Document:

Filed by Bowne Pure Compliance

Exhibit 10.10

			
	 	 	 
	Form RD 4279-14
	 	FORM APPROVED
	(05-07)
	 	OMB No. 0570-0017

UNITED STATES DEPARTMENT OF AGRICULTURE

RURAL DEVELOPMENT

UNCONDITIONAL GUARANTEE

BUSINESS AND INDUSTRY GUARANTEED LOAN PROGRAM

	 	 	 
	Agency Loan #

	 	42-035-260532690
	Agency Loan Name

	 	B&I Guarantee Loan
	Borrower

	 	RHA Tishomingo, LLC
	 

	 	3555 NW 58th Street, Suite 700
	 

	 	Oklahoma City, OK 73112
	Guarantor

	 	See page 5.
	Guarantor Tax ID#

	 	See page 5.
	Lender

	 	Canadian State Bank
	Date
	 	 
	Note Amount

	 	1,200,000.00

	1.	 	GUARANTEE
	 
	 	 	Guarantor unconditionally guarantees payment to Lender of 100% of all amounts owing under the
Note including any costs. Due under the Note when Lender makes written demand upon Guarantor.
Lender is not required to seek payment from any other source before demanding payment from
Guarantor.
	 
	2.	 	NOTE
	 
	 	 	The “Note” is the promissory note dated                     , 2008 in the principal amount of $1,200,000
Dollars, from Borrower to Lender. It includes all notes, including notes issued under the
multi-note system, and any assumptions, renewal, substitution, or replacement of the notes.
	 
	 	 	According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a
person is not required to respond to a collection of information unless it displays a valid OMB
control number. The valid OMB control number for this information collection is 0570-0017. The
time required to complete this information collection is estimated to average 30 minutes per
response including the time for reviewing instructions, searching existing data sources,
gathering and maintaining the data needed, and completing and reviewing the collection of
information.

 

 

 

	3.	 	DEFINITIONS
	 
	 	 	“Collateral” means any property taken as security for payment of the Note or any guarantee of
the Note.
	 
	 	 	“Guarantor” also includes single and multiple Guarantors who sign this Guarantee.

	 
	 	 	“Loan” means the loan evidenced by the Note.
	 
	 	 	“Loan Documents” means the documents related to the Loan signed by Borrower, Guarantor, or any
other guarantor, or anyone who pledges Collateral.
	 
	 	 	“Agency” means Rural Business Cooperative Service an Agency of the United States Department of
Agriculture, Rural Development.
	 
	4.	 	LENDER’S GENERAL POWERS
	 
	 	 	With prior written consent from the Agency, Lender may take any of the following actions at any
time, without notice to the Guarantor, without Guarantor’s consent and without making demand
upon Guarantor.

	 	A.	 	Modify the terms of the Note or any other Loan Document except to increase the amounts
due under the Note;
	 
	 	B.	 	Refrain from taking any action on the Note, the collateral, or any guarantee;
	 
	 	C.	 	Compromise or settle with the Borrower or any guarantor of the Note;
	 
	 	D.	 	Release any Borrower or any guarantor of the Note;
	 
	 	E.	 	Substitute or release any of the Collateral, whether or not Lender receives anything in
return:
	 
	 	F.	 	Foreclose upon or otherwise obtain, and dispose of, any Collateral at public or private
sale, with or without advertisement;
	 
	 	G.	 	Bid or buy at any sale of Collateral by Lender or any other lien holder, at any price
Lender chooses; and
	 
	 	H.	 	Exercise any rights it has, including those in the Note and other Loan Documents.

	 	 	These actions will not release or reduce the obligations of Guarantor or create any
rights or claims against Lender.
	 
	5.	 	FEDERAL LAW
	 
	 	 	When the Agency is the holder, the Note and this Guarantee will be construed and enforced
under Federal law, including Agency regulations. Lender or Agency may use state or local
procedures for filing papers, recording documents, giving notice, foreclosing liens,
and other purposes. By using such procedures, the Agency does not waive any federal immunity
from state or local control, penalty, tax, or liability. As to this Guarantee, Guarantor may not
claim or assert any local or state law against the Agency to deny any obligation, defeat any
claim of the Agency, or preempt federal law.

 

2

 

	6.	 	RIGHTS, NOTICES, AND DEFENSES THAT GUARANTOR WAIVES

	 	 	 To the extent
permitted by law.

	 	A.	 	Guarantor waives all rights to:

	 	1)	 	Require presentment, protest, or demand upon Borrower;
	 
	 	2)	 	Redeem any Collateral before or after Lender disposes of it;
	 
	 	3)	 	Have any disposition of Collateral advertised; and
	 
	 	4)	 	Require a valuation of Collateral before or after Lender disposes of it.

	 	B.	 	Guarantor waives any notice of:

	 	1)	 	Any default under the Note;
	 
	 	2)	 	Presentment, dishonor, protest, or demand;
	 
	 	3)	 	Execution of the Note;
	 
	 	4)	 	Any action or inaction on the Note or Collateral, such as
disbursements, payment, nonpayment, acceleration, intent to accelerate, assignment,
collection activity, and incurring enforcement expenses;
	 
	 	5)	 	Any change in the financial condition or business operations of
Borrower or any guarantor;
	 
	 	6)	 	Any changes in the terms of the Note or other Loan Documents, except
increases in the amounts due under the Note; and
	 
	 	7)	 	The time or place of any sale of other disposition of Collateral.

	 	C.	 	Guarantor waives defenses based upon any claim that:

	 	1)	 	Lender failed to obtain any guarantee;
	 
	 	2)	 	Lender failed to obtain, perfect, or maintain a security interest in
any property offered or taken as Collateral;
	 
	 	3)	 	Lender or others improperly valued or inspected the Collateral;
	 
	 	4)	 	The Collateral changed in value, or was neglected, lost, destroyed or underinsured:
	 
	 	5)	 	Lender impaired the Collateral;
	 
	 	6)	 	Lender did not dispose of any of the Collateral;
	 
	 	7)	 	Lender did not conduct a commercially reasonable sale;
	 
	 	8)	 	Lender did not obtain the fair market value of the Collateral;
	 
	 	9)	 	Lender did not make or perfect a claim upon the death or disability of
Borrower or any guarantor of the Note;
	 
	 	10)	 	Lender made errors or omissions in Loan Documents or administration of the Loan;
	 
	 	11)	 	The financial condition of Borrower or any guarantor was overstated or
has adversely changed;

 

3

 

	 	12)	 	Lender did not seek payment from the Borrower, any other guarantors, or any Collateral
before demanding payment from Guarantor;
	 
	 	13)	 	Lender impaired Guarantor’s suretyship rights;
	 
	 	14)	 	Lender modified the Note terms, other than to increase amounts due under the Note. If
Lender modifies the Note to increase the amounts due under the Note without Guarantor’s
consent, Guarantor will not be liable for the increased amounts and related interest and
expenses, but remains liable for all other amounts;
	 
	 	15)	 	Borrower has avoided liability on the Note; or
	 
	 	16)	 	Lender has taken an action allowed under the Note, this Guarantee, or other Loan
Documents.

	7.	 	DUTIES AS TO COLLATERAL
	 
	 	 	Guarantor will preserve the Collateral pledged by Guarantor to secure this Guarantee. Lender has no
duty to preserve or dispose of any Collateral.
	 
	8.	 	SUCCESSORS AND ASSIGNS
	 
	 	 	Under this Guarantee, Guarantor includes heirs and successors, and Lender includes its successors
and assigns.
	 
	9.	 	GENERAL PROVISIONS

	 	A.	 	ENFORCEMENT EXPENSES. Guarantor promises to pay all expenses Lender incurs to enforce
this Guarantee, including, but not limited to, attorney’s fees and costs.
	 
	 	B.	 	AGENCY NOT A CO-GUARANTOR. Guarantor’s liability will continue even if the Agency pays
Lender. The Agency is not a co-guarantor with Guarantor. Guarantor has no right of
contribution from the Agency.
	 
	 	C.	 	SUBROGATION RIGHTS. Guarantor has no subrogation rights as to the Note or the
Collateral until the Note is paid in full.
	 
	 	D.	 	JOINT AND SEVERAL LIABILITY. All individuals and entities signing as Guarantor are
jointly and severally liable.
	 
	 	E.	 	DOCUMENT SIGNING. Guarantor must sign all documents necessary at any time to comply
with the Loan Documents and to enable Lender to acquire, perfect, or maintain Lender’s
liens on Collateral.
	 
	 	F.	 	FINANCIAL STATEMENTS. Guarantor must give Lender financial statements or other
information requested by the Lender. Failure by the Guarantor to submit the requested
information can result in the Lender taking appropriate action consistent with applicable
law.
	 
	 	G.	 	LENDER’S RIGHTS CUMULATIVE, NOT WAIVED. Lender may exercise any of its rights
separately or together, as many times as it chooses. Lender may delay or forgo enforcing
any of its rights without losing or impairing any of them.

 

4

 

	 	H.	 	ORAL STATEMENTS NOT BINDING. Guarantor may not use an oral statement to contradict or alter
the written terms of the Note or this Guarantee, or to raise a defense
to this Guarantee.
	 
	 	I.	 	SEVERABILITY. If any part of this Guarantee is found to be
unenforceable, all other parts will remain in effect.
	 
	 	J.	 	CONSIDERATION. The consideration for this Guarantee is the Loan or any
accommodation by Lender as to the Loan.

	10.	 	GUARANTOR ACKNOWLEDGMENT OF TERMS
	 
	 	 	Guarantor acknowledges that Guarantor has read and understands the significance of all terms of the
Note and this Guarantee, including all waivers.
	 
	11.	 	GUARANTOR ACKNOWLEDGEMENT OF FEDERAL DEBT
	 
	 	 	Guarantor acknowledges and agrees that any loss claim paid by the Agency on the Note shall be a
Federal Debt owed by Guarantor up to the amount in paragraph 1. Guarantor agrees to immediately
reimburse the Agency for the loss claim. The Agency may use all remedies available to it, including
those under the Debt Collection Improvement Act, to recover the Federal Debt from the Guarantor.
The Agency’s right to collect from the Guarantor is independent of the Lender’s rights to collect
under the Note and will not be affected by any release by the Lender. Any Agency collection under
this paragraph does not need to be shared with the Lender.
	 
	12.	 	SIGNATURE(S)
	 
	 	 	By signing below, each individual or entity becomes obligated as Guarantor under this Guarantee.

	 	 	 
	/s/ David Hirschhorn, Chairman/CEO

	 	/s/ Dennis M. Smith, Manager 
	 

	 	 
	The Tri-Isthmus Group, Inc., 77-0557617

	 	RHA Stroud, LLC, 26-0532635
	 

	 	By: Rural Hospital Acquisition, LLC

as its Manager
	 
	 	 
	/s/ Dennis M. Smith, Manager
 

RHA Anadarko, LLC, 26-0532528

	 	 
	By: Rural Hospital Acquisition, LLC
	 	 
	as its Manager
	 	 
	 
	 	 
	/s/ Dennis M. Smith, Manager
 

Rural Hospital Acquisition, LLC, 26-0289589

	 	 
	 
	 	 
	/s/ David Hirschhorn, President/CEO
 

Surgical Center Acquisition Holdings, Inc., 20-8714448

	 	 
	 
	 	 
	/s/ Dennis M. Smith, Manager
 

TSG Physicians Group, LLC, 20-3123645

	 	 
	By: Rural Hospital Acquisition, LLC as its Manager
	 	 

 

5Filed by Bowne Pure Compliance

Exhibit
10.11

PROMISSORY NOTE

			
	 	 	 
	$1,500,000.00
	 	Date: December 11, 2008
	 	 	 

FOR VALUE RECEIVED, RURAL HOSPITAL ACQUISITION, LLC, an Oklahoma limited liability company
(“Maker”), hereby promises to pay to the order of Carol Schuster, an individual and
Oklahoma resident (“Payee”), at 2304 Old Farm Road, Edmond, Oklahoma 73013, or at such
other place as Payee designates to Maker in writing from time to time, on or before December 11,
2011 (the “Maturity Date”), the principal amount of One Million Five Hundred Thousand and
No/100 Dollars ($1,500,000.00), in lawful money of the United States of America, together with
accrued but unpaid interest on the unpaid balance from day-to-day outstanding, computed from the
date advanced until paid, at a rate per annum equal to the lesser of (a) the Maximum Rate (defined
below), and (b) five percent (5%) (the “Contract Rate”).

As used herein, the term “Maximum Rate” shall mean, at any time, the maximum rate of
interest under applicable law that Payee may charge Maker. The Maximum Rate shall be calculated in
a manner that takes into account any and all fees, payments, and other charges in respect of this
Promissory Note or any document executed in connection herewith that constitute interest under
applicable law. Each change in any interest rate provided for herein based upon the Maximum Rate
resulting from a change in the Maximum Rate shall take effect without notice to Maker at the time
of such change in the Maximum Rate.

Computation of interest on all amounts payable by Maker hereunder shall be computed on the
basis of a year of 360 days and the actual number of days elapsed (including the first day but
excluding the last day) unless such calculation would result in a usurious rate, in which case
interest shall be calculated on the basis of a year of 365 or 366 days, as the case may be.
Notwithstanding the foregoing, if at any time the Contract Rate shall exceed the Maximum Rate,
thereby causing the interest payable on this Note to be limited to the Maximum Rate, then any
subsequent reductions in the Contract Rate shall not reduce the rate of interest charged hereunder
below the Maximum Rate until the total amount of interest accrued hereon from and after the date
hereof equals the amount of interest that would have accrued hereon if Contract Rate had at all
times been in effect.

The principal of and interest upon this Promissory Note shall be due and payable as follows:

	 	(a)	 	interest, computed as aforesaid, shall be due and payable quarterly in
arrears as it accrues, with each payment due on the first day of each calendar quarter
(i.e., January 1, April 1, July 1, and October 1 of each year) and on the Maturity
Date; and

	 	(b)	 	the entire unpaid principal balance of this Promissory Note shall be due and
payable in full on the Maturity Date unless an Event of Default occurs to cause the
Maturity Date to be accelerated.

	 	(c)	 	In the event that Tri-Isthmus Group, Inc., a Delaware corporation and ultimate
parent of Maker, (“TIGroup”), receives aggregate net proceeds in excess of
$8,000,000 from [certain securities offerings], the principal and interest payments under
this Promissory Note will be accelerated and the principal amount
still owing, together with accrued but unpaid interest will become due and payable on the
thirtieth (30th) day following the date on which the aggregate net
proceeds received by TIGroup [*] exceed $8,000,000.

 

 

 

Maker may elect to prepay this Promissory Note in whole or in part from time to time without
premium, penalty or notice.

Maker agrees that the occurrence of any one or more of the following shall constitute an event
of default (“Event of Default”) under this Promissory Note:

(a) failure of Maker to pay principal of or interest on this Promissory Note when due;
or

(b) failure of Maker to honor and/or perform on any obligation owed to Payee under any
agreement, including without limitation, the failure to make any payment (after the
applicable cure period) to Payee of any of the $300,000.00 owed to Payee by Maker under that
certain Membership Interest Purchase Agreement dated of even herewith; or

(c) Maker becomes insolvent, or makes a transfer in fraud of creditors, or makes an
assignment for the benefit of creditors, or admits in writing its inability to pay its debts
as they become due, or generally is not paying its debts as such debts become due; or

(d) Maker has a receiver or custodian appointed for, or take possession of, all or
substantially all of the assets of such party, either in a proceeding brought by such party
or in a proceeding brought against such party and such appointment is not discharged or such
possession is not terminated within sixty (60) days after the effective date thereof or such
party consents to or acquiesces in such appointment or possession; or

(e) Maker files a petition for relief under the United States Bankruptcy Code or any
other present or future federal or state insolvency, bankruptcy or similar laws (all of the
foregoing hereinafter collectively called “Applicable Bankruptcy Law”) or an
involuntary petition for relief is filed against such party under any Applicable Bankruptcy
Law and such involuntary petition is not dismissed within sixty (60) days after the filing
thereof, or an order for relief naming such party is entered under any Applicable Bankruptcy
Law, or any composition, rearrangement, extension, reorganization or other relief of debtors
now or hereafter existing is requested or consented to by such party.

Maker agrees that upon the occurrence of an Event of Default, the holder of this Promissory
Note may, at its option, without further notice or demand, declare the outstanding principal
balance of and accrued but unpaid interest on this Promissory Note immediately due and payable.

If this Promissory Note is placed in the hands of an attorney for collection, or is collected
in whole or in part by suit or through probate, bankruptcy or other legal proceedings of any kind,
Maker agrees to pay, in addition to all other sums payable hereunder, all costs and expenses of
collection, including but not limited to reasonable attorneys’ fees.

 

 

 

Maker, and any surety, endorser, guarantor or other party ever liable for payment of any sums
of money on this Promissory Note, jointly and severally waive notice of acceptance, diligence,
demand for payment, presentment, protest, notice of protest and non-payment, or other notice of
default, notice of intention to accelerate the maturity of this Promissory Note, and notice of
acceleration of the maturity of this Promissory Note.

This Promissory Note is intended to be performed in accordance with, and only to the extent
permitted by, all applicable usury laws. If any provision hereof or the application thereof to any
person or circumstance shall, for any reason and to any extent, be invalid or unenforceable,
neither the application of such provision to any other person or circumstance nor the remainder of
the instrument in which such provision is contained shall be affected thereby and shall be enforced
to the greatest extent permitted by law. It is expressly stipulated and agreed to be the intent of
the holder hereof to at all times comply with the usury and other applicable laws now or hereafter
governing the interest payable on the indebtedness evidenced by this Promissory Note. If the
applicable law is ever revised, repealed or judicially interpreted so as to render usurious any
amount called for under this Promissory Note, or contracted for, charged, taken, reserved or
received with respect to the indebtedness evidenced by this Promissory Note, or if Payee’s exercise
of the option to accelerate the maturity of this Note, or if any prepayment by Maker results in
Maker having paid any interest in excess of that permitted by law, then it is the express intent of
Maker and Payee that all excess amounts theretofore collected by Payee be credited on the principal
balance of this Promissory Note (or, if this Promissory Note has been paid in full, refunded to
Maker), and the provisions of this Promissory Note immediately be deemed reformed and the amounts
thereafter collectable hereunder reduced, without the necessity of the execution of any new
document, so as to comply with the then applicable law, but so as to permit the recovery of the
fullest amount otherwise called for hereunder. All sums paid, or agreed to be paid, by Maker for
the use, forbearance, detention, taking, charging, receiving or reserving of the indebtedness of
Maker to Payee under this Promissory Note shall, to the maximum extent permitted by applicable law,
be amortized, prorated, allocated and spread throughout the full term of such indebtedness until
payment in full so that the rate or amount of interest on account of such indebtedness does not
exceed the usury ceiling from time to time in effect and applicable to such indebtedness for so
long as such indebtedness is outstanding. Notwithstanding anything to the contrary contained
herein, it is not the intention of Payee to accelerate the maturity of any interest that has not
accrued at the time of such acceleration or to collect unearned interest at the time of such
acceleration.

The indebtedness evidenced hereby shall be construed and enforced in accordance with and
governed by the laws of the State of Oklahoma.

	 	 	 	 	 	 	 	 	 
	 	 	MAKER:	 	 
	 
	 	 	 	 	 	 	 	 
	 	 	RURAL HOSPITAL ACQUISITION, LLC	 	 
	 
	 	 	 	 	 	 	 	 
	 

	 	By:	 	 	 	 	 	 
	 	 	 	 	 	 	 
	 

	 	 	 	Name:	 	 	 	 
	 

	 	 	 	 	 	 	 	 
	 

	 	 	 	Title:

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00150-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00150-of-00352.parquet"}]]