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                                                                   EXHIBIT 10.3

                               FIRST AMENDMENT TO
                             OPERATING AGREEMENT OF
                HEART HOSPITAL OF MILWAUKEE, LLC (the "Company")

         THIS AMENDMENT to the Operating Agreement of the Company is effective
as of the date the Operating Agreement is initially adopted by its Member(s)
(the "Amendment").

         1.       Section 5.10(b) of the Company's Operating Agreement is
                  hereby deleted and replaced in its entirety with the
                  following:

                           (a)      Except as specifically provided in this
                  Section 5.10, as long as any Member owns a Membership
                  Interest in the Company, and for a period of three (3) years
                  after a Member ceases for any reason to own a Membership
                  Interest in the Company, neither a Member, Investor Entity,
                  Owner, Practice nor any of their respective Affiliates, shall
                  hold, directly or indirectly, an investment, ownership or
                  other beneficial interest in (x) any hospital, or (y) any
                  other Entity (including a sole proprietorship), in either
                  case, which provides any of the following services or
                  facilities: cardiac catheterization, angioplasty, peripheral
                  angioplasty, atherectomy, stenting and PTCA, any cardiac
                  surgical procedures or services, or any cardiovascular
                  services, in any case within Milwaukee, Ozaukee, Waukesha,
                  Racine, and Washington Counties, Wisconsin (collectively, the
                  "Territory"). Notwithstanding the terms of this Section 5.10
                  (b):

                                    (i)      No Member or Owner who is a
                           physician shall be prohibited from maintaining his
                           or her staff privileges and admitting and treating
                           patients at any other hospital;

                                    (ii)     Nothing herein shall prohibit a
                           Member, Owner, Practice or their Affiliates from
                           owning up to three percent (3%) of the outstanding
                           capital stock of a company which provides healthcare
                           services or supplies and whose stock is publicly
                           traded and listed on a nationally recognized
                           securities exchange or from investing in a publicly
                           traded mutual fund or making other investments with
                           the prior written approval of the Board of
                           Directors;

                                    (iii)    Nothing herein shall prevent an
                           Investor Member who is a physician, an Owner who is
                           a physician or a Practice that is an Owner or an
                           Investor Member, from providing, and billing and
                           receiving fees from any payor for the services
                           required for therapeutic and diagnostic
                           cardiovascular services including, but not limited
                           to, nuclear imaging, echocardiography, stress
                           testing and other similar ancillary services
                           directly for the patients of such Investor Member,
                           Owner, or Practice at the regular office established
                           by such Investor Member, Owner or Practice for the
                           practice of medicine or any other office or location
                           except a hospital so long as they do not provide
                           diagnostic or interventional cardiac catheterization
                           services in such office or location;

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                                    (iv)     Nothing herein shall prevent an
                           Investor Member, and Owner or a Practice from
                           operating a cardiac catheterization laboratory in
                           the MOB located on the Hospital's campus in the
                           event that the Board of Directors first determines
                           in writing that the Hospital's cardiac
                           catheterization laboratories have reached maximum
                           capacity and the Board of Directors elects for the
                           Company not to add additional cardiac
                           catheterization laboratories in the Hospital or to
                           operate a cardiac catheterization laboratory in the
                           MOB; provided, however, that, subject to the
                           restrictions set forth above in this subsection
                           (iv), among the Investor Members, the Owners and the
                           Practices, there may only be a total of two (2)
                           cardiac catheterization laboratories in the MOB and
                           further provided that (x) only diagnostic (but not
                           interventional) cardiac catheterization services may
                           be provided in such laboratories and (y) MHMI or an
                           Affiliate is engaged to manage the laboratories;

                                    (v)      In addition, MHMI or its
                           Affiliates may separately operate a mobile
                           catheterization laboratory within the Territory, but
                           only if either MHMI or an Affiliate thereof is
                           providing such service pursuant to a lease of six
                           (6) months or less to a provider who is already
                           providing cath lab services and if the Board of
                           Directors has elected not to have such service
                           provided by the Company;

                                    (vi)     Nothing herein shall prevent any
                           Member or Owner who is a physician from personally
                           performing professional medical services directly
                           for his or her patients at any hospital or facility
                           and from billing and receiving professional fees as
                           a result of his or her professional medical services
                           from any payor.

         2.       A new Section 5.10 (h) shall be added as follows:

                           (h)      In the event that any Member, directly or
                  indirectly, with or without the participation of any third
                  party, intends (i) to obtain an investment, ownership or
                  other beneficial interest in any hospital which provides any
                  of the following services or facilities: cardiac
                  catheterization, angioplasty, peripheral angioplasty,
                  atherectomy, stenting and PTCA, any cardiac surgical
                  procedures or services, or any cardiovascular services, or
                  (ii) to develop, own, operate, or manage a hospital that
                  provides any such services in any case within the counties of
                  Dodge, Fond du Lac, Jefferson, Kenosha, Rock, Sheboygan, and
                  Walworth Counties, Wisconsin, then prior to agreeing to any
                  such transaction, such Member (the "Noticing Party") shall
                  give all of the other Members (the "Notice Recipients")
                  written notice of such proposed transaction including all of
                  its material terms and conditions (the "Third Party Notice").
                  The Notice Recipients shall then have sixty (60) days
                  following receipt of the Third Party Notice to elect to agree
                  by written notice to the Noticing Party to negotiate with the
                  Noticing Party the terms and conditions of the Notice
                  Recipient(s)' participation in the transaction set forth in
                  the Third Party Notice (the "Option"). Any Notice Recipient
                  who elects within such sixty (60) day period to participate
                  in the transaction described in the Third Party Notice shall
                  have the right to enter into the transaction on terms that
                  are substantially comparable to the terms available to

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                  the Noticing Party and the other participants in such
                  transactions, and the Noticing Party shall have a duty to
                  negotiate in good faith to provide the Notice Recipients the
                  opportunity to so participate in the transaction. In the
                  event that any Notice Recipient does not elect to exercise
                  any such Option within such sixty (60) day period and execute
                  final written agreements governing the transaction set forth
                  in the Third Party Notice within a total of one hundred and
                  twenty (120) days from the date of the Third Party Notice,
                  the Noticing Party may enter into the transaction set forth
                  in the Third Party Notice together with any Notice Recipients
                  who elect to participate but without participation of any
                  Notice Recipient who does not so elect. If the Noticing Party
                  does not enter into the transaction set forth in the Third
                  Party Notice within one hundred and eighty (180) days from
                  the Third Party Notice, the terms of this subsection (h)
                  shall again apply to such transaction

         3.       This Amendment may be executed in any number of counterparts,
                  each of which shall be deemed an original, but all of which
                  together shall constitute one and the same Amendment. The
                  Members may execute this Amendment on separate signature
                  pages, and there is no requirement that the Members sign the
                  same signature pages.

         4.       Except as provided herein, the Operating Agreement shall
                  remain in full force and effect.

                                            MEMBER(S):

                                            MILWAUKEE HOSPITAL MANAGEMENT, INC.

                                            By: /s/ Dennis I. Kelly
                                                -------------------------------
                                            Title: VP

[***]

[***] These portions of this exhibit have been omitted and filed separately
with the Commission pursuant to a request for confidential treatment.

                                       3<PAGE>

                                                                   EXHIBIT 10.4

                              SECOND AMENDMENT TO
                             OPERATING AGREEMENT OF
              THE HEART HOSPITAL OF MILWAUKEE, LLC (the "Company")

         THIS SECOND AMENDMENT to the Operating Agreement of the Company (the
"Amendment") is effective as of the date the Operating Agreement is initially
adopted by its Members.

         1.       Section 3.9, "Appointment of Board of Directors," is hereby
deleted and replaced in its entirety with the following:

                  SECTION 3.9       APPOINTMENT OF BOARD OF DIRECTORS.

                  The Members shall appoint a Board of Directors as follows:

                           (a)      MHMI shall appoint four (4) Directors; and

                           (b)      The Investor Members shall appoint four (4)
                  Directors, which Directors shall be appointed or removed
                  either (i) by a vote of a majority of the percentage
                  Membership Interests of the Investor Members at a meeting
                  held pursuant to Section 10.1(b); or (ii) by written consent
                  of a majority of the percentage Membership Interests of the
                  Investor Members.

                  A Director shall serve on the Board of Directors until
         removed by the Member or group of Members appointing such Director. A
         Member or group of Members shall have the right, with or without
         cause, to remove, substitute or replace any Director which it or they
         appointed.

         2.       Section 5.9, "Meetings, Quorum and Vote of the Board of
Directors," is hereby deleted and replaced in its entirety with the following:

                  SECTION 5.9.      MEETINGS, QUORUM AND VOTE OF THE BOARD OF
DIRECTORS.

                           (a)      The Board of Directors shall meet at least
                  quarterly. Notice of any meeting, regular or special, shall
                  be delivered to each Director personally, by telephone, by
                  electronic mail, by facsimile transmission or in writing at
                  least five (5) business days before the meeting.

                           (b)      An emergency meeting of the Board of
                  Directors may be called by any Director upon shorter notice.
                  Action taken at the emergency meeting shall be valid so long
                  as the meeting is attended by at least three (3) members of
                  the Board of Directors appointed by the Investor Members and
                  at least three (3) members of the Board of Directors
                  appointed by MHMI, and the action is approved in the manner
                  set forth in (e) below.

                           (c)      The Board of Directors shall elect one of
                  its members to preside over the meetings as the Chairperson
                  and one of its members, as the Secretary, to oversee the
                  preparation and delivery of meeting notices and the
                  preparation of minutes of the meetings of the Board of
                  Directors and Members.

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                           (d)      A quorum of the Board of Directors shall be
                  necessary to conduct business at any meeting. A quorum shall
                  consist of six (6) Directors and must include three (3)
                  Directors designated by MHMI and three (3) Directors
                  designated by the Investor Members. A Director may attend a
                  meeting by telephone or other electronic means and be
                  considered present for purposes of a quorum so long as the
                  telephone or other connection allows each Director to hear
                  and be heard by all other Directors.

                           (e)      Except as provided in Section 5.15 or as
                  otherwise expressly provided in this Agreement, any action
                  taken by the Board of Directors shall require the affirmative
                  vote of at least a majority of the Directors present at a
                  meeting at which a quorum is present and shall require the
                  consent of at least one Director designated by MHMI and one
                  Directors designated by the Investor Members.

                           (f)      Any action which is required to be or may
                  be taken at a meeting of the Board of Directors may be taken
                  without a meeting if consent in writing including the
                  required votes, either collectively or in counterparts,
                  setting forth the action so taken, is signed by the required
                  number of Directors as set forth in (e) above.

                           (g)      Attendance at a meeting of the Board of
                  Directors constitutes waiver of any objection to the notice
                  of the meeting.

         3.       This Amendment may be executed in any number of counterparts,
each of which shall be deemed an original, but all of which together shall
constitute one and the same Amendment. The Members may execute this Amendment
on separate signature pages, and there is no requirement that the Members sign
the same signature pages.

         4.       Except as provided herein, the Operating Agreement shall
remain in full force and effect.

                                            MEMBERS:

                                            MILWAUKEE HOSPITAL MANAGEMENT, INC.

                                            By: /s/ Dennis I. Kelly
                                                -------------------------------
                                            Title: VP

                                            /s/ Bruce C. Wilson, M.D.
                                            -----------------------------------
                                            Name: Bruce C. Wilson, M.D.

[***]

[***] These portions of this exhibit have been omitted and filed separately
with the Commission pursuant to a request for confidential treatment.

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