Document:

Form of 9.375% Capital Efficient Note

 Exhibit 4.4 
 SUSQUEHANNA BANCSHARES, INC. 
 9.375% Capital Efficient Note, Series I 
 No. T-1 
 $125,010,000 
 SUSQUEHANNA BANCSHARES, INC., a corporation organized and existing under the laws of the State of Pennsylvania (hereinafter called the
“Company,” which term includes any successor corporation under the Indenture hereinafter referred to), for value received, hereby promises to pay to The Bank of New York, as Property Trustee of Susquehanna Capital I, a statutory
trust formed under the laws of the State of Delaware, or registered assigns, the principal sum of one hundred twenty-five million ten thousand dollars ($125,010,000) on the Final Repayment Date (as hereinafter defined). The Final Repayment Date
shall initially be December 12, 2067, but the Company may elect to extend the Final Repayment Date up to two times in 10-year increments on either or both of December 12, 2017 and December 12, 2027 and, as a result, the Final
Repayment Date may be extended to December 12, 2077 or December 12, 2087, provided that certain extension criteria set forth in the Supplemental Indenture hereinafter referred to are satisfied. If the Final Repayment Date falls on a day
that is not a Business Day (as hereinafter defined), the Final Repayment Date shall be the following business day. The full principal amount of, and all accrued and unpaid interest on, this Security shall be payable in full on December 12,
2057, or if such day is not a Business Day, the following Business Day (the “Scheduled Maturity Date”) or any subsequent Interest Payment Date (as hereinafter defined) to the extent set forth in the Supplemental Indenture
hereinafter referred to. The Company further promises to pay interest on said principal sum from December 12, 2007 or from the most recent Interest Payment Date for which interest has been paid or duly provided. This Security shall bear
interest from and including December 12, 2007 to but excluding December 12, 2037 at the annual rate of 9.375%, payable quarterly in arrears on March 12, June 12, September 12 and December 12 of each year,
beginning on March 12, 2008. This Security shall bear interest from and including December 12, 2037 to but excluding the Final Repayment Date at an annual rate of interest equal to three-month LIBOR plus 5.455%, payable quarterly in
arrears on March 12, June 12, September 12, and December 12 of each year (each such date, including the dates in the preceding sentence, an “Interest Payment Date”). In the event that any Interest
Payment Date on or prior to December 12, 2037 would otherwise fall on a day that is not a Business Day, the payment of interest shall be postponed to the next day that is a Business Day and no interest shall accrue as a result of that
postponement. In the event that any Interest Payment Date in respect of an interest period commencing on or after December 12, 2037 would otherwise fall on a day that is not a Business Day, the Interest Payment Date shall be postponed to the
next day that is a Business Day, except that if the postponement would cause the day to fall in the next calendar 

 
month, the Interest Payment Date shall instead be brought forward to the immediately preceding Business Day. Interest in respect of any interest period
commencing on or after December 12, 2037 shall accrue to but excluding the date that interest is actually paid. Any installment of interest (or portion thereof) deferred in accordance with the Supplemental Indenture or otherwise unpaid on the
relevant Interest Payment Date shall bear interest, to the extent permitted by law, at the rate of interest then in effect on this Security, from the relevant Interest Payment Date, compounded on each subsequent Interest Payment Date, until paid in
accordance with the Supplemental Indenture. 
 The amount of interest payable on this Security for any interest period ending on or prior to
December 12, 2037 shall be computed on the basis of a 360-day year of twelve 30-day months. The amount of interest payable on this Security for any interest period commencing on or after December 12, 2037 shall be computed on the basis of
a 360-day year and the actual number of days elapsed during the relevant interest period. 
 A “Business Day” shall mean any
day other than (i) a Saturday or Sunday or other day on which banking institutions in the city of New York or in Pittsburgh, Pennsylvania, are authorized or required by law or executive order to remain closed, (ii) a day on which the
Corporate Trust Office of the Property Trustee or the Debenture Trustee is closed for business or (iii) during any Interest Period for which interest is based on LIBOR, a day that is not a day on which dealings in deposits in U.S. dollars
are transacted in the London interbank market. 
 The interest installment so payable, and punctually paid or duly provided for, on any
Interest Payment Date shall, as provided in the Indenture, be paid to the Person in whose name this Security (or one or more Predecessor Securities) is registered at the close of business on the Regular Record Date for such interest installment,
which shall be (i) the Business Day next preceding such Interest Payment Date if this Security is issued in the form of a Global Security and the Capital Securities are issued in the form of a global security, or (ii) the fifteenth day
(whether or not a Business Day) of the month preceding the month in which such Interest Payment Date occurs if this Security is not issued in the form of a Global Security and the Capital Securities are not issued in the form of a global security,
except that (i) interest payable on this Security pursuant to its repayment in full in accordance with Article III of the Supplemental Indenture and (ii) interest payable on the Final Repayment Date shall be paid to the Person to whom
principal is paid. Any such interest installment not so punctually paid or duly provided for shall forthwith cease to be payable to the Holder on such Regular Record Date and may either be paid to the Person in whose name this Security (or one or
more Predecessor Securities) is registered at the close of business on a Special Record Date for the payment of such Defaulted Interest to be fixed by the Trustee, notice whereof shall be mailed, first-class, postage prepaid, to each Holder of
Securities of this series not less than 10 days prior to such Special Record Date, or be paid at any time in any other lawful manner not inconsistent with the requirements of any securities exchange or automated quotation system on which the
Securities of this series may be listed or traded, and upon such notice as may be required by such exchange or self-regulatory organization, all as more fully provided in said Indenture. 
 The Company shall have the right, at any time and from time to time prior to the Final Repayment Date, to defer the payment of interest on this Security
for one or more consecutive Interest Periods that do not exceed 10 years; provided, however, that no Deferral Period (as hereinafter defined) shall extend beyond the Final Repayment Date or the earlier repayment or redemption in full of this
Security. 
  

 A-2 

 If an Event of Default has occurred and is continuing or the Company has given notice of its election to
defer interest payments but the Deferral Period has not yet commenced or a Deferral Period is continuing or the Company is in default regarding its payment of any obligation under the Guarantee (and, except as provided in the Supplemental Indenture
with respect to certain transactions, in the case of any Deferral Period that does not terminate on or prior to the first anniversary of the commencement of such Deferral Period), the Company shall not, and shall not permit any Subsidiary to:
(A) declare or pay any dividends or distributions on, or redeem, purchase, acquire or make a liquidation payment with respect to, any of the Company’s Capital Stock, (B) make any payment of principal of, or interest or premium, if
any, on, nor repay, purchase or redeem any Parity Securities or other debt securities of the Company that rank junior upon the liquidation of the Company to this Security, or (C) make any guarantee payments with respect to any guarantee by the
Company if such guarantee ranks junior to this Security. Notwithstanding the foregoing, at any time, including during a Deferral Period, the Company may: (a) make dividends or distributions payable in its Capital Stock or rights to acquire its
Capital Stock and any cash payments in lieu of fractional shares issued in connection therewith; (b) make payments under the Guarantee; (c) make any declaration of a dividend in connection with the implementation of a shareholders’
rights plan, or redeem or purchase any rights under any such plan; (d) purchase Capital Stock related to (1) the issuance of Capital Stock or rights under any benefit plans for directors, officers or employees of the Company; (2) the
issuance of Capital Stock or rights under a dividend reinvestment and stock purchase plan; (3) the issuance of Capital Stock, or securities convertible into Capital Stock, as consideration in an acquisition transaction that was entered into
before the beginning of the Deferral Period; (e) exchange or convert (1) any class or series of the Company’s Capital Stock for any other class or series of its Capital Stock or (2) any class or series of the Company’s
indebtedness for any class or series of its Capital Stock; (f) purchase fractional interests in shares of the Company’s Capital Stock pursuant to conversion or exchange provisions of such Capital Stock or the security being converted or
exchanged; (g) make payments of current or deferred interest in respect of Parity Securities that are made pro rata in respect of the amounts due on such Parity Securities and this Security or in accordance with clause (viii) of
Section 2.1(d) of the Supplemental Indenture to the extent it applies, and make payments of deferred interest on any Parity Securities that were issued prior to the date the CENts are initially issued (“Existing Parity
Securities”) that, if not made, would cause the Company to breach the terms of the instrument governing such Existing Parity Securities; or (h) make payments of principal in respect of Parity Securities having an earlier scheduled
maturity date than this Security, as required under a provision of such Parity Securities that is substantially the same as described under Section 2.1(d) of the Supplemental Indenture, and make payments of principal in respect of Parity
Securities having the same scheduled maturity date as this Security that are made on a pro rata basis among such Parity Securities and this Security. Each period beginning on the Interest Payment Date with respect to which the Company elects
to defer all or part of any interest payment and ending, subject to Section 2.1(m) of the Supplemental Indenture, on the earlier of (i) the Interest Payment Date falling on or about the tenth anniversary of such Interest Payment Date and
(ii) the next Interest Payment Date on which the Company has paid the deferred amount, all deferred amounts with respect to any subsequent Deferral Period and all other accrued and unpaid interest on this Security is referred to as a
“Deferral Period”. At the end of any such Deferral Period, the 

  

 A-3 

 
Company shall pay all interest then accrued and unpaid on this Security (together with Additional Interest thereon, if any, to the extent permitted by
applicable law) to the Person in whose name this Security is registered at the close of business on the Regular Record Date with respect to the Interest Payment Date at the end of such Deferral Period. Upon termination of any Deferral Period and
upon the payment of all deferred interest and any Additional Interest then due on any Interest Payment Date, the Company may elect to begin a new Deferral Period. The Company may elect to pay current interest on any Interest Payment Date during any
Deferral Period to the extent permitted, and shall pay deferred interest (including Additional Interest thereon) pursuant to the Alternative Payment Mechanism to the extent required, by the Supplemental Indenture. 
 The Company shall give written notice of its election to begin or extend any Deferral Period (i) if the Property Trustee is not the sole holder or a
holder of the Securities, to the Holders of the Securities and the Trustee at least one Business Day prior to the next succeeding Interest Payment Date or (ii) if the Property Trustee is the sole holder of the Securities, to the Property
Trustee and the Trustee at least one Business Day prior to the earlier of (a) the next Distribution Date or (b) the date the Administrative Trustees are required to give notice to any securities exchange or other applicable self-regulatory
organization or to holders of such Capital Securities of the Record Date or the date such Distributions are payable, but in any event not less than one Business Day prior to such record date. 
 Payment of principal of (and premium, if any) and interest on this Security shall be made at the office or agency of the Company maintained for that
purpose in the United States, in such coin or currency of the United States of America as at the time of payment is legal tender for payment of public and private debts; provided, however, that at the option of the Company payment of
interest may be made (i) by check mailed to the address of the Person entitled thereto as such address shall appear in the Securities Register or (ii) by wire transfer in immediately available funds at such place and to such account as may
be designated in writing at least 15 days before the relevant Interest Payment Date by the Person entitled thereto as specified in the Securities Register. 
 The indebtedness evidenced by this Security is, to the extent provided in the Indenture, subordinate and subject in right of payment to the prior payment in full of all Senior Indebtedness, and this Security is issued
subject to the provisions of the Indenture with respect thereto. Each Holder of this Security, by accepting the same, (a) agrees to and shall be bound by such provisions, (b) authorizes and directs the Trustee on his behalf to take such
actions as may be necessary or appropriate to effectuate the subordination so provided and (c) appoints the Trustee his attorney-in-fact for any and all such purposes. Each Holder hereof, by his acceptance hereof, waives all notice of the
acceptance of the subordination provisions contained herein and in the Indenture by each holder of Senior Indebtedness, whether now outstanding or hereafter incurred, and waives reliance by each such holder upon said provisions. 
 Reference is hereby made to the further provisions of this Security set forth on the reverse hereof, which further provisions shall for all purposes have
the same effect as if set forth at this place. 
  

 A-4 

 Unless the certificate of authentication hereon has been executed by the Trustee referred to on the
reverse hereof by manual signature, this Security shall not be entitled to any benefit under the Indenture or be valid or obligatory for any purpose. 
  

 A-5 

 IN WITNESS WHEREOF, the Company has caused this instrument to be duly executed under its corporate seal.

  

			
	SUSQUEHANNA BANCSHARES, INC.
		
	By:	 	 /s/ Drew K. Hostetter

	Name:	 	Drew K. Hostetter
	Title:	 	Executive Vice President, Treasurer and Chief Financial Officer

  

	
	 Attest:

	
	 /s/ Lisa Cavage

 Dated: December 12, 2007 
 This is one of the Securities referred to in the mentioned Indenture. 
  

			
	 THE BANK OF NEW YORK,
 as Trustee

		
	By:	 	 /s/ Mary LaGumina

	Name:	 	Mary LaGumina
	Title:	 	Vice President

 Dated: December 12, 2007 

 REVERSE OF SECURITY 
 This Security is one of a duly authorized issue of securities of the Company (herein called the “Securities”), issued and to be issued in one or more series under an Indenture, dated as of
November 5, 2007, as supplemented by the supplemental indenture thereto, dated as of December 12, 2007 (herein called the “Indenture”, and such supplemental indenture dated as of December 12, 2007, herein called the
“Supplemental Indenture”), between the Company and The Bank of New York, as Trustee (herein called the “Trustee,” which term includes any successor trustee under the Indenture), to which Indenture and all indentures
supplemental thereto reference is hereby made for a statement of the respective rights, limitations of rights, duties and immunities thereunder of the Trustee, the Company and the Holders of the Securities, and of the terms upon which the Securities
are, and are to be, authenticated and delivered. This Security is one of the series designated on the face hereof, which series is unlimited in aggregate principal amount. 
 All terms used in this Security that are defined in the Supplemental Indenture, in the Indenture or in the Amended and Restated Trust Agreement, dated as
of December 12, 2007 (the “Trust Agreement”), for Susquehanna Capital I, among Susquehanna Bancshares, Inc., as Depositor, and the Trustees named therein, shall have the meanings assigned to them in the Supplemental Indenture,
the Indenture or the Trust Agreement, as the case may be. 
 The Company may, at its option and subject to the terms and conditions of the
Supplemental Indenture and Article IV of the Indenture, redeem this Security, subject to the approval of the Federal Reserve (if the redemption occurs prior to the Scheduled Maturity Date): 
 (i) in whole or in part, at any time on or after December 12, 2012 at a redemption price equal to 100% of their principal amount plus
accrued and unpaid interest to the Redemption Date; 
 (ii) in whole but not in part, any time prior to December 12, 2012
at a redemption price equal to 100% of their principal amount plus accrued and unpaid interest to the Redemption Date, within 90 days after the occurrence of a Capital Treatment Event or a Tax Event; and 
 (iii) in whole but not in part, any time prior to December 12, 2012, within 90 days after the occurrence of a Rating Agency Event at
a redemption price equal to the greater of (x) 100% of the principal amount of the CENts being redeemed and (y) the Make-Whole Amount, in each case plus any accrued and unpaid interest to the Redemption Date. 
 In the event of redemption or repayment of this Security in part only, a new Security or Securities of this series for the unredeemed portion hereof
shall be issued in the name of the Holder hereof upon the cancellation hereof. 
 The Indenture contains provisions for satisfaction and
discharge of the entire indebtedness of this Security upon compliance by the Company with certain conditions set forth in the Indenture. 

 The Indenture permits, with certain exceptions as therein provided, the Company and the Trustee at any
time to enter into a supplemental indenture or indentures for the purpose of modifying in any manner the rights and obligations of the Company and of the Holders of the Securities, with the consent of the Holders of not less than a majority in
aggregate principal amount of the Outstanding Securities of each series to be affected by such supplemental indenture. The Indenture also contains provisions permitting Holders of a majority in aggregate principal amount of the securities of each
series issued under the Indenture at the time Outstanding, on behalf of the Holders of all securities of such series, to waive compliance by the Company with certain provisions of the Indenture and any past defaults in the performance of any of the
covenants contained in the Indenture, or established pursuant to the Indenture with respect to such series, and its consequences, except a default in the payment of the principal of or premium, if any, or interest on any of the securities of such
series. Any such consent or waiver by the registered Holders of this Security (unless revoked as provided in the Indenture) shall be conclusive and binding upon such Holder and upon all future Holders of this Security and of any Security issued upon
the registration of transfer hereof or in exchange hereof or in lieu hereof, whether or not notation of such consent or waiver is made upon this Security. 
 As provided in and subject to the provisions of the Indenture, if an Event of Default arising from a default in the payment of interest (including Additional Interest) in full for a period of 30 days after the
conclusion of a 10-year period following the commencement of any Deferral Period with respect to the Securities at the time Outstanding occurs and is continuing, then the Trustee or the Holders of not less than 25% in principal amount of the
Outstanding Securities may declare the principal amount of, and accrued interest (including Additional Interest) on, all the Securities of this series to be due and payable immediately, by a notice in writing to the Company (and to the Trustee if
given by Holders), provided that if, upon such an Event of Default, the Trustee or the Holders of not less than 25% in principal amount of the Outstanding Securities fail to declare the principal amount of all the Securities to be immediately
due and payable, the holders of at least 25% in aggregate liquidation amount of the Capital Securities then outstanding shall have such right by a notice in writing to the Company and the Trustee. Upon any such declaration such principal amount (or
specified portion thereof) of and the accrued interest (including any Additional Interest) on all the Securities shall become immediately due and payable. If an Event of Default arising from a Bankruptcy Event or insolvency or reorganization
involving the Company occurs, the principal amount of, and accrued interest (including Additional Interest) on, the Securities shall automatically, and without any declaration or other action on the part of the Trustee or any Holder, become
immediately due and payable. Any other Event of Default shall not result in the acceleration of the payments of principal or accrued interest on the Securities. In any case, the payment of principal and interest (including any Additional Interest)
on such Securities shall remain subordinated to the extent provided in Article XIV of the Indenture. 
 Each Holder, by such Holder’s
acceptance hereof, agrees that if a Bankruptcy Event shall occur prior to the redemption or repayment of this Security, such Holder shall have no claim for, and thus no right to receive, any interest optionally deferred pursuant to the Supplemental
Indenture and unpaid (including Additional Interest thereon) that has not been settled through the application of the Alternative Payment Mechanism set forth in the Supplemental Indenture to the extent the amount of such interest exceeds the sum of
(x) interest that relates to the earliest two years of the portion of the Deferral Period for which interest has not been paid and (y) an amount 

 
equal to the pro rata share of the excess, if any, of the Preferred Stock Issuance Cap over the aggregate amount of net proceeds from the sale of
Qualifying Preferred Stock and any still-outstanding Mandatory Convertible Preferred Stock that the Company has applied to pay such deferred interest on the Securities of this series pursuant to the Alternative Payment Mechanism; provided
that the Holder of this Security agrees that, to the extent the claim for deferred interest exceeds the amount set forth in clause (x), the amount the Holder of this Security shall receive in respect of such excess shall not exceed the amount such
Holder would have received had the claim for such excess ranked pari passu with the interest of the holders, if any, of Qualifying Preferred Stock. 
 No reference herein to the Indenture or the Supplemental Indenture and no provision of this Security or of the Indenture or the Supplemental Indenture shall alter or impair the obligation of the Company, which is
absolute and unconditional, to pay the principal of (and premium, if any) and interest on this Security at the times, places and rate, and in the coin or currency, herein prescribed. 
 As provided in the Indenture and subject to certain limitations therein set forth, the transfer of this Security is registrable in the Securities
Register, upon surrender of this Security for registration of transfer at the office or agency of the Company maintained under Section 5.02 of the Indenture duly endorsed by, or accompanied by written instrument of transfer in form satisfactory
to the Company and the Securities Registrar duly executed by, the Holder hereof or his attorney duly authorized in writing, and thereupon one or more new Securities of this series, of authorized denominations and for the same aggregate principal
amount, shall be issued to the designated transferee or transferees. No service charge shall be made for any such registration of transfer or exchange, but the Company may require payment of a sum sufficient to cover any tax or other governmental
charge payable in connection therewith. 
 Prior to due presentment of this Security for registration of transfer, the Company, the Trustee
and any agent of the Company or the Trustee may treat the Person in whose name this Security is registered as the owner hereof for all purposes, whether or not this Security be overdue, and neither the Company, the Trustee nor any such agent shall
be affected by notice to the contrary. 
 The Securities of this series are issuable only in registered form without coupons in denominations
of $25 and any integral multiple thereof. As provided in the Indenture and subject to certain limitations therein set forth, Securities of this series are exchangeable for like aggregate principal amount of Securities of a different authorized
denomination, as requested by the Holder surrendering the same. 
 The Company and, by its acceptance of this Security or a beneficial
interest therein, the Holder of, and any Person that acquires beneficial interest in, this Security agree that, for United States federal, state and local tax purposes, it is intended that this Security constitute indebtedness. 
 THE INDENTURE, THE SUPPLEMENTAL INDENTURE AND THIS SECURITY SHALL BE GOVERNED BY AND CONSTRUED IN ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK.AMENDMENT NO. 2 TO THE CREDIT AGREEMENT

 Exhibit 10.1 
 Execution Version 
 AMENDMENT NO. 2 TO THE CREDIT AGREEMENT 
 Dated as of December 6, 2007 
 AMENDMENT NO. 2 TO THE CREDIT AGREEMENT among LCI Holdco, LLC, a Delaware limited liability company (“Holdings”), LifeCare Holdings, Inc., successor in interest to Rainier Acquisition Corp., a Delaware corporation (the
“Borrower”), each of the Lenders (as defined in the Credit Agreement referred to below) listed on the signature pages hereto, and JPMorgan Chase Bank, N.A., as Administrative Agent (the “Agent”). 
 PRELIMINARY STATEMENTS: 
 (1) Holdings
and the Borrower have entered into that certain Credit Agreement, dated as of August 11, 2005 (as amended by Amendment No. 1 dated as of May 2, 2007, the “Credit Agreement”) with Agent, J.P. Morgan Securities Inc. and GECC
Capital Markets Group, Inc., as joint lead arrangers and joint bookrunning managers, General Electric Capital Corporation, as syndication agent, and Banc of America Securities LLC, as documentation agent and the Lenders referred to therein.
Capitalized terms not otherwise defined in this Amendment have the same meanings as specified in the Credit Agreement. 
 (2) Holdings and
the Borrower have requested the changes and modifications to the Credit Agreement as hereinafter set forth. 
 (3) The Required Lenders are,
on the terms and conditions stated below, willing to amend the Credit Agreement as hereinafter set forth. 
 SECTION 1. Amendments to
Credit Agreement. 
 (a) Section 1.01 of the Credit Agreement is hereby amended by deleting the table in the definition of
“Applicable Rate” and replacing such table with the following: 
  

																
	 Leverage Ratio:
	  	Term Loan ABR
Spread	 	 	Term Loan
Eurodollar
Spread	 	 	Revolving Loan
ABR Spread	 	 	Revolving Loan
Eurodollar
Spread	 	 	Commitment Fee
Rate	 
	 Category 1:
 Greater than or equal to 8.00 to 1.00
	  	3.25	%	 	4.25	%	 	3.25	%	 	4.25	%	 	0.50	%
	 Category 2:
 Less than 8.00 to 1.00 and greater than or equal to 6.75 to 1.00
	  	3.25	%	 	4.25	%	 	3.00	%	 	4.00	%	 	0.50	%
	 Category 3:
 Less than 6.75 to 1.00 and greater than or equal to 5.00 to 1.00
	  	3.25	%	 	4.25	%	 	2.25	%	 	3.25	%	 	0.50	%
	 Category 4:
 Less than 5.00 to 1.00 and greater than or equal to 4.25 to 1.00
	  	3.25	%	 	4.25	%	 	2.00	%	 	3.00	%	 	0.50	%
	 Category 5:
 Less than 4.25 to 1.00 and greater than or equal to 3.50 to 1.00
	  	3.25	%	 	4.25	%	 	1.75	%	 	2.75	%	 	0.375	%
	 Category 6:
 Less than 3.50 to 1.00
	  	3.25	%	 	4.25	%	 	1.50	%	 	2.50	%	 	0.375	%

  

 1 

 (b) Section 2.08 of the Credit Agreement is hereby amended by adding a new paragraph (e) at the
end thereof to read as follows: 
 “(e) Anything contained herein to the contrary notwithstanding, on December 6,
2008 the aggregate amount of the Lenders’ Revolving Commitments shall be reduced by $15,000,000, with such reduction being made ratably among the Revolving Lenders in accordance with their respective Revolving Commitments.” 
 (c) Section 6.14 of the Credit Agreement is hereby amended and restated in its entirety to read as follows: 
 “SECTION 6.14. Interest Coverage Ratio. The Borrower will not permit the Interest Coverage Ratio as of the end of any fiscal
quarter ending during any period set forth below to be less than the ratio set forth below opposite such period: 
  

			
	 Period
	  	 Ratio

	 October 1, 2007 though December 31, 2007
	  	1.20 to 1.00
		
	 January 1, 2008 through December 31, 2008
	  	1.20 to 1.00
		
	 January 1, 2009 through June 30, 2009
	  	1.30 to 1.00
		
	 July 1, 2009 through December 31, 2009
	  	1.40 to 1.00
		
	 January 1, 2010 through December 31, 2010
	  	1.60 to 1.00
		
	 January 1, 2011 through December 31, 2011
	  	1.75 to 1.00
		
	 January 1, 2012 and thereafter
	  	  2.00 to 1.00”

  

 2 

 (d) Section 6.15 of the Credit Agreement is hereby amended and restated in its entirety to read as
follows: 
 “SECTION 6.15. Leverage Ratio. The Borrower will not permit the Leverage Ratio as of the last day of a
fiscal quarter ending during any period set forth below to exceed the ratio set forth opposite such period: 
  

			
	 Period
	  	Ratio
	 October 1, 2007 through December 31, 2007
	  	8.75 to 1.00
		
	 January 1, 2007 through March 31, 2008
	  	8.75 to 1.00
		
	 April 1, 2008 through September 30, 2008
	  	8.50 to 1.00
		
	 October 1, 2008 through December 31, 2008
	  	8.25 to 1.00
		
	 January 1, 2009 through March 31, 2009
	  	8.00 to 1.00
		
	 April 1, 2009 through June 30, 2009
	  	7.75 to 1.00
		
	 July 1, 2009 through December 31, 2009
	  	7.50 to 1.00
		
	 January 1, 2010 through December 31, 2010
	  	7.00 to 1.00
		
	 January 1, 2011 and thereafter
	  	  6.00 to 1.00”

 (e) Section 6.16 of the Credit Agreement is hereby amended and restated in its entirety to
read as follows: 
 “SECTION 6.16. Capital Expenditures. The Borrower will not, and will not permit any of its
Subsidiaries to, make or become legally obligated to make any Capital Expenditure, except for Capital Expenditures in the ordinary course of business not exceeding in the aggregate for the Borrower and its Subsidiaries the amount set forth below
opposite such fiscal year; 
  

				
	 Fiscal Year
	  	Amount
	 Fiscal year ended December 31, 2007
	  	$	85,000,000
		
	 Fiscal year ended December 31, 2008
	  	$	30,000,000
		
	 Fiscal year ended December 31, 2009
	  	$	30,000,000
		
	 Each fiscal year ended December 31, 2010 and thereafter
	  	$	85,000,000

  

 3 

 provided, however, that so long as no Default has occurred and is continuing or would result from such
expenditure, any portion of any amount set forth above, if not expended in the fiscal year for which it is permitted above, may be carried over for expenditure in successive fiscal years (such amount, the “Capital Expenditure Carryover
Amount”); provided, further, that (i) Capital Expenditures made in connection with the purchase of a hospital and (ii) Capital Expenditures made solely with Eligible Equity Proceeds shall, in each case, be disregarded for purposes of
determining compliance with this Section 6.16.” 
 (f) Subclause (i) of the last clause (c) of Article VII of the Credit
Agreement is hereby amended and restated to read as follows: 
 “(i) in each four-fiscal-quarter period there shall be at
least two fiscal quarters in which the Cure Right is not exercised (the “Cure Test”), provided that the Borrower may, by giving written notice to the Agent prior to the exercise of any such Cure Right, designate up to two additional Cure
Rights at any time until the Term Loan Maturity Date (each an “Additional Cure Right”), with respect to which the Cure Test shall be disregarded, provided further that the Borrower may not exercise an Additional Cure Right for any fiscal
quarter ended on or after June 30, 2008, if the Leverage Ratio as of the last day of such fiscal quarter is more than 0.50 to 1.00 above the Leverage Ratio for such fiscal quarter set forth in Section 6.15 before giving effect to any such
Additional Cure Right.” 
 SECTION 2. Conditions of Effectiveness. This Amendment is subject to the provisions of
Section 9.02 of the Credit Agreement. This Amendment shall become effective on the date (the “Amendment No. 2 Effective Date”) when, and only when, the Agent shall have received (i) counterparts of this Amendment executed by
Holdings, the Borrower and the Required Lenders or, as to any of the Lenders, advice satisfactory to the Agent that such Lender has executed this Amendment, (ii) the consent attached hereto (the “Consent”) executed by each Guarantor
and (iii) evidence that all of the following conditions shall have been satisfied: 
 (a) All accrued costs and expenses of the Agent in
connection with the administration of the Credit Agreement and the preparation, execution, delivery and administration of this Amendment and the other instruments and documents to be delivered hereunder and under the Loan Documents (including,
without limitation, the reasonable fees and expenses of counsel for the Agent) shall have been paid by the Borrower to the extent invoiced prior to the date hereof. 
 (b) The amendment fee referred to in Section 4 hereof shall have been paid by the Borrower. 
 (c) The
arrangement fee referred to in the fee letter dated the date hereof shall have been paid by Holdings and the Borrower. 
 (d) The Agent shall
have received the following documents, each dated the Amendment No. 2 Effective Date (unless otherwise specified) and in form and substance satisfactory to the Agent: 
  

 4 

 (i) a certificate of each Loan Party dated as of the Amendment No. 2 Effective Date
signed by a responsible officer of such Loan Party (or, if such Loan Party is a limited liability company, a responsible officer of the sole member or sole manager thereof) (x) certifying as to incumbency and certifying and attaching the
resolutions adopted by such Loan Party approving or consenting to this Amendment or the Consent, as applicable, and (y) certifying that (1) the representations and warranties contained in Section 3 of this Amendment and the other Loan
Documents are true and correct in all material respects on and as of the Amendment No. 2 Effective Date, except to the extent that such representations and warranties specifically refer to an earlier date, in which case they are true and
correct in all material respects as of such earlier date, and (2) no Default exists; and 
 (ii) legal opinions
satisfactory to the Agent, dated the Amendment No. 2 Effective Date, covering such matters related to this Amendment and the Consent as the Agent shall reasonably request. 
 SECTION 3. Representations and Warranties of Holdings and the Borrower. Each of Holdings and the Borrower represents and warrants as follows:

 (a) The execution, delivery and performance by Holdings and the Borrower of this Amendment, the execution and delivery of the Consent
hereto by each Guarantor and the performance by Holdings and the Borrower of the Credit Agreement, as amended hereby, have been duly authorized by all necessary corporate action. 
 (b) This Amendment has been duly executed and delivered by Holdings and the Borrower and the Consent has been duly executed by each Guarantor. This
Amendment and the Credit Agreement, as amended hereby, constitute the legal, valid and binding obligations of Holdings and the Borrower, enforceable against Holdings and the Borrower in accordance with their respective terms, subject to the effect
of any applicable bankruptcy, insolvency, reorganization, moratorium or similar law affecting creditors’ rights generally, and subject to the effects of general principles of equity (regardless whether considered in a proceeding in equity or at
law). 
 SECTION 4. Amendment Fee. The Borrower hereby agrees to pay to the Agent, for the benefit of those Lenders described in that
certain Amendment Update Letter from the Agent to the Lenders dated December 5, 2007, an amendment fee equal to (a) 0.50% of the aggregate Revolving Commitments (before giving effect to this Amendment) of such Lender under the Credit
Agreement as of the Amendment No. 2 Effective Date, and (b) 0.75% of the aggregate outstanding principal balance of the Term Loans of such Lender under the Credit Agreement as of the Amendment No. 2 Effective Date. Such amendment fee
shall be paid on the Amendment No. 2 Effective Date. 
 SECTION 5. Reference to and Effect on the Credit Agreement and the other Loan
Documents. (a) On and after the effectiveness of this Amendment, each reference in the Credit Agreement to “this Agreement”, “hereunder”, “hereof” or words of like import referring to the Credit Agreement, and
each reference in each of the other Loan Documents to “the Credit Agreement”, “thereunder”, “thereof” or words of like import referring to the Credit Agreement, shall mean and be a reference to the Credit Agreement, as
amended by this Amendment. 
  

 5 

 (b) The Credit Agreement and each of the other Loan Documents, as specifically amended by this Amendment,
are and shall continue to be in full force and effect and are hereby in all respects ratified and confirmed. Without limiting the generality of the foregoing, the Security Documents and all of the Collateral described therein do and shall continue
to secure the payment of all Obligations of the Loan Parties under the Loan Documents, in each case as amended by this Amendment. 
 (c) The
execution, delivery and effectiveness of this Amendment shall not, except as expressly provided herein, operate as a waiver of any right, power or remedy of any Lender or the Agent under any of the Loan Documents, nor constitute a waiver of any
provision of any of the Loan Documents. 
 SECTION 6. Costs and Expenses. The Borrower agrees to pay on demand all costs and expenses
of the Agent in connection with the administration of the Credit Agreement and the preparation, execution, delivery and administration, modification and amendment of this Amendment and the other instruments and documents to be delivered hereunder
(including, without limitation, the reasonable fees and expenses of counsel for the Agent) in accordance with the terms of Section 9.03 of the Credit Agreement. 
 SECTION 7. Execution in Counterparts. 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 but one and the same agreement. Delivery of an executed counterpart of a signature page to this Amendment by telecopier shall be effective as delivery of a manually executed counterpart of
this Amendment. 
 SECTION 8. Governing Law. This Amendment shall be governed by, and construed in accordance with, the laws of the
State of New York. 
  

 6 

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by their respective
officers thereunto duly authorized, as of the date first above written. 
  

			
	LIFECARE HOLDINGS, INC.
		
	By	 	  

	Name:	 	
	Title:	 	
	  
 LCI HOLDCO, LLC

		
	By	 	  

	Name:	 	
	Title:	 	

			
	JPMORGAN CHASE BANK, N.A.,
	as Administrative Agent and as a Lender
		
	By	 	  

	Name:	 	
	Title:	 	

					
	        LENDERS:	 	Agreed as of the date first above written:
		
		 	  

		 	[Please type or print name of Lender]
			
		 	By:	 	  

		 	Name:	 	
		 	Title:	 	

 CONSENT 
 Dated as of December 6, 2007                 
 Reference is made to (a) Amendment No. 2 to the Credit Agreement dated as of December 6, 2007 (the “Amendment”; capitalized terms not otherwise defined herein being used herein as defined in
the Amendment and in the Credit Agreement referred to below), (b) the Credit Agreement dated as of August 11, 2005 among LCI Holdco, LLC, LifeCare Holdings, Inc., successor in interest to Rainier Acquisition Corp., as the Borrower,
JPMorgan Chase Bank, N.A., a national banking association, as administrative agent and collateral agent (in such capacities, the “Agent”), J.P. Morgan Securities Inc. and GECC Capital Markets Group, Inc., as joint lead arrangers and joint
bookrunning managers, General Electric Capital Corporation, as syndication agent, and Banc of America Securities LLC, as documentation agent and the Lenders referred to therein (as amended, the “Credit Agreement”), as amended by Amendment
No. 1 dated as of May 2, 2007, and (c) the other Loan Documents referred to therein. 
 The undersigned as parties to one or
more of the Loan Documents, each hereby consents to the execution, delivery and the performance of the Amendment and agrees that each of the Loan Documents to which it is a party is, and shall continue to be, in full force and effect and is hereby
in all respects ratified and confirmed on the Amendment No. 2 Effective Date, except that, on and after the Amendment No. 2 Effective Date, each reference to “the Credit Agreement”, “thereunder”, “thereof”,
“therein” or words of like import referring to the Credit Agreement shall mean and be a reference to the Credit Agreement, as amended and otherwise modified by the Amendment. 
 This Consent shall be governed by, and construed in accordance with, the laws of the State of New York. 
 [Signature pages follow] 

			
	 LIFECARE HOSPITALS, LLC (formerly LifeCare Hospitals, Inc.)

	 LIFECARE HOSPITALS OF DAYTON, INC.

	 LIFECARE HOSPITALS OF MILWAUKEE, INC.

	 LIFECARE HOSPITALS OF NORTHERN NEVADA, INC.

	 LIFECARE HOSPITALS OF PITTSBURGH, LLC

	    (formerly LifeCare Hospitals of Pittsburgh, Inc.)
	 LIFECARE HOSPITALS OF SOUTH TEXAS, INC.

	 LIFECARE HOSPITALS OF CHESTER COUNTY, INC.

	 NEXTCARE HOSPITALS/MUSKEGON, INC.

	 NEXTCARE SPECIALTY HOSPITAL OF DENVER, INC.

	 CAREREHAB SERVICES, L.L.C.

	 CRESCENT CITY HOSPITALS, L.L.C.

	 LIFECARE HOSPITALS OF NEW ORLEANS, L.L.C.

	 LIFECARE HOSPITALS OF NORTH CAROLINA, L.L.C.

	 LIFECARE INVESTMENTS, L.L.C.

	 LIFECARE MANAGEMENT SERVICES, L.L.C.

	 LIFECARE HOLDING COMPANY OF TEXAS, L.L.C.

	 LIFECARE REIT 1, INC.

	 LIFECARE AMBULATORY SURGERY CENTER, INC.

		
	 By
	 	  

	 Name:
	 	
	 Title:
	 	

									
	LIFECARE HOSPITALS OF NORTH TEXAS, L.P.
	SAN ANTONIO SPECIALTY HOSPITAL, LTD.
	LIFECARE HOSPITALS OF FORT WORTH, L.P.
			
		 	By:	 	LifeCare Holding Company of Texas, L.L.C., its General Partner
				
		 		 	By:	 	LifeCare Management Services, L.L.C., its Sole Member
					
		 		 		 	By:	 	LifeCare Holdings, Inc., its Sole Member
					
		 		 		 	By:	 	  

		 		 		 	Name:	 	
		 		 		 	Title:

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