Document:

EX-10.1

 Exhibit 10.1 
 Execution Version 
 FIFTH AMENDMENT TO REVOLVING CREDIT AGREEMENT

 THIS FIFTH AMENDMENT TO REVOLVING CREDIT AGREEMENT is dated as of November 7, 2012 (this
“Amendment”) by and among AMSURG CORP., a Tennessee corporation (the “Borrower”), each of the “Lenders” party to the Credit Agreement defined below (the “Lenders”) and SUNTRUST BANK, in
its capacity as administrative agent for the Lenders (the “Administrative Agent”). 
 WHEREAS, the Borrower,
the Lenders and the Administrative Agent are parties to that certain Revolving Credit Agreement dated as of May 28, 2010, as amended from time to time prior to the date hereof, among the Borrower, the Lenders party thereto and the
Administrative Agent (as so amended, the “Credit Agreement”; capitalized terms used herein and not otherwise defined herein shall have the respective definitions given them in the Credit Agreement); 

WHEREAS, the Borrower, the Lenders and the Administrative Agent desire to amend or otherwise modify certain terms and provisions of the
Credit Agreement on the terms and conditions more particularly set forth below. 
 NOW, THEREFORE, for good and valuable
consideration, the receipt and sufficiency of which are hereby acknowledged by the parties hereto, the parties hereto hereby agree as follows: 
 Section 1. Specific Amendments. 
 (a) Section 1.1. of the Credit
Agreement is hereby amended by deleting the following terms “Permitted Subordinated Debt” and “Subordinated Debt Documents” in their entirety. 
 (b) Section 1.1. of the Credit Agreement is hereby further amended by deleting the terms “Debt Issuance” and “Pro Forma Basis” and substituting in lieu thereof the following:

 “Debt Issuance” shall mean Indebtedness of Borrower or any consolidated Subsidiary in the
form of one or more series of senior notes or loans or senior subordinated notes or loans (in any case, whether secured or unsecured) issued on or after the Fifth Amendment Effective Date, including, but not limited to, the Permitted Debt.”

 “Pro Forma Basis” shall mean, in connection with any calculation of compliance with any
financial covenant in Article VI hereof or the Secured Leverage Ratio, the calculation thereof after giving effect on a pro forma basis to (x) the incurrence or repayment of any Indebtedness as if such Indebtedness had been incurred or
repaid on the first day of the Four-Quarter Period and (y) the making of any Restricted Payment or any Investment by the Borrower or a Subsidiary, if any, as if such Restricted Payment or Investment had been made on the first day of the
Four-Quarter Period; provided, that, in the case of Section 2.23, the entire Additional Commitment Amount being requested shall be deemed to be Indebtedness that is outstanding and will remain outstanding through the
relevant Four-Quarter Period. 

 (c) Section 1.1. of the Credit Agreement is hereby further amended by adding the
following new definitions in the appropriate alphabetical order: 
 “Consolidated Secured Debt”
shall mean, as of any date of determination, all Consolidated Total Debt that is secured by a Lien on any assets (including Equity Interests) of the Borrower or any of its Subsidiaries. 

“Fifth Amendment” shall mean that certain Fifth Amendment to Revolving Credit Agreement dated as of
November 7, 2012 by and among the Borrower, the Lenders party thereto and the Administrative Agent. 

“Fifth Amendment Effective Date” shall mean the date on which all of the conditions set forth in
Section 2 of the Fifth Amendment have been satisfied. 
 “Permitted Debt” shall mean
Permitted Ratio Debt, Permitted Senior Secured Debt and the Permitted Senior Unsecured Notes. 

“Permitted Debt Disclosure Documents” shall mean the Permitted Ratio Debt Disclosure Documents, the
Permitted Senior Secured Debt Disclosure Documents and the Permitted Senior Unsecured Note Disclosure Documents. 

“Permitted Debt Documents” shall mean the Permitted Ratio Debt Documents, the Permitted Senior Secured
Debt Documents and the Permitted Senior Unsecured Note Documents. 
 “Permitted Ratio Debt”
shall mean any unsecured Indebtedness of the Borrower (and, to the extent permitted by clause (f) immediately below, Subsidiaries of the Borrower): (i) in the form of one or more series of senior unsecured notes or loans or
(ii) expressly subordinated to the Obligations on terms satisfactory to the Administrative Agent in its sole discretion; provided that (a) such Indebtedness will not mature prior to the date that is 180 days after the Maturity Date,
(b) such Indebtedness has no scheduled amortization or scheduled payments of principal and is not subject to mandatory redemption, repurchase, prepayment or sinking fund obligation (other than customary offers to repurchase upon a change of
control, asset sale event and customary acceleration rights after an event of default) prior to the date that is 180 days after the Maturity Date, (c) immediately prior to and after giving effect to the incurrence of such Indebtedness, no
Default or Event of Default shall have occurred and be continuing, (d) immediately after giving effect thereto and to the use of the proceeds thereof, the Leverage Ratio, calculated on a Pro Forma Basis, would not exceed 3.50 to 1.00 as
of the most recently ended Fiscal Quarter for which financial statements have been delivered pursuant to Section 5.1, (e) the covenants, defaults, remedies and other terms of such Indebtedness are customary for similar Indebtedness
in light of then-prevailing market conditions and in any event, when taken as a whole (other than interest rate and redemption premiums), 

  
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are not more restrictive to the Loan Parties than those set forth in this Agreement (in each case, as reasonably determined by the Administrative Agent), (f) such Indebtedness is not
guaranteed by any Subsidiary of the Borrower that is not a party to the Subsidiary Guaranty Agreement, and (g) such Indebtedness is not secured by any Lien on any property or assets of the Borrower or any of its Subsidiaries. 

“Permitted Ratio Debt Disclosure Document” shall mean, if applicable, the information or offering
memorandum distributed in connection with the offering of the Permitted Ratio Debt. 
 “Permitted Ratio
Debt Document” shall mean, if applicable, (i) each of the notes evidencing the Permitted Ratio Debt, (ii) the indenture, note purchase agreement, securities purchase agreement, loan agreement or similar agreement pursuant to which
the Permitted Ratio Debt is issued or sold, (iii) any subordination agreement subordinating the Permitted Ratio Debt, and (iv) any other agreement, certificate, power of attorney or document related to any of the foregoing. 

“Permitted Refinancing” shall mean, with respect to any Person, any modification, refinancing,
replacement, refunding, renewal or extension of any Indebtedness of such Person; provided that (a) the principal amount (or accreted value, if applicable) thereof does not exceed the principal amount (or accreted value, if applicable) of
the Indebtedness so modified, refinanced, replaced, refunded, renewed or extended except by an amount equal to unpaid accrued interest, fees, expenses and premium thereon, (b) the Indebtedness resulting from any such modification, refinancing,
replacement, refunding, renewal or extension has (i) a final stated maturity date equal to or later than the date that is final stated maturity date of, and (ii) a Weighted Average Life to Maturity equal to or greater than the Weighted
Average Life to Maturity of, the Indebtedness being modified, refinanced, replaced, refunded, renewed, or extended (calculated at the time of the incurrence of such Indebtedness), (c) immediately prior to and after giving effect to the
incurrence of such modification, refinancing, replacement, refunding, renewal or extension, no Default or Event of Default shall have occurred and be continuing, (d) such modification, refinancing, replacement, refunding, renewal or extension
does not add guarantors or security from that which applied to such Indebtedness being modified, refinanced, replaced, refunded, renewed or extended, (e) to the extent such Indebtedness being modified, refinanced, replaced, refunded, renewed or
extended is subordinated in right of payment to the Obligations, such modification, refinancing, replacement, refunding, renewal or extension is subordinated in right of payment to the Obligations on terms (taken as a whole) that are at least as
favorable to the Lenders as those contained in the documentation governing the Indebtedness being modified, refinanced, replaced, refunded, renewed or extended (as reasonably determined by the Administrative Agent), (f) such modification,
refinancing, replacement, refunding, renewal or extension is incurred by the same Person or Persons who 

  
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are the obligors of the Indebtedness being modified, refinanced, replaced, refunded, renewed or extended and (g) the covenants, defaults, remedies and other terms of such modification,
refinancing, replacement, refunding, renewal or extension of such Indebtedness are customary for similar modifications, refinancings, replacements, refundings, renewals or extensions of such Indebtedness in light of then-prevailing market conditions
and in any event, when taken as a whole, are not more restrictive to the Loan Parties than those contained in the documentation governing such Indebtedness being modified, refinanced, replaced, refunded, renewed or extended (as reasonably determined
by the Administrative Agent). 
 “Permitted Senior Secured Debt” shall mean any secured
Indebtedness of the Borrower (and, to the extent permitted by clause (v) immediately below, Subsidiaries of the Borrower) in the form of one or more series of senior secured notes or loans; provided that (i) such Indebtedness is
secured by the Collateral on a pari passu basis (but without regard to the control of remedies) with the Obligations and is not secured by any property or assets of the Borrower or any of its Subsidiaries other than the Collateral, (ii) the
security documents relating to such Indebtedness are substantially the same as the Security Documents (with such differences as are reasonably satisfactory to the Administrative Agent), (iii) such Indebtedness will not mature prior to the date
that is 180 days after the Maturity Date, (iv) the amortization of any such Indebtedness shall not exceed ten percent (10%) of the original principal balance of such Indebtedness (at the time of issuance) in any year, (v) such
Indebtedness is not guaranteed by any Subsidiary of the Borrower that is not a party to the Subsidiary Guaranty Agreement, (vi) the covenants, defaults, remedies and other terms of such Indebtedness are customary for similar Indebtedness in
light of then-prevailing market conditions and in any event, when taken as a whole, are not more restrictive to the Loan Parties than those set forth in this Agreement (in each case, as reasonably determined by the Administrative Agent),
(vii) immediately prior to and after giving effect to the incurrence of such Indebtedness, no Default or Event of Default shall have occurred and be continuing, (viii) immediately after giving effect thereto and to the use of the proceeds
thereof, the Secured Leverage Ratio on a Pro Forma Basis would not exceed 2.75 to 1.00 as of the most recently ended Fiscal Quarter for which financial statements have been delivered pursuant to Section 5.1, and (ix) the
holders of such Indebtedness (or their representative) become a party to the Intercreditor Agreement, on terms and conditions, and with such changes, as shall be satisfactory to the Administrative Agent, and all necessary consents from the parties
to the Intercreditor Agreement shall have been obtained. 
 “Permitted Senior Secured Debt Disclosure
Document” shall mean, if applicable, the information or offering memorandum distributed in connection with the offering of the Permitted Senior Secured Debt. 

  
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 “Permitted Senior Secured Debt Document” shall mean, if
applicable, (i) each of the notes evidencing the Permitted Senior Secured Debt, (ii) the indenture, note purchase agreement, securities purchase agreement, loan agreement or similar agreement pursuant to which the Permitted Senior Secured
Debt is issued or sold, (iii) any security documents related to the Permitted Senior Secured Debt, and (iv) any other agreement, certificate, power of attorney or document related to any of the foregoing. 

“Permitted Senior Unsecured Notes” shall mean unsecured notes issued by the Borrower (and Guarantees
thereof by Subsidiaries of the Borrower who are party to the Subsidiary Guaranty Agreement) on or before December 31, 2012 in an aggregate principal amount not to exceed $275,000,000; provided that (i) such Indebtedness will not
mature prior to the date that is 180 days after the Maturity Date, (ii) such Indebtedness has no scheduled amortization or scheduled payments of principal and is not subject to mandatory redemption, repurchase, prepayment or sinking fund
obligation (other than customary offers to repurchase upon a change of control, asset sale event and customary acceleration rights after an event of default) prior to the date that is 180 days after the Maturity Date, (iii) immediately prior to
and after giving effect to the incurrence of such Indebtedness, no Default or Event of Default shall have occurred and be continuing, (iv) such Indebtedness is not guaranteed by any Subsidiary of the Borrower that is not a party to the
Subsidiary Guaranty Agreement and (v) such Indebtedness is not secured by any Lien on any property or assets of the Borrower or any of its Subsidiaries. 
 “Permitted Senior Unsecured Note Disclosure Document” shall mean, if applicable, the information or offering memorandum distributed in connection with the offering of the Permitted Senior
Unsecured Notes. 
 “Permitted Senior Unsecured Note Document” shall mean (i) each of the
notes evidencing the Permitted Senior Unsecured Notes, (ii) the indenture, note purchase agreement, securities purchase agreement, loan agreement or similar agreement pursuant to which the Permitted Senior Unsecured Notes are issued or sold and
(iii) and any other agreement, certificate, power of attorney or document related to any of the foregoing. 

“Secured Leverage Ratio” shall mean, as of any date of determination, the ratio of (i) Consolidated
Secured Debt to (ii) EBITDA for the Four-Quarter Period at the time of determination. 
 (d) Section 5.1. of the
Credit Agreement is hereby amended by re-designating clause (i) thereof as clause (j), re-designating clause (j) thereof as clause (k) and adding the following new clause (i) thereto: 

“(i) promptly after the sending or filing thereof, copies of all notices, certificates and reports delivered pursuant
to any Permitted Debt Document;” 

  
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 (e) Section 6.1. of the Credit Agreement is hereby amended by deleting such Section in
its entirety and substituting in lieu thereof the following: 
 “Section 6.1. Leverage Ratio.

 The Borrower shall maintain, on a consolidated basis and as calculated at the end of each Fiscal Quarter,
a Leverage Ratio of not greater than 3.75 to 1.00.” 
 (f) Section 7.1. of the Credit Agreement is hereby
amended by deleting such Section in its entirety and substituting in lieu thereof the following: 
 “Section 7.1.
Indebtedness. 
 The Borrower will not, and will not permit any of its Subsidiaries to,
create, incur, assume or suffer to exist any Indebtedness, except: 
 (a) Indebtedness arising under the Loan
Documents; 
 (b) Indebtedness of the Borrower and its Subsidiaries existing on the date hereof and extensions,
renewals and replacements of any such Indebtedness that do not increase the outstanding principal amount thereof (immediately prior to giving effect to such extension, renewal or replacement) or shorten the maturity or the weighted average life
thereof (all Indebtedness existing on the date hereof with a principal or committed amount outstanding equal to or greater than $250,000 is set forth on Schedule 7.1 attached hereto); 

(c) Intercompany Loans not to exceed in the aggregate at any time outstanding an amount equal to forty percent
(40%) of the sum of EBITDA for the relevant Four-Quarter Period, plus expense attributed to noncontrolling interests as identified as the line item “noncontrolling interests” on Borrower’s Consolidated Statements of Earnings;

 (d) Indebtedness in respect of Hedging Obligations permitted by Section 7.10; 

(e) Private Placement Indebtedness, including refundings, refinancings and replacements thereof, and amendments or
modifications to the Private Placement Documents; provided, however, that the aggregate principal amount of such Private Placement Indebtedness shall not at any time exceed $125,000,000 and all Guarantees thereof by Subsidiaries of the
Borrower that have also guaranteed the Obligations; provided, further, that, Private Placement Indebtedness resulting from any such refunding, refinancing, replacement, amendment and/or modification, or any permitted increase in the principal amount
thereof, shall have (i) a final maturity date equal to or later than the date that is six (6) months after the Maturity Date and (ii) a Weighted 

  
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Average Life to Maturity equal to or greater than the Weighted Average Life to Maturity of the Private Placement Indebtedness determined on and as of the Fourth Amendment Effective Date;

 (f) Indebtedness in respect of the Permitted Senior Unsecured Notes and any Permitted Refinancing thereof;

 (g) Permitted Ratio Debt and any Permitted Refinancing thereof; 

(h) Permitted Senior Secured Debt and any Permitted Refinancing thereof; and 

(i) Indebtedness that does not exceed the Debt Basket Amount at any time of determination, inclusive of all amounts
referenced in Section 7.1(b) above, but specifically excluding all amounts referred in Sections 7.1(a), Section 7.1(c), Section 7.1(d), Section 7.1(e), Section 7.1(f),
Section 7.1(g) and Section 7.1(h) above. 
 The Borrower will not, and will not permit any Subsidiary to,
issue any preferred stock or any other preferred equity interest that (i) matures or is mandatorily redeemable pursuant to a sinking fund obligation or otherwise, (ii) is or may become redeemable or repurchaseable by the Borrower or such
Subsidiary at the option of the holder thereof, in whole or in part or (iii) is convertible or exchangeable at the option of the holder thereof for Indebtedness or preferred stock or any other preferred equity interest described in this
paragraph, on or prior to, in the case of clause (i), (ii) or (iii), the first anniversary of the Maturity Date.” 

(g) Section 7.2. of the Credit Agreement is hereby amended by deleting such Section in its entirety and substituting in lieu thereof
the following: 
 “Section 7.2. Negative Pledge. 

The Borrower will not, and will not permit any of its Subsidiaries to, create, incur, assume or suffer to exist any Lien
on any of its assets or property now owned or hereafter acquired, except for the following (collectively, “Permitted Liens”): 
 (a) Liens securing the Obligations and Liens in favor of the Collateral Agent pursuant to the Security Documents securing the “Obligations” (under and as defined in the Note Purchase Agreement
as in effect on the date hereof) pari passu (and pursuant to the Intercreditor Agreement) with the Obligations; 

(b) Permitted Encumbrances; 
 (c) any Liens on any property or asset of the Borrower or any Subsidiary existing on the Closing Date set forth on Schedule 7.2; provided that (i) such Lien shall not apply to any other
property or asset of the Borrower or any Subsidiary and (ii) only Liens securing Indebtedness or other obligations in excess of $250,000 as of the Closing Date are required to be disclosed on Schedule 7.2; 

  
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 (d) Liens securing Permitted Senior Secured Debt; 

(e) Liens securing the Indebtedness permitted under Section 7.1(c) and/or Section 7.1(i) above;
provided that such Liens shall not encumber any of the Collateral; and 
 (f) extensions, renewals, or
replacements of any Lien referred to in paragraphs (a) through (e) of this Section; provided that the principal amount of the Indebtedness secured thereby is not increased and that any such extension, renewal or replacement is
limited to the assets originally encumbered thereby.” 
 (h) Section 7.8. of the Credit Agreement is hereby amended by
deleting such Section in its entirety and substituting in lieu thereof the following: 
 “Section 7.8. Restrictive
Agreements. 
 The Borrower will not, and will not permit any Subsidiary to, directly or
indirectly, enter into, incur or permit to exist any agreement that prohibits, restricts or imposes any condition upon (a) except for restrictions in certain limited partnership agreements on the ability of a partner to transfer partnership
interests for the Subsidiaries set forth on Schedule 7.8, the ability of the Borrower or any Subsidiary to create, incur or permit any Lien upon any of its assets or properties, whether now owned or hereafter acquired, or (b) the ability
of any Subsidiary to pay dividends or other distributions with respect to its Capital Stock, to make or repay loans or advances to the Borrower or any other Subsidiary, to Guarantee Indebtedness of the Borrower or any other Subsidiary or to
transfer any of its property or assets to the Borrower or any Subsidiary of the Borrower; provided, that (i) the foregoing shall not apply to restrictions or conditions imposed by law or by this Agreement, any other Loan
Document, the Private Placement Documents or the Permitted Debt Documents so long as any such Permitted Debt Documents do not restrict the ability of the Borrower or any of its Subsidiaries to create, incur or permit to exist any Lien upon any
assets of the Borrower or its Subsidiaries to secure the Obligations (other than (x) restrictions in the Permitted Senior Unsecured Note Documents related to the maximum amount of the Obligations that may be secured by Liens and
(y) restrictions on the maximum amount of the Obligations that may be secured by Liens in any other Permitted Debt Document so long as such restrictions are no more restrictive than those set forth in the Permitted Senior Unsecured Note
Documents), (ii) the foregoing shall not apply to customary restrictions and conditions contained in agreements relating to the sale of a Subsidiary pending such sale, provided such restrictions and conditions apply only to the Subsidiary that
is sold and such sale is permitted hereunder, (iii) clause (a) shall not apply to restrictions or conditions imposed by any agreement relating to secured 

  
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Indebtedness permitted by this Agreement if such restrictions and conditions apply only to the property or assets securing such Indebtedness and (iv) clause (a) shall not apply to
customary provisions in leases restricting the assignment thereof.” 
 (i) Section 7.11. of the Credit Agreement is
hereby amended by adding the following new clause (c) thereto: 
 “(c) Without limiting clause
(a) of this Section 7.11, the Borrower shall not, and shall not permit any Subsidiary to, change or amend the terms of any Permitted Debt or any Permitted Debt Documents if the effect of such amendment is to (i) increase the
interest rate thereon, (ii) change the dates upon which payments of principal or interest are due on such Permitted Debt other than to extend such dates, (iii) change any default or event of default other than to delete or make less
restrictive any default provision therein, (iv) change any covenant with respect to such Permitted Debt in any manner materially adverse to the Borrower, any of its Subsidiaries or the Lenders, (v) change the redemption or prepayment
provisions of such Permitted Debt other than to extend the dates thereof or to reduce the amount of any such redemption or prepayment or the premiums payable in connection therewith, (vi) change or amend any other term if such change or
amendment would materially increase the obligations of the obligor or confer additional material rights on the holder of such Permitted Debt in a manner adverse to the Borrower, any of its Subsidiaries or the Lenders or (vii) add any
restrictions, directly or indirectly, on the right or ability of (a) any Loan Party to make Restricted Payments or (b) of any Loan Party to create or suffer to exist any Liens securing any of the Obligations.” 

(j) Section 7.17. of the Credit Agreement is hereby amended by deleting such Section in its entirety and substituting in lieu
thereof the following: 
 “Section 7.17. [Intentionally Omitted].” 

(k) Article VII of the Credit Agreement is hereby amended by adding the following new Section 7.19.: 

“Section 7.19. Prepayment of Permitted Debt. 

The Borrower shall not, and shall not permit any of its Subsidiaries to, prepay, redeem, purchase, defease or otherwise
satisfy all or any portion of any Permitted Ratio Debt or the Permitted Senior Unsecured Notes prior to the scheduled maturity thereof; provided, however, that any Loan Party may (A) make regularly scheduled or otherwise required
repayments or redemptions of any Permitted Ratio Debt or the Permitted Senior Unsecured Notes in accordance with the terms of the respective Permitted Debt Documents (it being understood that payments when due of regularly scheduled interest shall
be permitted); and (B) refinance and refund any Permitted Ratio Debt or the Permitted Senior 

  
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Unsecured Notes, as long as such refinancing or refunding is a Permitted Refinancing; provided that, neither the Borrower nor any Subsidiary of the Borrower shall make (or give any notice
in respect of) any prepayment or redemption in respect of any Permitted Ratio Debt or the Permitted Senior Unsecured Notes as a result of any change of control, asset sale or similar event under the respective Permitted Debt Documents if a Default
or Event of Default shall exist at such time or would result therefrom after giving effect to any such prepayment or redemption on a pro forma basis.” 
 (l) Section 8.1. of the Credit Agreement is hereby amended by deleting clause (s) thereto in its entirety and substituting in lieu thereof the following new clause (s): 

“(s) any default or event of default (after giving effect to any grace period) shall have occurred and be continuing
under any Permitted Ratio Debt Documents to the extent the Permitted Ratio Debt evidenced thereby is (or is intended to be) subordinated to the Obligations (such Indebtedness, “Subordinated Debt”) or the validity or enforceability of the
subordination provisions thereof is disaffirmed by or on behalf of any lender or holder party thereto, or any Obligations fail for any reason to rank senior to such Subordinated Debt, or all or any part of such Subordinated Debt is accelerated, is
declared to be due and payable is required to be prepaid or redeemed, in each case prior to the stated maturity thereof;” 

(m) Section 10.3.(b) of the Credit Agreement is hereby amended by deleting clause (i) thereto in its entirety and substituting
in lieu thereof the following new clause (i): 
 “(i) the execution or delivery of this Agreement, any other Loan Document,
any Permitted Debt Document, Permitted Debt Disclosure Document or any agreement or instrument contemplated hereby or thereby, the performance by the parties hereto or thereto of their respective obligations hereunder or thereunder or the
consummation of the transactions contemplated hereby or thereby,” 
 Section 2. Conditions Precedent. The
effectiveness of this Amendment is subject to the truth and accuracy of the representations set forth in Section 3 below and receipt by the Administrative Agent of each of the following, each of which shall be in form and substance satisfactory
to Administrative Agent: 
 (i) This Amendment duly executed by the Borrower, the Required Lenders and the Administrative Agent;

 (ii) A Reaffirmation of Obligations Under Loan Documents (the “Reaffirmation”) duly executed by the Borrower
and each other Loan Party, in the form of Exhibit A attached hereto; 

  
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 (iii) A copy of each Permitted Senior Unsecured Note Document and the Permitted Senior
Unsecured Note Disclosure Document, in each case certified as being complete and correct by a Responsible Officer of the Borrower; 
 (iv) Evidence that, immediately after giving effect on a Pro Forma Basis to the incurrence of the Indebtedness evidenced by the Permitted Senior Unsecured Notes on the Fifth Amendment Effective Date
(after giving effect to the prepayment described in clause (v) immediately below), the Borrower shall have a Leverage Ratio of no greater than 3.75 to 1.00 as of the most recently ended Fiscal Quarter for which financial statements have
been delivered pursuant to Section 5.1 of the Credit Agreement; 
 (v) Evidence that the Net Debt Issuance Proceeds with
respect to the issuance of the Permitted Senior Unsecured Notes will be paid to the Administrative Agent for application to the Revolving Loans (and the Borrower hereby instructs the Administrative Agent to prepay the Revolving Loans with such
proceeds upon receipt); 
 (vi) An officer’s certificate, dated as of the Fifth Amendment Effective Date, signed by the
Secretary and a Responsible Officer of each Loan Party (together with certifications as to incumbency and signatures of such officers) with appropriate insertions and deletions, certifying that: (A) attached thereto are copies of resolutions
adopted by of the board of directors (or equivalent thereof) of the Borrower, approving the execution, delivery and performance of this Amendment and the other documents to be executed in connection herewith; (B) there have been no changes in
the articles of incorporation of the Borrower from those delivered in connection with the closing of the Credit Agreement; (C) no consents, approvals, authorizations, registrations, filings or orders are required to be made or obtained under
any Requirement of Law or Material Contract of any Loan Party in connection with the execution, delivery, performance, validity and enforceability of this Amendment and the Permitted Senior Unsecured Note Documents or any of the transactions
contemplated hereby or thereby, except those which have been made or obtained and are in full force and effect (with all applicable waiting periods, if any, having expired); and (D) no Default or Event of Default exists immediately before
giving effect to amendments provided for herein and no Default or Event of Default will result immediately after giving effect to amendments provided for herein; 
 (vii) A written opinion of Bass Berry & Sims PLC, counsel to the Borrower and the other Loan Parties, addressed to the Administrative Agent and the Lenders and covering such matters relating to
the Loan Parties, this Amendment, the Permitted Senior Unsecured Note Documents executed in connection herewith (which may include a reliance letter with respect to the opinions delivered in connection with the offering of the Permitted Senior
Unsecured Notes), and the transactions contemplated herein and therein as the Administrative Agent or the Required Lenders shall reasonably request, all in form and substance satisfactory to the Administrative Agent and its counsel; 

(viii) A duly executed copy of an amendment to the Note Purchase Agreement in form and substance satisfactory to the Administrative Agent
and its counsel; 

  
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 (ix) The payment of all amounts due and payable on or prior to the Fifth Amendment Effective
Date, including reimbursement or payment of all out-of-pocket expenses (including reasonable fees, charges and disbursements of counsel to the Administrative Agent) required to be reimbursed or paid by the Borrower hereunder or under any other
agreement with the Administrative Agent or SunTrust Robinson Humphrey, Inc., including, without limitation, those under Section 4 hereof; and 
 (x) Such other documents, instruments, agreements, certifications and opinions as the Administrative Agent, on behalf of the Lenders, may reasonably request. 

Section 3. Representations. The Borrower represents and warrants to the Administrative Agent and the Lenders that:

 (a) Authorization, etc. The execution, delivery and performance by each Loan Party of this Amendment and each Permitted
Senior Unsecured Note Document to which it is a party executed in connection herewith are within such Loan Party’s powers and have been duly authorized by all necessary action on the part of such Loan Party. Each of the Borrower and the other
Loan Parties have the right and power, and have taken all necessary action to authorize them, to execute and deliver this Amendment, the Reaffirmation and each Permitted Senior Unsecured Note Document to which it is a party executed in connection
herewith, and to perform their respective obligations hereunder and under the Credit Agreement, as amended by this Amendment, and the other Loan Documents to which they are a party in accordance with their respective terms. This Amendment, the
Reaffirmation and the Permitted Senior Unsecured Note Documents executed in connection herewith have been duly executed and delivered by each Loan Party a party thereto. The Credit Agreement, as amended hereby, and the Permitted Senior Unsecured
Note Documents executed in connection herewith each constitute the valid and binding obligations of the Loan Parties party thereto, enforceable against them in accordance with their respective terms, except as may be limited by applicable
bankruptcy, insolvency, reorganization, moratorium, or similar laws affecting the enforcement of creditors’ rights generally and by general principles of equity. 
 (b) Approvals and No Conflict. The execution and delivery by the Borrower and the other Loan Parties of this Amendment, the Reaffirmation and the Permitted Senior Unsecured Note Documents to which
they are a party executed in connection herewith, and the performance by the Borrower of this Amendment and the Credit Agreement, as amended by this Amendment, and the Permitted Senior Unsecured Note Documents executed in connection herewith in
accordance with their respective terms, do not and will not, by the passage of time, the giving of notice or otherwise: (i) require any consent or approval of, registration or filing with, or any action by, any Governmental Authority or any
other Person or violate any Requirements of Law applicable to the Loan Parties or any judgment, order or ruling of any Governmental Authority; (ii) violate or result in a default under any Material Contract binding on the Loan Parties or any of
their assets or give rise to a right thereunder to require any payment to be made by the Loan Parties; or (iii) result in the creation or imposition of any Lien on any asset of the Loan Parties. 

  
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 (c) Reaffirmation. As of the date of this Amendment and immediately after giving
effect to this Amendment, all representations and warranties of each Loan Party set forth in the Loan Documents is true and correct in all material respects (except to the extent that any such representation or warranty expressly relates to a
specified earlier date, in which case such representation or warranty shall be true and correct as of such earlier date). 
 (d)
No Default. As of the date hereof and immediately after giving effect to this Amendment, no Default or Event of Default shall exist. 
 (e) No Impairment of Liens. The execution, delivery, performance and effectiveness of this Amendment will not: (a) impair the validity, effectiveness or priority of the Liens granted pursuant
to any Loan Document, and such Liens continue unimpaired with the same priority to secure repayment of all of the applicable Obligations, whether heretofore or hereafter incurred, and (b) require that any new filings be made or other action
taken to perfect or to maintain the perfection of such Liens. 
 (f) No Material Adverse Effect. Since the date of the
most recent financial statements of the Borrower described in Section 5.1(a) of the Credit Agreement, there has been no change which has had or could reasonably be expected to have a Material Adverse Effect. 

(g) Loan Parties. Schedule 1 attached hereto sets forth a true, correct and complete list of all of the Loan Parties as of
the date hereof and the tax identification number of each Loan Party. 
 (h) Margin Regulations. None of the proceeds of
the Permitted Senior Unsecured Notes incurred in connection herewith, the Loans or Letters of Credit will be used, directly or indirectly, for “purchasing” or “carrying” any “margin stock” with the respective meanings
of each of such terms under Regulation U or for any purpose that violates the provisions of the Regulation T, U or X. 
 (i)
Disclosure. The Loan Parties have disclosed to the Lenders all agreements, instruments, and corporate or other restrictions to which the Loan Parties or any of their Subsidiaries are subject, and all other matters known to any of them, that,
individually or in the aggregate, could reasonably be expected to result in a Material Adverse Effect. None of this Amendment, any Loan Document, the Permitted Senior Unsecured Note Documents executed in connection herewith nor the related Permitted
Senior Unsecured Note Disclosure Document contains any untrue statement of a material fact or omits to state a material fact necessary in order to make the statements contained herein or therein not misleading in light of the circumstances under
which such statements were made. 
 Section 4. Payment of Fees and Expenses. The Borrower agrees to pay or reimburse
the Administrative Agent for its reasonable out-of-pocket fees, costs and expenses incurred in connection with the preparation, negotiation, execution and delivery of this Amendment and the other documents and agreements executed and delivered in
connection herewith. 

  
 - 13 -

 Section 5. Release. In consideration of the amendments contained herein, the
Borrower hereby waives and releases each of the Lenders, the Administrative Agent and the Issuing Bank from any and all claims and defenses, known or unknown as of the date hereof, with respect to the Credit Agreement and the other Loan Documents
and the transactions contemplated thereby. 
 Section 6. Effect; Ratification. 

(a) Except as expressly herein amended, the terms and conditions of the Credit Agreement and the other Loan Documents remain unchanged
and continue to be in full force and effect. The amendments contained herein shall be deemed to have prospective application only, unless otherwise specifically stated herein. The Credit Agreement is hereby ratified and confirmed in all respects.
Each reference to the Credit Agreement in any of the Loan Documents (including the Credit Agreement) shall be deemed to be a reference to the Credit Agreement, as amended by this Amendment. 

(b) Nothing contained herein shall be deemed to constitute a waiver of compliance with any term or condition contained in the Credit
Agreement or any of the other Loan Documents, or constitute a course of conduct or dealing among the parties. The Administrative Agent and the Lenders reserve all rights, privileges and remedies under the Loan Documents. 

(c) Nothing in this Amendment is intended, or shall be construed, to constitute a novation or an accord and satisfaction of any of the
Obligations or to modify, affect or impair the perfection, priority or continuation of the security interests in, security titles to or other Liens on any collateral (including the Collateral) securing the Obligations. 

(d) This Amendment constitutes the entire agreement and understanding among the parties hereto with respect to the subject matter hereof
and supersedes any and all prior agreements and understandings, oral or written, relating to the subject matter hereof. 
 (e)
This Amendment may be executed in any number of counterparts and by different parties hereto on separate counterparts, each of which when so executed and delivered shall be deemed to be an original, but all of which when taken together shall
constitute a single instrument. Delivery of an executed counterpart of a signature page of this Amendment by facsimile transmission or by email in Adobe “.pdf” format shall be effective as delivery of a manually executed counterpart
hereof. 
 Section 7. Further Assurances. The Borrower agrees to, and to cause any Loan Party to, take all further
actions and execute such other documents and instruments as the Administrative Agent may from time to time reasonably request to carry out the transactions contemplated by this Amendment, the Loan Documents and all other agreements executed and
delivered in connection herewith. 
 Section 8. Miscellaneous. THIS AMENDMENT SHALL BE GOVERNED BY, AND CONSTRUED IN
ACCORDANCE WITH, THE INTERNAL LAWS OF THE STATE OF TENNESSEE WITHOUT REGARD TO CONFLICT OF LAWS PRINCIPLES THEREOF. This Amendment shall be binding upon and shall inure to the benefit of the parties hereto and their respective permitted successors
and assigns. 

  
 - 14 -

 Section 9. Severability. In case any provision of or obligation under this
Amendment 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. 
 [Signature Pages Follow] 

  
 - 15 -

 IN WITNESS WHEREOF, the parties hereto have caused this Fifth Amendment to Revolving
Credit Agreement to be duly executed by their respective authorized officers as of the day and year first above written. 
  

			
	BORROWER:
	
	 AMSURG CORP.

		
	 By:
	 	 /s/ Claire M. Gulmi

	 Title:
	 	 Executive Vice President,
 Chief Financial Officer and Secretary

 Signature page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	 SUNTRUST BANK
 as
Administrative Agent, as Issuing Bank, and as a Lender

		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	REGIONS BANK
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	 BANK OF AMERICA, N.A.

		
	 By:
	 	 /s/

	 Title:
	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	JPMORGAN CHASE BANK, N.A.
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	US BANK NATIONAL ASSOCIATION
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	BRANCH BANKING AND TRUST COMPANY
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	FIFTH THIRD BANK, N.A.
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	KEYBANK NATIONAL ASSOCIATION
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	UNION BANK, N.A.
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	WELLS FARGO BANK, N.A.
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	CITIBANK, N.A.
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	FIRST TENNESSEE BANK NATIONAL ASSOCIATION
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	COMPASS BANK
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	SYNOVUS BANK
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	CADENCE BANK, N.A.
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	GOLDMAN SACHS BANK USA
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 
			
	LENDER:
	
	AVENUE BANK
		
	By:	 	 /s/

	Title:	 	  

  
 Signature
page to Fifth Amendment to Revolving Credit Agreement 

 Schedule 1 

Loan Parties 
  

			
	 Loan Party
	  	 Tax Identification Number

		
	 AmSurg Corp.
	  	62-1493316
		
	 AmSurg Holdings, Inc.
	  	62-1595888
		
	 AmSurg EC Topeka, Inc.
	  	62-1512093
		
	 AmSurg EC St. Thomas, Inc.
	  	62-1511996
		
	 AmSurg EC Beaumont, Inc.
	  	62-1524208
		
	 AmSurg KEC, Inc.
	  	62-1510489
		
	 AmSurg EC Santa Fe, Inc.
	  	62-1523398
		
	 AmSurg EC Washington, Inc.
	  	62-1506354
		
	 AmSurg Torrance, Inc.
	  	62-1545685
		
	 AmSurg Abilene, Inc.
	  	62-1555413
		
	 AmSurg Suncoast, Inc.
	  	62-1555677
		
	 AmSurg Lorain, Inc.
	  	62-1595307
		
	 AmSurg La Jolla, Inc.
	  	62-1625304
		
	 AmSurg Hillmont, Inc.
	  	62-1632685
		
	 AmSurg Palmetto, Inc.
	  	62-1647404
		
	 AmSurg Northwest Florida, Inc.
	  	62-1519549
		
	 AmSurg Ocala, Inc.
	  	62-1650493
		
	 AmSurg Maryville, Inc.
	  	62-1586143
		
	 AmSurg Miami, Inc.
	  	62-1598504
		
	 AmSurg Burbank, Inc.
	  	62-1619548
		
	 AmSurg Melbourne, Inc.
	  	62-1625312

			
		
	 AmSurg El Paso, Inc.
	  	62-1711537
		
	 AmSurg Crystal River, Inc.
	  	62-1666189
		
	 AmSurg Abilene Eye, Inc.
	  	62-1692556
		
	 AmSurg Inglewood, Inc.
	  	62-1814134
		
	 AmSurg Glendale, Inc.
	  	62-1807967
		
	 AmSurg San Antonio TX, Inc.
	  	20-0075736
		
	 AmSurg San Luis Obispo CA, Inc.
	  	20-1965555
		
	 AmSurg Temecula CA, Inc.
	  	20-0095263
		
	 AmSurg Escondido CA, Inc.
	  	20-1626979
		
	 AmSurg Scranton PA, Inc.
	  	20-2853308
		
	 AmSurg Arcadia CA Inc.
	  	20-4483684
		
	 AmSurg Main Line PA, Inc.
	  	20-5408469
		
	 AmSurg Oakland CA, Inc.
	  	20-5645841
		
	 AmSurg Lancaster PA, Inc.
	  	20-5988960
		
	 AmSurg Pottsville PA, Inc.
	  	26-0303835
		
	 AmSurg Glendora CA, Inc.
	  	20-5732564
		
	 AmSurg Kissimmee FL, Inc.
	  	62-1567628
		
	 AmSurg Altamonte Springs FL., Inc.
	  	26-0289067
		
	 AmSurg New Port Richey FL, Inc.
	  	62-1612176
		
	 AmSurg Naples, Inc.
	  	62-1659906
		
	 AmSurg EC Centennial, Inc.
	  	62-1511980
		
	 Illinois NSC, Inc.
	  	20-2393903
		
	 NSC Healthcare, Inc.
	  	84-1209756

			
		
	 AmSurg Anesthesia Management Services, LLC
	  	27-1174941
		
	 NSC RBO West, LLC
	  	26-3816052
		
	 NSC RBO East, LLC
	  	27-3205481
		
	 Long Beach NSC, LLC
	  	20-1048768
		
	 Torrance NSC, LLC
	  	20-1048801
		
	 DAVIS NSC, LLC
	  	20-5451784
		
	 FULLERTON NSC, LLC
	  	20-3435683
		
	 San Antonio NSC, LLC
	  	20-0322582
		
	 Austin NSC, LLC
	  	20-4942934
		
	 Twin Falls NSC, LLC
	  	20-8086602
		
	 Ardmore NSC, LLC
	  	26-1651465
		
	 KENWOOD NSC, LLC
	  	26-3055899
		
	 Towson NSC, LLC
	  	20-0314129
		
	 NSC West Palm, LLC
	  	76-0740666
		
	 Tampa Bay NSC, LLC
	  	20-3447384
		
	 CORAL SPRINGS NSC, LLC
	  	26-1649639
		
	 WESTON NSC, LLC
	  	26-3435641
		
	 Wilton NSC, LLC
	  	26-1653853
		
	 Austin NSC, L.P.
	  	20-4943017
		
	 AmSurg Fresno CA, Inc.
	  	46-1290033

 EXHIBIT A 

REAFFIRMATION OF OBLIGATIONS UNDER LOAN DOCUMENTS 
 Reference is hereby made to that certain Revolving Credit Agreement dated as of May 28, 2010, among AmSurg Corp. (the “Borrower”), the Lenders party thereto and SunTrust Bank, as
Administrative Agent (as previously amended and as further amended by the Fifth Amendment defined below, the “Credit Agreement”; capitalized terms used herein and not defined herein have the meanings ascribed to such terms in the
Credit Agreement). 
 Each of the undersigned Loan Parties hereby: (i) agrees that (A) the amendments contained in the
Fifth Amendment to Revolving Credit Agreement dated as of the date hereof (the “Fifth Amendment”) shall not in any way affect the validity and/or enforceability of any Loan Document, or reduce, impair or discharge the obligations of
such Person thereunder and (B) nothing in the Fifth Amendment is intended, or shall be construed, to constitute a novation or an accord and satisfaction of any of the Obligations or to modify, affect or impair the perfection, priority or
continuation of the security interests in, security titles to or other Liens on any collateral (including the Collateral) securing the Obligations; (ii) reaffirms its continuing obligations owing to the Administrative Agent and the Lenders
under each of the other Loan Documents to which such Person is a party; and (iii) confirms that the liens and security interests created by the Loan Documents continue to secure the Obligations. 

Each of the undersigned Loan Parties (other than the Borrower) hereby represents and warrants to the Administrative Agent and the Lenders
that each of the representations and warranties applicable to such Loan Party made by the Borrower in Section 4 of the Fifth Amendment are true and correct. 
 This Reaffirmation shall be construed in accordance with and be governed by the law of the State of Tennessee. 
 [Signature page follows] 

 IN WITNESS WHEREOF, each of the undersigned has duly executed and delivered this
Reaffirmation of Obligations under Loan Documents as of November     , 2012. 
  

			
	AMSURG CORP.
		
	By:	 	  

		 	Name:
		 	Title:

  

	
	AmSurg Holdings, Inc.
	AmSurg Anesthesia Management Services, LLC
	AmSurg EC Topeka, Inc.
	AmSurg EC St. Thomas, Inc.
	AmSurg EC Beaumont, Inc.
	AmSurg KEC, Inc.
	AmSurg EC Santa Fe, Inc.
	AmSurg EC Washington, Inc.
	AmSurg Torrance, Inc.
	AmSurg Abilene, Inc.
	AmSurg Suncoast, Inc.
	AmSurg Lorain, Inc.
	AmSurg La Jolla, Inc.
	AmSurg Hillmont, Inc.
	AmSurg Palmetto, Inc.
	AmSurg Northwest Florida, Inc.
	AmSurg Ocala, Inc.
	AmSurg Maryville, Inc.
	AmSurg Miami, Inc.
	AmSurg Burbank, Inc.
	AmSurg Melbourne, Inc.
	AmSurg El Paso, Inc.
	AmSurg Crystal River, Inc.
	AmSurg Abilene Eye, Inc.
	AmSurg Inglewood, Inc.
	AmSurg Glendale, Inc.
	AmSurg San Antonio TX, Inc.
	AmSurg San Luis Obispo CA, Inc.
	AmSurg Temecula CA, Inc.
	AmSurg Escondido CA, Inc.
	AmSurg Scranton PA, Inc.
	AmSurg Arcadia CA Inc.
	AmSurg Main Line PA, Inc.
	AmSurg Oakland CA, Inc.
	AmSurg Lancaster PA, Inc.

 
	
	AmSurg Pottsville PA, Inc.
	AmSurg Glendora CA, Inc.
	AmSurg Kissimmee FL, Inc.
	AmSurg Altamonte Springs FL., Inc.
	AmSurg New Port Richey FL, Inc.
	AmSurg EC Centennial, Inc.
	AmSurg Naples, Inc.
	Illinois NSC, Inc.
	NSC Healthcare, Inc.
	NSC RBO West, LLC
	NSC RBO East, LLC
	Long Beach NSC, LLC
	Torrance NSC, LLC
	Davis NSC, LLC
	Fullerton NSC, LLC
	San Antonio NSC, LLC
	Austin NSC, LLC
	Twin Falls NSC, LLC
	Ardmore NSC, LLC
	Kenwood NSC, LLC
	Towson NSC, LLC
	Wilton NSC, LLC
	NSC West Palm, LLC
	Tampa Bay NSC, LLC
	Coral Springs NSC, LLC
	Weston NSC, LLC
	AmSurg Fresno CA, Inc.

 

			
	By:	 	  

		 	Name:
		 	Title:
	
	Austin NSC, L.P.
	
	By: Austin NSC, LLC, its general partner
		
	By:	 	  

		 	Name:
		 	Title:EX-10.2

 Exhibit 10.2 
 Execution Version 
 FOURTH AMENDMENT TO NOTE PURCHASE AGREEMENT

 THIS FOURTH AMENDMENT TO NOTE PURCHASE AGREEMENT (this “Amendment”), is made and
entered into as of November 7, 2012, by and among AMSURG CORP., a Tennessee corporation (the “Company”), the other Credit Parties signatory hereto, THE PRUDENTIAL INSURANCE COMPANY OF AMERICA and the other holders of
Notes (as defined in the Note Agreement defined below) that are signatories hereto (together with their successors and assigns, the “Noteholders”). 
 W I T N E S S E T H: 
 WHEREAS, the Company and the Noteholders are parties to a certain Note Purchase Agreement, dated as of May 28, 2010 (as amended by that certain First Amendment to Note Purchase Agreement dated as of
April 6, 2011, by that certain Second Amendment to Note Purchase Agreement dated as of August 30, 2011, by that certain Third Amendment to Note Purchase Agreement, dated as of June 29, 2012, and as further amended, restated,
supplemented or otherwise modified from time to time, the “Note Agreement”; capitalized terms used herein and not otherwise defined shall have the meanings assigned to such terms in the Note Agreement), pursuant to which the
Noteholders have purchased Notes from the Company; 
 WHEREAS, the Company has requested that the Noteholders amend certain
provisions of the Note Agreement and, subject to the terms and conditions hereof, the Noteholders are willing to do so; 
 NOW,
THEREFORE, for good and valuable consideration, the sufficiency and receipt of all of which are acknowledged, the Company and the Noteholders agree as follows: 
 1. Amendments Effective as of the Date Hereof. 
 (a) Section 2
of the Note Agreement is hereby amended by adding the following new paragraph 2C: 
 “2C. Increase in
Interest Rate. 
 As of November 7, 2012, the per annum interest rate applicable to the Notes shall be increased by 2.00%
to 8.04% per annum.” 
 (b) Exhibit A to the Note Agreement is hereby amended by deleting such Exhibit in its entirety
and substituting in lieu thereof Exhibit A to this Amendment. 
 2. Amendments Effective as of the Fourth Amendment
Effective Date. 
 (a) Paragraph 5A of the Note Agreement is hereby amended by re-designating clause (xi) thereof
as clause (xii) and adding the following new clause (xi) thereto: 
 “(xi) promptly after the
sending or filing thereof, copies of all notices, certificates and reports delivered pursuant to any Permitted Debt Document; and” 

 (b) Paragraph 6A(1) of the Note Agreement is hereby amended by deleting such paragraph in
its entirety and substituting in lieu thereof the following: 
 “6A(1). Leverage Ratio. The Company
shall maintain, on a consolidated basis and as calculated at the end of each Fiscal Quarter, a Leverage Ratio of not greater than 3.75 to 1.00.” 
 (c) Paragraph 6B of the Note Agreement is hereby amended by deleting such paragraph in its entirety and substituting in lieu thereof the following: 

“6B. Indebtedness. 
 The Company will not, and will not permit any of its Subsidiaries to, create, incur, assume or suffer to exist any Indebtedness, except: 

(i) Indebtedness arising under the Note Documents; 

(ii) Indebtedness of the Company and its Subsidiaries existing on the date hereof and extensions, renewals and
replacements of any such Indebtedness that do not increase the outstanding principal amount thereof (immediately prior to giving effect to such extension, renewal or replacement) or shorten the maturity or the weighted average life thereof (all
Indebtedness existing on the date hereof with a principal or committed amount outstanding equal to or greater than $250,000 is set forth on Schedule 6B attached hereto); 

(iii) Intercompany Loans not to exceed in the aggregate at any time outstanding an amount equal to forty percent
(40%) of the sum of EBITDA for the relevant Four-Quarter Period, plus expense attributed to noncontrolling interests as identified as the line item “noncontrolling interests” on Company’s Consolidated Statements of Earnings;

 (iv) Indebtedness in respect of Hedging Obligations permitted by paragraph 6K; 

(v) Indebtedness under the Credit Agreement, including refundings, refinancings and replacements thereof, and amendments
or modifications to the Loan Documents; provided, however, that the aggregate principal amount of such Indebtedness shall not at any time exceed $625,000,000, and all Guarantees thereof by Subsidiaries of the Company that have also guaranteed the
Notes; 
 (vi) Indebtedness in respect of the Permitted Senior Unsecured Notes and any Permitted Refinancing
thereof; 
 (vii) Permitted Ratio Debt and any Permitted Refinancing thereof; 

  
 2 

 (viii) Permitted Senior Secured Debt and any Permitted Refinancing thereof;
and 
 (ix) Indebtedness that does not exceed the Debt Basket Amount at any time of determination, inclusive of
all amounts referenced in paragraph 6B(ii) above, but specifically excluding all amounts referred in paragraph 6B(i), paragraph 6B(iii), paragraph 6B(iv), paragraph 6B(v), paragraph 6B(vi), paragraph 6B(vii) and paragraph 6B(viii) above. 

The Company will not, and will not permit any Subsidiary to, issue any preferred stock or any other preferred equity
interest that (i) matures or is mandatorily redeemable pursuant to a sinking fund obligation or otherwise, (ii) is or may become redeemable or repurchaseable by the Company or such Subsidiary at the option of the holder thereof, in whole
or in part or (iii) is convertible or exchangeable at the option of the holder thereof for Indebtedness or preferred stock or any other preferred equity interest described in this paragraph, on or prior to, in the case of clause (i),
(ii) or (iii), the first anniversary of the Maturity Date.” 
 (d) Paragraph 6C of the Note Agreement is hereby
amended by deleting such paragraph in its entirety and substituting in lieu thereof the following: 

“6C. Negative Pledge 
 The Company will not, and will not permit any of its Subsidiaries to, create, incur, assume or suffer to exist any Lien on any of its assets or property now owned or hereafter acquired, except for the
following (collectively, “Permitted Liens”): 
 (i) Liens securing the Obligations and Liens in
favor of the Collateral Agent pursuant to the Security Documents securing the “Obligations” (as defined in the Credit Agreement as in effect on the date hereof or in any replacement Credit Agreement to the extent that such definition is
the same in all material respects as that in effect on the date hereof) pari passu (and pursuant to the Intercreditor Agreement) with the Obligations or the Permitted Senior Secured Debt, all on a basis pari passu (and pursuant to the Intercreditor
Agreement) with the Obligations; 
 (ii) Permitted Encumbrances; 

(iii) any Liens on any property or asset of the Company or any Subsidiary existing on the Closing Day set forth on
Schedule 6C; provided that (A) such Lien shall not apply to any other property or asset of the Company or any Subsidiary and (B) only Liens securing Indebtedness or other obligations in excess of $250,000 as of the Closing Day are required
to be disclosed on Schedule 6C; 
 (iv) Liens securing Indebtedness permitted under paragraphs 6B(iii) and 6B(ix)
above, provided that such Liens shall not encumber any of the Collateral; and 
 (vi) extensions, renewals, or
replacements of any Lien referred to in paragraphs (i) through (iii) of this paragraph; provided that the principal amount of the Indebtedness secured thereby is not increased and that any such extension, renewal or replacement is limited
to the assets originally encumbered thereby.” 

  
 3 

 (e) Paragraph 6I of the Note Agreement is hereby amended by deleting such paragraph in its
entirety and substituting in lieu thereof the following: 
 “6I. Restrictive Agreements. 

The Company will not, and will not permit any Subsidiary to, directly or indirectly, enter into, incur or permit to exist
any agreement that prohibits, restricts or imposes any condition upon (i) except for restrictions in the limited partnership agreements set forth on Schedule 6I on the ability of a partner to transfer partnership interests, the ability of the
Company or any Subsidiary to create, incur or permit any Lien upon any of its assets or properties, whether now owned or hereafter acquired, or (ii) the ability of any Subsidiary to pay dividends or other distributions with respect to its
Capital Stock, to make or repay loans or advances to the Company or any other Subsidiary, to Guarantee Indebtedness of the Company or any other Subsidiary or to transfer any of its property or assets to the Company or any Subsidiary of the Company;
provided, that (1) the foregoing shall not apply to restrictions or conditions imposed by law or by this Agreement, any other Note Document, the Loan Documents or the Permitted Debt Documents so long as any such Permitted Debt Documents do not
restrict the ability of the Company or any of its Subsidiaries to create, incur or permit to exist any Lien upon its assets to secure the Obligations (other than (x) restrictions in the Permitted Senior Unsecured Note Documents related to the
maximum amount of the Obligations that may be secured by Liens and (y) restrictions on the maximum amount of the Obligations that may be secured by Liens in any other Permitted Debt Document so long as such restrictions are no more restrictive
than those set forth in the Permitted Senior Unsecured Note Documents), (2) the foregoing shall not apply to customary restrictions and conditions contained in agreements relating to the sale of a Subsidiary pending such sale, provided such
restrictions and conditions apply only to the Subsidiary that is sold and such sale is permitted hereunder, (3) clause (i) shall not apply to restrictions or conditions imposed by any agreement relating to secured Indebtedness permitted by
this Agreement if such restrictions and conditions apply only to the property or assets securing such Indebtedness and (4) clause (i) shall not apply to customary provisions in leases restricting the assignment thereof.” 

(f) Paragraph 6L of the Note Agreement is hereby amended by adding the following new clause (iii) thereto: 

“(iii) Without limiting clause (i) of this paragraph 6L, the Company shall not, and shall not permit any
Subsidiary to, change or amend the terms of any Permitted Debt or any Permitted Debt Documents if the effect of such amendment is to (A) increase the interest rate thereon, (B) change the dates upon

  
 4 

 
which payments of principal or interest are due on such Permitted Debt other than to extend such dates, (C) change any default or event of default other than to delete or make less
restrictive any default provision therein, (D) change any covenant with respect to such Permitted Debt in any manner materially adverse to the Company, any of its Subsidiaries or the holders of the Notes, (E) change the redemption or
prepayment provisions of such Permitted Debt other than to extend the dates thereof or to reduce the amount of any such redemption or prepayment or the premiums payable in connection therewith, (F) change or amend any other term if such change
or amendment would materially increase the obligations of the obligor or confer additional material rights on the holder of such Permitted Debt in a manner adverse to the Company, any of its Subsidiaries or the holders of the Notes or (G) add
any restrictions, directly or indirectly, on the right or ability of (1) any Credit Party to make Restricted Payments or (2) of any Credit Party to create or suffer to exist any Liens securing any of the Obligations.” 

(g) Paragraph 6R of the Note Agreement is hereby amended by deleting such paragraph in its entirety and substituting in lieu thereof the
following: 
 “6R [Intentionally Omitted].” 

(h) Section 6 of the Note Agreement is hereby amended by adding the following new paragraph 6T: 

“Paragraph 6T. Prepayment of Permitted Debt. 

The Company shall not, and shall not permit any of its Subsidiaries to, prepay, redeem, purchase, defease or otherwise
satisfy all or any portion of any Permitted Ratio Debt or the Permitted Senior Unsecured Notes prior to the scheduled maturity thereof; provided, however, that any Credit Party may (A) make regularly scheduled or otherwise
required repayments or redemptions of any Permitted Ratio Debt or the Permitted Senior Unsecured Notes in accordance with the terms of the respective Permitted Debt Documents (it being understood that payments when due of regularly scheduled
interest shall be permitted); and (B) refinance and refund any Permitted Ratio Debt or the Permitted Senior Unsecured Notes, as long as such refinancing or refunding is a Permitted Refinancing; provided that, neither the Company nor any
Subsidiary of the Company shall make (or give any notice in respect of) any prepayment or redemption in respect of any Permitted Ratio Debt or the Permitted Senior Unsecured Notes as a result of any change of control, asset sale or similar event
under the respective Permitted Debt Documents if a Default or Event of Default shall exist at such time or would result therefrom after giving effect to any such prepayment or redemption on a pro forma basis.” 

  
 5 

 (i) Paragraph 7A. of the Note Agreement is hereby amended by deleting clause
(xix) thereto in its entirety and substituting in lieu thereof the following new clause (xix): 

“(xix) any default or event of default (after giving effect to any grace period) shall have occurred and be
continuing under any Permitted Ratio Debt Documents to the extent the Permitted Ratio Debt evidenced thereby is (or is intended to be) subordinated to the Obligations (such Indebtedness, “Subordinated Debt”) or the validity or
enforceability of the subordination provisions thereof is disaffirmed by or on behalf of any lender or holder party thereto, or any Obligations fail for any reason to rank senior to such Subordinated Debt, or all or any part of such Subordinated
Debt is accelerated, is declared to be due and payable is required to be prepaid or redeemed, in each case prior to the stated maturity thereof;” 
 (j) Paragraph 10B of the Note Agreement is hereby amended by adding the following new definitions in proper alphabetical order: 

“Consolidated Secured Debt” shall mean, as of any date of determination, all Consolidated Total Debt that
is secured by a Lien on any assets (including Equity Interests) of the Company or any of its Subsidiaries. 

“Fourth Amendment” shall mean that certain Fourth Amendment to Note Purchase Agreement, dated as of
November 7, 2012, by and among the Company, the other Credit Parties party thereto and the holders of the Notes party thereto. 
 “Fourth Amendment Effective Date” shall mean the date on which all of the conditions set forth in Section 3 of the Fourth Amendment have been satisfied. 

“Permitted Debt” shall mean Permitted Ratio Debt, Permitted Senior Secured Debt and the Permitted Senior
Unsecured Notes. 
 “Permitted Debt Disclosure Documents” shall mean the Permitted Ratio Debt
Disclosure Documents, the Permitted Senior Secured Debt Disclosure Documents and the Permitted Senior Unsecured Note Disclosure Documents. 
 “Permitted Debt Documents” shall mean the Permitted Ratio Debt Documents, the Permitted Senior Secured Debt Documents and the Permitted Senior Unsecured Note Documents. 

“Permitted Ratio Debt” shall mean any unsecured Indebtedness of the Company (and, to the extent permitted
by clause (f) immediately below, Subsidiaries of the Company): (i) in the form of one or more series of senior unsecured notes or loans or (ii) expressly subordinated to the Obligations on terms satisfactory to the Required Holders in
their sole discretion; provided that (a) such Indebtedness will not mature prior to the date that is 180 days after the Maturity Date, (b) such Indebtedness has no scheduled amortization or scheduled payments of principal and is not
subject to mandatory redemption, repurchase, prepayment or sinking fund obligation (other than customary offers to repurchase upon a change of control, asset sale event and customary acceleration rights after an

  
 6 

 
event of default) prior to the date that is 180 days after the Maturity Date, (c) immediately prior to and after giving effect to the incurrence of such Indebtedness, no Default or Event of
Default shall have occurred and be continuing, (d) immediately after giving effect thereto and to the use of the proceeds thereof, the Leverage Ratio, calculated on a Pro Forma Basis, would not exceed 3.50 to 1.00 as of the most recently ended
Fiscal Quarter for which financial statements have been delivered pursuant to paragraph 5A, (e) the covenants, defaults, remedies and other terms of such Indebtedness are customary for similar Indebtedness in light of then-prevailing market
conditions and in any event, when taken as a whole (other than interest rate and redemption premiums), are not more restrictive to the Credit Parties than those set forth in this Agreement (in each case, as reasonably determined by the Required
Holders), (f) such Indebtedness is not guaranteed by any Subsidiary of the Company that is not a party to the Guaranty Agreement, and (g) such Indebtedness is not secured by any Lien on any property or assets of the Company or any of its
Subsidiaries. 
 “Permitted Ratio Debt Disclosure Document” shall mean, if applicable, the
information or offering memorandum distributed in connection with the offering of the Permitted Ratio Debt. 

“Permitted Ratio Debt Document” shall mean, if applicable, (i) each of the notes evidencing the
Permitted Ratio Debt, (ii) the indenture, note purchase agreement, securities purchase agreement, loan agreement or similar agreement pursuant to which the Permitted Ratio Debt is issued or sold, (iii) any subordination agreement
subordinating the Permitted Ratio Debt, and (iv) any other agreement, certificate, power of attorney or document related to any of the foregoing. 
 “Permitted Refinancing” shall mean, with respect to any Person, any modification, refinancing, replacement, refunding, renewal or extension of any Indebtedness of such Person; provided
that (a) the principal amount (or accreted value, if applicable) thereof does not exceed the principal amount (or accreted value, if applicable) of the Indebtedness so modified, refinanced, replaced, refunded, renewed or extended except by an
amount equal to unpaid accrued interest, fees, expenses and premium thereon, (b) the Indebtedness resulting from any such modification, refinancing, replacement, refunding, renewal or extension has (i) a final stated maturity date equal to
or later than the date that is final stated maturity date of, and (ii) a Weighted Average Life to Maturity equal to or greater than the Weighted Average Life to Maturity of, the Indebtedness being modified, refinanced, replaced, refunded,
renewed, or extended (calculated at the time of the incurrence of such Indebtedness), (c) immediately prior to and after giving effect to the incurrence of such modification, refinancing, replacement, refunding, renewal or extension, no Default
or Event of Default shall have occurred and be continuing, (d) such modification, refinancing, replacement, refunding, renewal or extension does not add guarantors or security from that which applied to such Indebtedness being modified,
refinanced, replaced, refunded, renewed or extended, (e) to the extent such Indebtedness being modified, refinanced, 

  
 7 

 
replaced, refunded, renewed or extended is subordinated in right of payment to the Obligations, such modification, refinancing, replacement, refunding, renewal or extension is subordinated in
right of payment to the Obligations on terms (taken as a whole) that are at least as favorable to the holders of the Notes as those contained in the documentation governing the Indebtedness being modified, refinanced, replaced, refunded, renewed or
extended (as reasonably determined by the Required Holders), (f) such modification, refinancing, replacement, refunding, renewal or extension is incurred by the same Person or Persons who are the obligors of the Indebtedness being modified,
refinanced, replaced, refunded, renewed or extended and (g) the covenants, defaults, remedies and other terms of such modification, refinancing, replacement, refunding, renewal or extension of such Indebtedness are customary for similar
modifications, refinancings, replacements, refundings, renewals or extensions of such Indebtedness in light of then-prevailing market conditions and in any event, when taken as a whole, are not more restrictive to the Credit Parties than those
contained in the documentation governing such Indebtedness being modified, refinanced, replaced, refunded, renewed or extended (as reasonably determined by the Required Holders). 

“Permitted Senior Secured Debt” shall mean any secured Indebtedness of the Company (and, to the extent
permitted by clause (v) immediately below, Subsidiaries of the Company) in the form of one or more series of senior secured notes or loans; provided that (i) such Indebtedness is secured by the Collateral on a pari passu basis (but without
regard to the control of remedies) with the Obligations and is not secured by any property or assets of the Company or any of its Subsidiaries other than the Collateral, (ii) the security documents relating to such Indebtedness are
substantially the same as the Security Documents (with such differences as are reasonably satisfactory to the Required Holders), (iii) such Indebtedness will not mature prior to the date that is 180 days after the Maturity Date, (iv) the
amortization of any such Indebtedness shall not exceed ten percent (10%) of the original principal balance of such Indebtedness (at the time of issuance) in any year, (v) such Indebtedness is not guaranteed by any Subsidiary of the Company
that is not a party to the Guaranty Agreement, (vi) the covenants, defaults, remedies and other terms of such Indebtedness are customary for similar Indebtedness in light of then-prevailing market conditions and in any event, when taken as a
whole, are not more restrictive to the Credit Parties than those set forth in this Agreement (in each case, as reasonably determined by the Required Holders), (vii) immediately prior to and after giving effect to the incurrence of such
Indebtedness, no Default or Event of Default shall have occurred and be continuing, (viii) immediately after giving effect thereto and to the use of the proceeds thereof, the Secured Leverage Ratio on a Pro Forma Basis would not exceed 2.75 to
1.00 as of the most recently ended Fiscal Quarter for which financial statements have been delivered pursuant to paragraph 5A, and (ix) the holders of such Indebtedness (or their representative) become a party to the Intercreditor Agreement, on
terms and conditions, and with such changes, as shall be satisfactory to the Required Holders, and all necessary consents from the parties to the Intercreditor Agreement shall have been obtained. 

  
 8 

 “Permitted Senior Secured Debt Disclosure Document” shall
mean, if applicable, the information or offering memorandum distributed in connection with the offering of the Permitted Senior Secured Debt. 
 “Permitted Senior Secured Debt Document” shall mean, if applicable, (i) each of the notes evidencing the Permitted Senior Secured Debt, (ii) the indenture, note purchase
agreement, securities purchase agreement, loan agreement or similar agreement pursuant to which the Permitted Senior Secured Debt is issued or sold, (iii) any security documents related to the Permitted Senior Secured Debt, and (iv) any
other agreement, certificate, power of attorney or document related to any of the foregoing. 

“Permitted Senior Unsecured Notes” shall mean unsecured notes issued by the Company (and Guarantees
thereof by Subsidiaries of the Company that are party to the Guaranty Agreement) on or before December 31, 2012 in an aggregate principal amount not to exceed $275,000,000; provided that (i) such Indebtedness will not mature prior to the
date that is 180 days after the Maturity Date, (ii) such Indebtedness has no scheduled amortization or scheduled payments of principal and is not subject to mandatory redemption, repurchase, prepayment or sinking fund obligation (other than
customary offers to repurchase upon a change of control, asset sale event and customary acceleration rights after an event of default) prior to the date that is 180 days after the Maturity Date, (iii) immediately prior to and after giving
effect to the incurrence of such Indebtedness, no Default or Event of Default shall have occurred and be continuing, (iv) such Indebtedness is not guaranteed by any Subsidiary of the Company that is not a party to the Guaranty Agreement and
(v) such Indebtedness is not secured by any Lien on any property or assets of the Company or any of its Subsidiaries. 
 “Permitted Senior Unsecured Note Disclosure Document” shall mean, if applicable, the information or offering memorandum distributed in connection with the offering of the Permitted Senior
Unsecured Notes. 
 “Permitted Senior Unsecured Note Document” shall mean (i) each of the
notes evidencing the Permitted Senior Unsecured Notes, (ii) the indenture, note purchase agreement, securities purchase agreement, loan agreement or similar agreement pursuant to which the Permitted Senior Unsecured Notes are issued or sold and
(iii) and any other agreement, certificate, power of attorney or document related to any of the foregoing. 

“Secured Leverage Ratio” shall mean, as of any date of determination, the ratio of (i) Consolidated
Secured Debt to (ii) EBITDA for the Four-Quarter Period at the time of determination. 
 “Weighted
Average Life to Maturity” means, when applied to any Indebtedness at any date, the number of years obtained by dividing: (a) the sum of the products obtained by multiplying (i) the amount of each then remaining

  
 9 

 
installment, sinking fund, serial maturity or other required payments of principal, including payment at final maturity, in respect thereof, by (ii) the number of years (calculated to the
nearest one-twelfth) that will elapse between such date and the making of such payment; by (b) the then outstanding principal amount of such Indebtedness. 
 (k) Paragraph 10B of the Note Agreement is hereby amended by replacing the definition of “Pro Forma Basis” in its entirety with the following definition: 

“Pro Forma Basis” shall mean, in connection with any calculation of compliance with any financial
covenant in paragraph 6A hereof or the Secured Leverage Ratio, the calculation thereof after giving effect on a pro forma basis to (x) the incurrence or repayment of any Indebtedness as if such Indebtedness had been incurred or repaid on the
first day of the Four-Quarter Period and (y) the making of any Restricted Payment or any Investment by the Company or a Subsidiary, if any, as if such Restricted Payment or Investment had been made on the first day of the Four-Quarter Period.

 (l) Paragraph 10B of the Note Agreement is hereby amended by deleting the terms “Permitted Subordinated Debt” and
“Subordinated Debt Documents” in their entirety. 
 (m) Paragraph 11B of the Note Agreement is hereby amended by
deleting clause (i) of the third paragraph thereof in its entirety and substituting in lieu thereof the following new clause (i): 
 “(i) the execution or delivery of this Agreement, the Notes, the other Note Documents, any Permitted Debt Document, any Permitted Debt Disclosure Document or any agreement or instrument contemplated
hereby or thereby, the performance by the parties hereto or thereto of their respective obligations hereunder or thereunder or the consummation of the transactions contemplated hereby or thereby,” 

3. Conditions to Effectiveness of this Amendment. Notwithstanding any other provision of this Amendment and without
affecting in any manner the rights of the holders of the Notes hereunder, it is understood and agreed that this Amendment, including, without limitation, the amendments set forth in Section 1 of this Amendment, shall not become effective, and
the Company shall have no rights under this Amendment, until the Noteholders shall have received executed counterparts to this Amendment from the Company, each of the Guarantors and the Noteholders. 

Without limiting the foregoing, the amendments set forth in Section 2 of this Amendment shall not become effective until the
Noteholders shall have received (i) reimbursement or payment of their costs and expenses incurred in connection with this Amendment or the Note Agreement (including reasonable fees, charges and disbursements of King & Spalding LLP,
counsel to the Noteholders), and (ii) each of the following documents: 
 (a) A duly executed copy of an amendment to the
Credit Agreement, in form and substance satisfactory to the Noteholders and their counsel; 

  
 10 

 (b) A copy of each Permitted Senior Unsecured Note Document and the Permitted Senior
Unsecured Note Disclosure Document, in each case certified as being complete and correct by a Responsible Officer of the Company; 
 (c) Evidence that, immediately after giving effect on a Pro Forma Basis to the incurrence of the Indebtedness evidenced by the Permitted Senior Unsecured Notes on the Fourth Amendment Effective Date
(after giving effect to the prepayment described in Section 2(v) of the Credit Agreement amendment referred to in clause (a) above), the Company shall have a Leverage Ratio of no greater than 3.75 to 1.00 as of the most recently ended
Fiscal Quarter for which financial statements have been delivered pursuant to paragraph 5A of the Note Agreement; 
 (d) An
officer’s certificate, dated as of the Fourth Amendment Effective Date, signed by the Secretary and a Responsible Officer of each Credit Party (together with certifications as to incumbency and signatures of such officers) with appropriate
insertions and deletions, certifying that: (A) attached thereto are copies of resolutions adopted by of the board of directors (or equivalent thereof) of the Company, approving the execution, delivery and performance of this Amendment and the
other documents to be executed in connection herewith; (B) there have been no changes in the articles of incorporation of the Company from those delivered in connection with the closing of the Credit Agreement; (C) no consents, approvals,
authorizations, registrations, filings or orders are required to be made or obtained under any Requirement of Law or Material Contract of any Credit Party in connection with the execution, delivery, performance, validity and enforceability of this
Amendment and the Permitted Senior Unsecured Note Documents or any of the transactions contemplated hereby or thereby, except those which have been made or obtained and are in full force and effect (with all applicable waiting periods, if any,
having expired); and (D) no Default or Event of Default exists immediately before giving effect to amendments provided for herein and no Default or Event of Default will result immediately after giving effect to amendments provided for herein;

 (e) A written opinion of Bass Berry & Sims PLC, counsel to the Company and the other Credit Parties, addressed to
the holders of the Notes and covering such matters relating to the Credit Parties, this Amendment, the replacement Notes, the Permitted Senior Unsecured Note Documents executed in connection herewith (which may include a reliance letter with respect
to the opinions delivered in connection with the offering of the Permitted Senior Unsecured Notes), and the transactions contemplated herein and therein as the holders of the Notes shall reasonably request, all in form and substance satisfactory to
the holders of the Notes and their counsel; and 
 (f) Such other documents, instruments, agreements, certifications and
opinions as any Noteholder may reasonably request. 
 4. Representations and Warranties. To induce the Noteholders
to enter into this Amendment, each Credit Party hereby represents and warrants to the Noteholders that: 
 (a) The execution,
delivery and performance by such Credit Party of this Amendment (i) are within such Credit Party’s power and authority; (ii) have been duly authorized by all necessary corporate and shareholder action; (iii) are not in
contravention of any provision of such Credit Party’s certificate of incorporation or bylaws or other organizational documents; (iv) do 

  
 11 

 
not violate any law or regulation, or any order or decree of any Governmental Authority; (v) do not conflict with or result in the breach or termination of, constitute a default under or
accelerate any performance required by, any indenture, mortgage, deed of trust, lease, agreement or other instrument to which such Credit Party or any of its Subsidiaries is a party or by which such Credit Party or any such Subsidiary or any of
their respective property is bound; (vi) do not result in the creation or imposition of any Lien upon any of the property of such Credit Party or any of its Subsidiaries; and (vii) do not require the consent or approval of any Governmental
Authority or any other person; 
 (b) This Amendment has been duly executed and delivered for the benefit of or on behalf of
each Credit Party and constitutes a legal, valid and binding obligation of each Credit Party, enforceable against such Credit Party in accordance with its terms; 
 (c) After giving effect to this Amendment, the representations and warranties contained in the Note Agreement and the other Note Documents are true and correct in all material respects, and no Default or
Event of Default has occurred and is continuing as of the date hereof; 
 (d) The execution, delivery, performance and
effectiveness of this Amendment will not: (a) impair the validity, effectiveness or priority of the Liens granted pursuant to any Note Document, and such Liens continue unimpaired with the same priority to secure repayment of all of the
applicable Obligations, whether heretofore or hereafter incurred, and (b) require that any new filings be made or other action taken to perfect or to maintain the perfection of such Liens; 

(e) Since the date of the most recent financial statements of the Company described in paragraph 5A(i) of the Note Agreement, there has
been no change which has had or could reasonably be expected to have a Material Adverse Effect; and 
 (f) As of the date
hereof, the parties listed as signatories to this Amendment represent a true, correct and complete list of the all the Credit Parties. 
 5. Reaffirmations and Acknowledgments.  
 (a) Reaffirmation of
Guaranty. Each Guarantor consents to the execution and delivery by the Company of this Amendment and jointly and severally ratifies and confirms the terms of the Guaranty Agreement with respect to the indebtedness now or hereafter outstanding
under the Note Agreement as amended hereby and all promissory notes issued thereunder. Each Guarantor acknowledges that, notwithstanding anything to the contrary contained herein or in any other document evidencing any indebtedness of the Company to
the Noteholders or any other obligation of the Company, or any actions now or hereafter taken by the Noteholders with respect to any obligation of the Company, the Guaranty Agreement (i) is and shall continue to be a primary obligation of the
Guarantors, (ii) is and shall continue to be an absolute, unconditional, joint and several, continuing and irrevocable guaranty of payment, and (iii) is and shall continue to be in full force and effect in accordance with its terms.
Nothing contained herein to the contrary shall release, discharge, modify, change or affect the original liability of the Guarantors under the Guaranty Agreement. 
 (b) Acknowledgment of Perfection of Security Interest. Each Credit Party hereby acknowledges that, as of the date hereof, the security interests and liens granted to the Collateral Agent under the
Security Documents for the benefit of the Noteholders and other secured parties are in full force and effect, are properly perfected and are enforceable in accordance with the terms of the Note Agreement, the Security Documents and the other Note
Documents. 

  
 12 

 6. Delivery of Notes. Promptly following the date hereof, the Company shall
deliver original replacement Notes in the form of Exhibit A to the Note Agreement, as amended hereby, to each Noteholder. 
 7.
Release. In consideration of the amendments contained herein, each Credit Party hereby waives and releases each of the Noteholders from any and all claims and defenses, known or unknown as of the date hereof, with respect to the Note
Agreement and the other Note Documents and the transactions contemplated thereby. 
 8. Effect of Amendment.
Except as set forth expressly herein, all terms of the Note Agreement, as amended hereby, and the other Note Documents shall be and remain in full force and effect and shall constitute the legal, valid, binding and enforceable obligations of the
Company and the other Credit Parties party thereto to all holders of the Notes. 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 the
holders of the Notes under the Note Agreement, nor constitute a waiver of any provision of the Note Agreement. From and after the date hereof, all references to the Note Agreement shall mean the Note Agreement as modified by this Amendment. This
Amendment shall constitute a Note Document for all purposes of the Note Agreement. 
 9. Governing Law. This
Amendment shall be governed by, and construed in accordance with, the internal laws of the State of New York and all applicable federal laws of the United States of America. 
 10. No Novation. This Amendment is not intended by the parties to be, and shall not be construed to be, a novation of the Note Agreement or an accord and satisfaction in regard thereto.

 11. Costs and Expenses. The Company agrees to pay on demand all costs and expenses of the Noteholders in
connection with the preparation, execution and delivery of this Amendment, including, without limitation, the reasonable fees and out-of-pocket expenses of outside counsel for the Noteholders with respect thereto. 

12. Counterparts. This Amendment may be executed by one or more of the parties hereto in any number of separate
counterparts, each of which shall be deemed an original and all of which, taken together, shall be deemed to constitute one and the same instrument. Delivery of an executed counterpart of this Amendment by facsimile transmission or by electronic
mail in pdf form shall be as effective as delivery of a manually executed counterpart hereof. 
 13. Binding
Nature. This Amendment shall be binding upon and inure to the benefit of the parties hereto, any other holders of Notes from time to time and their respective successors, successors-in-titles, and assigns. 

  
 13 

 14. Entire Understanding. This Amendment sets forth the entire understanding
of the parties with respect to the matters set forth herein, and shall supersede any prior negotiations or agreements, whether written or oral, with respect thereto. 
 [remainder of page intentionally left blank] 

  
 14 

 IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be duly executed, under
seal in the case of the Company and the Guarantors, by their respective authorized officers as of the day and year first above written. 
  

					
	COMPANY:
	
	AMSURG CORP.
		
	By:	 	 /s/ Claire M. Gulmi

		 	Name:	 	Claire M. Gulmi
		 	Title:	 	Executive Vice President, Chief Financial Officer, and Secretary

 [SIGNATURE PAGE TO FOURTH AMENDMENT TO NOTE PURCHASE AGREEMENT] 

 
	
	GUARANTORS:
	
	AmSurg Holdings, Inc.
	AmSurg Anesthesia Management Services, LLC
	AmSurg EC Topeka, Inc.
	AmSurg EC St. Thomas, Inc.
	AmSurg EC Beaumont, Inc.
	AmSurg KEC, Inc.
	AmSurg EC Santa Fe, Inc.
	AmSurg EC Washington, Inc.
	AmSurg Fresno CA, Inc.
	AmSurg Torrance, Inc.
	AmSurg Abilene, Inc.
	AmSurg Suncoast, Inc.
	AmSurg Lorain, Inc.
	AmSurg La Jolla, Inc.
	AmSurg Hillmont, Inc.
	AmSurg Palmetto, Inc.
	AmSurg Northwest Florida, Inc.
	AmSurg Ocala, Inc.
	AmSurg Maryville, Inc.
	AmSurg Miami, Inc.
	AmSurg Burbank, Inc.
	AmSurg Melbourne, Inc.
	AmSurg El Paso, Inc.
	AmSurg Crystal River, Inc.
	AmSurg Abilene Eye, Inc.
	AmSurg Inglewood, Inc.
	AmSurg Glendale, Inc.
	AmSurg San Antonio TX, Inc.
	AmSurg San Luis Obispo CA, Inc.
	AmSurg Temecula CA, Inc.
	AmSurg Escondido CA, Inc.
	AmSurg Scranton PA, Inc.
	AmSurg Arcadia CA Inc.
	AmSurg Main Line PA, Inc.
	AmSurg Oakland CA, Inc.
	AmSurg Lancaster PA, Inc.
	AmSurg Pottsville PA, Inc.
	AmSurg Glendora CA, Inc.
	AmSurg Kissimmee FL, Inc.
	AmSurg Altamonte Springs FL., Inc.
	AmSurg New Port Richey FL, Inc.
	AmSurg EC Centennial, Inc.
	AmSurg Naples, Inc.

  
 [SIGNATURE
PAGE TO FOURTH AMENDMENT TO NOTE PURCHASE AGREEMENT] 

			
	Illinois NSC, Inc.
	NSC Healthcare, Inc.
	NSC RBO West, LLC
	NSC RBO East, LLC
	Long Beach NSC, LLC
	Torrance NSC, LLC
	Davis NSC, LLC
	Fullerton NSC, LLC
	San Antonio NSC, LLC
	Austin NSC, LLC
	Twin Falls NSC, LLC
	Ardmore NSC, LLC
	Kenwood NSC, LLC
	Towson NSC, LLC
	Wilton NSC, LLC
	NSC West Palm, LLC
	Tampa Bay NSC, LLC
	Coral Springs NSC, LLC
	Weston NSC, LLC
		
	By:	 	 /s/ Claire M. Gulmi

		 	Name: Claire M. Gulmi
		 	Title: Vice President, Secretary and Treasurer
	
	Austin NSC, LP
		
	By:	 	Austin NSC, LLC, its general partner
		
	By:	 	 /s/ Claire M. Gulmi

		 	Name: Claire M. Gulmi
		 	Title: Vice President, Secretary and Treasurer

  
 [SIGNATURE
PAGE TO FOURTH AMENDMENT TO NOTE PURCHASE AGREEMENT] 

 
					
	NOTEHOLDERS:
	
	THE PRUDENTIAL INSURANCE COMPANY OF AMERICA
		
	By:	 	 /s/

		 	Senior Vice President
	
	PRUCO LIFE INSURANCE COMPANY
		
	By:	 	 /s/

		 	Assistant Vice President
	
	PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY
		
	By:	 	 Prudential Investment Management, Inc.,
 as investment manager

			
		 	By:	 	 /s/

		 		 	Senior Vice President
	
	FORETHOUGHT LIFE INSURANCE COMPANY
		
	By:	 	 Prudential Private Placement Investors, L.P.
 (as Investment Advisor)

		
	By:	 	 Prudential Private Placement Investors, Inc.
 (as its General Partner)

			
		 	By:	 	 /s/

		 		 	Senior Vice President

  
 [SIGNATURE
PAGE TO FOURTH AMENDMENT TO NOTE PURCHASE AGREEMENT] 

 Exhibit A 

EXHIBIT A 
 [FORM OF NOTE] 
 AMSURG CORP. 

8.04% SENIOR NOTE DUE [MAY     , 2020] 
 No. [    ] 
 PPN
[                    ] 

ORIGINAL PRINCIPAL AMOUNT: 
 ORIGINAL ISSUE DATE:
May 28, 2010 
 INTEREST RATE: 8.04% per annum 

INTEREST PAYMENT DATES: May 28, August 28, November 28 and February 28 of each calendar
year, commencing on August 28, 2010 
 FINAL MATURITY DATE: MAY 28, 2020 

PRINCIPAL PREPAYMENT DATES AND AMOUNTS: [$        ] on
May 28, August 28, November 28 and February 28 of each calendar year, commencing on August 28, 2013, with the remaining unpaid principal amount due on the Final Maturity Date 

For Value Received, the undersigned, AmSurg Corp. (the “Company”), a corporation organized and existing under the laws
of the State of Tennessee, hereby promises to pay to [                    ], or registered assigns, the principal sum of
[                            ] Dollars, payable on the Principal Prepayment Dates and in the
amounts specified above, and on the Final Maturity Date specified above in an amount equal to the unpaid balance of the principal hereof, with interest (computed on the basis of a 360-day year of twelve 30-day months) (a) on the unpaid balance
hereof at the Interest Rate per annum specified above if no Event of Default has occurred and is continuing, payable on each Interest Payment Date specified above and on the Final Maturity Date specified above, commencing with the Interest Payment
Date next succeeding the date hereof, until the principal hereof shall have become due and payable, and (b) on the unpaid balance hereof at the Default Rate (as defined in the Note Purchase Agreement referred to below) if an Event of Default
has occurred and is continuing, and to the extent permitted by law on any overdue payment of interest and any Yield-Maintenance Amount (as defined in the Note Purchase Agreement referred to below), payable at the Default Rate on each Interest
Payment Date as aforesaid (or, at the option of the registered holder hereof, on demand). Additional interest hereon may also be required pursuant to paragraph 2B of the Note Purchase Agreement referred to below. 

Payments of principal of, interest on and any Yield-Maintenance Amount with respect to this Note are to be made in lawful money of the
United States of America at such place as the Company shall have designated by written notice to the holder of this Note as provided in the Note Purchase Agreement referred to below. 

This Note is one of a series of Senior Notes (the “Notes”) issued pursuant to the Note Purchase Agreement, dated as of
May 28, 2010 (as from time to time amended, the “Note Purchase Agreement”), among the Company and the respective Purchasers named therein and is entitled to the benefits thereof. Unless otherwise indicated, capitalized terms
used in this Note shall have the respective meanings ascribed to such terms in the Note Purchase Agreement. 

 This Note is a registered Note and, as provided in the Note Purchase Agreement, upon
surrender of this Note for registration of transfer accompanied by a written instrument of transfer duly executed, by the registered holder hereof or such holder’s attorney duly authorized in writing, a new Note for a like principal amount will
be issued to, and registered in the name of, the transferee. Prior to due presentment for registration of transfer, the Company may treat the person in whose name this Note is registered as the owner hereof for the purpose of receiving payment and
for all other purposes, and the Company will not be affected by any notice to the contrary. 
 The Company will make required
prepayments of principal on the dates and in the amounts specified in the Note Purchase Agreement. This Note is also subject to optional prepayment, in whole or from time to time in part, at the times and on the terms specified in the Note Purchase
Agreement, but not otherwise. 
 If an Event of Default occurs and is continuing, the principal of this Note may be declared or
otherwise become due and payable in the manner, at the price (including any applicable Yield-Maintenance Amount) and with the effect provided in the Note Purchase Agreement. 
 THIS NOTE IS INTENDED TO BE PERFORMED IN THE STATE OF NEW YORK AND SHALL BE CONSTRUED AND ENFORCED IN ACCORDANCE WITH THE INTERNAL LAW OF SUCH STATE, IN ACCORDANCE WITH THE PROVISIONS OF §5-1401 OF
THE NEW YORK GENERAL OBLIGATIONS LAW. 
 This Note is a replacement note for, and constitutes an amendment and restatement of,
that certain 6.04% Senior Note Due May 28, 2020, in the original principal amount of $[        ] made and executed by the Company and payable to the order of
[                    ]. 
  

			
	AMSURG CORP.
		
	By:	 	  

	Its:

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