Document:

exv10w34

Exhibit 10.34

AMENDMENT NO. 3 TO SECOND AMENDED AND RESTATED CREDIT AGREEMENT

          This AMENDMENT NO. 3 TO SECOND AMENDED AND RESTATED CREDIT AGREEMENT (this “Amendment”) dated
as of July 19, 2011 is by and among BLUESTEM BRANDS, INC. (the “Borrower”), each of the Lenders
party to the Credit Agreement (as defined below) as of the date hereof, and JPMORGAN CHASE BANK,
N.A., as administrative agent for the Lenders (“Administrative Agent”).

R E C I T A L S:

          WHEREAS, Administrative Agent, Lenders and Borrower are parties to that certain Second Amended
and Restated Credit Agreement dated as of August 20, 2010 (as amended, supplemented, restated or
otherwise modified from time to time, the “Credit Agreement”); capitalized terms used and not
defined herein shall have the meanings assigned to them in the Credit Agreement, as amended hereby;
and

          WHEREAS, the Borrower has requested that the Lenders amend the Credit Agreement pursuant to
the terms and conditions set forth herein;

          NOW, THEREFORE, in consideration of the premises contained herein, and for other good and
valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties
hereto hereby agree as follows:

Section 1. Amendments to Credit Agreement. Immediately upon the satisfaction of each of
the applicable conditions precedent set forth in Section 2 of this Amendment, the following
amendments to the Credit Agreement shall become effective:

     (a) Amendment to Section 1.01. Clause (a)(vi) of the definition of
“Consolidated Adjusted EBITDA” is hereby amended and restated in its entirety as follows:

“(vi) for the period from, and including, (x) the Closing Date to, and including,
the last day of the first Fiscal Quarter to end after the Closing Date, other fees
and expenses in an amount not to exceed $6,500,000 paid in connection with the SPV
Credit Documents and the transactions contemplated therein and the refinancing or
replacement of credit facilities existing prior to the Closing Date and (y) July 19, 2011, and including, the last day of the first Fiscal Quarter to end after the
Third Amendment Date, other fees and expenses in an amount not to exceed $3,000,000
paid in connection with the Third Amendment and the transactions contemplated
therein and the refinancing or replacement of credit facilities existing prior to
the Third Amendment Date,”

     (b) Amendment to Section 1.01. The definition of “Consolidated Fixed Charges”
is hereby amended and restated in its entirety as follows:

““Consolidated Fixed Charges” means, with reference to any period,
without duplication, Consolidated Cash Interest Expense plus any administration fees owed pursuant to the fee letter
under the SPV Credit Documents and any commitment fees owed pursuant to the SPV Credit Agreement and under this Agreement,
plus scheduled principal payments on Indebtedness made during such period (not including principal payments under the SPV Credit Agreement or
under this Agreement), plus the amount of any prepayment premiums or other similar fees paid in connection with
the SPV Credit Documents or the Loan Documents (excluding any prepayment premiums or other similar fees paid (directly or indirectly)
from the net proceeds of an Initial Public Offering), plus income and franchise taxes paid in cash net of income and franchise tax refunds (but
not less than zero), plus (x) dividends or distributions paid in cash and (y) any other restricted payments permitted
under Section 6.08(a)(iii), (iv), (v) and (vi) and paid in cash, all calculated for the Borrower and its Subsidiaries on a consolidated basis.”

     (c) Amendment to Section 1.01. The
definition of “Consolidated Interest Expense” is hereby amended and restated in its entirety as follows:

““Consolidated Interest Expense” shall mean, for any period, total interest expense (including that portion attributable to Capital
Lease Obligations, but excluding any portion attributable to leases characterized as operating leases under FASB ASC 840 as in effect as of the date hereof but
characterized as Capital Lease Obligations following changes to FASB ASC 840 taking effect after the date hereof) of the Servicer Consolidated Group for such
period with respect to all outstanding Indebtedness of the Servicer Consolidated Group (including all commissions, discounts and other fees and
charges owed with respect to letters of credit and bankers’ acceptance financing and net costs under Swap Agreements in respect of interest rates to the extent such net
costs are allocable to such period in accordance with GAAP), calculated on a consolidated basis for the Servicer Consolidated Group for such
period in accordance with GAAP.”

     (d) Amendment to Section 1.01. Clause (h) of the definition of “Indebtedness”
is hereby amended and restated in its entirety as follows:

“(h) all Capital Lease Obligations of such Person (excluding any liability with
respect to leases characterized as operating leases under FASB ASC 840 as in effect
as of the Third Amendment Date but characterized as Capital Leases

 

following changes to FASB ASC 840 taking effect after the Third Amendment Date),”

     (e) Amendment to Section 1.01. Section 1.01 is hereby amended by amending and
restating the following defined terms to read in their entirety as follows:

““Change in Control” means any Person or “group” (within the meaning of
Rules 13d-3 and 13d-5 under the Exchange Act) other than the Control Parties and any
of their Affiliates (a) shall have acquired beneficial ownership of 35% or more on a
fully diluted basis of the voting and/or economic interest in the Capital Stock of
the Borrower or (b) shall have obtained the power (whether or not exercised) to
elect a majority of the members of the board of directors (or similar governing
body) of the Borrower.”

““Control Parties” means one or more of: (i) Bain Capital Venture Fund,
L.P., BCIP Associates III, LLC, BCIP Associates III-B, LLC, Bain Capital Venture
Fund 2001, L.P., Bain Capital Venture Fund 2007, L.P., BCIP Venture Associates, BCIP
Venture Associates B and Brookside Capital Partners Fund, L.P. and (ii) Battery
Ventures VI, L.P. and Battery Investment Partners VI, LLC.”

     (f) Amendment to Section 1.01. Section 1.01 is hereby amended by inserting, in
their proper alphabetical order, the following new definitions:

““Third Amendment” means that Amendment No. 3 to Second Amended and Restated Credit
Agreement dated as of July 19, 2011 among the Borrower, Administrative Agent and
Lenders.”

““Third Amendment Date” means the date the conditions set forth in Section 2 of the
Third Amendment are satisfied.

     (g) Amendment to Section 1.01. Section 1.01 is hereby amended by deleting in
their entirety the following defined terms: “LTM EBITDA Margin”, “Petters Group”, and “Total
Payment Ratio” and all references thereto shall be deleted.

     (h) Amendment to Section 5.04(c). Section 5.04(c) is hereby amended and restated in its entirety as follows:

     “(c) such liabilities would not result in aggregate liabilities in
excess of $3,500,000 and none of the Collateral becomes subject to forfeiture or loss as a result of the contest.”

     (i) Amendment to Section 6.14(b). Section 6.14(b) is hereby amended and
restated in its entirety as follows:

     “[Intentionally Omitted]”

     (j) Amendment to Section 6.14(c). Section 6.14(c) is hereby amended and
restated in its entirety as follows:

     “[Intentionally Omitted]”

     (k) Amendment to Section 6.14(d). Section 6.14(d) is hereby amended and
restated in its entirety as follows:

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     ““Minimum Net Liquidity. The Servicer Consolidated Group’s Net Liquidity shall
be equal to or greater than $22,500,000 (measured as of the last day of each fiscal month of
the Servicer) after giving effect to any payments under this Agreement or the SPV Credit
Agreement on such date of measurement.”

     (l) Amendment to Section 6.15. Section 6.15 is hereby amended and restated in
its entirety as follows:

“Portfolio Covenants. So long as the SPV Credit Agreement is in
effect, the Borrower shall not violate the following performance measurements, in
each case to be determined on a monthly basis as of the last calendar day of any
calendar month following the Closing Date and calculated on the first Determination
Date occurring after such last calendar day of such calendar month (and based on the
information for the preceding calendar month or months, as applicable, set forth in
any Monthly Servicing Report related to such Determination Date):

     (a) The average Principal Payment Ratio for the preceding three-month period
shall be greater than (1) for any three month period ending on any date from
February 1 to and including October 31 of the applicable calendar year, 4.75% and
(2) otherwise, 4.50%.

     (b) The average Principal Default Ratio for the preceding three-month period
shall be less than (1) for any three-month period ending on any date from April 1 to
and including August 31 of the applicable calendar year, 24.00% and (2) otherwise,
28.00%.

     (c) The average Principal Delinquency Ratio for the preceding three-month
period shall be less than 14.50%.

     (d) The average Excess Spread Ratio for the preceding three-month period shall
be greater than 8.00%.

     (e) The average Adjusted Excess Spread Ratio for the preceding three-month
period shall be greater than —4.00% (negative four percent).”

     (m) Amendment to Subsection 7(k). Subsection 7(k) is
hereby amended by replacing the reference to “$2,500,000” with a reference to “$3,500,000”.

Section 2. Conditions Precedent to Effectiveness of Amendment. This Amendment shall be
effective on the date on which (i) this Amendment shall have been duly executed and delivered by
the parties hereto, (ii) Administrative Agent shall have received fully executed copies of the
Amended and Restated Servicing Agreement, Amended and Restated SPV Credit Agreement, and all
documents related thereto, in each case, in form and substance reasonably satisfactory to
Administrative Agent and (iii) the Borrower shall have paid to the Administrative Agent, and the
Administrative Agent shall have received, for the benefit of the Lenders, in immediately available
funds, as consideration for the execution and delivery of this Amendment, an amendment fee in an
amount equal $100,000, which fee missing (x) & (y) is non-refundable and fully earned on the date hereof.

Section 3. Representations, Warranties and Covenants. In order to induce Administrative
Agent and Lenders to enter into this Amendment, Borrower represents, warrants and covenants to

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Administrative Agent and Lenders, upon the effectiveness of this Amendment, which representations,
warranties and covenants shall survive the execution and delivery of this Amendment, that:

          (a) No Default; etc. No Event of Default and no event or condition which, merely with
notice or the passage of time or both, would constitute an Event of Default, has occurred and is
continuing after giving effect to this Amendment or would result from the execution or delivery of
this Amendment or the consummation of the transactions contemplated hereby.

          (b) Power and Authority; Authorization. Borrower has the corporate power and
authority to execute and deliver this Amendment and to carry out the terms and provisions of the
Credit Agreement, as amended by this Amendment, and the execution and delivery by Borrower of this
Amendment, and the performance by Borrower of its obligations hereunder and under the Loan
Documents have been duly authorized by all requisite corporate action by Borrower.

          (c) Execution and Delivery. Borrower has duly executed and delivered this Amendment.

          (d) Enforceability. This Amendment and the Credit Agreement, as amended by this
Amendment, constitute the legal, valid and binding obligations of Borrower, enforceable against
Borrower in accordance with its terms, except as enforcement may be limited by bankruptcy,
insolvency, reorganization, moratorium or similar laws affecting the enforcement of creditors’
right generally, and by general principles of equity, regardless of whether considered in a
proceeding in equity or at law.

          (e) Representations and Warranties. All of the representations and warranties
contained in the Credit Agreement and in the other Loan Documents (other than those which speak
expressly only as of a different date) are true and correct in all material respects as of the date
hereof after giving effect to this Amendment and the transactions contemplated hereby.

Section 4. Consent to Amendments or Consents to the Amended and Restated Servicing Agreement,
Amended and Restated SPV Credit Agreement, the Amended and Restated Receivables Purchase Agreement,
the Amended and Restated Equity Pledge Agreement, the Amended and Restated Holdings Letter
Agreement, Amended and Restated SPV Security Agreement. By their execution of this Amendment,
the Lenders and the Administrative Agent hereby consent (to the extent required) to the execution
and delivery by the Borrower of the Amended and Restated Servicing Agreement, the Amended and
Restated SPV Credit Agreement, the Amended and Restated Receivables Purchase Agreement, the Amended
and Restated Equity Pledge Agreement, the Amended and Restated Holdings Letter Agreement and the
Amended and Restated SPV Security Agreement and this Amendment shall constitute proper notice under
the Loan Documents (to the extent required) with respect to such amendments.

Section 5. Miscellaneous.

          (a) Effect; Ratification. Borrower acknowledges that all of the reasonable legal
expenses incurred by Administrative Agent in connection herewith shall be reimbursable

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under
Section 9.03 of the Credit Agreement. The amendments set forth herein are effective solely for the
purposes set forth herein and shall be limited precisely as written, and shall not be deemed to (i)
be a consent to any amendment, waiver or modification of any other term or condition of the Credit
Agreement, as amended hereby, or of any other Loan Document or (ii) prejudice any right or rights
that Administrative Agent or any Lender may now have or may have in the future under or in
connection with the Credit Agreement or any other Loan Document. Each reference in the Credit
Agreement to “this Agreement”, “herein”, “hereof” and words of like import and each reference in
the other Loan Documents to the “Credit Agreement” shall mean the Credit Agreement as amended
hereby. This Amendment shall be construed in connection with and as part of the Credit Agreement
and all terms, conditions, representations, warranties, covenants and agreements set forth in the
Credit Agreement and each other Loan Document, except as herein amended, are hereby ratified and
confirmed and shall remain in full force and effect.

          (b) Counterparts. This Amendment may be executed via facsimile transmission in any
number of counterparts and by different parties hereto in separate counterparts, each of which when
so executed and delivered shall be deemed an original, but all of which counterparts together shall
constitute one and the same instrument.

          (c) Severability. In case any provision in 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.

          (d) Loan Document. This Amendment shall constitute a Loan Document.

          (e) Reaffirmation of Guaranties. Borrower hereby reaffirms its Secured Obligations
and Guaranteed Obligations.

          (f) Governing Law. This Amendment shall be governed by and construed in accordance
with, the internal laws of the State of New York.

[Signature Page Follows]

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          IN WITNESS WHEREOF, the parties hereto have caused this Amendment No. 3 to Second Amended and
Restated Credit Agreement to be duly executed by their respective authorized officers as of the
date first above written.

	 	 	 	 	 
	 	BLUESTEM BRANDS, INC.

 	 
	 	By:  	/s/ Mark P. Wagener	 
	 	 	Name:  	Mark P. Wagener	 
	 	 	Title:  	EVP, Chief Financial Officer	 

 

 

	 	 	 	 	 
	 	JPMORGAN CHASE BANK, N.A., individually,

as Administrative Agent, and Lender

 	 
	 	By:  	/s/ Bradford R. Kuhn	 
	 	 	Name:  	Bradford R. Kuhn	 
	 	 	Title:  	Duly Authorized Signatory	 

 

 

	 	 	 	 	 
	 	U.S. BANK NATIONAL ASSOCIATION,

as a Lender

 	 
	 	By:  	/s/ Elizabeth J. Limpert	 
	 	 	Name:  	Elizabeth J. Limpert	 
	 	 	Title:  	Vice Presidentexv4w4

Exhibit 4.4

SUPPLEMENTAL INDENTURE

          Supplemental Indenture (this “Supplemental Indenture”), dated as of September 1, 2011
among Ophthalmic Imaging Systems, a California corporation (“OIS”), Abraxas Medical
Solutions, Inc. (“Abraxas”; together with OIS, each a “Guaranteeing Subsidiary”),
each a subsidiary of Merge Healthcare Incorporated, a Delaware corporation (the “Issuer”),
and The Bank of New York Mellon Trust Company, N.A., as trustee (the “Trustee”) and
Collateral Agent.

W I T N E S S E T H

          WHEREAS, the Issuer and each of the Guarantors (as defined in the Indenture referred to below)
have heretofore executed and delivered to the Trustee an indenture, dated as of April 28, 2010, as
amended by that certain First Supplemental Indenture dated as of June 14, 2011, and by that certain
Second Supplemental Indenture dated as of June 20, 2011, (together, as amended, supplemented or
otherwise modified from time to time, the “Indenture”), providing for the issuance of
11.75% Senior Secured Notes due 2015 (the “Notes”);

          WHEREAS, the Indenture provides that under certain circumstances each Guaranteeing Subsidiary
shall execute and deliver to the Trustee a supplemental indenture pursuant to which each
Guaranteeing Subsidiary shall unconditionally guarantee all of the Issuer’s Obligations under the
Notes and the Indenture on the terms and conditions set forth herein and under the Indenture (the
“Guarantee”); and

          WHEREAS, pursuant to Section 9.01 of the Indenture, 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 mutually covenant and agree
for the equal and ratable benefit of the Holders of the Notes as follows:

          (1) Capitalized Terms. Capitalized terms used herein without definition shall have
the meanings assigned to them in the Indenture.

          (2) Agreement to Guarantee. Each Guaranteeing Subsidiary hereby agrees as follows:

(a) Along with all Guarantors named in the Indenture, to jointly and severally
unconditionally guarantee to each Holder of a Note authenticated and delivered by the
Trustee and to the Trustee and its successors and assigns, irrespective of the validity and
enforceability of the Indenture, the Notes or the obligations of the Issuer hereunder or
thereunder, that:

     (i) the principal of and interest, premium and Additional Interest, if any, on
the Notes will be promptly paid in full when due, whether at maturity, by
acceleration, redemption or otherwise, and interest on the overdue principal of and
interest on the Notes, if any, if lawful, and all other obligations of the Issuer to
the Holders or the Trustee hereunder or thereunder will be promptly paid in full or
performed, all in accordance with the terms hereof and thereof; and

     (ii) in case of any extension of time of payment or renewal of any Notes or any
of such other obligations, that same will be promptly paid in full when due or

 

 

performed in accordance with the terms of the extension or renewal, whether at
stated maturity, by acceleration or otherwise. Failing payment when due of any
amount so guaranteed or any performance so guaranteed for whatever reason, the
Guarantors and each Guaranteeing Subsidiary shall be jointly and severally obligated
to pay the same immediately. This is a guarantee of payment and not a guarantee of
collection.

(b) The obligations hereunder shall be unconditional, irrespective of the validity,
regularity or enforceability of the Notes or the Indenture, the absence of any action to
enforce the same, any waiver or consent by any Holder of the Notes with respect to any
provisions hereof or thereof, the recovery of any judgment against the Issuer, any action to
enforce the same or any other circumstance which might otherwise constitute a legal or
equitable discharge or defense of a guarantor.

(c) The following is hereby waived: diligence, presentment, demand of payment, filing of
claims with a court in the event of insolvency or bankruptcy of the Issuer, any right to
require a proceeding first against the Issuer, protest, notice and all demands whatsoever.

(d) This Guarantee shall not be discharged except by complete performance of the obligations
contained in the Notes, the Indenture and this Supplemental Indenture, and each Guaranteeing
Subsidiary accepts all obligations of a Guarantor under the Indenture.

(e) If any Holder or the Trustee is required by any court or otherwise to return to the
Issuer, the Guarantors (including each Guaranteeing Subsidiary), or any custodian, trustee,
liquidator or other similar official acting in relation to either the Issuer or the
Guarantors, any amount paid either to the Trustee or such Holder, this Guarantee, to the
extent theretofore discharged, shall be reinstated in full force and effect.

(f) Each Guaranteeing Subsidiary shall not be entitled to any right of subrogation in
relation to the Holders in respect of any obligations guaranteed hereby until payment in
full of all obligations guaranteed hereby.

(g) As between each Guaranteeing Subsidiary, on the one hand, and the Holders and the
Trustee, on the other hand, (x) the maturity of the obligations guaranteed hereby may be
accelerated as provided in Article VI of the Indenture for the purposes of this Guarantee,
notwithstanding any stay, injunction or other prohibition preventing such acceleration in
respect of the obligations guaranteed hereby, and (y) in the event of any declaration of
acceleration of such obligations as provided in Article VI of the Indenture, such
obligations (whether or not due and payable) shall forthwith become due and payable by each
Guaranteeing Subsidiary for the purpose of this Guarantee.

(h) Each Guaranteeing Subsidiary shall have the right to seek contribution from any
non-paying Guarantor so long as the exercise of such right does not impair the rights of the
Holders under this Guarantee.

(i) In case any provision of this Guarantee shall be invalid, illegal or unenforceable, the
validity, legality, and enforceability of the remaining provisions shall not in any way be
affected or impaired thereby.

(j) This Guarantee shall be a general unsecured senior obligation of such Guaranteeing
Subsidiary, ranking pari passu with any other future Senior Indebtedness of such
Guaranteeing Subsidiary, if any.

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(k) Each payment to be made by each Guaranteeing Subsidiary in respect of this Guarantee
shall be made without set-off, counterclaim, reduction or diminution of any kind or nature.

(l) This Guarantee shall be governed by the terms and provisions set forth in Section 2 of
the Guarantee and Collateral Agreement.

          (3) Execution and Delivery. Each Guaranteeing Subsidiary agrees that the Guarantee
shall remain in full force and effect notwithstanding the absence of the endorsement of any
notation of such Guarantee on the Notes.

          (4) Merger, Consolidation or Sale of All or Substantially All Assets.

          (a) Except as otherwise provided in Section 5.01(c) of the Indenture, each Guaranteeing
Subsidiary may not consolidate or merge with or into or wind up into (whether or not the Issuer or
such Guaranteeing Subsidiary is the surviving corporation), or sell, assign, transfer, lease,
convey or otherwise dispose of all or substantially all of its properties or assets, in one or more
related transactions, to any Person unless:

(i) (A) such Guaranteeing Subsidiary is the surviving corporation or the Person formed by or
surviving any such consolidation or merger (if other than such Guaranteeing Subsidiary) or
to which such sale, assignment, transfer, lease, conveyance or other disposition will have
been made is a corporation organized or existing under the laws of the jurisdiction of
organization of such Guaranteeing Subsidiary, as the case may be, or the laws of the United
States, any state thereof, the District of Columbia, or any territory thereof (such
Guaranteeing Subsidiary or such Person, as the case may be, being herein called the
“Successor Person”);

(B) the Successor Person, if other than such Guaranteeing Subsidiary, expressly assumes all
the obligations of such Guaranteeing Subsidiary under the Indenture, the Security Documents
and such Guaranteeing Subsidiary’s related Guarantee pursuant to supplemental indentures or
other documents or instruments in form reasonably satisfactory to the Trustee;

(C) immediately after such transaction, no Default exists; and

(D) the Issuer shall have delivered to the Trustee an Officer’s Certificate and an Opinion
of Counsel, each stating that such consolidation, merger or transfer and such supplemental
indentures, if any, comply with the Indenture;

(E) any Collateral owned by or transferred to the Successor Person shall (i) continue to
constitute Collateral under the Indenture and the Security Documents, (ii) be subject to the
Lien in favor of the Collateral Agent for the benefit of the Trustee and the Holders of the
Notes, and (iii) not be subject to any Lien other than Permitted Liens and other Liens
permitted under Section 4.12 of the Indenture; and

(F) to the extent any assets of the Person which is merged or consolidated with or into the
Successor Company are assets of the type which would constitute Collateral under the
Securities Documents, the Successor Company will take such action as may be reasonably
necessary to cause such property and assets to be made subject to the Lien of the Security
Documents in the manner and to the extent required in the Indenture or any of the Security
Documents and shall take all reasonably necessary action so that such Lien is perfected to
the extent required by the Security Documents; or

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(ii) the transaction is made in compliance with Section 4.10 of the Indenture;

          (b) Subject to certain limitations described in the Indenture, the Successor Person will
succeed to, and be substituted for, such Guaranteeing Subsidiary under the Indenture and such
Guaranteeing Subsidiary’s Guarantee. Notwithstanding the foregoing, each Guaranteeing Subsidiary
may merge into or transfer all or part of its properties and assets to another Guarantor or the
Issuer.

          (5) Releases.

          The Guarantee of each Guaranteeing Subsidiary shall be automatically and unconditionally
released and discharged, and no further action by such Guaranteeing Subsidiary, the Issuer or the
Trustee is required for the release of such Guaranteeing Subsidiary’s Guarantee, upon:

(1) (A) in connection with any sale or other disposition of all or substantially
all of the assets of such Guaranteeing Subsidiary (including by way of merger or
consolidation) to a Person that is not (either before or after giving effect to such
transaction) such Guaranteeing Subsidiary, if the sale or other disposition does not violate
Section 4.10;

(B) in connection with any sale or other disposition of the capital stock of such
Guaranteeing Subsidiary (including by way of merger or consolidation) to a Person that is
not (either before or after giving effect to such transaction) the Company or a Restricted
Subsidiary of the Company, such that, immediately after giving effect to such transaction,
such Guaranteeing Subsidiary would no longer constitute a Subsidiary of the Company, if the
sale or other disposition does not violate Section 4.10;

(C) the proper designation of such Guaranteeing Subsidiary as an Unrestricted Subsidiary;

(D) the Issuer exercising its Legal Defeasance option or Covenant Defeasance option in
accordance with Article VIII of the Indenture or the Issuer’s obligations under the
Indenture being discharged in accordance with the terms of the Indenture; and

(2) such Guaranteeing Subsidiary delivering to the Trustee an Officer’s Certificate and an
Opinion of Counsel, each stating that all conditions precedent provided for in the Indenture
relating to such transaction have been complied with. Upon delivery of such Officer’s Certificate
and Opinion of Counsel, the Trustee shall execute any documents reasonably required in order to
acknowledge the release of such Guarantor from its obligations under its Guarantee.

          (6) No Recourse Against Others. No director, officer, employee, incorporator or
stockholder of each Guaranteeing Subsidiary shall have any liability for any obligations of the
Issuer or the Guarantors (including each Guaranteeing Subsidiary) under the Notes, any Guarantees,
the Indenture or this Supplemental Indenture or for any claim based on, in respect of, or by reason
of, such obligations or their creation. Each Holder by accepting Notes waives and releases all
such liability. The waiver and release are part of the consideration for issuance of the Notes.

          (7) Governing Law. THIS SUPPLEMENTAL INDENTURE WILL BE GOVERNED BY AND CONSTRUED IN
ACCORDANCE WITH THE LAWS OF THE STATE OF NEW YORK.

          (8) 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.

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          (9) Effect of Headings. The Section headings herein are for convenience only and
shall not affect the construction hereof.

          (10) 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 each Guaranteeing
Subsidiary.

          (12) Benefits Acknowledged. Each Guaranteeing Subsidiary’s Guarantee is subject to
the terms and conditions set forth in the Indenture. Each Guaranteeing Subsidiary acknowledges
that it will receive direct and indirect benefits from the financing arrangements contemplated by
the Indenture and this Supplemental Indenture and that the guarantee and waivers made by it
pursuant to this Guarantee are knowingly made in contemplation of such benefits.

          (13) Successors. All agreements of each Guaranteeing Subsidiary in this Supplemental
Indenture shall bind its Successors, except as otherwise provided in Section 2(k) hereof or
elsewhere in this Supplemental Indenture. All agreements of the Trustee in this Supplemental
Indenture shall bind its successors.

[Remainder of Page Intentionally Left Blank]

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

	 	 	 	 	 
	 	OPHTHALMIC IMAGING SYSTEMS

 	 
	 	By:  	/s/  Ann G. Mayberry-French
 	 
	 	 	Name:  	Ann G. Mayberry-French 	 
	 	 	Title:  	Corporate Secretary 	 
	 
	 	ABRAXAS MEDICAL SOLUTIONS, INC.

 	 
	 	By:  	/s/  Ann G. Mayberry-French
 	 
	 	 	Name:  	Ann G. Mayberry-French 	 
	 	 	Title:  	Corporate Secretary 	 
	 
	 	THE BANK OF NEW YORK 
MELLON TRUST COMPANY,
N.A., as Trustee

 	 
	 	By:  	/s/  Benita A. Vaughn
 	 
	 	 	Name:  	Benita A. Vaughn 	 
	 	 	Title:  	Vice President 	 

[Signature Page to Supplemental Indenture]

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