Document:

Exhibit 4.17

 

EXECUTION VERSION

 

AMENDMENT NO. 4

 

Dated as of March 13, 2020

 

to

 

SECOND AMENDED AND RESTATED RECEIVABLES PURCHASE AGREEMENT

 

Dated as of January 17, 2013

 

THIS AMENDMENT No. 3 (this “Amendment”) dated as of March 13, 2020 is entered into by and between NMC FUNDING CORPORATION, a Delaware corporation, as Purchaser (the “Purchaser”) and NATIONAL MEDICAL CARE, INC., a Delaware corporation, as Seller (the “Seller”).

 

PRELIMINARY STATEMENTS

 

A. The Purchaser and the Seller are parties to that certain Second Amended and Restated Receivables Purchase Agreement dated as of January 17, 2013 (as amended or otherwise modified prior to the date hereof, the “RPA”). Capitalized terms used herein and not otherwise defined shall have the meanings ascribed to them in the RPA.

 

B. The Purchaser and the Seller have agreed to amend the RPA on the terms and conditions hereinafter set forth.

 

NOW, THEREFORE, in consideration of the premises set forth above, and other good and valuable consideration the receipt and sufficiency of which is hereby acknowledged, the parties hereto agree as follows:

 

SECTION 1.                            Amendments.

 

1.1          Capitalized Lease. The definition of “Capitalized Lease” in Section 1.1 of the RPA is hereby deleted.

 

1.2          Indebtedness. The definition of “Indebtedness” or “indebtedness” in Section 1.1 of the RPA is hereby deleted and replaced with the following:

 

“Indebtedness” or “indebtedness” means, with respect to any Person and without duplication, such Person’s (i) obligations for borrowed money, (ii) obligations representing the deferred purchase price of property other than accounts payable arising in the ordinary course of such Person’s business on terms customary in the trade, (iii) obligations, whether or not assumed, secured by liens or payable out of the proceeds or production from property now or hereafter owned or acquired by such Person, (iv) obligations which are evidenced by notes, acceptances, or other instruments, (v) obligations in respect of leases as determined under IFRS and (vi) obligations for which such Person is obligated pursuant to a Guaranty.

 

 

1.3          Exhibit J. Exhibit J (List of Transferring Affiliates, Chief Executive Offices of Transferring Affiliates and Tradenames) of the RPA is hereby deleted and replaced with the new Exhibit J attached hereto as Exhibit 1.

 

SECTION 2.         Conditions Precedent. This Amendment shall become effective and be deemed effective as of the date hereof upon (i) the receipt by the Purchaser of counterparts of this Amendment duly executed by the Purchaser and the Seller, and (ii) the effectiveness of Amendment No. 3 to the Seventh Amended and Restated Transfer and Administration Agreement of even date herewith among the Seller, the Purchaser, the Transferor, the Collection Agent, the Administrative Agents, the Conduit Investors, the Bank Investors and the Agent.

 

SECTION 3.         Covenants, Representations and Warranties of the Seller.

 

3.1          Upon the effectiveness of this Amendment, the Seller hereby reaffirms all covenants, representations and warranties made by it in the RPA and agrees that all such covenants, representations and warranties shall be deemed to have been remade as of the effective date of this Amendment.

 

3.2          Upon the effectiveness of this Amendment, the Seller hereby represents and warrants that (i) this Amendment constitutes the legal, valid and binding obligation of such party, enforceable against it in accordance with its terms and (ii) no Seller Default or Potential Seller Default shall exist under the RPA.

 

SECTION 4.         Acknowledgements of the Amendment to Exhibit J of the RPA.

 

Each of the Purchaser and the Seller hereby acknowledges that the amendment to Exhibit J of the RPA that is being effected pursuant to Section 1.3 of this Amendment is solely for the convenience of the parties and reflects the removal of Transferring Affiliates that occurred since December 20, 2018 pursuant to Section 2.7(b) of the RPA.

 

SECTION 5.         Reference to and Effect on the RPA.

 

5.1          Upon the effectiveness of this Amendment, each reference in the RPA to “this Agreement,” “hereunder,” “hereof,” “herein,” “hereby” or words of like import shall mean and be a reference to the RPA as amended hereby, and each reference to the RPA in any other document, instrument and agreement executed and/or delivered in connection with the RPA shall mean and be a reference to the RPA as amended hereby.

 

5.2          Except as specifically amended hereby, the RPA and all other documents, instruments and agreements executed and/or delivered in connection therewith shall remain in full force and effect and are hereby ratified and confirmed.

 

5.3          The execution, delivery and effectiveness of this Amendment shall not operate as a waiver of any right, power or remedy of the Purchaser or any of its assignees under the RPA or any other document, instrument, or agreement executed in connection therewith, nor constitute a waiver of any provision contained therein.

 

2

 

SECTION 6.         Governing Law. THIS AMENDMENT SHALL BE GOVERNED AND CONSTRUED IN ACCORDANCE WITH THE INTERNAL LAWS (AS OPPOSED TO THE CONFLICT OF LAW PROVISIONS) AND DECISIONS OF THE STATE OF NEW YORK.

 

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 and delivered shall be deemed to be an original and all of which taken together shall constitute but one and the same instrument. Delivery of an executed counterpart via facsimile or other electronic transmission shall be deemed delivery of an original counterpart.

 

SECTION 8.         Headings. Section headings in this Amendment are included herein for convenience of reference only and shall not constitute a part of this Amendment for any other purpose.

 

[The remainder of this page intentionally left blank]

 

3

 

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 written above.

 

 

	
 
    	
 
    	
NMC FUNDING CORPORATION,
    
	
 
    	
 
    	
as Transferor
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/ Mark Fawcett
    
	
 
    	
 
    	
Name:
    	
Mark Fawcett
    
	
 
    	
 
    	
Title:
    	
Senior Vice President & Treasurer
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
NATIONAL MEDICAL CARE, INC.,
   as Collection Agent
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
By:
    	
/s/ Mark Fawcett
    
	
 
    	
 
    	
Name:
    	
Mark Fawcett
    
	
 
    	
 
    	
Title:
    	
Senior Vice President & Treasurer
    

 

 

Signature Page
 Amendment No. 3 to Seventh Amended and Restated
 Transfer and Administration Agreement

 

 

Exhibit 1
 to Amendment

 

EXHIBIT J

 

to

 

AMENDED AND RESTATED RECEIVABLES PURCHASE AGREEMENT

 

LIST OF TRANSFERRING AFFILIATES, CHIEF EXECUTIVE

 

OFFICES OF TRANSFERRING AFFILIATES AND TRADENAMES

 

SECTIONS 2.7(b), 3.1(i) and 3.1(k)(iv)

 

	
 
    	
 
    	
 
    	
 
    	
State of
    
	
 
    	
 
    	
Transferring Affiliate
    	
 
    	
Incorporation
    
	
1.
    	
 
    	
Apheresis Care Group, Inc.
    	
 
    	
Delaware
    
	
2.
    	
 
    	
Bio-Medical Applications Management   Company, Inc.
    	
 
    	
Delaware
    
	
3.
    	
 
    	
Bio-Medical Applications of Alabama, Inc.
    	
 
    	
Delaware
    
	
4.
    	
 
    	
Bio-Medical Applications of Amarillo, Inc.
    	
 
    	
Delaware
    
	
5.
    	
 
    	
Bio-Medical Applications of Anacostia, Inc.
    	
 
    	
Delaware
    
	
6.
    	
 
    	
Bio-Medical Applications of Aquadilla, Inc.
    	
 
    	
Delaware
    
	
7.
    	
 
    	
Bio-Medical Applications of Arecibo, Inc.
    	
 
    	
Delaware
    
	
8.
    	
 
    	
Bio-Medical Applications of Arkansas, Inc.
    	
 
    	
Delaware
    
	
9.
    	
 
    	
Bio-Medical Applications of Bayamon, Inc.
    	
 
    	
Delaware
    
	
10.
    	
 
    	
Bio-Medical Applications of Blue Springs, Inc.
    	
 
    	
Delaware
    
	
11.
    	
 
    	
Bio-Medical Applications of Caguas, Inc.
    	
 
    	
Delaware
    
	
12.
    	
 
    	
Bio-Medical Applications of California, Inc.
    	
 
    	
Delaware
    
	
13.
    	
 
    	
Bio-Medical Applications of Camarillo, Inc.
    	
 
    	
Delaware
    
	
14.
    	
 
    	
Bio-Medical Applications of Carolina, Inc.
    	
 
    	
Delaware
    
	
15.
    	
 
    	
Bio-Medical Applications of Clinton, Inc.
    	
 
    	
Delaware
    
	
16.
    	
 
    	
Bio-Medical Applications of Columbia   Heights, Inc.
    	
 
    	
Delaware
    
	
17.
    	
 
    	
Bio-Medical Applications of Connecticut, Inc.
    	
 
    	
Delaware
    
	
18.
    	
 
    	
Bio-Medical Applications of Delaware, Inc.
    	
 
    	
Delaware
    
	
19.
    	
 
    	
Bio-Medical Applications of Dover, Inc.
    	
 
    	
Delaware
    
	
20.
    	
 
    	
Bio-Medical Applications of Eureka, Inc.
    	
 
    	
Delaware
    
	
21.
    	
 
    	
Bio-Medical Applications of Fayetteville, Inc.
    	
 
    	
Delaware
    
	
22.
    	
 
    	
Bio-Medical Applications of Florida, Inc.
    	
 
    	
Delaware
    
	
23.
    	
 
    	
Bio-Medical Applications of Fremont, Inc.
    	
 
    	
Delaware
    
	
24.
    	
 
    	
Bio-Medical Applications of Fresno, Inc.
    	
 
    	
Delaware
    
	
25.
    	
 
    	
Bio-Medical Applications of Georgia, Inc.
    	
 
    	
Delaware
    
	
26.
    	
 
    	
Bio-Medical Applications of Guayama, Inc.
    	
 
    	
Delaware
    
	
27.
    	
 
    	
Bio-Medical Applications of Humacao, Inc.
    	
 
    	
Delaware
    
	
28.
    	
 
    	
Bio-Medical Applications of Illinois, Inc.
    	
 
    	
Delaware
    
	
29.
    	
 
    	
Bio-Medical Applications of Indiana, Inc.
    	
 
    	
Delaware
    

 

J-1

 

	
 
    	
 
    	
 
    	
 
    	
State of
    
	
 
    	
 
    	
Transferring Affiliate
    	
 
    	
Incorporation
    
	
30.
    	
 
    	
Bio-Medical Applications of Kansas, Inc.
    	
 
    	
Delaware
    
	
31.
    	
 
    	
Bio-Medical Applications of Kentucky, Inc.
    	
 
    	
Delaware
    
	
32.
    	
 
    	
Bio-Medical Applications of Los Gatos, Inc.
    	
 
    	
Delaware
    
	
33.
    	
 
    	
Bio-Medical Applications of Louisiana, LLC
    	
 
    	
Delaware
    
	
34.
    	
 
    	
Bio-Medical Applications of Maine, Inc.
    	
 
    	
Delaware
    
	
35.
    	
 
    	
Bio-Medical Applications of Manchester, Inc.
    	
 
    	
Delaware
    
	
36.
    	
 
    	
Bio-Medical Applications of Maryland, Inc.
    	
 
    	
Delaware
    
	
37.
    	
 
    	
Bio-Medical Applications of Massachusetts, Inc.
    	
 
    	
Delaware
    
	
38.
    	
 
    	
Bio-Medical Applications of Mayaguez, Inc.
    	
 
    	
Delaware
    
	
39.
    	
 
    	
Bio-Medical Applications of Michigan, Inc.
    	
 
    	
Delaware
    
	
40.
    	
 
    	
Bio-Medical Applications of Minnesota, Inc.
    	
 
    	
Delaware
    
	
41.
    	
 
    	
Bio-Medical Applications of Mississippi, Inc.
    	
 
    	
Delaware
    
	
42.
    	
 
    	
Bio-Medical Applications of Missouri, Inc.
    	
 
    	
Delaware
    
	
43.
    	
 
    	
Bio-Medical Applications of New Hampshire, Inc.
    	
 
    	
Delaware
    
	
44.
    	
 
    	
Bio-Medical Applications of New Jersey, Inc.
    	
 
    	
Delaware
    
	
45.
    	
 
    	
Bio-Medical Applications of New Mexico, Inc.
    	
 
    	
Delaware
    
	
46.
    	
 
    	
Bio-Medical Applications of North   Carolina, Inc.
    	
 
    	
Delaware
    
	
47.
    	
 
    	
Bio-Medical Applications of Northeast   D.C., Inc.
    	
 
    	
Delaware
    
	
48.
    	
 
    	
Bio-Medical Applications of Ohio, Inc.
    	
 
    	
Delaware
    
	
49.
    	
 
    	
Bio-Medical Applications of Oklahoma, Inc.
    	
 
    	
Delaware
    
	
50.
    	
 
    	
Bio-Medical Applications of Pennsylvania, Inc.
    	
 
    	
Delaware
    
	
51.
    	
 
    	
Bio-Medical Applications of Ponce, Inc.
    	
 
    	
Delaware
    
	
52.
    	
 
    	
Bio-Medical Applications of Puerto Rico, Inc.
    	
 
    	
Delaware
    
	
53.
    	
 
    	
Bio-Medical Applications of Rhode Island, Inc.
    	
 
    	
Delaware
    
	
54.
    	
 
    	
Bio-Medical Applications of Rio Piedras, Inc.
    	
 
    	
Delaware
    
	
55.
    	
 
    	
Bio-Medical Applications of San German, Inc.
    	
 
    	
Delaware
    
	
56.
    	
 
    	
Bio-Medical Applications of San Juan, Inc.
    	
 
    	
Delaware
    
	
57.
    	
 
    	
Bio-Medical Applications of South   Carolina, Inc.
    	
 
    	
Delaware
    
	
58.
    	
 
    	
Bio-Medical Applications of Southeast   Washington, Inc.
    	
 
    	
Delaware
    
	
59.
    	
 
    	
Bio-Medical Applications of Tennessee, Inc.
    	
 
    	
Delaware
    
	
60.
    	
 
    	
Bio-Medical Applications of Texas, Inc.
    	
 
    	
Delaware
    
	
61.
    	
 
    	
Bio-Medical Applications of the District of   Columbia, Inc.
    	
 
    	
Delaware
    
	
62.
    	
 
    	
Bio-Medical Applications of Virginia, Inc.
    	
 
    	
Delaware
    
	
63.
    	
 
    	
Bio-Medical Applications of West Virginia, Inc.
    	
 
    	
Delaware
    
	
64.
    	
 
    	
Bio-Medical Applications of Wisconsin, Inc.
    	
 
    	
Delaware
    
	
65.
    	
 
    	
Bio-Medical Applications of Wyoming, LLC
    	
 
    	
Delaware
    
	
66.
    	
 
    	
Brevard County Dialysis, LLC
    	
 
    	
Florida
    
	
67.
    	
 
    	
Clayton County Dialysis, LLC
    	
 
    	
Georgia
    
	
68.
    	
 
    	
Clermont Dialysis Center, LLC
    	
 
    	
Georgia
    
	
69.
    	
 
    	
College Park Dialysis, LLC
    	
 
    	
Georgia
    
	
70.
    	
 
    	
Columbus Area Renal Alliance, LLC
    	
 
    	
Delaware
    
	
71.
    	
 
    	
Conejo Valley Dialysis, Inc.
    	
 
    	
California
    
	
72.
    	
 
    	
Dialysis America Georgia, LLC
    	
 
    	
Delaware
    
	
73.
    	
 
    	
Dialysis Associates of Northern New Jersey, L.L.C.
    	
 
    	
New Jersey
    

 

J-2

 

	
 
    	
 
    	
 
    	
 
    	
State of
    
	
 
    	
 
    	
Transferring Affiliate
    	
 
    	
Incorporation
    
	
74.
    	
 
    	
Dialysis Centers of America - Illinois, Inc.
    	
 
    	
Illinois
    
	
75.
    	
 
    	
Dialysis Management Corporation
    	
 
    	
Texas
    
	
76.
    	
 
    	
Dialysis Services of Atlanta, Inc.
    	
 
    	
Georgia
    
	
77.
    	
 
    	
Dialysis Services of Cincinnati, Inc.
    	
 
    	
Ohio
    
	
78.
    	
 
    	
Dialysis Specialists of Marietta, Ltd.
    	
 
    	
Ohio
    
	
79.
    	
 
    	
Dialysis Specialists of Topeka, Inc.
    	
 
    	
Kansas
    
	
80.
    	
 
    	
Douglas County Dialysis, LLC
    	
 
    	
Georgia
    
	
81.
    	
 
    	
Du Page Dialysis Ltd.
    	
 
    	
Illinois
    
	
82.
    	
 
    	
Everest Healthcare Holdings, Inc.
    	
 
    	
Delaware
    
	
83.
    	
 
    	
Everest Healthcare Indiana, Inc.
    	
 
    	
Indiana
    
	
84.
    	
 
    	
Everest Healthcare Ohio, Inc.
    	
 
    	
Ohio
    
	
85.
    	
 
    	
Everest Healthcare Rhode Island, Inc.
    	
 
    	
Delaware
    
	
86.
    	
 
    	
Everest Healthcare Texas, L.P.
    	
 
    	
Delaware
    
	
87.
    	
 
    	
FMS Delaware Dialysis, LLC
    	
 
    	
Delaware
    
	
88.
    	
 
    	
FMS Philadelphia Dialysis, LLC
    	
 
    	
Delaware
    
	
89.
    	
 
    	
Fondren Dialysis Clinic, Inc.
    	
 
    	
Texas
    
	
90.
    	
 
    	
Fort Scott Regional Dialysis Center, Inc.
    	
 
    	
Missouri
    
	
91.
    	
 
    	
Four State Regional Dialysis Center, Inc.
    	
 
    	
Missouri
    
	
92.
    	
 
    	
Fresenius Kidney Care Pittsburgh, LLC
    	
 
    	
Delaware
    
	
93.
    	
 
    	
Fresenius Management Services, Inc.
    	
 
    	
Delaware
    
	
94.
    	
 
    	
Fresenius Medical Care – South Texas Kidney, LLC
    	
 
    	
Delaware
    
	
95.
    	
 
    	
Fresenius Medical Care Dialysis Services Colorado,   LLC
    	
 
    	
Delaware
    
	
96.
    	
 
    	
Fresenius Medical Care Dialysis Services-Oregon, LLC
    	
 
    	
Oregon
    
	
97.
    	
 
    	
Fresenius Medical Care Harston Hall, LLC
    	
 
    	
Delaware
    
	
98.
    	
 
    	
Fresenius Medical Care Holdings, Inc.
    	
 
    	
New York
    
	
99.
    	
 
    	
Fresenius Medical Care of Illinois, LLC
    	
 
    	
Delaware
    
	
100.
    	
 
    	
Fresenius Medical Care of Montana, LLC
    	
 
    	
Delaware
    
	
101.
    	
 
    	
Fresenius Medical Care Ventures, LLC
    	
 
    	
Delaware
    
	
102.
    	
 
    	
Fresenius Medical Care West Bexar, LLC
    	
 
    	
Delaware
    
	
103.
    	
 
    	
Fresenius Medical Care-OSUIM Kidney Centers, LLC
    	
 
    	
Delaware
    
	
104.
    	
 
    	
Fresenius USA Manufacturing, Inc.
    	
 
    	
Delaware
    
	
105.
    	
 
    	
Fresenius USA Marketing, Inc.
    	
 
    	
Delaware
    
	
106.
    	
 
    	
Fresenius USA, Inc.
    	
 
    	
Massachusetts
    
	
107.
    	
 
    	
Gulf Region Mobile Dialysis, Inc.
    	
 
    	
Delaware
    
	
108.
    	
 
    	
Haemo-Stat, Inc.
    	
 
    	
California
    
	
109.
    	
 
    	
Hauppauge Dialysis Center, LLC
    	
 
    	
New York
    
	
110.
    	
 
    	
Henry Dialysis Center, LLC
    	
 
    	
Georgia
    
	
111.
    	
 
    	
Holton Dialysis Clinic, LLC
    	
 
    	
Georgia
    
	
112.
    	
 
    	
Home Dialysis of Muhlenberg County, Inc.
    	
 
    	
Kentucky
    
	
113.
    	
 
    	
Homestead Artificial Kidney Center, Inc.
    	
 
    	
Florida
    
	
114.
    	
 
    	
Inland Northwest Renal Care Group, LLC
    	
 
    	
Washington
    
	
115.
    	
 
    	
Jefferson County Dialysis, Inc.
    	
 
    	
Arkansas
    
	
116.
    	
 
    	
KDCO, Inc.
    	
 
    	
Missouri
    
	
117.
    	
 
    	
Kentucky Renal Care Group, LLC
    	
 
    	
Delaware
    

 

J-3

 

	
 
    	
 
    	
 
    	
 
    	
State of
    
	
 
    	
 
    	
Transferring Affiliate
    	
 
    	
Incorporation
    
	
118.
    	
 
    	
Little Rock Dialysis, Inc.
    	
 
    	
Arkansas
    
	
119.
    	
 
    	
Maumee Dialysis Services, LLC
    	
 
    	
Delaware
    
	
120.
    	
 
    	
Metro Dialysis Center - Normandy, Inc.
    	
 
    	
Missouri
    
	
121.
    	
 
    	
Metro Dialysis Center - North, Inc.
    	
 
    	
Missouri
    
	
122.
    	
 
    	
National Medical Care, Inc.
    	
 
    	
Delaware
    
	
123.
    	
 
    	
National Nephrology Associates of Texas, L.P.
    	
 
    	
Texas
    
	
124.
    	
 
    	
New York Dialysis Services, Inc.
    	
 
    	
New York
    
	
125.
    	
 
    	
NNA of Alabama, Inc.
    	
 
    	
Alabama
    
	
126.
    	
 
    	
NNA of East Orange, L.L.C.
    	
 
    	
New Jersey
    
	
127.
    	
 
    	
NNA of Georgia, Inc.
    	
 
    	
Delaware
    
	
128.
    	
 
    	
NNA of Harrison, L.L.C.
    	
 
    	
New Jersey
    
	
129.
    	
 
    	
NNA of Louisiana, LLC
    	
 
    	
Louisiana
    
	
130.
    	
 
    	
NNA of Oklahoma, Inc.
    	
 
    	
Nevada
    
	
131.
    	
 
    	
NNA of Oklahoma, L.L.C.
    	
 
    	
Oklahoma
    
	
132.
    	
 
    	
NNA of Rhode Island, Inc.
    	
 
    	
Rhode Island
    
	
133.
    	
 
    	
NNA of Toledo, Inc.
    	
 
    	
Ohio
    
	
134.
    	
 
    	
NNA-Saint Barnabas-Livingston, L.L.C.
    	
 
    	
New Jersey
    
	
135.
    	
 
    	
NNA-Saint Barnabas, L.L.C.
    	
 
    	
New Jersey
    
	
136.
    	
 
    	
Northeast Alabama Kidney Clinic, Inc.
    	
 
    	
Alabama
    
	
137.
    	
 
    	
Northern New Jersey Dialysis, L.L.C.
    	
 
    	
Delaware
    
	
138.
    	
 
    	
NRA-Ada, Oklahoma, LLC
    	
 
    	
Delaware
    
	
139.
    	
 
    	
NRA-Augusta, Georgia, LLC
    	
 
    	
Georgia
    
	
140.
    	
 
    	
NRA-Bamberg, South Carolina, LLC
    	
 
    	
Tennessee
    
	
141.
    	
 
    	
NRA-Crossville, Tennessee, LLC
    	
 
    	
Tennessee
    
	
142.
    	
 
    	
NRA-Farmington, Missouri, LLC
    	
 
    	
Delaware
    
	
143.
    	
 
    	
NRA-Georgetown, Kentucky, LLC
    	
 
    	
Delaware
    
	
144.
    	
 
    	
NRA-Hogansville, Georgia, LLC
    	
 
    	
Delaware
    
	
145.
    	
 
    	
NRA-Holly Hill, South Carolina, LLC
    	
 
    	
Tennessee
    
	
146.
    	
 
    	
NRA-Hollywood, South Carolina, LLC
    	
 
    	
Delaware
    
	
147.
    	
 
    	
NRA-Inpatient Dialysis, LLC
    	
 
    	
Tennessee
    
	
148.
    	
 
    	
NRA-LaGrange, Georgia, LLC
    	
 
    	
Delaware
    
	
149.
    	
 
    	
NRA-Mt. Pleasant, South Carolina, LLC
    	
 
    	
Tennessee
    
	
150.
    	
 
    	
NRA-New Castle, Indiana, LLC
    	
 
    	
Delaware
    
	
151.
    	
 
    	
NRA-Newnan Acquisition, LLC
    	
 
    	
Tennessee
    
	
152.
    	
 
    	
NRA-Orangeburg, South Carolina, LLC
    	
 
    	
Tennessee
    
	
153.
    	
 
    	
NRA-Palmetto, Georgia, LLC
    	
 
    	
Delaware
    
	
154.
    	
 
    	
NRA-Princeton, Kentucky, LLC
    	
 
    	
Tennessee
    
	
155.
    	
 
    	
NRA-Roanoke, Alabama, LLC
    	
 
    	
Tennessee
    
	
156.
    	
 
    	
NRA-South City, Missouri, LLC
    	
 
    	
Delaware
    
	
157.
    	
 
    	
NRA-St. Louis (Home Therapy Center), Missouri, LLC
    	
 
    	
Delaware
    
	
158.
    	
 
    	
NRA-St. Louis, Missouri, LLC
    	
 
    	
Delaware
    
	
159.
    	
 
    	
NRA-Talladega, Alabama, LLC
    	
 
    	
Tennessee
    
	
160.
    	
 
    	
NRA-Valdosta (North), Georgia, LLC
    	
 
    	
Delaware
    
	
161.
    	
 
    	
NRA-Valdosta, Georgia, LLC
    	
 
    	
Delaware
    

 

J-4

 

	
 
    	
 
    	
 
    	
 
    	
State of
    
	
 
    	
 
    	
Transferring Affiliate
    	
 
    	
Incorporation
    
	
162.
    	
 
    	
NRA-Varnville, South Carolina, LLC
    	
 
    	
Tennessee
    
	
163.
    	
 
    	
NRA-Washington County, Missouri, LLC
    	
 
    	
Delaware
    
	
164.
    	
 
    	
NRA-Winchester, Indiana, LLC
    	
 
    	
Delaware
    
	
165.
    	
 
    	
Physicians Dialysis Company, Inc.
    	
 
    	
Pennsylvania
    
	
166.
    	
 
    	
QualiCenters Albany, Ltd.
    	
 
    	
Colorado
    
	
167.
    	
 
    	
QualiCenters Bend LLC
    	
 
    	
Colorado
    
	
168.
    	
 
    	
QualiCenters Coos Bay, Ltd.
    	
 
    	
Colorado
    
	
169.
    	
 
    	
QualiCenters Eugene-Springfield, Ltd.
    	
 
    	
Colorado
    
	
170.
    	
 
    	
QualiCenters Inland Northwest L.L.C.
    	
 
    	
Colorado
    
	
171.
    	
 
    	
QualiCenters Pueblo LLC
    	
 
    	
Colorado
    
	
172.
    	
 
    	
QualiCenters Salem LLC
    	
 
    	
Colorado
    
	
173.
    	
 
    	
RAI Care Centers of Alabama, LLC
    	
 
    	
Delaware
    
	
174.
    	
 
    	
RAI Care Centers of Florida I, LLC
    	
 
    	
Delaware
    
	
175.
    	
 
    	
RAI Care Centers of Florida II, LLC
    	
 
    	
Delaware
    
	
176.
    	
 
    	
RAI Care Centers of Georgia I, LLC
    	
 
    	
Delaware
    
	
177.
    	
 
    	
RAI Care Centers of Illinois I, LLC
    	
 
    	
Delaware
    
	
178.
    	
 
    	
RAI Care Centers of Illinois II, LLC
    	
 
    	
Delaware
    
	
179.
    	
 
    	
RAI Care Centers of Maryland I, LLC
    	
 
    	
Delaware
    
	
180.
    	
 
    	
RAI Care Centers of Michigan I, LLC
    	
 
    	
Delaware
    
	
181.
    	
 
    	
RAI Care Centers of Michigan II, LLC
    	
 
    	
Delaware
    
	
182.
    	
 
    	
RAI Care Centers of Nebraska II, LLC
    	
 
    	
Delaware
    
	
183.
    	
 
    	
RAI Care Centers of North Carolina II, LLC
    	
 
    	
Delaware
    
	
184.
    	
 
    	
RAI Care Centers of Northern California I, LLC
    	
 
    	
Delaware
    
	
185.
    	
 
    	
RAI Care Centers of Northern California II, LLC
    	
 
    	
Delaware
    
	
186.
    	
 
    	
RAI Care Centers of Oakland II, LLC
    	
 
    	
Delaware
    
	
187.
    	
 
    	
RAI Care Centers of South Carolina I, LLC
    	
 
    	
Delaware
    
	
188.
    	
 
    	
RAI Care Centers of Southern California I, LLC
    	
 
    	
Delaware
    
	
189.
    	
 
    	
RAI Care Centers of Southern California II, LLC
    	
 
    	
Delaware
    
	
190.
    	
 
    	
RAI Care Centers of Virginia I, LLC
    	
 
    	
Delaware
    
	
191.
    	
 
    	
RCG Bloomington, LLC
    	
 
    	
Delaware
    
	
192.
    	
 
    	
RCG East Texas, LLP
    	
 
    	
Delaware
    
	
193.
    	
 
    	
RCG Indiana, L.L.C.
    	
 
    	
Delaware
    
	
194.
    	
 
    	
RCG Irving, LLP
    	
 
    	
Delaware
    
	
195.
    	
 
    	
RCG Martin, LLC
    	
 
    	
Delaware
    
	
196.
    	
 
    	
RCG Memphis East, LLC
    	
 
    	
Delaware
    
	
197.
    	
 
    	
RCG Mississippi, Inc.
    	
 
    	
Delaware
    
	
198.
    	
 
    	
RCG Pensacola, LLC
    	
 
    	
Delaware
    
	
199.
    	
 
    	
RCG Robstown, LLP
    	
 
    	
Delaware
    
	
200.
    	
 
    	
RCG University Division, Inc.
    	
 
    	
Tennessee
    
	
201.
    	
 
    	
Renal Care Group, Inc.
    	
 
    	
Delaware
    
	
202.
    	
 
    	
Renal Care Group Alaska, Inc.
    	
 
    	
Alaska
    
	
203.
    	
 
    	
Renal Care Group East, Inc.
    	
 
    	
Pennsylvania
    
	
204.
    	
 
    	
Renal Care Group Maplewood, LLC
    	
 
    	
Delaware
    
	
205.
    	
 
    	
Renal Care Group Northwest, Inc.
    	
 
    	
Delaware
    

 

J-5

 

 

	
 
    	
 
    	
 
    	
 
    	
State of
    
	
 
    	
 
    	
Transferring Affiliate
    	
 
    	
Incorporation
    
	
206.
    	
 
    	
Renal Care Group of the Midwest, Inc.
    	
 
    	
Kansas
    
	
207.
    	
 
    	
Renal Care Group of the Ozarks, LLC
    	
 
    	
Delaware
    
	
208.
    	
 
    	
Renal Care Group of the Rockies, LLC
    	
 
    	
Delaware
    
	
209.
    	
 
    	
Renal Care Group of the South, Inc.
    	
 
    	
Delaware
    
	
210.
    	
 
    	
Renal Care Group of the Southeast, Inc.
    	
 
    	
Florida
    
	
211.
    	
 
    	
Renal Care Group South New Mexico, LLC
    	
 
    	
Delaware
    
	
212.
    	
 
    	
Renal Care Group Southwest Michigan, LLC
    	
 
    	
Delaware
    
	
213.
    	
 
    	
Renal Care Group Southwest, L.P.
    	
 
    	
Delaware
    
	
214.
    	
 
    	
Renal Care Group Terre Haute, LLC
    	
 
    	
Delaware
    
	
215.
    	
 
    	
Renal Care Group Texas, Inc.
    	
 
    	
Texas
    
	
216.
    	
 
    	
Renal Care Group Toledo, LLC
    	
 
    	
Delaware
    
	
217.
    	
 
    	
Renal Care Group-Harlingen, L.P.
    	
 
    	
Delaware
    
	
218.
    	
 
    	
RenalPartners, Inc.
    	
 
    	
Delaware
    
	
219.
    	
 
    	
Renex Dialysis Clinic of Bloomfield, Inc.
    	
 
    	
New Jersey
    
	
220.
    	
 
    	
Renex Dialysis Clinic of Bridgeton, Inc.
    	
 
    	
Missouri
    
	
221.
    	
 
    	
Renex Dialysis Clinic of Creve Coeur, Inc.
    	
 
    	
Missouri
    
	
222.
    	
 
    	
Renex Dialysis Clinic of Maplewood, Inc.
    	
 
    	
Missouri
    
	
223.
    	
 
    	
Renex Dialysis Clinic of Orange, Inc.
    	
 
    	
New Jersey
    
	
224.
    	
 
    	
Renex Dialysis Clinic of Pittsburgh, Inc.
    	
 
    	
Pennsylvania
    
	
225.
    	
 
    	
Renex Dialysis Clinic of South Georgia, Inc.
    	
 
    	
Georgia
    
	
226.
    	
 
    	
Renex Dialysis Clinic of St. Louis, Inc.
    	
 
    	
Missouri
    
	
227.
    	
 
    	
Renex Dialysis Clinic of Tampa, Inc.
    	
 
    	
Florida
    
	
228.
    	
 
    	
Renex Dialysis Clinic of University City, Inc.
    	
 
    	
Missouri
    
	
229.
    	
 
    	
Renex Dialysis Facilities, Inc.
    	
 
    	
Mississippi
    
	
230.
    	
 
    	
Saint Louis Renal Care, LLC
    	
 
    	
Delaware
    
	
231.
    	
 
    	
San Diego Dialysis Services, Inc.
    	
 
    	
Delaware
    
	
232.
    	
 
    	
Santa Barbara Community Dialysis Center, Inc.
    	
 
    	
California
    
	
233.
    	
 
    	
Smyrna Dialysis Center, LLC
    	
 
    	
Georgia
    
	
234.
    	
 
    	
SSKG, Inc.
    	
 
    	
Illinois
    
	
235.
    	
 
    	
St. Louis Regional Dialysis Center, Inc.
    	
 
    	
Missouri
    
	
236.
    	
 
    	
STAT Dialysis Corporation
    	
 
    	
Delaware
    
	
237.
    	
 
    	
Stone Mountain Dialysis Center, LLC
    	
 
    	
Georgia
    
	
238.
    	
 
    	
Stuttgart Dialysis, LLC
    	
 
    	
Arkansas
    
	
239.
    	
 
    	
Tappahannock Dialysis Center, Inc.
    	
 
    	
Virginia
    
	
240.
    	
 
    	
Terrell Dialysis Center, L.L.C.
    	
 
    	
Delaware
    
	
241.
    	
 
    	
Warrenton Dialysis Facility, Inc.
    	
 
    	
Virginia
    
	
242.
    	
 
    	
West End Dialysis Center, Inc.
    	
 
    	
Virginia
    
	
243.
    	
 
    	
WSKC Dialysis Services, Inc.
    	
 
    	
Illinois
    

 

J-6

 

3.1(i) Place of Business: For each Transferring Affiliate, the principal place of business, chief executive office, and the offices where each Transferring Affiliate keeps substantially all its Records is 920 Winter Street, Waltham, MA 02451 and such other locations listed in Exhibit G.

 

 

	
3.1(k)(iv)
    	
 
    	
Tradenames:
    	
 
    	
Renal Care Group
    	
 
    	
Fresenius Renal Technologies
    
	
 
    	
 
    	
 
    	
 
    	
National   Nephrology Associates
    	
 
    	
Fresenius Renal   Therapies
    
	
 
    	
 
    	
 
    	
 
    	
TruBlu   Logistics (FUSA Mfg)
    	
 
    	
Fresenius Kidney Care
    
	
 
    	
 
    	
 
    	
 
    	
Fresenius   Renal Pharmaceuticals
    	
 
    	
Fresenius USA
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    	
 
    
	
 
    	
 
    	
Merger:
    	
 
    	
On September 25,   2018, Mercy Dialysis Center, Inc. merged into Bio-Medical Applications   of Wisconsin, Inc.
    

 

J-7Exhibit 4.18

 

FOURTH AMENDED AND RESTATED LOAN NOTE

 

	
€600,000,000
    	
March   10, 2020
    

 

FOR VALUE RECEIVED, Fresenius Medical Care AG & Co. KGaA, a German partnership limited by shares, and Fresenius Medical Care Holdings, Inc., a New York corporation (collectively, the “Borrowers”), jointly and severally promise to pay to the order of Fresenius SE & Co. KGaA, a German partnership limited by shares, or its specified subsidiary (the “Lender”) the lesser of (i) the principal amount of €600,000,000 (Six Hundred Million Euros) (or the Euro equivalent of any amount denominated in any other currency as determined by Lender based on the spot rate as reasonably selected by Lender), or (ii) the unpaid principal amount of all Advances (as defined in Clause 2) made by the Lender to the Borrowers hereunder, together with interest accrued thereon at the rate set forth below, on the date specified for repayment of such Advance pursuant to Clause 3 hereof or such earlier date as such amounts may become payable pursuant to the terms hereof.

 

1.                                      The following terms used in this Note shall have the following meanings:

 

“FMC Credit Agreement” means the Credit Agreement dated as of October 30, 2012 among FMC and FMCH, as borrowers and guarantors, the other borrowers and guarantors party thereto, the lenders party thereto, Bank of America, N.A., as Administrative Agent, as amended pursuant to Amendment No. 2 thereto, dated as of July 11, 2017, and as it may be further amended, restated, supplemented, or otherwise modified, or renewed, refunded, replaced, or refinanced from time to time.

 

“FMC” means Fresenius Medical Care AG & Co. KGaA, a German partnership limited by shares, and its successors and permitted assigns.

 

“FMCH” means Fresenius Medical Care Holdings, Inc., a New York corporation, and its successors and permitted assigns.

 

All other capitalized terms used but not otherwise defined herein shall bear the meanings assigned thereto in the FMC Credit Agreement. This Note amends and restates and supersedes the Third Amended and Restated Loan Note dated as of July 31, 2019 (the “Third Amended and Restated Note”) in the original principal amount of €600,000,000 issued by the Borrowers to Lender.

 

2.                                      The Lender may lend (but shall not have any commitment to lend) one or more advances (each an “Advance”) to the Borrowers jointly and severally from time to time upon request during the period from the date hereof to but excluding July 31, 2022 in an aggregate amount which shall not exceed €600,000,000 (or the Euro equivalent of any amount denominated in any other currency as determined by Lender at the time of making any Advance hereunder based on the spot rate as reasonably selected by Lender at that

 

 

time). Amounts borrowed hereunder may be repaid and reborrowed pursuant to this Clause. The Lender shall have no obligation to make any Advance requested hereunder. The Borrowers and Lender hereby agree that all advances made under the Second Amended and Restated Note and outstanding on the date hereof shall be deemed Advances made under this Note and subject to the terms hereof.

 

3.                                      Each Advance shall be repaid in full on the date that is one, two or three months after the date on which it is made, as agreed by the Borrowers and the Lender on the date such Advance is made, or any other period agreed between the Borrowers and the Lender; provided, that if no maturity date is so agreed, such Advance shall have a term of one month. The Borrower shall have the right at any time and from time to time to prepay any Advance in whole or part without penalty; provided that any such prepayment shall be accompanied by interest in the amount of the Advance being prepaid to the date of prepayment. In addition, upon demand, the Borrowers shall promptly compensate the Lender and hold the Lender harmless from any loss, cost or expense incurred by it as a result of any prepayment of any Advance other than on the last day of the Interest Period for such Advance, including any foreign exchange losses and any loss or expense arising from the liquidation or reemployment of funds obtained by it to maintain such Advance.

 

4.                                      Borrowers and Lender hereby agree that with effect from the date hereof, the unpaid principal amount of each Advance made hereunder shall bear interest at a fluctuating rate per annum equal to the Fixed LIBOR Rate (as defined in and calculated pursuant to the FMC Credit Agreement) for an Interest Period equivalent to the term of such Advance plus a margin, determined pursuant to the pricing matrix set forth below, that is based on the Consolidated Leverage Ratio (as defined in and calculated pursuant to the FMC Credit Agreement) and the corresponding Pricing Level then in effect under the definition of Applicable Percentage (as defined in the FMC Credit Agreement), and shall change as and when the Applicable Percentage (as calculated pursuant to the FMC Credit Agreement) changes:

 

	
Pricing Level in effect under the FMC
   Credit Agreement
    	
 
    	
Margin
    
	
I
    	
 
    	
1.185%
    
	
II
    	
 
    	
1.110%
    
	
III
    	
 
    	
1.010%
    
	
IV
    	
 
    	
0.930%
    
	
V
    	
 
    	
0.825%
    

 

Interest shall be payable in arrears upon maturity, on any prepayment and on any acceleration of the principal amount hereof and shall be computed on the basis of a 360-day year for the actual number of days elapsed (including the first day and excluding the last day).

 

2

 

5.                                      Whenever any payment on this Note shall be stated to be due on a day which is not a Business Day or is a day on which commercial banks are authorized or required by law to close in the Federal Republic of Germany, such payment shall be made on the next succeeding Business Day on which commercial banks are not authorized or required by law to close in the Federal Republic of Germany, and such extension of time shall be included in the computation of the payment of interest on this Note.

 

6.                                      All payments of principal and interest in respect of this Note shall be made in same day funds in the currency in which the related Advance was made to the Lender’s account as notified in writing by the Lender.

 

7.                                      If any proceeding under any Debtor Relief Law shall be commenced by or against the Borrowers, all amounts of principal and accrued interest outstanding under this Note shall become immediately due and payable.

 

8.                                      The Lender agrees, by its acceptance hereof, that before disposing of this Note or any part hereof it will make a notation hereon of all Advances, the maturity date of each such Advance and principal payments previously made hereunder and of the date to which interest hereon has been paid; provided, however, that the failure to make a notation of any Advance or any payment made on this Note (including Advances made under the Second Amended and Restated Note and deemed Advances hereunder) shall not limit or otherwise affect the obligation of the Borrowers hereunder with respect to payments of principal or interest on this Note.

 

9.                                      Any Borrower may cease to be a Borrower hereunder by delivering a written notice to the Lender, effective on the later to occur of (i) the date the Lender receives such written notice and (ii) the date such Borrower has paid all of its obligations and all accrued and unpaid interest, fees and other obligations hereunder or in connection herewith.

 

10.                               [Reserved]

 

11.          THIS NOTE AND THE OBLIGATIONS OF THE BORROWERS ARISING HEREUNDER AND ALL OTHER ASPECTS HEREOF SHALL BE DEEMED TO BE MADE UNDER, SHALL BE GOVERNED BY, AND SHALL BE CONSTRUED AND ENFORCED IN ACCORDANCE WITH THE LAWS OF NEW YORK WITHOUT REGARD TO CONFLICTS OF LAWS PRINCIPLES.

 

12.                               The obligations of the Borrowers arising under this Note may be prepaid in whole or in part, together with all accrued interest thereon, without penalty or premium.

 

13.                               The terms of this Note are subject to amendment only by a writing signed by the Borrowers and the Lender.

 

14.                               In no event shall any interest be payable under this Note to the extent that the payment thereof would be prohibited by applicable law.

 

15.                               The Borrowers hereby waive diligence, presentment, protest, demand and notice of every kind and, to the full extent permitted by law, the right to plead any statute

 

3

 

of limitations as a defense to any demand hereunder.

 

16.                               No delay on the part of the Lender in the exercise of any right or remedy shall operate as a waiver thereof, and no single or partial exercise by the Lender, of any right or remedy shall preclude any other or further exercise of any other right or remedy.

 

17.                               In case any provision in or obligation under this Note shall be invalid, illegal or unenforceable in any jurisdiction, the validity, legality and enforceability of the remaining provisions or obligations, or of such provision or obligation in any other jurisdiction, shall not in any way be affected or impaired thereby.

 

[INTENTIONALLY LEFT BLANK]

 

4

 

IN WITNESS WHEREOF, this Note has been executed as of the day and year first written above.

 

BORROWERS:

 

	
 
    	
FRESENIUS MEDICAL CARE AG & Co. 
   KGaA, a German partnership limited by 
   shares, represented by FRESENIUS 
   MEDICAL CARE MANAGEMENT AG, 
   a German corporation, its general partner
    
	
 
    	
 
    
	
 
    	
 
    
	
 
    	
By:
    	
/s/ Helen Giza
    
	
 
    	
Name:
    	
Helen Giza
    
	
 
    	
Title:
    	
Member of the Management Board
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
/s/ Dr. Katarzyna Mazur-Hofsäß
    
	
 
    	
Name:
    	
Dr. Katarzyna Mazur-Hofsäß
    
	
 
    	
Title:
    	
Member of the Management Board
    

 

5

 

FRESENIUS MEDICAL CARE HOLDINGS, INC., a New York corporation

 

 

	
 
    	
By:
    	
/s/ Mark Fawcett
    
	
 
    	
Name:
    	
Mark Fawcett
    
	
 
    	
Title:
    	
Senior Vice President and Treasurer
    

 

[Signature Page -Loan Note]

 

 

ACKNOWLEDGED AND AGREED:

 

	
 
    	
FRESENIUS SE & Co. KGaA,   represented 
   by FRESENIUS MANAGEMENT SE, its 
   general partner, as Lender
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
 
    
	
 
    	
Name:
    	
 
    
	
 
    	
Title:
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
 
    	
 
    
	
 
    	
By:
    	
 
    
	
 
    	
Name:
    	
 
    
	
 
    	
Title:
    	
 
    

 

[Signature Page -Loan Note]

 

 

 

TRANSACTIONS ON PROMISSORY NOTE

 

	
Date
    	
 
    	
Amount of
   Advance Made
   This Date
    	
 
    	
Maturity Date
   of Such
   Advance
    	
 
    	
Amount of
   Principal Paid
   This Date
    	
 
    	
Amount of
   Interest Paid
   This Date
    	
 
    	
Outstanding
   Principal
   Balance This
   Date
    	
 
    	
Notation Made
   By

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