Document:

Exhibit 10.9a

 

ADDENDUM

 

TO LEASE AGREEMENT FOR A GAMMA
KNIFE UNIT

 

This
ADDENDUM TO LEASE AGREEMENT FOR A GAMMA KNIFE UNIT
(this “Addendum”)
is effective December
1, 1998 between Sunrise Hospital and Medical Center, LLC, d/b/a
as Sunrise Hospital and Medical Center, a Nevada corporation ("Medical Center"), and GK Financing, LLC, a California
limited liability company (“GKF”).

 

RECITALS

 

WHEREAS,
on June 3, 1999, GKF
and Medical Center executed a Lease Agreement
for a Gamma Knife Unit (the “Original
Lease”);

 

WHEREAS,
the parties desire to amend the
terms and provisions of
the Original Lease as set forth herein.

 

NOW,
THEREFORE, in consideration of the
mutual covenants and agreements set forth herein, and
for other good and
valuable consideration, the receipt and sufficiency of
which are hereby acknowledged,
the parties agree as follows:

 

AGREEMENT

 

1.          Defined
Terms. Unless otherwise defined herein, the capitalized
terms used herein
shall have the same
meaning set forth
in the Original Lease.

 

2.          Costs
of Site Preparation; Costs of Installation. Section 4 of the
original lease is hereby
amended as follows:

 

In
the event that Sunrise's
Gamma Knife program does not perform at least
85 procedures in its first year
of operation, GKF shall reimburse Sunrise for $100,000 of its
Gamma Knife installation costs.

 

In
the event that Sunrise's
Gamma Knife program does not
perform at least 85
procedures in its second year of
operation, GKF shall reimburse Sunrise for $100,000 of
its Gamma Knife installation costs.

 

3.          Full
Force and Effect. Except as otherwise amended hereby
or provided herein, all
of the terms and provisions
of the Original
Lease shall remain in full force
and effect.

 

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

 

	“MEDICAL CENTER”	Sunrise Hospital and Medical Center
	 	 
	BY:	/s/ Jerald F. Mitchell
	 	Jerald F. Mitchell, President and Chief Executive Officer
	 	 
	“GKF”	GK Financing, LLC
	 	 
	BY:	/s/ Craig K. Tagawa
	 	Craig K. Tagawa, Chief Executive OfficerExhibit 10.9b

 

ADDENDUM TWO

 

LEASE AGREEMENT FOR A GAMMA KNIFE

 

This ADDENDUM TWO TO LEASE AGREEMENT
FOR A GAMMA KNIFE UNIT (this “Addendum”) is dated effective as of January 13, 2007, and is entered into between GK
Financing, LLC, a California limited liability company (“GKF”), and SUNRISE HOSPITAL MEDICAL CENTER, LLC d/b/a as Sunrise
Hospital Medical Center, [a Nevada corporation] (“Medical Center”), with reference to the following recitals:

Recitals:

 

A.           On
January 8, 2001, GKF and Medical Center executed a Lease Agreeme11t for a Gamma Knife Unit which Lease Agreement was amended by
a certain Addendum dated June 3, 1999 (such Lease Agreement. as amended by such Addendum, is referred to herein as the "Lease");

 

B.           Section
8 of the Lease obligates Medical Center to provide properly trained professional; technical and support personnel (including without
limitation, physicists) for the proper performance of Gamma Knife procedures utilizing the Equipment.

 

C.           Medical
Center has requested GKF to provide the services of a medical radiation physicist, and GKF is willing to provide such personnel
on the terms and conditions set forth herein.

 

NOW THEREFORE,
in consideration of the mutual covenants and agreements set forth herein, and for other good and valuable consideration, the receipt
and sufficiency of which are hereby acknowledged, the parties agree as follows:

 

Agreement:

 

1.          Defined
Terms. Unless otherwise defined herein, the capitalized terms used herein shall have the same meanings set forth in the
Lease.

 

2.          Provision
of a Medical Radiation Physicist.

 

a.           For
so long as GKF is under contract with a medical radiation physicist (a ("Physicist") to provide the services set forth
in Exhibit A (Specification) attached hereto (the ''Services"), and said physicists is available to provide the services.
GKF' shall make available such Physicist to Medical Center to provide the Services. The Services shall be performed at the Site.
Medical Center and the physicians performing the Gamma Knife radiosurgery procedure shall have sole responsibility to supervise
and direct the Physicist.

 

b.           Physicist
shall only perform Services as, when and if requested by Medical Center, which request shall be made telephonically or in writing
not less than ten (10) days in advance of the date the Services are requested, unless less days of advance notice is mutually agreed
to by both parties.

 

     

     

    

 

c.           Medical
Center shall have sole responsibility to credential Physicist to provide the Services at the Facility, and to verify that Physicist
is in compliance with all state and regulatory requirements in connection therewith.

 

d.           Medical
Center agrees to reimburse GKF at the per case rates shown Exhibit B (Rates) attached hereto, which rates shall be subject to increase
by the amount of any increase to GKF's costs, GKF shall submit a detailed invoice to Medical Center on a monthly basis for Services
rendered, and such invoices shall be payable within ten (10) days following receipt.

 

e.           As
GKF is making the Physicist available to Medical Center as provided herein only as an accommodation to Medical Center. Medical
Center shall release, defend" indemnify, protect and hold harmless GKF, its officers, directors, managers, members, affiliates,
employees and agents, and each of them, from any and all liability, obligation, damage, loss, cost, clai1n or demand whatsoever
of any kind or nature, including reasonable attorney's fees, and costs arising directly or indirectly from action taken or omissions
made by Physicist in the provision of Services. This Section shall survive the termination of this agreement.

 

f.            Nothing
set forth herein shall (i) relieve or release Medical Center of its obligation under the Lease to provide properly trained professional,
technical and support personnel (including, without limitation, physicists) for the proper performance of Gamma Knife procedures
utilizing the Equipment; and/or (ii) obligate GKF to furnish a Physicist to Medical Center except on the terms set forth herein.

 

3.          Captions.
The captions and paragraph headings used herein are for convenience only and shall not be used in construing or interpreting this
Addendum.

 

4.          Full
Force and Effect. Except as amended by this Addendum, all of the terms and provisions of the Lease, including without limitation,
the amount of the Lease Payments; shall remain in full force and effect.

 

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

 

“MEDICAL
CENTER”     Sunrise Hospital and Medical Center

 

	BY:	/s/ Jerald F. Mitchell
	 	Jerald F. Mitchell, President and
	 	Chief Executive Officer

 

“GKF”    GK Financing,
LLC

 

	BY: 	/s/ Craig K. Tagawa
	 	Craig K. Tagawa, Chief Executive Officer

 

     

     

    

 

Exhibit A

 

SERVICES

 

Gamma Knife radiosurgery:

 

		•	Perform stereotactic treatment planning for Gamma Knife radiosurgeries.

 

		•	Operate GK unit during treatment. Assure that all treatment parameters are set correctly and documented.

 

		•	Calibrate and perform quality assurance on Gamma Knife unit as required by state law and JCAHO (daily, monthly, and annual
schedule).

 

		•	Work with client to select optimum imaging parameters (MRl, CT and/or angiography) appropriate to each case.

 

		•	Interface with physicians (radiation oncologists and neurosurgeons) to provide necessary physics information for their treatment
decisions.

 

     

     

    

 

Exhibit B

 

RATES

 

The following fees shall apply:

 

		•	Gamma Knife stereotactic radiosurgery case rate: One Thousand One Hundred Dollars ($1,100.00) per case (multiple fraction cases
will be counted as a single case)

 

		•	Monthly Gamma Knife calibration is included in the per case rate so long as at least one

(1) case is performed in any month.

 

		•	Annual Gamma Knife calibration and submission of quality controls (one-time annual foe): One Thousand Dollars ($1,000.00)

 

The foregoing fees include all
expenses and fees associated with procedures, travel and accommodations during scheduled visits.Exhibit 10.9c

 

ADDENDUM THREE 

 

TO LEASE AGREEMENT FOR A GAMMA KNIFE
UNIT

 

This ADDENDUM THREE
TO LEASE AGREEMENT FOR A GAMMA KNIFE UNIT (this “Addendum”) is dated effective as of June 20, 2007, and is entered
into between (i) GK FINANCING, LLC, a California limited liability company (“GKF”), and (ii) SUNRISE HOSPITAL AND MEDICAL
CENTER, LLC, a Delaware limited liability company that is qualified to do business in the State of Nevada, d/b/a/ Sunrise Hospital
and Medical Center (“Medical Center”), with reference to the following recitals:

 

Recitals:

 

A.           Medical
Center owns and operates an acute care hospital facility located at 3186 South Maryland Parkway, Las Vegas, NV 89109.

 

B.           On
June 3, 1999, GKF and Medical Center executed a Lease Agreement for a Gamma Knife Unit, which Lease Agreement was amended by a
certain Addendum dated effective December 1, 1998, and a certain Addendum Two (“Addendum Two”) dated effective January
17, 2007 (as amended, the “Lease”).

 

C.           The
parties desire to further amend the terms and provisions of the Lease as set forth herein.

 

NOW THEREFORE, in consideration
of the mutual covenants and agreements set forth herein, and for other good and valuable consideration, the receipt and sufficiency
of which are hereby acknowledged, the parties agree as follows:

 

Agreement:

 

1.          Defined
Terms. Unless otherwise defined herein, the capitalized terms used herein shall have the same meanings set forth in the
Lease.

 

2.          Cobalt
Reload of the Equipment.

 

a.           Cobalt
Reload. Pursuant to Section 14 of the Lease, and subject to the terms and conditions set forth below, (i) GKF, at GKF’s
cost and expense, shall reload the Equipment with new cobalt-60 (the “Reload”), which Reload shall be performed at
the Site and shall include any required installation and rigging; and (ii) GKF shall use its commercially reasonable efforts to
perform the Reload prior to December 31, 2007. It is anticipated that the Equipment will be unavailable to perform procedures for
approximately three to four weeks due to the Reload process.

 

b.           Medical
Center Support. In connection with the Reload, Medical Center, at Medical Center’s cost and expense, shall provide GKF
with Medical Center personnel (including Medical Center physicists) and services upon request and as required by GKF, among other
things, to oversee, supervise and assist with construction and compliance with local, state and federal regulatory requirements
and with nuclear regulatory compliance issues.

 

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c.           Permits.
Notwithstanding the foregoing, the Reload shall be performed by GKF only after all necessary and appropriate licenses, permits,
approvals, consents and authorizations, including, without limitation, the proper handling of the cobalt-60 (collectively, the
“Permits”), have been obtained by Medical Center at Medical Center’s sole cost and expense. The timing and procedure
for the Reload shall be as mutually agreed upon between the parties. Notwithstanding anything to the contrary contained in the
Lease and/or this Addendum, GKF makes no representation or warranty to Medical Center concerning the Reload, and GKF shall have
no obligation or liability to pay any damages to Medical Center resulting therefrom, including, without limitation, any lost revenues
or profits during the period of time that the Equipment is unavailable to perform procedures due to the Reload process

 

3.          Per
Procedure Payment.

 

Notwithstanding anything
to the contrary contained in the Lease, for each of the “Increased Rent Procedures” (as defined below), the per procedure
payment set forth in Section 6 of the Lease shall be increased to Ten Thousand Two Hundred Dollars ($10,200) from Eight Thousand
Five Hundred Dollars ($8,500) per procedure. Immediately following the completion of the last Increased Rent Procedure, the per
procedure payment shall return to Eight Thousand Five Hundred Dollars ($8,500) per procedure. As used herein, (i) the term, “Increased
Rent Procedures” shall mean the first three hundred (300) procedures performed from and after the completion of the Reload;
and (ii) the term “procedure” shall mean each individual treatment session (fraction) that involves stereotactic, external,
single fraction, conformal radiation, commonly called radiosurgery, that may include one or more isocenters during the patient
treatment session, delivered to any site(s) superior to the foramen magnum, whether performed on an inpatient or outpatient basis,
using the Equipment and/or any other equipment or devices that are used in lieu of, or as an alternative to, the Equipment. It
is acknowledged by the parties that the Increased Rent Procedures are intended to allow GKF to recover its costs to perform the
Reload. Nothing set forth herein shall affect the per case reimbursement rates for medical radiation physicist services payable
to GKF pursuant to Addendum Two.

 

4.          No
Responsibility for Additional Reloading. It is understood by the parties that GKF is not responsible for any additional
cobalt reloading, except as expressly agreed upon in writing by Medical Center and GKF. However, if Medical Center and GKF mutually
agree in writing to another cobalt reloading of the Equipment, then, the costs for such reloading shall be shared equally between
Medical Center and GKF.

 

5.          Captions.
The captions and paragraph headings used herein are for convenience only and shall not be used in construing or interpreting this
Addendum.

 

6.          Full
Force and Effect. Except as amended by this Addendum, all of the terms and provisions of the Lease shall remain in full
force and effect.

 

7.          Assignment.
Pursuant to Section 24 of the Lease, GKF shall be permitted at any
time to assign any and all of its rights and obligations under the Lease to its
wholly-owned subsidiary, provided that such all of such assigned obligations shall be guaranteed by GKF.

 

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

 

	GK FINANCING, LLC	 	SUNRISE HOSPITAL AND MEDICAL CENTER, LLC
	 	 	 	 	 
	By:	/s/ Ernest A. Bates, M.D.	 	By:	/s/ Steve Otto
	 	Ernest A. Bates, M.D.	 	Name:	Steve Otto
	 	Policy Committee Member	 	Title:	COO

 

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