares if no Stockholder Shares are sold in such offering, and (ii) the Company shall not be required to include in any registration
pursuant to this Section 7 any Stockholder Shares (other than any Investor Shares in the case of a Demand Registration) that are then eligible for transfer pursuant to Rule 144 under the Securities Act or may otherwise be freely transferred
without registration under the Securities Act. 
 (e) Other Registration Rights. The Company shall not, without the
prior written consent of the holders of at least a majority of the outstanding Investor Shares, enter into any agreement with any holder or prospective holder of any securities of the Company that would allow such holder or prospective holder
(a) to include such securities in any registration filed under Section 7 hereof, unless under the terms of such agreement, such holder or prospective holder may include such securities in any such registration only to the extent that the
inclusion of such holder’s securities will not reduce the amount of the Investor Shares that is included or (b) to make a demand registration that could result in such registration statement being declared effective prior to the earlier of
either of the date set forth in Section 7(a) or within 180 days of the effective date of any registration effected pursuant to Section 7. 
 Section 8. Repurchase Option. Subject to the provisions of any employment agreement with the applicable Management Stockholder, in the event that the employment with the Company or any of its subsidiaries of any Management
Stockholder is terminated for any reason whatsoever (including by reason of death or disability), any Management Shares held by such Management Stockholder shall be subject to repurchase by the Company at the Company’s option as of the date of
such termination at a price equal to the Fair Market Value of such Management Shares as of the date of such termination; provided that in the event such 

  

 8 

 
termination is for Cause, the price shall be the lesser of Fair Market Value and the original cost of such Management Shares. The Company may exercise its
repurchase option at any time within 180 days following such termination by providing written notice to such Management Stockholder. To the extent that this Section 8 is inconsistent with the terms of any employment agreement or option
agreement for such Management Stockholder, the terms of such employment agreement or option agreement shall control and supersede this Section 8. 
 Section 9. Corporate Governance. 
 (a) Board of Directors. Each of the
Stockholders agrees to vote all securities of the Company over which such Stockholder has voting control and to take all other necessary or desirable actions within its control (whether as a stockholder, director or officer of the Company or
otherwise, and including, without limitation, attendance at meetings in person or by proxy for purposes of obtaining a quorum and execution of written consents in lieu of meetings), and the Company shall take all necessary and desirable actions
within its control (including, without limitation, calling special board and stockholder meetings), so that: 
 (i) the
Company shall have a Board consisting of no more than six members; 
 (ii) the following persons shall be elected to the
Board: 
 (A) the Chief Executive Officer of the Company; and 
 (B) the remaining five representatives shall be designated by holders of a majority of the Shares owned by the Kohlberg Stockholders;

 (iii) if the Person(s) entitled to designate a director pursuant to Sections 9(a)(ii)(B) fails to designate one or more of
the individuals to serve on the Board pursuant to Section 9(a)(ii)(B) or if the Company does not then have a Chief Executive Officer or if any director designated by such a Person resigns or otherwise is no longer serving on the Board, such
directorship(s) shall remain vacant until the Person entitled to designate such directorship(s) designates an individual(s) to serve on the Board. 
 (b) Inconsistent Provisions. To the extent that any provision of the Certificate of Incorporation or Bylaws is inconsistent with the provisions of this Agreement, the Stockholders agree to take all actions
necessary to effect such amendments to the Certificate of Incorporation or Bylaws as may be necessary and appropriate to give full effect to the provisions of this Agreement. 
 (c) Agreement to be Bound. The Company agrees that, in connection with the sale and issuance of any capital stock of the Company
(or other security convertible into capital stock of the Company) after the date hereof, the Company shall require the purchasers of such securities to execute an addendum to this Agreement agreeing to be bound to the terms of this Agreement.

 (d) Shares. The Stockholders agree that, to the extent that they acquire any shares of capital stock of the Company
during the term of this Agreement, each Stockholder shall 

  

 9 

 
vote all such shares and take all other necessary or desirable actions within its control (whether as a stockholder, director or officer of the Company or
otherwise, and including, without limitation, attendance at meetings in person or by proxy for purposes of obtaining a quorum and execution of written consents in lieu of meetings) so the Board is comprised of the individuals described in
Section 9(a). 
 Section 10. Assignment of Rights; Representations on Sale. The Kohlberg Stockholders may assign to one or more
third parties its rights to purchase shares of Management Shares pursuant to Section 2, subject only to compliance with applicable securities laws. The purchasers of Management Shares pursuant to Section 2 shall be entitled to receive
customary representations and warranties from the seller thereof regarding the seller’s good title to, and freedom from liens, encumbrances and restrictions on the sale of, such Management Shares, not arising under this Agreement or federal or
state securities laws. 
 Section 11. Transfers in Violation of Agreement. Any transfer or attempted transfer of any Management
Shares, Institutional Shares or Investor Shares in violation of this Agreement shall be void, and the Company shall not be obligated to record such transfer on its books or treat any purported transferee of such Management Shares or Stockholder
Shares as the owner of such Shares for any purpose. 
 Section 12. Amendment and Waiver. Except as otherwise provided herein, no
amendment of any provision of this Agreement shall be effective unless such amendment or waiver is approved in writing by the Company, the Kohlberg Stockholders, the holders of at least a majority of the then-outstanding Institutional Shares and the
holders of at least a majority of the then-outstanding Management Shares. The failure of any party to enforce any provision of this Agreement shall not be construed as a waiver of such provision and shall not affect the right of such party
thereafter to enforce each provision of this Agreement in accordance with its terms. 
 Section 13. Severability. If any provision of
this Agreement is held to be invalid, illegal or unenforceable in any respect under any applicable law or rule in any jurisdiction, such invalidity, illegality or unenforceability shall not affect any other provision or any other jurisdiction, but
this Agreement shall be reformed, construed and enforced in such jurisdiction as if such invalid, illegal or unenforceable provision had never been contained herein. 
 Section 14. Entire Agreement. Except as otherwise expressly set forth herein, this document embodies the complete agreement and understanding among the parties hereto with respect to the subject matter hereof
and supersedes and preempts any prior understandings, agreements or representations by or among the parties, written or oral, which may have related to the subject matter hereof in any way. 
 Section 15. Successors and Assigns. This Agreement shall bind and inure to the benefit of and be enforceable by the Company, the Institutional
Stockholders and the Kohlberg Stockholders and their respective successors and assigns, and the Management Stockholders and their Permitted Transferees so long as such Management Stockholders or Permitted Transferees hold Management Shares.
Management Shares shall continue to constitute Management Shares following the termination of a Management Stockholder’s employment with the Company. 
  

 10 

 Section 16. Counterparts. This Agreement may be executed in separate counterparts each of which
shall be an original but all of which taken together shall constitute but one instrument. 
 Section 17. Remedies. The Company, the
Kohlberg Stockholders, the Institutional Stockholders and the Management Stockholders shall be entitled to enforce their rights under this Agreement specifically to recover damages by reason of any breach of any provision of this Agreement and to
exercise all other rights existing in their favor. The parties hereto agree and acknowledge that money damages may not be an adequate remedy for any breach of the provisions of this Agreement and that the Company, the Kohlberg Stockholders, the
Institutional Stockholders or any Management Stockholder may in its sole discretion apply to any court of law or equity of competent jurisdiction for specific performance and/or injunctive relief (without posting a bond or other security) in order
to enforce or prevent any violation of the provisions of this Agreement. 
 Section 18. Notices. Any notice, payment, demand or
communication required or permitted to be given pursuant to this Agreement shall be in writing and shall be (i) delivered personally, (ii) transmitted by telecopy, or (iii) delivered by nationally recognized overnight courier service
for next business day delivery, addressed as follows, or to such other address as such person may from time to time specify by notice to the parties hereto: 
 The Company: 
 KCHS Holdings, Inc. 
 Two Tower Bridge 
 One Fayette Street 
 Conshohocken, PA 19428 
 Attention: Chief Executive Officer 
 Fax: (610) 834-3231 
 with a copy to: 
 Kohlberg & Company, LLC 
 111 Radio Circle 
 Mt. Kisco, New York 10549 
 Attention: Gordon Woodward 

	 	  	   Evan LePatner 

 Fax:
(914) 244-3985 
 and 
 Brownstein Hyatt Farber Schreck, P.C. 
 410 17th Street, Suite 2200 
 Denver, CO 80202 
 Attention: Christopher Reiss 
 Fax: (303) 223-1111 
  

 11 

 The Kohlberg Stockholders: 
 Kohlberg & Company, LLC 
 111 Radio Circle 
 Mt. Kisco, New York 10549 
 Attention: Gordon Woodward 

	 	    	   Evan LePatner 

 Fax:
(914) 244-3985 
 The Institutional Stockholders: 
 Blackstone Mezzanine Partners II L.P. 
 Blackstone Mezzanine Holdings II L.P. 
 c/o Blackstone Mezzanine Advisors II L.P. 

345 Park Avenue, 29th Floor 
 New York, New York 10154 
 Attention: Salvatore Gentile, or his authorized representative

 Fax: (212) 583-5482 
 and 
 S.A.C. Domestic Investments, L.P. 
 72 Cummings Point Road 
 Stamford, Connecticut 06902 
 Attention: Mark Gudis 
 Fax: (203) 890-3371 
 in each case, with a copy (which shall not constitute notice) to: 
 White & Case
LLP 
 1155 Avenue of the Americas 
 New York, New York 10036 
 Attention: S. Ward Atterbury 
 Fax: (212) 354-8113 
 The Management Stockholders: 
 To the address specified on the applicable subscription agreement executed by such Management Stockholder 
 Section 19. Governing Law. The General Corporation Law of the State of Delaware shall govern all issues concerning the relative rights of the Company and its Stockholders. All other questions concerning the construction, validity and
interpretation of this Agreement shall be governed by the internal law, and not the law of conflicts, of the State of New York. 
 Section
20. Descriptive Headings. The descriptive headings of this Agreement are inserted for convenience only and do not constitute a part of this Agreement. 
  

 12 

 Section 21. Termination; Survival. This Agreement (other than Section 7 hereof) shall
terminate and be of no further force and effect upon consummation of the Company’s initial underwritten public offering of Shares registered under the Securities Act. 
 * * * * * 
  

 13 

 IN WITNESS WHEREOF, the parties have executed this Agreement as of the date first above written.

  

			
	 KCHS HOLDINGS, INC.,
 a Delaware
corporation

		
	By:	 	/s/ Mary Jane Graves
		 	 Mary Jane Graves
 Chief Financial
Officer

	
	 THE KOHLBERG STOCKHOLDERS:
  
 Kohlberg Investors V, L.P.

		
	By:	 	 Kohlberg Management V, L.L.C.,
 its General
Partner

		
	By:	 	 /s/ Gordon Woodward

		 	Name: Gordon Woodward
		 	Title: Authorized Representative
	
	Kohlberg Partners V, L.P.
		
	By:	 	 Kohlberg Management V, L.L.C.,
 its General
Partner

		
	By:	 	 /s/ Gordon Woodward

		 	Name: Gordon Woodward
		 	Title: Authorized Representative
	
	Kohlberg Offshore Investors V, L.P.
		
	By:	 	 Kohlberg Management V, L.L.C.,
 its General
Partner

		
	By:	 	 /s/ Gordon Woodward

		 	Name: Gordon Woodward
		 	Title: Authorized Representative

  

 14 

			
	Kohlberg TE Investors V, L.P.
		
	By:	 	 Kohlberg Management V, L.L.C.,
 its General
Partner

		
	By:	 	 /s/ Gordon Woodward

		 	Name: Gordon Woodward
		 	Title: Authorized Representative
	
	KOCO Investors V, L.P.
		
	By:	 	 Kohlberg Management V, L.L.C.,
 its General
Partner

		
	By:	 	 /s/ Gordon Woodward

		 	Name: Gordon Woodward
		 	Title: Authorized Representative
	
	 THE INSTITUTIONAL STOCKHOLDERS
  
 Blackstone Mezzanine Partners II L.P.

		
	By:	 	Blackstone Mezzanine Associates II, L.P.,
its General Partner
		
	By:	 	Blackstone Mezzanine Management
Associates II, L.L.C., its General Partner
		
	By:	 	 /s/ Salvatore Gentile

		 	Name: Salvatore Gentile
		 	Title: Authorized Signer
	
	Blackstone Mezzanine Holdings II L.P.
		
	By:	 	Blackstone Mezzanine Associates II, L.P.,
its General Partner
		
	By:	 	Blackstone Mezzanine Management
Associates II, L.L.C., its General Partner
		
	By:	 	 /s/ Salvatore Gentile

		 	Name: Salvatore Gentile
		 	Title: Authorized Signer

  

 15 

			
	S.A.C. Domestic Investments, L.P.
		
	By:	 	 S.A.C. Capital Management, LLC,
 its General
Partner

		
	By:	 	/s/ Peter A. Nussbaum
		 	Name: Peter A. Nussbaum
		 	Title: General Counsel
	
	MANAGEMENT STOCKHOLDERS:
	
	/s/ Robert Cucuel
	Robert Cucuel
	
	/s/ Mary Jane Graves
	Mary Jane Graves
	
	/s/ Nitin Patel
	Nitin Patel

  

 16

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