Document:

EX-10.6

 Exhibit 10.6 
 SUPPLEMENT NO. 1 TO GUARANTY 
 SUPPLEMENT NO. 1 dated as of
December     16     , 2010, to the Guaranty dated as of June 29, 2007, among ASC ACQUISITION, LLC, a Delaware limited liability company (“Holdings”), SURGERY CENTERS
MERGER SUB LLC, a Delaware limited liability company (“Merger Sub”) to be merged with and into SURGICAL CARE AFFILIATES, LLC, a Delaware limited liability company (“SCA”), certain subsidiaries of SCA from time to
time party hereto (collectively, “Subsidiaries” and, individually, “Subsidiary”), and JPMORGAN CHASE BANK, N.A., as Administrative Agent (as defined below). 

A. Reference is made to (i) the Credit Agreement dated as of June 29, 2007 (as amended, supplemented or otherwise modified from
time to time, the “Credit Agreement”), among the Borrower (as defined below), Holdings, JPMorgan Chase Bank, N.A., as Administrative Agent, Swing Line Lender, and L/C Issuer, each lender from time to time party thereto
(collectively, the “Lenders” and individually, a “Lender”), J.P. Morgan Securities Inc. and Goldman Sachs Credit Partners L.P., as joint lead arrangers and joint bookrunners, Goldman Sachs Credit Partners L.P., as
syndication agent, and General Electric Capital Corporation, Natixis and the Royal Bank of Scotland plc, as documentation agents, (ii) each Secured Hedge Agreement (as defined in the Credit Agreement), and (iii) the Cash Management
Obligations (as defined in the Credit Agreement). 
 B. Capitalized terms used herein and not otherwise defined herein shall
have the meanings assigned to such terms in the Credit Agreement. 
 C. The Guarantors have entered into the Guaranty in order
to induce (i) the Lenders to make Loans and the L/C Issuers to issue Letters of Credit, (ii) the Hedge Banks to enter into and/or maintain Secured Hedge Agreements and (iii) the Cash Management Banks to provide Cash Management
Services. Section 4.11 of the Guaranty provides that additional wholly-owned Domestic Material Subsidiaries of the Borrower may become Guarantors under the Guaranty by execution and delivery of an instrument in the form of this Supplement. The
undersigned wholly-owned Domestic Material Subsidiary (the “New Subsidiary”) is executing this Supplement in accordance with the requirements of the Credit Agreement to become a Guarantor under the Guaranty in order to induce
(A) the Lenders to make additional Loans and the L/C Issuers to issue additional Letters of Credit, (B) the Hedge Banks to enter into and/or maintain Secured Hedge Agreements and (C) the Cash Management Banks to provide Cash
Management Services and as consideration for (x) Loans previously made and Letters of Credit previously issued, (y) Secured Hedge Agreements previously entered into and/or maintained and (z) Cash Management Services previously
provided. 
 Accordingly, the Administrative Agent and the New Subsidiary agree as follows: 

SECTION 1. In accordance with Section 4.11 of the Guaranty, the New Subsidiary by its signature below becomes a Guarantor under
the Guaranty with the same force and effect as if originally named therein as a Guarantor and the New Subsidiary hereby (a) agrees to all the terms and provisions of the Guaranty applicable to it as a Guarantor thereunder and
(b) represents and warrants that the representations and warranties made by it as a Guarantor thereunder are true and correct on and as of the date hereof. In furtherance of the foregoing, the

 
New Subsidiary, as security for the payment and performance in full of the Obligations does hereby, for the benefit of the Secured Parties, their successors and assigns, irrevocably, absolutely
and unconditionally guaranty, jointly with the other Guarantors and severally, the due and punctual payment and performance of the Obligations. Each reference to a “Guarantor” in the Guaranty shall be deemed to include the New
Subsidiary. The Guaranty is hereby incorporated herein by reference. 
 SECTION 2. The New Subsidiary represents and
warrants to the Administrative Agent and the Secured Parties that this Supplement has been duly authorized, executed and delivered by it and constitutes its legal, valid and binding obligation, enforceable against it in accordance with its terms,
except as such enforceability may be limited by Debtor Relief Laws and by general principles of equity. 
 SECTION 3. This
Supplement may be executed in counterparts (and by different parties hereto on different counterparts), each of which shall constitute an original, but all of which when taken together shall constitute a single contract. This Supplement shall become
effective when the Administrative Agent shall have received a counterpart of this Supplement that bears the signature of the New Subsidiary, and the Administrative Agent has executed a counterpart hereof. Delivery of an executed signature page to
this Supplement by facsimile transmission or other electronic communication shall be as effective as delivery of a manually signed counterpart of this Supplement. 
 SECTION 4. Except as expressly supplemented hereby, the Guaranty shall remain in full force and effect. 
 SECTION 5. THIS SUPPLEMENT SHALL BE GOVERNED BY, AND CONSTRUED IN ACCORDANCE WITH, THE LAWS OF THE STATE OF NEW YORK. 
 SECTION 6. If any provision contained in this Supplement is held to be invalid, illegal or unenforceable, the legality, validity, and enforceability of the remaining provisions contained herein and
in the Guaranty shall not be affected or impaired thereby. The invalidity of a provision in a particular jurisdiction shall not invalidate or render unenforceable such provision in any other jurisdiction. 

SECTION 7. All communications and notices hereunder shall be in writing and given as provided in Section 4.01 of the Guaranty.

 SECTION 8. The New Subsidiary agrees to reimburse the Administrative Agent for its reasonable out-of-pocket expenses in
connection with the execution and delivery of this Supplement, including the reasonable fees, other charges and disbursements of counsel for the Administrative Agent. 
 [SIGNATURES ON THE FOLLOWING PAGE] 

  
 2 

 IN WITNESS WHEREOF, the New Subsidiary and the Administrative Agent have duly executed this
Supplement to the Guaranty as of the day and year first above written. 
  

			
	SCA SURGERY HOLDINGS, LLC
		
	By:	 	/s/ Richard L. Sharff, Jr.
		 	Name: Richard L. Sharff, Jr.
		 	Title: Vice President and Secretary
	  
 Jurisdiction of Formation: Delaware

 
 Organizational Identification Number: # 4545056

 
 Address of Chief Executive Office:

3000 Riverchase Galleria
 Suite 500

Birmingham, AL 35244
  
 JPMORGAN CHASE BANK, NA.,
    as Administrative Agent

		
	By:	 	 
		 	Name:
		 	Title:

 Signature Page for Supplement No. 1 to Guaranty 

 IN WITNESS WHEREOF, the New Subsidiary and the Administrative Agent have duly executed this
Supplement to the Guaranty as of the day and year first above written. 
  

			
	SCA SURGERY HOLDINGS, LLC
		
	By:	 	 
		 	Name: Richard L. Sharff, Jr.
		 	Title: Vice President and Secretary
	  
 Jurisdiction of Formation: Delaware

 
 Organizational Identification Number: # 4545056

 
 Address Of Chief Executive Office:

3000 Riverchase Galleria
 Suite 500

Birmingham, AL 35244
  
 JPMORGAN CHASE BANK, NA.,
    as Administrative Agent

		
	By:	 	/s/ Dawn LeeLum
		 	Name: Dawn LeeLum
		 	Title: Executive Director

 Signature Page for Supplement No. 1 to GuarantyEX-10.7

 Exhibit 10.7 
 EXECUTION VERSION 
 REAFFIRMATION AGREEMENT dated as of June 30, 2011 (this
“Reaffirmation Agreement”), among SURGICAL CARE AFFILIATES, LLC (the “Borrower”), ASC ACQUISITION LLC (“Holdings”), the subsidiaries of the Borrower listed on Schedule A hereto
(collectively, together with the Borrower and Holdings, the “Reaffirming Parties”), and JPMORGAN CHASE BANK, N.A., as the Administrative Agent, Swing Line Lender, and L/C Issuer for the Lenders (in such capacity, the
“Agent”). 
 WHEREAS, the Borrower, Holdings, the Lenders party thereto, and the Agent are parties to the
Credit Agreement dated as of June 29, 2007 (as amended, supplemented or otherwise modified prior to the Restatement Effective Date, the “Existing Credit Agreement”), and are entering into the Amendment and Restatement Agreement
dated as of the date thereof (the “Amendment”) (the Existing Credit Agreement as amended by the Amendment, the “Amended and Restated Credit Agreement”); 

WHEREAS, the Borrower, the Reaffirming Parties and the Agent are parties to the Guaranty dated as of June 29, 2007 (the
“Guaranty”), pursuant to which the Reaffirming Parties agreed to guarantee, subject to the terms and conditions set forth therein, all of the Obligations; 
 WHEREAS, the Borrower, the Reaffirming Parties and the Agent are parties to the Pledge and Security Agreement dated as of June 29, 2007 (the “Pledge and Security Agreement”),
pursuant to which the Reaffirming Parties agreed to secure, subject to the terms and conditions therein, all of the Obligations; 
 WHEREAS, the parties hereto intend that (a) the Obligations shall be in all respects continuing under the Amended and Restated Credit Agreement, on the terms set forth therein and (b) the
Guaranty and Pledge and Security Agreement shall continue to support and otherwise benefit the Obligations; 
 WHEREAS, each
Reaffirming Party expects to realize substantial direct and indirect benefits as a result of the Amendment becoming effective and the consummation of the transactions contemplated thereby; 

WHEREAS, the execution and delivery of this Reaffirmation Agreement is a condition precedent to the effectiveness of the Amendment and
the consummation of the transactions contemplated thereby; and 
 WHEREAS, capitalized terms used but not otherwise defined
herein have the meanings assigned to them in the Amended and Restated Credit Agreement or the Amendment, as applicable; 

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

 Reaffirmation 
 SECTION 1.01. Reaffirmation. Each Reaffirming Party hereby acknowledges its receipt of a copy of the Amendment and consents to the terms and conditions of the Amendment and the transactions
contemplated thereby. Each Reaffirming Party hereby further (a) affirms and confirms its respective guarantees, pledges and grants of security interests and other commitments and obligations under the Guaranty and the Pledge and Security
Agreement and (b) confirms and agrees that the Guaranty and the Pledge and Security Agreement and all its guarantees and other commitments and obligations under any Loan Document or Collateral Document shall continue to be in full force and
effect following the effectiveness of the Amendment. Each Reaffirming Party hereby agrees that, on and after the Restatement Effective Date, each reference to the “Credit Agreement” in the Guaranty and the Pledge and Security Agreement
shall be deemed to be a reference to the Amended and Restated Credit Agreement. 
 SECTION 1.02. Credit Agreement as
Amended. On and after the date on which the Amendment becomes effective in accordance with its terms, each reference to the Credit Agreement (and any terms defined in the Credit Agreement) in any other Loan Document shall be deemed a reference
to the Credit Agreement (or such defined terms, as applicable) as amended by the Amendment. 
 ARTICLE II 

Representations and Warranties 
 Each Reaffirming Party hereby represents and warrants, which representations and warranties shall survive execution and delivery of this Reaffirmation Agreement, as follows: 

SECTION 2.01. Organization. Such Reaffirming Party is duly formed and validly existing in good standing under the laws of its
jurisdiction of organization or formation, as applicable. 
 SECTION 2.02. Authority; Enforceability. Such Reaffirming
Party has the power and authority to execute, deliver and carry out the terms and provisions of this Reaffirmation Agreement and has taken all necessary action to authorize the execution, delivery and performance by it of this Reaffirmation
Agreement. Such Reaffirming Party has duly executed and delivered this Reaffirmation Agreement, and this Reaffirmation Agreement constitutes its legal, valid, and binding obligation, enforceable against it in accordance with its terms. 

  
 2 

 SECTION 2.03. Guaranty. The representations and warranties of such Reaffirming Party
contained in the Guaranty are true and correct on and as of the date hereof with the same effect as though made on and as of such date, except to the extent such representations and warranties expressly relate to an earlier date (in which case such
representation and warranty shall have been true and correct as of such earlier date). 
 SECTION 2.04. Pledge and Security
Agreement. The representations and warranties of such Reaffirming Party contained in the Pledge and Security Agreement are true and correct on and as of the date hereof with the same effect as though made on and as of such date, except to the
extent such representations and warranties expressly relate to an earlier date (in which case such representation and warranty shall have been true and correct as of such earlier date), and except to the extent of updates to the Schedules thereto or
to the Perfection Certificate, which updates have been delivered to the Agent. 
 ARTICLE III 

Miscellaneous 
 SECTION 3.01. Notices. All communications and notices hereunder shall be in writing and given as provided in Section 10.02 of the Amended and Restated Credit Agreement. All communications and
notices hereunder to any Reaffirming Party shall be given to the Borrower as provided in Section 10.02 of the Amended and Restated Credit Agreement. 
 SECTION 3.02. Expenses. The Reaffirming Parties acknowledge and agree that the Agent and the Lenders shall be entitled to reimbursement of expenses as provided in the Amendment and in Sections 9.07
and 10.04 of the Amended and Restated Credit Agreement. 
 SECTION 3.03. Loan Document. This Reaffirmation Agreement is a
“Loan Document” executed pursuant to the Amendment and the Amended and Restated Credit Agreement and shall be construed, administered and applied in accordance with the terms and provisions thereof. 

SECTION 3.04. Successors and Assigns. The provisions of this Reaffirmation Agreement shall be binding upon and inure to the
benefit of the parties hereto and their respective successors and assigns. 
 SECTION 3.05. Counterparts. This
Reaffirmation Agreement may be executed in counterparts (and by different parties hereto in different counterparts), each of which shall constitute 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 Reaffirmation Agreement by telecopy or other electronic transmission shall be effective as delivery of a manually executed counterpart hereof. 

  
 3 

 SECTION 3.06. No Novation. Nothing herein contained shall be construed as a
substitution or novation of the Obligations outstanding under the Amended and Restated Credit Agreement, the Guaranty or the Pledge and Security Agreement, which shall remain in full force and effect except as modified by the Amendment. 

SECTION 3.07. Governing Law; Waiver of Jury Trial. (a) This Reaffirmation Agreement shall be construed in accordance with and
governed by the laws of the State of New York. 
 (b) Each party hereto hereby agrees as set forth in Section 10.15 and
Section 10.16 of the Amended and Restated Credit Agreement as if such Sections were set forth in full herein. 

  
 4 

 IN WITNESS WHEREOF, each Reaffirming Party and the Agent have caused this Reaffirmation
Agreement to be duly executed by their respective authorized officers as of the day and year first above written. 
  

			
	SURGICAL CARE AFFILIATES, LLC,
		
	 by  
	 	/s/ Andrew P. Hayek
		 	Name: Andrew P. Hayek
		 	Title: President & CEO

  

			
	ASC ACQUISITION LLC,
		
	 by  
	 	/s/ Ronald Cami
		 	Name: Ronald Cami
		 	Title: Authorized Representative

  

			
	 EACH OF THE SUBSIDIARIES OF THE
 BORROWER LISTED ON SCHEDULE A
 HERETO,

		
	 by  
	 	/s/ Andrew P. Hayek
		 	Name: Andrew P. Hayek
		 	Title: President

  

			
	JPMORGAN CHASE BANK, N.A., as the Agent,
		
	 by  
	 	/s/ Dawn LeeLum
		 	Name: Dawn LeeLum
		 	Title: Executive Director

 [SIGNATURE PAGE TO REAFFIRMATION
AGREEMENT] 

 SCHEDULE A 
 TO REAFFIRMATION AGREEMENT 
 List of Subsidiaries of the Borrower

  

	1.	SCA Surgery Holdings, LLC 

  

	2.	Surgical Holdings, Inc. 

  

	3.	SC Affiliates, LLC 

  

	4.	ASC Network, LLC 

  

	5.	eCode Solutions, LLC 

  

	6.	Surgery Centers-West Holdings, LLC 

  

	7.	Surgical Center of Tuscaloosa Holdings, Inc. 

  

	8.	National Surgery Centers, LLC 

  

	9.	Surgery Center Holding, LLC 

  

	10.	Surgical Health, LLC

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