Document:

Exhibit 10.1 Third Amendment to the Third Amended and Restated Receivables Purchase Agreement

Exhibit 10.1

THIRD AMENDMENT TO THE
THIRD AMENDED AND RESTATED 
RECEIVABLES PURCHASE AGREEMENT

This THIRD AMENDMENT TO THE THIRD AMENDED AND RESTATED RECEIVABLES PURCHASE AGREEMENT, dated as of December 5, 2012 (this “Amendment”), is among:
		
	(i) 
	RADNOR FUNDING CORP., as Seller (the “Seller”);

		
	(ii) 
	AIRGAS, INC. (in its individual capacity, “Airgas”), as Servicer (in such capacity, the “Servicer”);

		
	(iii) 
	VICTORY RECEIVABLES CORPORATION (“Victory”), as a Conduit Purchaser;

		
	(iv) 
	THE BANK OF TOKYO-MITSUBISHI UFJ, LTD., NEW YORK BRANCH, as Administrator (in such capacity, the “Administrator”), as Purchaser Agent (in such capacity, the “Victory Purchaser Agent”) and as Related Committed Purchaser for the Purchaser Group that includes Victory (the “Victory Purchaser Group”);

		
	(v) 
	WORKING CAPITAL MANAGEMENT CO., LP (“Working Capital”), as a Conduit Purchaser and as Related Committed Purchaser for the Purchaser Group that includes Working Capital (the “Working Capital Purchaser Group”);

		
	(vi) 
	MIZUHO CORPORATE BANK, LTD., as Purchaser Agent (in such capacity, the “Working Capital Purchaser Agent”) for the Working Capital Purchaser Group;

		
	(vii)
	ATLANTIC ASSET SECURITIZATION LLC (“Atlantic”), as a Conduit Purchaser; and

		
	(viii)
	Credit Agricole Corporate and Investment Bank New York Branch, as Purchaser Agent (in such capacity, the “Atlantic Purchaser Agent”) and as Related Committed Purchaser for the Purchaser Group that includes Atlantic (the “Atlantic Purchaser Group”).

The foregoing entities are herein collectively referred to as the “Parties”, and capitalized terms used but not otherwise defined herein (including such terms used above) have the respective meanings set forth in the Receivables Purchase Agreement (as defined below).
BACKGROUND
WHEREAS, the Parties have entered into that certain Third Amended and Restated Receivables Purchase Agreement, dated as of March 17, 2010 (as amended, supplemented or otherwise modified through the date hereof, the “Receivables Purchase Agreement”); and
WHEREAS, the Parties desire to amend the Receivables Purchase Agreement as set forth herein; and
WHEREAS, in connection with this Amendment and concurrently herewith,  the Seller, the Servicer and the members of the Victory Purchaser Group are entering into a Fifth Amended and Restated Fee Letter, dated the date hereof (the “Victory Fee Letter”); and
WHEREAS, in connection with this Amendment and concurrently herewith,  the Seller, the Servicer and the members of the Working Capital Purchaser Group are entering into an Amended and Restated Fee Letter, dated the date hereof (the “Working Capital Fee Letter”); and
WHEREAS, in connection with this Amendment and concurrently herewith,  the Seller, the Servicer and the members of the Atlantic Purchaser Group are entering into an Amended and Restated Fee Letter, dated the date hereof (the “Atlantic Fee Letter”, together with the Victory Fee Letter and the Working Capital Fee Letter, collectively, the “Fee Letters”); and

1

WHEREAS, in connection with this Amendment and concurrently herewith,  the Seller, Wells Fargo Bank, National Association and The Bank of Tokyo-Mitsubishi UFJ, Ltd., New York Branch are entering into a Second Amendment to the Deposit Account Control Agreement, dated as of the date hereof (the “DACA Amendment”).
NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows:
SECTION 1.Amendments to the Receivables Purchase Agreement.  The Receivables Purchase Agreement is amended as follows:

(a)The definition of “Facility Termination Date” set forth in Exhibit I to the Receivables Purchase Agreement is amended by deleting the date “December 21, 2013” where it appears in clause (a) thereof and substituting the date “December 4, 2015” therefor.

(b)Schedule II to the Receivables Purchase Agreement is replaced in its entirety with Exhibit A attached hereto.

(c)Schedule IV to the Receivables Purchase Agreement is replaced in its entirety with Exhibit B attached hereto.

SECTION 2.Certain Representations, Warranties and Covenants.  Each of the Seller, Airgas and the Servicer hereby represents, warrants and covenants to each of the other Parties that:

(a)the representations and warranties of such Person contained in Exhibit III to the Receivables Purchase Agreement are true and correct as of the date hereof (unless stated to relate solely to an earlier date, in which case such representations and warranties were true and correct as of such earlier date);

(b)the execution and delivery by such Person of this Amendment, and the performance of its obligations under this Amendment and the Receivables Purchase Agreement (as amended hereby) are within its corporate powers and have been duly authorized by all necessary corporate action on its part, and this Amendment and the Receivables Purchase Agreement (as amended hereby) are its valid and legally binding obligations, enforceable in accordance with its terms, subject to the effect of bankruptcy, insolvency, reorganization or other similar laws affecting the enforcement of creditors' rights generally; and

(c)no Termination Event or Unmatured Termination Event has occurred, is continuing, or would occur as a result of this Amendment.

SECTION 3.Effectiveness.  This Amendment shall become effective as of the date hereof upon receipt by (i) the Victory Purchaser Agent of counterparts of the Victory Fee Letter, duly executed by each of the Parties party thereto, (ii) the Working Capital Purchaser Agent of counterparts of the Working Capital Fee Letter, duly executed by each of the Parties party thereto, (iii) the Atlantic Purchaser Agent of counterparts of the Atlantic Fee Letter, duly executed by each of the Parties party thereto and (iv) the Administrator of the following, in each case, in form and substance satisfactory to the Administrator:

(a)counterparts of this Amendment, duly executed by each of the Parties;

(b)counterparts of the DACA Amendment, duly executed by each of the parties thereto;

(c)confirmation from each Purchaser Agent that the “Amendment Fee” (as defined in each applicable Fee Letter) payable to such Purchaser Agent has been paid in full in accordance with the terms of the related Fee Letter; and

(d)such other documents and instruments as the Administrator may reasonably request.

SECTION 4.Effect of Amendment.  Except as expressly amended and modified by this Amendment, all provisions of the Receivables Purchase Agreement remain in full force and effect.  After this Amendment becomes effective, all references in the Receivables Purchase Agreement (or in any other Transaction Document) to “the Receivables Purchase Agreement,” “this Agreement,” “hereof,” “herein” or words of similar effect, in each case referring to the Receivables Purchase Agreement, shall be deemed to be references to the Receivables Purchase Agreement as amended by this Amendment.  This Amendment shall not be deemed to expressly or impliedly waive, amend or supplement any provision of the Receivables Purchase Agreement other than as set forth herein.

2

SECTION 5.Ratification.  After giving effect to this Amendment and each of the transactions contemplated by this Amendment, all of the provisions of the Parent Undertaking Agreement shall remain in full force and effect and Airgas, as parent under the Parent Undertaking Agreement, hereby ratifies and affirms the Parent Undertaking Agreement and acknowledges that the Parent Undertaking Agreement has continued and shall continue in full force and effect in accordance with its terms.    

SECTION 6.Counterparts.  This Amendment may be executed in any number of counterparts and by different Parties on separate counterparts, and each counterpart shall be deemed to be an original, and all such counterparts shall together constitute but one and the same instrument.  Delivery of an executed counterpart of this Amendment by facsimile or other electronic transmission shall be as effective as delivery of a manually executed counterpart.

SECTION 7.Governing Law.  This Amendment shall be governed by, and construed in accordance with, the internal laws of the State of New York without regard to any otherwise applicable conflict of law principles which would require the application of the laws of any jurisdiction other than those of the state of New York.

SECTION 8.Section Headings.  The various headings of this Amendment are inserted for convenience only and shall not affect the meaning or interpretation of this Amendment or the Receivables Purchase Agreement or any provision hereof or thereof.

[Signatures begin on the following page]

3

IN WITNESS WHEREOF, the Parties have caused this Amendment to be executed by their respective officers thereunto duly authorized, as of the date first above written.

RADNOR FUNDING CORP., as Seller

By: /s/ Melanie S. Andrews
Name: Melanie S. Andrews
Title: President & Treasurer

S  - 1

AIRGAS, INC., as Servicer

By: /s/ Joseph C. Sullivan
Name: Joseph C. Sullivan
Title: Vice President and Treasurer

S  - 2

THE BANK OF TOKYO-MITSUBISHI UFJ, LTD., NEW YORK BRANCH, as Administrator

By: /s/ Christopher Pohl
Name: Christopher Pohl
Title: Managing Director

THE BANK OF TOKYO-MITSUBISHI UFJ, LTD., NEW YORK BRANCH, as Purchaser Agent for Victory's Purchaser Group

By: /s/ Christopher Pohl
Name: Christopher Pohl
Title: Managing Director

THE BANK OF TOKYO-MITSUBISHI UFJ, LTD., NEW YORK BRANCH, as Related Committed Purchaser for Victory's Purchaser Group

By: /s/ George Stoecklein
Name: George Stoecklein
Title: Director

S  - 3

VICTORY RECEIVABLES CORPORATION, as a Conduit Purchaser

By: /s/ David V. DeAngelis
Name: David V. DeAngelis    
Title: Vice President

S  - 4

WORKING CAPITAL MANAGEMENT CO., LP, as a Conduit Purchaser and as Related Committed Purchaser for Working Capital's Purchaser Group

By: /s/ Shinichi Nochiide
Name: Shinichi Nochiide
Title: Attorney-in- Fact

S  - 5

MIZUHO CORPORATE BANK, LTD.,
as Purchaser Agent for Working Capital's Purchaser Group

By: /s/ Leon Mo
Name: Leon Mo    
Title: Authorized Signatory

S  - 6

ATLANTIC ASSET SECURITIZATION LLC, as a Conduit Purchaser

By: /s/ Sam Pilcer
Name: Sam Pilcer
Title: Managing Director

By: /s/ Kostantina Kourmpetis
Name: Kostantina Kourmpetis
Title: Managing Director

S  - 7

Credit Agricole Corporate and Investment Bank New York Branch, as Purchaser Agent and Related Committed Purchaser for Atlantic's Purchaser Group

By: /s/ Sam Pilcer
Name: Sam Pilcer
Title: Managing Director

By: /s/ Kostantina Kourmpetis
Name: Kostantina Kourmpetis
Title: Managing Director

S  - 8

Acknowledge and Agreed:

AIRGAS, INC., as the Parent under the 
Parent Undertaking Agreement

By:/s/ Joseph C. Sullivan
Name: Joseph C. Sullivan
Title: Vice President and Treasurer

S  - 9

EXHIBIT A

SCHEDULE II
BLOCKED ACCOUNT BANKS AND LOCK-BOX ACCOUNTS

	
			
	Bank
	DDA No.
	Lock-Box No.

	PNC Bank, National Association
	8606074174
8606074182
8606074166
8606074158
8606074131
8606074123
8606074115
8606074318
8611720839
8606074772
8606074799
8606074203
8611726982
	676015
532609
532625
917423
802588
802615
917427
802576
917430
676031
827049
917425
773225

	Bank of Hawaii
	0081-599467
	5494

	Wells Fargo Bank, National Association
	2000030514506
	951884

	 
	2000030514519
	951873

	 
	2000030514522
2000030514535
2000030514962
	934402
934434
601985

	 
	4122368897
	602792

Schedule II -1

EXHIBIT B

SCHEDULE IV
LOCATION OF RECORDS
	
		
	Servicer
	Location of Records

	Airgas, Inc.
	259 N. Radnor Chester Rd., Suite 100
Radnor, PA 19087

	Seller
	 

	Radnor Funding Corp.
	210 G Baynard Bldg.
3411 Silverside Rd.
Wilmington, DE 19810

	Originator
	 

	Airgas Carbonic, Inc.
	2530 Sever Rd., Suite 300
Lawrenceville, GA 30043

	Airgas Merchant Gases, LLC
	259 N. Radnor Chester Rd., Suite 100
Radnor, PA 19087

	Airgas Safety, Inc.
	128 Wharton Road
Bristol, PA 19007

	Airgas Specialty Gases, Inc.
	2530 Sever Rd., Suite 300
Lawrenceville, GA 30043

	Airgas Specialty Products, Inc.
	2530 Sever Rd., Suite 300
Lawrenceville, GA 30043

	Airgas USA, LLC
	259 N. Radnor Chester Rd., Suite 100
Radnor, PA 19087

	National Welders Supply Company, Inc.
	5311 Seventy Seven Center Drive,
Charlotte, NC 28217

	Nitrous Oxide Corp.
	2530 Sever Rd., Suite 300
Lawrenceville, GA 30043

Schedule IV - 1EXHIBIT 10.1

 

FIRST Amendment
to Loan and security agreement

THIS
FIRST AMENDMENT TO LOAN AND SECURITY AGREEMENT (this “Amendment”) is entered into this 30th
day of November, 2012 (“Closing Date”), by and between SILICON VALLEY BANK, a California corporation (“Bank”)
and UROLOGIX, INC., a Minnesota corporation (“Borrower”).

Recitals

A.                 
Bank and Borrower have entered into that certain Loan and Security Agreement dated as of January
11, 2012 (as the same may from time to time be further amended, modified, supplemented or restated, the “Loan Agreement”).

B.                 
Bank has extended credit to Borrower for the purposes permitted in the Loan Agreement.

C.                 
Borrower has requested that Bank amend the Maximum Loss covenant and make certain other revisions
to the Loan Agreement as more fully set forth herein.

D.                 
Although Bank is under no obligation to do so, Bank is willing to amend the Maximum Loss covenant
and make certain other revisions to the Loan Agreement, but only to the extent, in accordance with the terms, subject to the conditions
and in reliance upon the representations and warranties set forth below.

Agreement

Now,
Therefore, in consideration of the foregoing recitals and other good and valuable consideration, the receipt and adequacy
of which is hereby acknowledged, and intending to be legally bound, the parties hereto agree as follows:

1.                  
Definitions. Capitalized terms used but not
defined in this Amendment, including its preamble and recitals, shall have the meanings given to them in the Loan Agreement.

2.                  
Amendments to Loan Agreement.

2.1               
Section 2.3 (Payment of Interest on the Credit Extensions).
Section 2.3(e) of the Loan Agreement is hereby amended by deleting it in its entirety and replacing it with the following:

(e)            Payment;
Interest Computation. Interest is payable monthly on the last calendar day of each month and shall be computed on the basis
of a 360-day year for the actual number of days elapsed. In computing interest, (i) all Payments received after 12:00 p.m. Pacific
time on any day shall be deemed received at the opening of business on the next Business Day, and (ii) the date of the making of
any Credit Extension shall be included and the date of payment shall be excluded; provided, however, that if any Credit Extension
is repaid on the same day on which it is made, such day shall be included in computing interest on such Credit Extension. Bank
shall not, however, be required to credit Borrower’s account for the amount of any item of payment which is unsatisfactory
to Bank in its good faith business judgment, and Bank may charge Borrower’s Designated Deposit Account for the amount of
any item of payment which is returned to Bank unpaid.

    	 

    	 	

    
 

2.2               
Section 6.9 (Financial Covenants). Section 6.9(a)
of the Loan Agreement is hereby amended by deleting it in its entirety and replacing it with the following:

(a)            Maximum Loss.
A Maximum Loss, tested on a trailing three (3) month period, of not greater than ($1,500,000) commencing with the trailing three
(3) month period ending October 31, 2012 and on the last day of each month thereafter through June 30, 2013. Commencing with the
month ending July 31, 2013, the required amount of Borrower’s Maximum Loss is subject to change based on Borrower’s
annual financial projections approved by Borrower’s Board of Directors for the June 30, 2014 fiscal year end (the “2014
Maximum Loss Covenant”). Borrower’s failure to reach an agreement with Bank on the 2014 Maximum Loss Covenant
and to execute and deliver to Bank an amendment to this Agreement, shall constitute an immediate Event of Default under this Agreement.

3.                  
Compliance Certificate. From and after the
Closing Date, Exhibit D of the Loan Agreement is replaced in its entirety with Exhibit D attached hereto and all
references in the Loan Agreement to the Compliance Certificate shall be deemed to refer to Exhibit D attached hereto.

4.                  
Limitation of Amendments.

4.1               
The amendments set forth in Sections 2 and 3 above, are effective for the purposes set forth herein and shall be limited precisely as written and shall
not be deemed to (a) be a consent to any amendment, waiver or modification of any other term or condition
of any Loan Document, or (b) otherwise prejudice any right or remedy which Bank may now have or may have in the future under
or in connection with any Loan Document.

4.2               
This Amendment shall be construed in connection with and as part of the Loan Documents
and all terms, conditions, representations, warranties, covenants and agreements set forth in the Loan Documents, except as herein
amended, are hereby ratified and confirmed and shall remain in full force and effect.

4.3               
In addition to those Events of Default specifically enumerated in the Loan Documents,
the failure to comply with the terms of any covenant or agreement contained herein shall constitute an Event of Default and shall
entitle the Bank to exercise all rights and remedies provided to the Bank under the terms of any of the other Loan Documents as
a result of the occurrence of the same. 

    	2

    	 

    
 

5.                  
Representations and Warranties. To induce
Bank to enter into this Amendment, Borrower hereby represents and warrants to Bank as follows:

5.1               
Immediately after giving effect to this Amendment (a) the representations and warranties
contained in the Loan Documents are true, accurate and complete in all material respects as of the date hereof (except to the extent
such representations and warranties relate to an earlier date, in which case they are true and correct as of such date), and (b) no
Event of Default has occurred and is continuing;

5.2               
Borrower has the power and authority to execute and deliver this Amendment and to perform
its obligations under the Loan Agreement, as amended by this Amendment;

5.3               
The organizational documents of Borrower delivered to Bank on the Effective Date remain
true, accurate and complete and have not been amended, supplemented or restated and are and continue to be in full force and effect;

5.4               
The execution and delivery by Borrower of this Amendment and the performance by Borrower
of its obligations under the Loan Agreement, as amended by this Amendment, have been duly authorized;

5.5               
The execution and delivery by Borrower of this Amendment and the performance by Borrower
of its obligations under the Loan Agreement, as amended by this Amendment, do not and will not contravene (a) any law or regulation
binding on or affecting Borrower, (b) any contractual restriction with a Person binding on Borrower, (c) any order, judgment
or decree of any court or other governmental or public body or authority, or subdivision thereof, binding on Borrower, or (d) the
organizational documents of Borrower;

5.6               
The execution and delivery by Borrower of this Amendment and the performance by Borrower
of its obligations under the Loan Agreement, as amended by this Amendment, do not require any order, consent, approval, license,
authorization or validation of, or filing, recording or registration with, or exemption by any governmental or public body or authority,
or subdivision thereof, binding on Borrower, except as already has been obtained or made; and

5.7               
This Amendment has been duly executed and delivered by Borrower and is the binding obligation
of Borrower, enforceable against Borrower in accordance with its terms, except as such enforceability may be limited by bankruptcy,
insolvency, reorganization, liquidation, moratorium or other similar laws of general application and equitable principles relating
to or affecting creditors’ rights.

6.                  
Integration. This Amendment and the Loan Documents
represent the entire agreement about this subject matter and supersede prior negotiations or agreements. All prior agreements,
understandings, representations, warranties, and negotiations between the parties about the subject matter of this Amendment and
the Loan Documents merge into this Amendment and the Loan Documents.

    	3

    	 

    
 

7.                  
Counterparts. This Amendment may be executed
in any number of counterparts and all of such counterparts taken together shall be deemed to constitute one and the same instrument.

8.                  
Effectiveness. This Amendment shall be deemed
effective upon (a) the due execution and delivery to Bank of this Amendment by each party hereto and (b)  payment of
Bank’s legal fees and expenses in connection with the negotiation and preparation of this Amendment.

[Signature page follows.]

 

 

 

 

 

    	4

    	 

    

In
Witness Whereof, the parties hereto have caused this Amendment to be duly executed and delivered as of the date first
written above.

 

	BANK
	 
	SILICON VALLEY BANK
	 
	By:  	/s/ Kimberly A. Stover
	 	Name: Kimberly A. Stover
 Title: Relationship Manager
	 	 
	BORROWER:
	 	 
	UROLOGIX, INC.
	 	 
	 	 
	By:	/s/ Brian J. Smrdel
	 	Name: Brian J. Smrdel
 Title: Chief Financial Officer

 

 

 

 

 

 

 

 

 

 

[Signature Page to First Amendment to Loan and Security
Agreement]

 

 

 

    	 

    	 

    

EXHIBIT D

COMPLIANCE CERTIFICATE

 

	TO:	SILICON VALLEY BANK	 	Date:	  
	FROM:  	Urologix, Inc.	 	 	 

 

The undersigned authorized
officer of Urologix, Inc. (“Borrower”) certifies that under the terms and conditions of the Loan and Security
Agreement between Borrower and Bank (the “Agreement”):

(1) Borrower is in complete
compliance for the period ending _______________ with all required covenants except as noted below; (2) there are no Events of
Default; (3) all representations and warranties in the Agreement are true and correct in all material respects on this date except
as noted below; provided, however, that such materiality qualifier shall not be applicable to any representations and warranties
that already are qualified or modified by materiality in the text thereof; and provided, further that those representations and
warranties expressly referring to a specific date shall be true, accurate and complete in all material respects as of such date;
(4) Borrower, and each of its Subsidiaries, has timely filed all required tax returns and reports, and Borrower has timely paid
all foreign, federal, state and local taxes, assessments, deposits and contributions owed by Borrower except as otherwise permitted
pursuant to the terms of Section 5.9 of the Agreement; and (5) no Liens have been levied or claims made against Borrower or any
of its Subsidiaries relating to unpaid employee payroll or benefits of which Borrower has not previously provided written notification
to Bank.

Attached are the required
documents supporting the certification. The undersigned certifies that these are prepared in accordance with GAAP consistently
applied from one period to the next except as explained in an accompanying letter or footnotes. The undersigned acknowledges that
no borrowings may be requested at any time or date of determination that Borrower is not in compliance with any of the terms of
the Agreement, and that compliance is determined not just at the date this certificate is delivered. Capitalized terms used but
not otherwise defined herein shall have the meanings given them in the Agreement.

	Please indicate compliance status by circling Yes/No under “Complies” column.
	 
	Reporting Covenant	Required	Complies
	 	 	 
	Monthly financial statements with Compliance Certificate	Monthly within 30 days	Yes   No
	Annual financial statement (CPA Audited)	FYE within 120 days	Yes   No
	Board Projections	FYE within 30 days	Yes   No
	A/R & A/P Agings	Monthly within 30 days	Yes   No
	Transaction Report	Weekly; or
 Monthly within 30 days if
 Streamline Eligible	Yes    No
	Deferred Revenue Reports	Monthly within 30 days	Yes    No
	 

 

    	 

    	 

    
 

 

	Financial Covenants	Required	Actual	Complies
	 	 	 	 
	Maintain on a Monthly Basis:	 	 	 
	Monthly Maximum Loss (trailing 3 month period):	 	 	 
	October 31, 2012 through June 30, 2013	($1,500,000)	$________	Yes   No
	July 31, 2013 and at all times thereafter	TBD based on
 2014 Board
 approved plan	$________	Yes   No

 

The following financial covenant
analysis and information set forth in Schedule 1 attached hereto are true and accurate as of the date of this Certificate.

 

The following are the exceptions
with respect to the certification above: (If no exceptions exist, state “No exceptions to note.”)

 

 

 

 

	
        UROLOGIX, Inc.

         

         

        By: __________________________________________

               Name:

               Title:

         
	
        BANK USE ONLY

         

        Received by: ___________________________________

                       
                             authorized         signer

        Date: _________________________________________

        Verified:  ______________________________________

                                                     authorized
        signer

        Date: _________________________________________

        Compliance Status:        Yes   No

 

 

 

 

 

 

 

 

 

 

 

    	 

    	 

    

Schedule 1 to Compliance Certificate

 

Financial Covenants of Borrower

 

In the event of a conflict between this Schedule
and the Loan Agreement, the terms of the Loan Agreement shall govern.

 

Dated:  ____________________

 

Maximum Loss (Section 6.9(a))

Required:     A Maximum
Loss, tested on a trailing three (3) month period, of not greater than ($1,500,000) commencing with the trailing three (3) month
period ending October 31, 2012 and on the last day of each month thereafter through June 30, 2013.

 

Actual:

 

	A.	Net loss	$_____
	B.	Interest Expense	$_____
	C.	To the extent deducted in the determination of Net loss, depreciation expense, plus amortization expense	$_____
	D.	Income tax expense	$_____
	E 	Non-cash compensation expense	$_____
	F.	Loss (line A, plus line B, plus line C, plus line D, plus line E)	$_____

 

Is line F equal to or greater than the required amount?

 

_________  No, not in compliance                                                           _________  Yes,
in compliance

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