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                                                                   EXHIBIT 10.22

                                 THIRD AMENDMENT
                                     TO THE
                      SYMBION EMPLOYEE STOCK PURCHASE PLAN

      THIS AMENDMENT is made to the Symbion Employee Stock Purchase Plan (the
"Plan") by Symbion, Inc. (the "Company") on this 22nd day of February, 2006.

                                   RECITALS:

      WHEREAS, the Company established the Plan to be an employee stock purchase
plan described in section 423 of the Internal Revenue Code in order to provide
eligible employees with an opportunity to purchase the common stock of the
Company, and amended the Plan effective May 31, 2002, and October 1, 2005;

      WHEREAS, the Company desires to amend the Plan to provide for the
additional offerings of options to eligible employees in the discretion of the
compensation committee and, pursuant to Treas. Reg. Section 1.423-2(a)(2),
desires to continue to provide offerings under the Plan that satisfy the
requirements of section 423 of the Internal Revenue Code; and

      WHEREAS, the Plan may be amended at any time by action of the board of
directors of the Company, and the board of directors has determined that this
amendment will be effective without the approval of the shareholders of the
Company;

      NOW, THEREFORE, the Plan is hereby amended as provided below, effective
February 22, 2006:

      A NEW SECTION 5.4 IS ADDED TO THE PLAN AT THE END OF ARTICLE V:

      5.4. Effective February 22, 2006, the Committee may from time to time in
its discretion make offerings of options to purchase Company Stock
("Discretionary Options") to Employees who are otherwise eligible to participate
in the Plan, whether or not such Employees become Participants pursuant to
Article III of the Plan; provided, however, that such Discretionary Options
shall be granted to Employees in an offering that is separate from the offering
described in Section 5.1. Otherwise, the Committee shall have authority to grant
Discretionary Options upon such terms the Committee deems appropriate and are
consistent with this Section 5.4. Notwithstanding Section 11.14, Discretionary
Options are not intended to satisfy section 423 of the Code. The Committee may
bifurcate this Plan or take any other action to ensure that options granted
under the Plan that are not Discretionary Options shall continue to be granted
pursuant to a plan that is described in section 423 of the Code. Notwithstanding
any other provision of this Plan, Discretionary Options are subject to the
following:

      (a)   An Employee who is included in the offering described in this
            Section 5.4 may participate in the Plan in accordance with the terms
            specified in the Discretionary Option. The provisions for Plan
            participation described in Sections 3.2 and 3.3 and in Article IV
            shall not apply to the offering described in this Section 5.4. Each
            offering of a Discretionary

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            Option shall identify the Employee receiving the award, the exercise
            price, the expiration date and the conditions for exercise or
            vesting. The exercise price of a Discretionary Option shall not be
            less than 100% of the Market Price of a share of Company Stock on
            the date of grant. The limitations of Section 5.3 shall not apply to
            Discretionary Options.

      (b)   A Discretionary Option may be exercisable on the date of grant or on
            such other date(s) established by the Committee, provided, however,
            that Discretionary Options granted to officers or directors subject
            to section 16 of the Securities Exchange Act shall not be
            exercisable or transferable for a period of at least six months.

      (c)   The maximum period in which a Discretionary Option may be exercised
            shall be determined by the Committee on the date of grant. Unless
            specified otherwise in an award, an Employee must exercise a
            Discretionary Option while he is an employee of an Employer, or
            within three months of termination of employment with an Employer
            (one year in the case of termination due to disability or death).

      (d)   Payment of the exercise price shall be made (i) in cash (including
            an exercise involving the pledge of shares and a loan through a
            broker described in Securities and Exchange Commission Regulation
            T), (ii) Company Stock that was acquired at least six months prior
            to the exercise of the Option, (iii) upon approval of the Committee,
            by surrendering a portion of a Discretionary Option, (iv) other
            consideration acceptable to the Committee, or (v) a combination
            thereof.

      (e)   Upon the exercise of a Discretionary Option, the Participant shall,
            upon notification of the amount due and as a condition to exercise,
            pay to the Company amounts necessary to satisfy applicable federal,
            state and local withholding tax requirements or shall otherwise make
            arrangements satisfactory to the Company for such requirements.

      (f)   Company Stock to be issued pursuant to the exercise of a
            Discretionary Option shall be delivered by the Company (or its
            transfer agent) as soon as administratively feasible after exercise
            and all conditions for the transfer of Company Stock specified in
            the award have occurred; provided, however, that the Company may
            condition the delivery of shares on the Employee's execution of any
            applicable shareholder agreement or resale restriction that the
            Company requires at the time of exercise.

      (g)   Discretionary Options shall be evidenced by agreements that shall be
            subject to applicable provisions of this Plan and this Section 5.4
            or such other provisions as the Committee may adopt that are not
            inconsistent herewith. Such terms shall supersede any contrary
            provisions for participation that are contained in the Plan or that
            otherwise apply to the offerings described in Section 5.1.

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                                 EXECUTION PAGE

      IN WITNESS WHEREOF, the undersigned officer of the Company has executed
this Amendment on the date first written above.

                              SYMBION, INC.

                              By:  /s/ Richard E. Francis, Jr.
                                   ---------------------------------------------
                                   Richard E. Francis, Jr.
                                   Chairman and Chief Executive Officer

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                                                                   EXHIBIT 10.27

                     2005 BONUS PLAN FOR EXECUTIVE OFFICERS

      The Compensation Committee of the Board of Directors of Symbion, Inc.
approved the following bonuses for the Company's executive officers for services
rendered during 2005:

<TABLE>
<S>                                                             <C>
Richard E. Francis, Jr.                                         $    322,640
Clifford G. Adlerz                                              $    256,647
William V.B. Webb                                               $    174,902
Kenneth C. Mitchell                                             $     70,170
R. Dale Kennedy                                                 $     66,600
</TABLE>

      The bonuses of Richard E. Francis, Jr. and Kenneth C. Mitchell were based
75% upon the Company's attainment of earnings per share targets during 2005 and
25% upon the Company's attainment of profit targets. The bonuses of Clifford G.
Adlerz and R. Dale Kennedy were based 50% upon the Company's attainment of
earnings per share targets during 2005 and 50% upon the Company's attainment of
profit targets. The bonus of William V.B. Webb was based 30% upon targets
related to the profits of surgery centers acquired or developed during 2005; 35%
upon targets related to the number of development projects completed during 2005
and 35% upon the Company's attainment of earnings per share targets during 2005.

      Mr. Kennedy's bonus was paid in cash. Messrs. Francis, Adlerz, Webb and
Mitchell elected to participate in the Company's Deferred Stock Purchase Program
pursuant to which they received shares of restricted stock in lieu of a portion
of their bonuses. Accordingly, Mr. Francis received $288,121 in cash and 1,813
shares of restricted stock; Mr. Adlerz received $205,334 in cash and 2,695
shares of restricted stock; Mr. Webb received $104,950 in cash and 3,674 shares
of restricted stock; and Mr. Mitchell received $35,099 in cash and 1,842 shares
of restricted stock. The shares of restricted stock were issued on February 28,
2006 at a 20% discount from the market price on such date in accordance with the
Deferred Stock Purchase Program. The shares vest on February 28, 2007, or
immediately upon death, disability or a change of control of the Company.
Generally, the shares will be repurchased by the Company if employment
terminates prior to vesting.<PAGE>
                                                                   EXHIBIT 10.28

                        SUMMARY OF DIRECTOR COMPENSATION

Annual Retainer

      Members of the Board of Directors of Symbion, Inc. who are also officers
or employees of the Company receive no additional compensation, beyond that
which they receive as officers of the Company, for serving on the Company's
Board of Directors. Non-employee members of the Board receive a $10,000 annual
retainer for serving on the Board and an additional $5,000 annual retainer if
they serve on one or more Board Committees. The chairperson of the Audit and
Compliance Committee also receives a $4,000 annual retainer in addition to the
Board and Committee retainers.

Meeting Fees

      Non-employee members of the Board of Directors receive up to $6,000 per
year for attendance at Board meetings ($1,500 for attendance at regularly
scheduled meetings of the Board or $1,000 if the member participates in a
meeting by telephone). Non-employee directors are reimbursed for expenses
incurred in attending meetings of the Board and Board Committees.

Equity Incentives

      The Company maintains a Non-Employee Directors Stock Option Plan under
which options to purchase shares of its Common Stock are available for issuance
to the non-employee members of the Board of Directors. Each non-employee
director of the Company typically receives an annual grant of options to
purchase a number of shares determined by the Compensation Committee of the
Board of Directors. The options are exercisable at the fair market value of the
Common Stock on the date of grant, and each option becomes fully exercisable one
year from the date of grant. The options expire on the earlier of ten years
after the date of grant or immediately upon a director's termination on account
of fraud, dishonesty or other acts detrimental to the Company. In the event of
any other termination of a director, any vested options granted to the director
may be exercised for a period of 12 months after termination. Upon a change in
the control of the Company, as described in the Non-Employee Directors Stock
Option Plan, all options become immediately vested and exercisable.

      On May 10, 2005, each non-employee director received a grant of an option
to purchase 4,050 shares of Common Stock, exercisable at $23.68 per share, the
fair market value of the Common Stock on the date of the grant.

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