Document:

EXHIBIT 10.23

                                ORTHOMETRIX, INC.
                            FORM 10-QSB JUNE 30, 2006

                   THIS NOTE HAS BEEN ACQUIRED FOR INVESTMENT
                      AND HAS NOT BEEN REGISTERED UNDER THE
                    SECURITIES ACT OF 1933 OR THE SECURITIES
                     LAWS OF ANY STATE. THIS NOTE MAY NOT BE
                   SOLD OR TRANSFERRED IN THE ABSENCE OF SUCH
                      REGISTRATION OR AN OPINION OF COUNSEL
                      SATISFACTORY TO THE ISSUER THAT SUCH
                    REGISTRATION IS NOT REQUIRED BY SAID ACT
                                 OR STATE LAWS,

                                ORTHOMETRIX, INC.

$250,000.00                                               White Plains, New York
                                                                   June 23, 2006

          ORTHOMETRIX, INC., a Delaware corporation (the "Company"), for value
received, promises to pay to PSILOS GROUP PARTNERS II-S, L.P. (the "Payee"), the
principal sum of Two Hundred and Fifty thousand U.S. Dollars ($250,000) on June
23, 2007 (the "Maturity Date"), except as otherwise provided herein, together
with interest on the outstanding principal amount of this Note at the rate of
twelve percent (12%) per annum. Interest shall be payable quarterly on the last
business day of each March, June, September and December, commencing June 30,
2006.

          1. Payments and Prepayments.

          1.1. Payments and prepayments of principal and interest on this Note
shall be made to Payee at 625 Avenue of the Americas, 4th Floor, New York, NY
10011.

          1.2. Payments and prepayments of principal and interest on this Note
shall be made in lawful money of the United States of America.

          1.3. If any payment on this Note becomes due and payable on a
Saturday, Sunday or other day an which commercial banks in New York City are
authorized or required by law to close, the maturity thereof shall be extended
to the next succeeding business day, and, with respect to payments of principal,
interest thereon shall be payable during such extension at the applicable rate.

          1.4. The Company shall be obligated to prepay the outstanding
principal amount of this Note within ten (10) days after such time as (i) the
Company receives net proceeds of at least $5,000,000 from any financing or
series of related financings, or (ii) the Company sells all or substantially all
of its assets. The Company shall have the right at any time and from time to
time to prepay this Note in whole or in part, together with interest on the
amount prepaid to the date of prepayment, without penalty or premium. Upon
payment of part of the principal amount

of this Note, the Company may require the holder to present this Note for
notation of such payment and, if this Note is paid in full, require the holder
to surrender this Note.

          1.5. Upon payment in full of all outstanding principal and interest
due under this Note, the Company's obligations in respect of payment of this
Note shall terminate and the holder shall return it to the Company.

          2. Events of Default and Remedies.

In the event that:

          (a) the Company defaults for more than five business days in making
          any payment required to be made on this Note; or

          (b) the Company hereafter makes an assignment for the benefit of
          creditors, or files a petition in bankruptcy as to itself, is
          adjudicated insolvent or bankrupt, petitions or applies to any
          tribunal for the appointment of any receiver of or any trustee for the
          Company or any substantial part of its property under any bankruptcy,
          reorganization, arrangement, readjustment of debt, dissolution or
          liquidation law or statute of any jurisdiction, whether now or
          hereafter in effect; or if there is hereafter commenced against the
          Company any such proceeding and an order approving the petition is
          entered or such proceeding remains undismissed for a period of 60
          days, or the Company by any act or omission to act indicates its
          consent to or approval of or acquiescence in any such proceeding or
          the appointment of any receiver of, or trustee for, the Company or any
          substantial part of its property, or suffers any such receivership or
          trusteeship to continue undischarged for a period of 60 days;.

          the holder of this Note may: (a) by notice to the Maker, declare the
principal of and accrued interest on this Note to be immediately due and payable
and/or (b) pursue any available remedy to collect the payment of interest,
principal or premium, if any, on this Note or to enforce any provision of this
Note. A delay or omission by the holder of this Note in exercising any right or
remedy accruing upon an event of default shall not impair the right or remedy or
constitute a waiver or acquiesce in the event of default. All remedies are
cumulative to the extent permitted by law.

          3. Investment Representation.

          3.1. The Payee hereby acknowledges that the Note is not being
registered (i) under the Securities Act of 1933, as amended (the "Act"), on the
ground that the issuance of the Note is exempt from registration under Section
4(2) of the Act as not involving any public offering or (ii) under any
applicable state securities law because the issuance of the Note does not
involve any public offering; and that the Company's reliance on the Section 4(2)
exemption of the Act and under applicable state securities laws is predicated in
part on the representations hereby made to the Company by the Payee that it is
acquiring the Note for investment for its own account, with no present intention
of dividing its participation with others or reselling or otherwise distributing
the same, subject, nevertheless, to any requirement of law that the disposition
of its property shall at all times be within its control.

                                       -2-

          4. Miscellaneous.

          4.1. Upon receipt of evidence reasonably satisfactory to the Company
of the loss, theft, destruction or mutilation of this Note and of a letter of
indemnity reasonably satisfactory to the Company, and upon reimbursement to the
Company of all reasonable expenses incident thereto, and upon surrender or
cancellation of the Note, if mutilated, the Company will make and deliver a new
Note of like tenor in lieu of such lost, stolen, destroyed or mutilated Note.

          4.2 The undersigned hereby waives presentment, demand for payment,
notice of dishonor, and any and all other notices or demands in connection with
the delivery, acceptance, performance, default or enforcement of this Note, and
hereby consents to any extensions of time, renewals, releases of any party to
this Note, waivers or modifications that may be granted or consented to by the
Payee in respect to the time of payment or any other provision of this Note.

          4.3 No course of dealing of Payee or another holder hereof nor any
failure or delay by Payee or any such holder to exercise any right, power,
privilege, remedy or discretion under this Note shall operate as a waiver
thereof on that occasion or any other occasion, and any single or partial
exercise of any such right, power, privilege, remedy or discretion shall not
preclude any later exercise thereof or any exercise of any other right, power,
privilege, remedy or discretion hereunder. No covenant, obligation or other
provision of this Note may be waived, and no consent contemplated hereby may be
given, other than in a writing signed by Payee or another holder waiving such
covenant, obligation or provision or giving such consent.

          4.4 Maker will pay on demand all reasonable costs and expenses
(including attorneys' reasonable fees and expenses) incurred by Payee in
connection with the enforcement of this Note and the preservation of Payee's
rights hereunder.

          4.5. Payee may not assign or transfer this Note in any manner
whatsoever without the prior written consent of the Maker. Notwithstanding any
other provision hereof, Payee or any other holder of this Note may assign or
transfer this Note without the consent of Maker or any other person to any
affiliate of such holder, including without limitation to any stockholder,
partner, member or other owner of such holder.

          4.6 This Note and the rights and obligations of the Company and each
holder hereunder shall be construed in accordance with and be governed by the
laws of the State of New York.

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

                                        ORTHOMETRIX, INC,

                                        By: Reynald Bonmati
                                        ----------------------------------------
                                        Name: Reynald Bonmati
                                        Title: President

                                       -3-Exhibit
10.1.6

FIFTH SUPPLEMENTAL INDENTURE

FIFTH SUPPLEMENTAL
INDENTURE (this ‘‘Supplemental Indenture’’),
dated as of April  26,  2006, among Ormat Funding Corp., a
Delaware corporation (the ‘‘Issuer’’), and
Union Bank of California, N.A., as trustee (the
‘‘Trustee’’) and as collateral agent (the
‘‘Collateral Agent’’), in each case, under the
Indenture referred to below.

WITNESSETH

WHEREAS,
the Issuer and the guarantors named therein have heretofore executed
and delivered to the Trustee an indenture (as supplemented, the
‘‘Indenture’’), dated as of February
13,  2004 providing for the issuance of
81⁄4% Senior Secured Notes due 2020 (the
‘‘Senior Secured
Notes’’);

WHEREAS, the Indenture provides that
under certain circumstances the Indenture may be supplemented or
amended by the Issuer, the Trustee and the Collateral
Agent;

WHEREAS, in accordance with the terms of the
Indenture, the Issuer has solicited, and obtained, the consent of the
Required Holders (as defined in the Indenture) of the Senior Secured
Notes to amend certain provisions of the Indenture;
and

WHEREAS, pursuant to Article VIII of the Indenture,
all conditions precedent provided for in the Indenture with respect to
the execution of this Supplemental Indenture have been complied with
and the Trustee is authorized to execute and deliver this Supplemental
Indenture.

NOW, THEREFORE, in consideration of the
foregoing and for other good and valuable consideration, the receipt of
which is hereby acknowledged, the parties hereto mutually covenant and
agree for the equal and ratable benefit of the Holders of the Senior
Secured Notes as follows:

1.    CAPITALIZED
TERMS.    Capitalized terms used herein without definition shall
have the meaning assigned to them in the
Indenture.

2.    AMENDMENT.    The parties hereby
agree to amend Section 4.03 of the Indenture, by deleting Section 4.03
and replacing it in its entirety by the following new
provision:

‘‘Section 4.03 Reporting
Requirements.    The Issuer shall deliver to the Trustee and the
Collateral Agent (and, upon request of a Holder (or owner of a
beneficial interest in a Global Note) shall deliver directly to such
Holder (or owner of a beneficial interest in a Global Note) (which
request may indicate that it is a continuing request for such
information until further notice from such Holder (or such owner of a
beneficial interest in a Global Note) to the
contrary):

(a)    As soon as available
but, in any event, within 45 days after the close of each of the first
three quarterly accounting periods in each fiscal year, a complete
unaudited consolidated balance sheet of the Issuer and its Subsidiaries
as at the end of such quarterly period with related statements of
income and capital and statements of cash flows for such quarterly
period and for the elapsed portion of the fiscal year ended with the
last day of such quarterly period, prepared in accordance with GAAP
(but without footnotes), consistently applied and setting forth
comparative unaudited figures for the related periods in the prior
fiscal year, all of which shall be accompanied by a certificate of an
Authorized Representative of the Issuer to the effect that such
financial statements present fairly the financial condition and results
of operation of the Issuer on the dates and for the periods indicated,
subject to normal year-end audit
adjustments;

(b)    As soon as
available but, in any event, within 90 days after the close of each
fiscal year, the following: (i) a consolidated balance sheet of the
Issuer and its Subsidiaries as at the end of such fiscal year with the
related statements of income and capital and statements of cash flows
for such fiscal year, in each case setting forth comparative figures
for the preceding fiscal year and certified by the Issuer's
certified independent accountants (the
‘‘Auditors’’) (all such statements

being in agreement with the Issuer's
books of account and prepared in accordance with GAAP, consistently
applied); and (ii) a report or other written communication from the
Auditors indicating whether, in the course of their regular audit of
the consolidated financial statements of the Issuer, the Auditors
obtained actual knowledge of any Default or Event of Default which has
occurred and is continuing (and, in the event the Auditors obtained any
such actual knowledge, indicating the nature of such Default or Event
of Default);

(c)    At the time of the
delivery of the financial statements provided for in clause (a) or (b)
immediately above, a certificate of an Authorized Officer of the Issuer
to the effect that, to such Authorized Officer's actual
knowledge, (i) no Default or Event of Default has occurred and is
continuing or, if any Default or Event of Default has occurred and is
continuing, specifying the nature and extent thereof and what action
the Issuer or any Guarantor is taking or proposes to take in response
thereto and (ii) such Person is in compliance with all of its material
obligations under the terms of the Financing Documents to which it is a
party or, if not, specifying the nature and extent thereof and what
action the Issuer or any Guarantor is taking or proposes to take in
response thereto;

(d) (i)    promptly,
but in all cases within three Business Days after the Issuer or any
Guarantor obtains actual knowledge thereof, notice of any event which
constitutes a Default or an Event of Default, specifying the nature of
such Default or Event of Default and any steps that the Issuer or any
such Guarantor is taking or proposes to take to remedy the same, and
(ii) promptly, and in any event within 3 Business Days after the Issuer
or any Guarantor obtains actual knowledge thereof, notice
of:

(A)    any litigation, arbitration
or governmental proceeding (other than any governmental proceeding in
the ordinary course of business) pending (x) against the Issuer or any
Guarantor or (y) with respect to any Transaction Document to which the
Issuer or such Guarantor is a party or, to the actual knowledge of the
Issuer or any Guarantor, which, in either case, individually or in the
aggregate could reasonably be expected to result in a Material Adverse
Effect;

(B)    the occurrence and
continuance of any Event of Loss, Event of Eminent Domain or Title
Event that could reasonably be expected to give rise to Loss Proceeds,
Eminent Domain Proceeds or Title Event Proceeds, as applicable, in an
amount in excess of $5.0
million;

(C)    any change in the
Authorized Representatives of the Issuer or any Guarantor, accompanied
by certified specimen signatures of any Authorized Representatives so
appointed;

(D)    any report, notice
or correspondence received or initiated by the Issuer or any Guarantor
relating to any Governmental Approval or any other license or
authorization necessary for the performance by the Issuer or any
Guarantor of its obligations under the Transaction Documents, which
report, notice, correspondence and other document is received or
initiated other than in the ordinary course of business and which could
reasonably be expected to result in a Material Adverse Effect;
or

(E)    any downgrade in the credit
rating of any provider of an Acceptable Letter of Credit below
Investment Grade.

In addition, the Issuer and the
Guarantors agree that they shall furnish to the Holders and to
prospective investors, upon the request of such Holders, the
information required to be delivered pursuant to Rule 144(A)(d)(4)
under the Securities Act so long as the Senior Secured Notes are not
freely transferable under the Securities Act.

The receipt
by the Trustee of any such reports and documents pursuant to this
Section 4.03 shall not constitute notice or constructive notice of any
information contained in such documents or determinable from
information contained in such documents, including the Issuer's
compliance with any covenants hereunder (as to which the Trustee is
entitled to rely exclusively on an Officers'
Certificate).

3.    REFERENCES TO AND EFFECT
ON INDENTURE.    (a) On and after the execution of this Supplemental
Indenture, each reference in the Indenture to ‘‘this
Indenture,’’ ‘‘hereunder,’’
‘‘hereof,’’ or words of like import referring
to the Indenture, shall mean and be a reference to the Indenture, as
amended by this Supplemental Indenture.

(b)    The
Indenture, as specifically amended by this Supplemental Indenture, is
and shall continue to be in full force and effect and is hereby in all
respects ratified and
confirmed.

4.    EFFECTIVENESS.    This Supplemental
Indenture shall be effective upon execution hereof by the Issuer, the
Trustee and the Collateral Agent.

5.    BENEFITS OF
THIS SUPPLEMENTAL INDENTURE.    Nothing in this Supplemental
Indenture, express or implied, shall give to any person, other than the
parties to the Indenture and their respective successors thereunder and
the Holders of the Notes, any benefit or any legal or equitable right,
remedy or claim under this Supplemental
Indenture.

6.    GOVERNING LAW. THE INTERNAL LAW OF
THE STATE OF NEW YORK SHALL GOVERN AND BE USED TO CONSTRUE THIS
SUPPLEMENTAL INDENTURE WITHOUT GIVING EFFECT TO APPLICABLE PRINCIPLES
OF CONFLICTS OF LAW TO THE EXTENT THAT THE APPLICATION OF THE LAWS OF
ANOTHER JURISDICTION WOULD BE REQUIRED
THEREBY.

7.    COUNTERPARTS.    The parties may sign
any number of copies of this Supplemental Indenture. Each signed copy
shall be an original, but all of them together represent the same
agreement.

8.    EFFECT OF HEADINGS.    The Section
headings herein are for convenience only and shall not affect the
construction hereof.

9.    THE TRUSTEE.    The
Trustee shall not be responsible in any manner whatsoever for or in
respect of the validity or sufficiency of this Supplemental Indenture
or for or in respect of the recitals contained herein, all of which
recitals are made solely by the Issuer.

IN WITNESS WHEREOF, the parties hereto have
caused this Supplemental Indenture to be duly executed and attested,
all as of the date first above written.

Dated: April 26,
2006

							
	 			ORMAT
FUNDING CORP.
	 			 			 
	 			By:			 /s/ Ran
Raviv
	 			 			Name:   Ran
Raviv
	 			 			Title:    Authorized
Representative
	 			 			 
	 			 			 
	 			UNION
BANK OF CALIFORNIA, N.A., as
Trustee
	 			 			 
	 			By:			 /s/ James
Myers
	 			 			Name:   James
Myers
	 			 			Title:    Vice
President
	 			 			 
	 			 			 
	 			UNION
BANK OF CALIFORNIA, N.A., as Collateral
Agent
	 			 			 
	 			By:			 /s/ James
Myers
	 			 			Name:   James
Myers
	 			 			Title:    Vice
President
	

[Signature Page to Fifth
Supplemental Indenture]

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