Document:

EXHIBIT
      10.52

    

    Second
      Amendment to Services and License Agreement

    

    

    Second
      Amendment to Services and License Agreement made
      as
      of the 1st day of April 2006 (“Effective Date of Second Amendment”), by
      CareAdvantage, Inc. (“CareAdvantage” or “CAI”), a Delaware corporation with its
      principal place of business at 485-C Route One South, Iselin, New Jersey 08830,
      and Kaiser Foundation Health Plan of the Northwest (“Kaiser”), with its
      principal place of business at 500 NE Multnomah St., Suite 100, Portland, Oregon
      97232.

    

    Whereas,
      Kaiser
      and CareAdvantage have entered into a Services and License Agreement as of
      January 1, 2005 (the “Agreement”), which Agreement was amended as of January 1,
      2006 (“First Amendment”);

    

    Whereas,
      the parties desire to further amend the Agreement to provide for quarterly
      updates of paid claims data, to provide for analysis using APR-DRGs groupings,
      and to provide for training account managers with respect to customer
      communications and to extend the term of the Agreement;

    

    Whereas,
      the parties also desire to amend the compensation payable under the Agreement;
      

    

    Now,
      Therefore,
      in
      consideration of the premises the parties agree as follows:

    

    1. Quarterly
      Processing of Paid Claims Data.
      Commencing as of the Effective Date of the Second Amendment, Attachment 1.1
      of
      the Agreement is amended in its entirety as provided in Attachment 1.1.1
      attached hereto.

    

    2. APR-DRGs.
      Commencing as of the Effective Date of the Second Amendment, 

    

    a. Section
      1.1 of the Agreement is amended by substituting “Attachments 1.1.1 and 1.1.2”
for “Attachment 1.1”; 

    

    b. adding
      new Attachment 1.1.2 as attached hereto;

     

    c. amending
      Section 2.2 of the Agreement to add immediately prior to the end of the first
      sentence the following: “, including the right to access and use the Portal to
      consider APR-DRG groupings on Kaiser Data.” (The parties acknowledge that
      initially, the APR-DRG groupings will be available merely through written
      reports and not at the Portal; CAI expects that the APR-DRG groupings will
      become available at the Portal no later than the second quarter
      2007.)

    

    3. Training
      in Customer-Specific Communications 

    

    a. Additional
      Services.
      Commencing as of the Effective Date of the Second Amendment, in accordance
      with
      Section 1.2 of the Agreement, CareAdvantage will provide the following
      Additional Services: Following CareAdvantage’s release of the processed Kaiser
      Data received in March and September, CareAdvantage will provide a one-day
      on-site communications training program to Kaiser account managers with respect
      to five to ten customers to be selected by Kaiser. In connection with each
      customer selected for the training program, CareAdvantage will learn Kaiser’s
      current strategy for maintaining and retaining the customer and will prepare
      a
      report profiling the customer based on its paid claims experience. The training
      program will focus on adapting Kaiser’s strategy as indicated by the
      customer-specific report and, consistent with that strategy, communicating
      to
      the customer the contents of the report; the program will include drafting
      cover
      letters and preparing for (but not attending) meetings with customers to review
      the customer-specific reports.

    

    b. Additional
      Compensation.
      Commencing as of the Effective Date of the Second Amendment, in accordance
      with
      Section 4.2 of the Agreement, Kaiser will pay CAI for the Additional Services
      for training set forth herein $* for each customer selected. Such amounts shall
      be paid (1) one-half upon Kaiser’s advising CareAdvantage of those customers
      selected, and (2) the balance within thirty (30) days of completion of each
      semi-annual training program.

    * 
      Portions of this page have been omitted pursuant to a Confidential Treatment
      request and filed separately with the Commission.

    

    
      
        
        

      

      
        1

        
          

        

      

      
        
        

      

    

    4. Term.
      Commencing as of the Effective Date of the Second Amendment, Section 5.1 is
      amended by substituting “March 31, 2008” for “December 31, 2006.”

    

    5. Compensation.
      Commencing
      as of the Effective Date of the Second Amendment: 

    

    a. Section
      4.1 of the Agreement is amended in its entirety as follows:

    

    4.1. Generally.
      Kaiser
      shall pay CareAdvantage for the services and license provided under this
      Agreement, as amended (including but not limited to APR-DRG Recurring Services),
      the sum of $* per month plus $* PMPM for each discrete member in the Kaiser
      Data
      in excess of *. During the term of this Agreement, compensation shall be payable
      without invoice quarterly commencing on the 1st day of April 2006, and on the
      1st
      day of
      each subsequent quarter; payment for the quarter commencing April 1, 2006,
      shall
      be $* (which assumes * members). Payments made pursuant to the foregoing
      sentence shall be reconciled to the Kaiser Data that Kaiser makes available
      to
      CareAdvantage pursuant to Attachment 1.1.1, and CareAdvantage shall pay any
      reconciling adjustment to Kaiser within thirty (30) days of its making a
      determination that such adjustment is owing, and Kaiser shall pay any
      reconciling adjustment to CareAdvantage within thirty (30) days of
      CareAdvantage’s notifying it in writing that such adjustment is owing.
      Notwithstanding the preceding sentence, in no event shall CareAdvantage be
      required to pay a reconciling adjustment to Kaiser for any quarter in excess
      of
      $*. 

    

    b. There
      is
      added a new Section 4.1.1 as follows:

    

    4.1.1 Credit.
      Kaiser
      shall be allowed a one-time credit in the amount of $* to the compensation
      otherwise due CareAdvantage on April 1, 2006,.

     

    c. There
      is
      added a new Section 4.4.1 as follows:

    

    4.4.1. On
      Account of Increases in Kaiser Northwest’s Covered
      Population. CareAdvantage’s
      compensation under Section 4.1 has been determined by assuming that the Kaiser
      Data contains at least 500,000 but less than 750,000 discrete members. If the
      Kaiser Data increases beyond 750,000 members, then in lieu of the amounts
      provided by Section 4.1, the rate shall be determined in accordance with
      Attachment 4.4.1.

    

    d. There
      is
      added a new Attachment 4.4.1 as attached hereto.

    

    

    6. Except
      to
      the extent set forth herein, the Agreement, as amended, shall remain in full
      force and effect.

     

    

    * 
Portions
      of this page have been omitted
      pursuant to a Confidential Treatment request and filed separately with the
      Commission.

     

     

    
      
        
        

      

      
        2

        
          

        

      

      
        
        

      

    

     

    
      This
        Second Amendment may be executed in several counterparts, each of which is
        an
        original but all of which shall constitute one and the same
        instrument.

      

      In
        Witness Whereof,
        the
        parties have executed this Second Amendment as of the date set forth
        above.

    
      
        	
                CAREADVANTAGE,
                  INC.

              	
                 

              	
                KAISER FOUNDATION HEALTH PLAN OF THE
                  NORTHWEST

              
	 	 	 	 	 
	By:	Dennis
                J. Mouras	 	By:	Gary
                O. Morgan
	 	CEO	 	 	Title: VP
                Product & Business
                Development

      

    

     

    
       

    

     

    
      
        
        

      

      
        3

        
          

        

      

      
        
        

      

    

    

    

      ATTACHMENT
        1.1.1

      

      CRG
        RECURRING SERVICES

       

      During
        the term of this Agreement, no later than the 1st day of March, June, September,
        and December, Kaiser will provide CareAdvantage with claims data for all
        claims
        in the Covered Population paid subsequent to Kaiser’s last providing
        CareAdvantage with its paid claims data. Within approximately four weeks
        of
        CareAdvantage’s receipt of this data, CareAdvantage will:

      

      
        	·  	
                Load
                  data into data processing
                  environment

              

      

      
        	·  	
                Conduct
                  technical and initial clinical review of data (review for
                  completeness)

              

      

      
        	·  	
                Run
                  data through conversion program 

              

      

      
        	·  	
                Validate
                  data conversion

              

      

      
        	·  	
                Prepare\run
                  data files though CRG algorithms

              

      

      
        	·  	
                Validate
                  CRG assignments (validity check)

              

      

      
        	·  	
                Program
                  reports to generate analyses with updated data
                  elements

              

      

      
        	·  	
                Review
                  RPNavigator analyses results 

              

      

      
        	·  	
                Move
                  into production environment

              

      

      
        	·  	
                Deliver
                  observations summary report (which would address significant changes
                  from
                  previous periods)

              

      

      

      Thereafter,
        CareAdvantage will conduct at least one day of on-site consulting per quarter,
        including data analytical and operational integration reviews.

      

      During
        the term of this Agreement, CareAdvantage will maintain telephone support
        for
        technical and clinical inquiries 6:00 a.m. through 6:00 p.m., Pacific Time,
        Monday through Friday. 

      

      (The
        four-week schedule provided by this Attachment assumes that there will be
        no
        change in Kaiser’s claims system(s) and business rules from those provided by
        Kaiser to CareAdvantage on or before September 1, 2004. In the event of any
        such
        change, the four-week schedule is subject to adjustment, and any additional
        services required by CareAdvantage on account of such changes will be billed
        in
        accordance with Attachment 4.2.)

      

      
        
          
          

        

        
          4

          
            

          

        

        
          
          

        

      

      ATTACHMENT
        1.1.2

       

      APR-DRG
        RECURRING SERVICES

       

      During
        the term of this Agreement, on a semi-annual basis (during March and September),
        upon receipt of the Kaiser Data as provided in Attachment 1.1.1 CAI will
        perform
        the following tasks within four weeks:

      

      
        	·  	
                Load
                  data into data processing
                  environment

              

      

      
        	·  	
                Conduct
                  technical and initial clinical review of data (review for
                  completeness)

              

      

      
        	·  	
                Run
                  data through conversion program 

              

      

      
        	·  	
                Validate
                  data conversion

              

      

      
        	·  	
                Prepare\run
                  data files though APR-DRG algorithm

              

      

      
        	·  	
                Validate
                  APR-DRG assignments (validity
                  check)

              

      

      
        	·  	
                Conduct
                  clinical analysis

              

      

      
        	·  	
                Program
                  reports to generate analyses with updated data
                  elements

              

      

      
        	·  	
                Review
                  analyses results 

              

      

      
        	·  	
                Deliver
                  Executive Summary with Key Findings and Observations summary report
                  

              

      

      

      During
        the term of this Agreement, CareAdvantage will maintain telephone support
        for
        technical and clinical inquiries 6:00 a.m. through 6:00 p.m., Pacific Time,
        Monday through Friday. 

      

      

      (The
        four-week schedule provided by this Attachment assumes that there will be
        no
        change in Kaiser’s claims system(s) and business rules from those provided by
        Kaiser to CareAdvantage on or before September 1, 2004. In the event of any
        such
        change, the four-week schedule is subject to adjustment, and any additional
        services required by CareAdvantage on account of such changes will be billed
        in
        accordance with Attachment 4.2.)

       

      
        
          
          

        

        
          5

          
            

          

        

        
          
          

        

      

      ATTACHMENT
        4.4.1

      

      

      PMPM
        FEES FOR INCREASES IN DISCRETE MEMBERS IN KAISER DATA

      

      

      
        	
                Number
                  of Discrete Members

              	
                Fees

              
	 	 
	
                at
                  least 500,000 but less than 750,000

              	
                $*
                  per month plus $* PMPM for each member over 500,000

              
	
                at
                  least 750,000 but less than 1,000,000

              	
                $*
                  per month plus $* PMPM for each member over 750,000

              
	
                at
                  least 1,00,000 but less than 3,000,000

              	
                $*
                  per month plus $* PMPM for each member over 1,000,000

              
	
                more
                  than 3,000,000

              	
                to
                  be determined

              

      

      

      

      

      
        
          	·  	
                  Portions
                    of this page have been omitted pursuant to a Confidential Treatment
                    request and filed separately
                    with the Commission

                

        

      
        
          
          

        

        
          6Unassociated Document

    
      MODIFICATION
        OF LEASE AGREEMENT

      

      

       MODIFICATION
        OF LEASE AGREEMENT
        dated as
        of the 11th day of November, 2005 between SLG GRAYBAR SUBLEASE LLC, having
        an office c/o SL Green Realty Corp., 420 Lexington Avenue, New York, New
        York
        10170 (hereinafter referred to as “Landlord”) and FUSION TELECOMMUNICATIONS,
        INC., having an office at 420 Lexington Avenue, New York, New York 10170
        (hereinafter referred to as “Tenant”).

      

      WITNESSETH:

      

      WHEREAS,
        Landlord
        and Tenant have previously entered into that certain lease agreement dated
        January 19, 2000 (the “Lease”) covering the premises known as Rooms 518-25, as
        more particularly described in the Lease, (the “Premises”) in the building known
        as the Graybar Building and located at 420 Lexington Avenue, New York, New
        York
        10170 (the “Building”), under the terms and conditions contained therein;
        and

      

      WHEREAS,
        Landlord
        has agreed to modify the Lease in order to allow Tenant a one (1) time option
        to
        cancel the Lease, subject to the terms and conditions as set forth at length
        below;

       

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

      

      1.
        Tenant
        shall have the one (1) time option to cancel the Lease in its entirety (the
        “Cancellation Option”), provided that (i) Tenant delivers written notice to
        Owner of its intention to exercise the Cancellation Option (the “Cancellation
        Notice”) no less than forty-five (45) days (time being of the essence) prior to
        the effective date of such cancellation (the “Cancellation Date”), (ii) the
        Cancellation Date shall occur no earlier than February 1, 2006 and no later
        than
        July 30, 2006 (time being of the essence) (the “Cancellation Period”), (iii) the
        Cancellation Date shall occur on the last day of a calendar month during
        the
        Cancellation Period, (iv) Tenant is not in default of any of the terms,
        covenants and conditions of this Lease after notice, (a) on the date that
        the
        Cancellation Notice is delivered by Tenant to Landlord, and (b) the Cancellation
        Date, and (v) Tenant delivers to Landlord possession of the Premises vacant
        and
        broom clean, free of all personal property, occupancies, liens and encumbrances
        on the Cancellation Date. Tenant’s failure to timely and fully comply with
        aforementioned sections (i) through (iv) of this Article 1, shall constitute
        a
        waiver of the Cancellation Option. Landlord
        shall
        have the right, in its sole discretion, to waive any or all of the foregoing
        conditions to Tenant’s exercise of the cancellation of the Lease
        hereunder.

      

      2.
        Notwithstanding any cancellation by Tenant in accordance with the provisions
        of
        this Article, Tenant shall remain liable to satisfy any and all of its
        obligations under the terms, covenants and conditions of this Lease which
        have
        accrued through the Cancellation Date, which obligations shall survive such
        cancellation.

      
        
          
          

        

        
          1

          
            

          

        

        
          
          

        

      

      

      

      3. Tenant’s
        Representations and Warranties.Tenant
        hereby represents and warrants to Landlord, its successors and assigns, that:
        (i) the Lease has not been assigned, pledged or encumbered, (ii) except for
        Tenant, the Premises are currently free of all occupancies, (iii) Tenant
        has not
        created or suffered any occupancies by third parties in and/or to the Premises
        through and including the date of this agreement and (iv) no materials
        or fixtures presently in the Premises (“Property”) are subject to any lien,
        encumbrance, chattel mortgage, title retention or security agreement and
        no
        action has been taken or suffered by Tenant as a result of which either the
        Premises or any Property shall or might be subject thereto. Tenant
        covenants and agrees that it shall not at any time hereafter create, suffer
        or
        permit the creation of any such rights or encumbrances in or to the Premises
        or
        the Property contained therein.
        Any
        Property left in the Premises by Tenant after the Cancellation Date shall
        be
        deemed to have been abandoned by Tenant, and Landlord shall have the right
        to
        retain or dispose of such Property at the expense of Tenant without any
        obligation to account to Tenant therefor.

      

      4.
        Rental
        Arrears.
        Notwithstanding the cancellation of the Lease contemplated in this agreement
        and
        notwithstanding anything to the contrary contained in this agreement, Tenant
        shall to remain liable for any unpaid rent, additional rent and charges accruing
        under the Lease through and including the Cancellation Date.

      

      5. Successors/Assigns.
        This
        agreement shall be binding upon and inure to the benefit of the parties and
        their respective successors and permitted assigns.

      

      6. Entire
        Agreement.
        This
        agreement represents the entire understanding between the parties with regard
        to
        the matters addressed herein and may only be modified by written agreement
        executed by all parties hereto. All prior understandings or representations
        between the parties hereto, oral or written, with regard to the matters
        addressed herein, other than the Lease, are hereby merged herein.

      

         7.
        Effectiveness.
        This
        agreement shall not be binding upon Landlord until executed and delivered
        by
        both Landlord and Tenant.

      

      8. Ratification.
        Except
        as specifically modified herein, all other terms, covenants and conditions
        of
        the Lease are and shall remain in full force and effect through the Cancellation
        Date and are hereby ratified and confirmed.

      

      9.
        No
        Brokers/Indemnification.
        Tenant
        covenants, represents and warrants that Tenant has had no dealings or
        negotiations with any broker or agent in connection with the consummation
        of
        this agreement other than SL Green Leasing (the “Broker”) and Tenant covenants
        and agrees to defend, hold harmless and indemnify Landlord from and against
        any
        and all cost, expense (including reasonable attorneys' fees) or liability
        for
        any compensation, commissions or charges claimed by any other broker or agent
        other than the Broker, with respect to this Agreement or the negotiation
        thereof. 

      

       

      
        
          
          

        

        
          2

          
            

          

        

        
          
          

        

      

      

      

      

      10. Miscellaneous.

      

      A.
        The
        captions in this agreement are for convenience only and are not to be considered
        in construing this agreement.

      

      B.
        This
        agreement shall be construed without regard to any presumption or other rule
        requiring construction against the party causing this agreement to be
        drafted.

      

      C.
        Terms
        used in this agreement and not otherwise defined herein shall have the
        respective meanings ascribed thereto in the Lease. 

      

       
        [REMAINDER OF THIS PAGE IS INTENTRIONALLY LEFT BLANK]

      

       

       

      
        
          
          

        

        
          3

          
            

          

        

        
          
          

        

      

      

      

      

      D.
        If any
        provision of this agreement or its application to any person or circumstances
        is
        invalid or unenforceable to any extent, the remainder of this agreement,
        or the
        applicability of such provision to other persons or circumstances, shall
        be
        valid and enforceable to the fullest extent permitted by law and shall be
        deemed
        to be separate from such invalid or unenforceable provisions and shall continue
        in full force and effect.

       

      
        
          	 	 	 
	 	SLG
                  GRAYBAR SUBLEASE LLC,
                  as Landlord
	 
 	 
 	 
 
	 	By:  	 
	 	Name:	 
	 	Title:	 
	 	 

        

      
        	Witness:	 	 	 
	 
                	 	 	 
	
                
                  Name:

                  Title:

                

              	 	 	
              
	 	 	 	 

      

      
         

        
          
            	 	 	 
	 	FUSION
                    TELECOMMUNICATIONS, INC.,
                    as Tenant
	 
 	 
 	 
 
	 	By:  	 
	 	Name:	 
	 	Title:	 
	 	 

          

        
          	Witness:	 	 	 
	 
                  	 	 	 
	
                  
                    Name:

                    Title:

                  

                	 	 	
                
	 	 	 	 

        

        

        
          
            
            

          

          
            4

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