Document:

Exhibit 10.7d

 

FIRST AMENDMENT TO LEASE AGREEMENT
FOR A GAMMA KNIFE UNIT

 

This FIRST AMENDMENT TO LEASE
AGREEMENT FOR A GAMMA KNIFE UNIT (this “Amendment”) is dated as of the 29th day of December, 2008, and is entered into
between GK FINANCING, LLC, a California limited liability company (“GKF”), and FROEDTERT MEMORIAL LUTHERAN HOSPITAL,
INC., a non-profit Wisconsin corporation (“Medical Center”), with reference to the following facts:

 

Recitals

 

A.  GKF and Medical
Center are parties to a certain Lease Agreement for a Gamma Knife Unit dated May 28, 1999, which has been amended by letter addendum
(as amended, the “Agreement”).

 

B.  Pursuant to Section
14 of the Agreement, the parties desire to upgrade the Equipment from a Leksell Gamma Knife Model B Unit to a Leksell Gamma Knife
Model C Unit, and to amend the Agreement, on the terms set forth herein.

 

NOW THEREFORE, for valuable consideration,
the receipt and sufficiency of which are acknowledged, the parties hereby amend the Agreement as follows:

 

Agreement

 

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

 

2.  Upgrade of the
Equipment.

 

a.  GKF shall upgrade
the existing Equipment to a Leksell Gamma Knife Model C with Automatic Positioning System manufactured by Elekta Instruments,
Inc (the “Model C”), and which will continue to be located at the existing Site (i.e., Froedtert Memorial Lutheran
Hospital, 9200 W. Wisconsin Avenue, Milwaukee, Wisconsin 53226) (the “Upgrade”). GKF shall be responsible for the
costs of implementing changes to the Site which are required to support the Model C. However, Medical Center will provide Medical
Center personnel and services upon request and as required by GKF to perform the Upgrade at no cost to GKF. Such personnel and
services shall include, but not be limited to, oversight supervision and assistance by Medical Center with construction and compliance
with building requirements, and by Medical Center physicists with nuclear regulatory compliance issues and the calibration of
the Model C. It is anticipated but not guaranteed that the Upgrade will occur in or around the first half of 2009, provided that
all Permits have been obtained.

 

b.  The
Upgrade will be performed by GKF after all appropriate licenses, permits, approvals, consents and authorizations (collectively,
the “Permits”) have been obtained by Medical Center at Medical Center’s cost for the Upgrade, including, without
limitation, the proper handling of the cobalt-60 during the Upgrade. The timing and procedure for the Upgrade shall be as mutually
agreed upon between the parties. Notwithstanding anything to the contrary set forth herein, the Upgrade shall not include loading
new cobalt-60 sources. Furthermore, GKF is not responsible for any additional hardware, cobalt reloading, software changes and/or
other modifications to the Model C except as agreed upon in writing by Medical Center and GKF. Upon completion of the Upgrade,
all references in the Agreement to the “Equipment” shall be to the Model C.

 

3.  Per Procedure
Payments. In consideration of the Upgrade, effective on the date the Model C becomes operational to perform clinical treatments,
Exhibit 1 of the Agreement (Per Procedure Payments) shall be deleted in its entirety and replaced with Exhibit 1 attached hereto.

 

     

     

    

  

4.  Extension of
Term. In view of the Upgrade, the term of the Agreement shall be extended by the number of days the Equipment (and the Model
C) will not be available for clinical use during the Upgrade process. The parties confirm that the Commencement Date (as defined
in the Agreement) is December 15, 1999, and that, pursuant to letter addendum between the parties (pertaining to the prior reload
of the cobalt 60 source), the term of the Agreement expires on December 15, 2014 (which does not take into account the further
extension based on the Upgrade).

 

5.  Full Force and
Effect. Except as amended by this Amendment, all of the terms and provisions of the Agreement shall remain in full force and
effect. Notwithstanding the foregoing, to the extent of any conflict or inconsistency between the terms and provisions of this
Amendment and that of the Agreement, the terms and provisions of this Amendment shall prevail and control.

 

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

 

	GKF:	Medical Center:
	GK FINANCING, LLC	FROEDTERT MEMORIAL LUTHERAN HOSPITAL, INC.
	By: /s/ Ernest A. Bates, M.D.	/s/ Blaine J. O’Connell
	Title: Policy Committee Member	Title: Sr. VP Finance and CFO

 

     

     

    

  

Exhibit 1

PER PROCEDURE PAYMENTS

 

	Annual Paid Procedures Performed	 	Fee Per Procedure	 
	 	 	 	 
	1-100	 	$	9,500	 
	101-150	 	$	7,750	 
	151+	 	$	7,000	 

 

Notwithstanding anything to the contrary set forth
herein, (a) for purposes of determining the per Procedure payment, the number of annual Procedures performed shall be reset to
zero (0) at the commencement of each anniversary of the Commencement Date; (b) for Procedure count purposes, any patient treatment
provided on a fractionated basis shall count as one (1) Procedure; and (c) there shall be no retroactive adjustment of the
per Procedure payment irrespective of whether the number of Procedures performed reaches a lower per Procedure payment level. For
example, if 140 procedures are performed during a particular year, Medical Center would pay $9,500 for each of the first 100 Procedures,
and $7,750 for each of the next Forty procedures (i.e., for Procedures 101 through 140).

 

If no Procedures are performed utilizing the Equipment,
no charges shall be incurred by Medical Center.

 

As used in the Agreement, a “Procedure”
shall mean any treatment, whether performed on an inpatient or outpatient basis, that involves stereotactic, external, single fraction,
conformal radiation, commonly called radiosurgery, that may include one or more isocenters during the patient treatment session,
delivered to any site(s) superior to the foramen magnum, that is performed by Medical Center or its representatives or affiliates,
irrespective of whether the Procedure is performed on the Model C or using any other equipment or devices.

 

Within ten (10) days after Medical Center’s
receipt of written request by GKF, GKF shall have the right to audit Medical Center’s books and records (including, without
limitation, the books and records pertaining to any other radiosurgery equipment or devices) to verify the number of Procedures
that have been performed by Medical Center, and Medical Center shall provide GKF with access to such books and records; provided
that any patient names or identifiers shall not be disclosed.Exhibit 10.7e

 

SECOND AMENDMENT TO LEASE AGREEMENT FOR
A GAMMA KNIFE UNIT

 

This SECOND AMENDMENT TO LEASE AGREEMENT
FOR A GAMMA KNIFE UNIT (this “Second Amendment”) is dated as of the 16th day of May, 2013, and is entered
into between GK FINANCING, LLC, a California limited liability company (“GKF”), and FROEDTERT MEMORIAL LUTHERAN HOSPITAL,
INC., a non-profit Wisconsin corporation (“Medical Center”), with reference to the following facts:

 

RECITALS

 

		A.	GKF and Medical Center are parties to a certain Lease Agreement for a Gamma Knife United dated May 28, 1999, which Lease Agreement
was amended by letter addendums and by a First Amendment dated December 29, 2008 (as amended, the “Agreement”).

 

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

 

NOW THEREFORE, for valuable consideration,
the receipt and sufficiency of which are acknowledged, the parties hereby amend the Agreement as follows:

 

AGREEMENT

 

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

 

2.              Per Procedure Payment. In consideration
of implementation of the American Tax Payer Relief Act of 2012, effective on May 1, 2013, Exhibit 1 of the Agreement (Per Procedure
Payments) shall be deleted in its entirety and replaced with Exhibit 1 attached hereto. Provided, however, if Section 634 is modified
or repealed, Medical Center shall pay to GKF the non-Medicare fee per procedure payment for Medicare procedures effective the date
of the modification or repeal of Section 634.

 

3.              Full Force and Effect. Except
as amended by this Second Amendment, all of the terms and provisions of the Agreement shall remain in full force and effect. Notwithstanding
the foregoing, to the extent of any conflict or inconsistency between the terms and provisions of this Second Amendment and that
of the Agreement, the terms and provisions of this Second Amendment shall prevail and control.

 

[Signatures continued on next page]

 

     

     

    

  

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

 

	GKF:	 	 	Medical Center:
	 	 	 	 
	GK FINANCING, LLC	 	FROEDTERT MEMORIAL LUTHERAN
	 	 	 	HOSPITAL, INC.
	 	 	 	 
	By:	/s/ Ernest A. Bates, MD	 	By:	/s/ Jeffrey Van De Kreeke
	Name:	Ernest A. Bates, MD	 	Name:	Jeffrey Van De Kreeke
	Title:	Policy Committee Member	 	Title:	VP – Finance 

 

     

     

    

  

Exhibit 1

 

PER PROCEDURE PAYMENTS

 

	Annual Paid Procedures 

Performed	 	Non-Medicare 
Fee Per Procedure	 	 	Medicare 
Fee Per Procedure	 
	1-100	 	$	9,500	 	 	$	9,200	 
	101-150	 	$	7,750	 	 	$	7,450	 
	151+	 	$	7,000	 	 	$	6,700	 

 

Notwithstanding anything to the contrary set forth herein, (a)
for purposes of determining the per procedure payment, the number of annual procedures performed shall be reset to zero (0) on
each anniversary of the first day of the first full month after the Effective Date of this Agreement; (b) for purposes of determining
the applicable per procedure payment tier, non-Medicare and Medicare procedures will be grouped chronologically as they are performed;
and (c) there shall be no retroactive adjustment of the per procedure payment irrespective of whether the number of procedures
performed during any fiscal year reaches a lower per procedure payment level. For example, if during an annual measuring period,
120 procedures are performed (of which 70 are non-Medicare procedures and 50 are Medicare procedures), then, (i) for each of the
first 100 procedures performed (irrespective of the number of non-Medicare and Medicare procedures comprising the first 100 procedures),
Medical Center would pay $9,500 for each non-Medicare procedure and $9,200 for each Medicare procedure; and (ii) for each of the
next 20 procedures performed (irrespective of the number of non-Medicare and Medicare procedures comprising the next 20 procedures),
Medical Center would pay $7,750 for each non-Medicare procedure and $7,450 for each Medicare procedure.

 

If no Procedures are performed utilizing the Equipment, no charges
shall be incurred by Medical Center.

 

As used in the Agreement, a “Procedure” shall mean
any treatment, whether performed on an inpatient or outpatient basis, that involves stereotactic, external, single fraction, conformal
radiation, commonly called radiosurgery, that may include one or more isocenters during the patient treatment session, delivered
to any site(s) superior to the foramen magnum, that is performed by Medical Center or its representatives or affiliates, irrespective
of whether the Procedure is performed on the Model C or using any other equipment or devices.

 

Within then (10) days after Medical Center’s receipt of
written request by GKF, GKF shall have the right to audit Medical Center’s books and records (including, without limitation,
the books and records pertaining to any other radiosurgery equipment or devices) to verify the number of Procedures that have been
performed by Medical Center, and Medical Center shall provide GKF with access to such books and records; provided that any patient
names or identifiers shall not be disclosed.

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