Document:

Repertory
      No. 4940418370 

     

    LOAN
      CONTRACT

    Italian
      Republic

    In
      the
      year 2006 two thousand six, on the 14th
      fourteenth day of June,

    In
      Como,
      in my legal office in via Pessina n. 3, 

    Before
      me, Dr. Massimo Caspani, Public Notary in Como, registered with the Public
      Notary Roll of Como, are personally present: 

    -
      On
      behalf of “BANCA
      NAZIONALE DEL LAVORO S.P.A.”, with
      registered offices in Rome, via Vittorio Veneto n. 119, registered with the
      Banks Registry and parent company of the Bank Group B.N.L., registered with
      the
      Registry of Bank Groups at the Bank of Italy, share capital of euro
      2,225,462,862.24 fully paid up, tax code and Registry of Companies of Rome
      No.
      00651990582 (in the present Agreement referred to in short as the “Bank”),
      Messrs.: 

    Bruno
      Dagostini, born in Como on 28 July 1968,

    Claudio
      Lunati, born in Alessandria on 30 July 1965,

    Both
      domiciled for their office in Como, piazza Cavour n. 33-34. The above people,
      are acting in their office of managers, with powers of signature, for the Area
      of the Lombardy Territory of the "Bank", by virtue of the resolution passed
      by
      the Executive Committee on 14 May 2004 - minutes n. 5489. An authenticated
      excerpt of the above minutes is attached under the letter "A" to the deed dated
      27 June 2005, repertory n. 47251/17361 under my seal, registered in Como on
      28
      June 2005 under n. 5432;

    Laura
      Iris Ferro, born in Milan on 3 August 1951, domiciled for her office in Villa
      Guardia, locality Civello, piazza XX Settembre n. 2, who has declared that
      she
      is entering this deed on behalf and as representative of “Gentium
      - S.p.A.”,
      with
      registered offices in Villa Guardia, locality Civello, piazza XX Settembre
      n. 2,
      share capital of euro 9.711.488, registered with the Registry of Companies
      of
      Como, registration number and tax code: 02098100130. The above person is acting
      in her office of Chairperson of the Board of Directors of the Company, and
      possesses the necessary powers by virtue of the Board resolution passed on
      16
      May 2006, (in the present Agreement referred to in short as
“Debtor”).

    The
      above
      people, whose personal data, office and powers I, Public Notary, am certain
      of,
      agree as follows.-

    Art.
      1

    (Loan
      Amount)-

    1.
      The
“Bank”, represented as indicated above, grants to the “Debtor”, which accepts
      through its representative, a loan of euro 2,800,000.00 (two million eight
      hundred thousand point zero zero) in compliance with the company memorandum
      and
      articles 10, 38 and following of Law Decree n. 385 of 1st
      September
      1933 issued regarding treasury needs connected with business development
      (Consolidation Act of the Laws regulating Bank and Credit Matters).
      -

    2.
      The
      loan is granted in compliance with the covenants and obligations laid down
      by
      the norms of Law regulating these matters, with the Civil Code, the present
      Agreement, the deeds of quittance and the covenants specifications. The latter
      are undersigned by the parties and me, Public Notary, and are attached to the
      present deed under the letter “A”, to form an integral and substantial part of
      the same. The parties declare that they have already read all the above and
      that
      they accept all the clauses contained therein.  

    Art.
      2

    (Interest
      Rate and Fee)

    1.
      With
      regard to the loan, the "Debtor" undertakes to pay interest to the “Bank” at the
      end of each six-month period. The interest shall be calculated according to
      the
      effective days, by applying the 360 (three hundred and sixty) divisor. The
      nominal annual rate shall correspond to the six months "Euribor" - Euro
      Interbank Offered Rate - increased by 0.15 (zero point fifteen)
      points.

    The
      above
      rate shall be increased by an annual spread equal to 0.85 (zero point
      eighty-five) points, to the benefit of the "Bank".

    2.
      For
      the first period of interest, starting from the date of disbursement of the
      loan
      until the due date of the first installment, rather than the six-month
“Euribor”, the “Bank” shall calculate the “Euribor” rate corresponding to the
      shortest time of the same period.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    3.
      The
“Euribor” applied shall be the rate offered with regard to the inter-bank time
      deposits denominated in euro at 11.00, Central Europe time, as communicated
      by
      the Euribor Panel Steering Committee. The above rate is publicized on the
      telematic network and is generally published in the daily newspaper Il Sole
      24
      ore, on the second working day prior to the due date of the previous period
      of
      interest (installment). Should the latter date fall on a bank holiday day,
      the
      value date of the “Euribor” shall be calculated with reference to the first
      working day after the above date (unless it falls on the last day of the month,
      in which case, the value date of the rate shall be calculated with reference
      to
      the first working day before such date). On the current date, the six-month
      “Euribor” rate is equal to the nominal annual rate of 3.108% (three point one
      zero eight). 

    4.
      Should
      the “Euribor” rate not be offered or made available on the date of
      calculation:

    -
      With
      regard to the amounts not yet disbursed: the date of disbursement shall be
      the
      next first working day in which the rate offered is made available;

    -
      With
      regard to the amounts already disbursed: the rate of the previous period of
      interest (installment) shall be applied.

    5.
      Before
      the due date of each installment, the “Bank” shall communicate to the “Debtor”
the applicable rate and the amount of the installment which must be paid by
      the
“Debtor”. 

    6.
      The
“Debtor” furthermore undertakes to pay the “Bank”, at the time of execution of
      the present Agreement, a una
      tantum grant
      fee
      equal to 0.05% (zero point zero five per cent) on the amount of the loan.

    7.
      The
      cost synthetic indicator applied to the present loan, as laid down by the norms
      and regulations on the transparency of the contractual conditions of bank and
      financial operations and services, is equal to 4.23% (four point two three
      per
      cent), as shown in the Synthetic Document attached to the present Agreement
      under the letter “B”. 

    The
      above
      indicator is mentioned just as an indication, since the date of disbursement
      of
      the loan is still unknown. 

    Art.
      3

    (Terms
      and Conditions of Disbursement and Reimbursement)

    1.
      The
      loan shall be paid out in one or more installments, as decided by the “Bank”, in
      accordance with the terms and conditions laid down in article 1 of the covenants
      specifications. 

    2.
      The
      loan shall have a duration of 8 (eight) years, with a maximum pre-amortization
      period of 12 (twelve) months (included). The loan must be used by 30 September
      2006.

    The
      due
      dates of the installments, the start date of the amortization period, as well
      as
      the due dates of the first and last installments shall be fixed at the time
      of
      execution of the deed of quittance.

    3.
      The
      loan must be reimbursed through n. 14 (fourteen) deferred six-month
      installments, constituted by a constant principal share amounting to euro
      200,000.00 (two hundred thousand point zero zero), plus interest, calculated
      in
      accordance with the criteria indicated in arti-cle 2 above.

    4.
      The
      interest related to the pre-amortization period shall be paid at the end of
      every six-months, starting from the date of disbursement, or, in the case of
      more than one disbursements, from the date of each individual disbursement
      until
      the beginning of the amortization period. The interest rate shall be calculated
      in accordance with the criteria indicated in article 2 above.

    Art.
      4

    (Default
      Interest)

    1.
      The
“Debtor” shall pay default interest on any sums due to the “Bank” for any title,
      or with regard to any capital sum, interest, expenses or accessory costs paid
      after the due date. The interest shall be equal to the rate agreed in the
      Contract increased by five points, and it shall not be subject to periodic
      capitalization.

    2.
      Should
      the default interest, calculated as specified above, be equal to or higher
      than
      the three-month threshold rate established pursuant to law n. 108/1996
      (“Provisions On Usury”) - issued with regard to “Loan” operations - the related
      threshold rate, currently equal to the annual 6.24% (six point two four per
      cent), shall be applied to each calendar quarter of default. In any case, the
      default rate shall not be lower than the rate agreed in the present Contract.
      

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    3.
      The
      default interest shall be calculated by full right, just in the event of expiry
      of the terms, without need of any order or statement of default. This shall
      not
      prejudice the faculty of the “Bank” to decide that the “Debtor” shall no longer
      benefit from the term, or its right to terminate the Agreement and,
      consequently, to obtain the total reimbursement of the sums due for the residual
      principal, interest, expenses and accessory costs.

    Art.
      5

    (Real
      Estate Mortgage)

    1.
      As a
      warranty for the complete and regular fulfillment of all the obligations
      undertaken by the “Debtor”, in compliance with the present Agreement and the
      covenants specifications attached herewith, in particular with regard to the
      reimbursement, including the early reimbursement of the principal sum, the
      payment of the interest or any possible default interest, any accessory
      expenses, as well as the reimbursement of the expenses, the “Debtor” undertakes,
      at its own charge and to the benefit of the “Bank”, to register a mortgage on
      the real estate owned by the same “Debtor”. The real estate, which is described
      at the foot of the present Agreement, shall include any adjacent parts,
      accretions, new buildings, developments, additional raise floors, any
      appurtenances or anything which, in any case, is considered to be real estate
      in
      compliance with the law, as well as anything which may be introduced or
      transported into the same in the future.

    2.
      The
      mortgage is recorded for the total sum of euro 4,704,000.00 (four million seven
      hundred four thousand point ze-ro zero), of which euro 2,800,000.00 (two million
      eight hundred point zero zero) for principal, euro 1,344,000.00 (one million
      three hundred forty-four point zero zero) for a three-year period of interest,
      including any default interest, at the rate which, for the sole ends of the
      mortgage registration, is fixed as 16% (sixteen
      per cent) annually, plus euro 560,000.00 (five hundred sixty thousand point
      zero
      zero) for expenses and accessories (for example the charges contractually agreed
      for the cases of lapses from the benefit of the term, termination of the
      Agreement or early total repayment of the loan; foreign exchange risk, foreign
      exchange fees or other fees in the case of disbursement of the loan in foreign
      currency; any judgment expenses, as well as those laid down in the first point
      of article 2855 of the Civil Code; insurance premiums for policies against
      fire
      or lightening; the reimbursement of any taxes or duties) and any sum which
      may
      be due in connection with the present Agreement or any additional or quittance
      deeds.

    3.
      Pursuant to article 39, third point of Law Decree n. 385/1993, the mortgage,
      following the application of the index-linking clause to the loan, in accordance
      with article 2 of the present Agreement, guarantees the credit of the “Bank” up
      to the amount which is effectively due in compliance with the application of
      the
      above clause. 

    4.
      The
“Debtor” expressly authorizes the competent Office of the Territory - Real
      Estate Advertising Service to proceed to record the mortgage in the appropriate
      registers, as permitted above, on the simple request of the “Bank” and with
      exoneration of every responsibility.

    5.
      The
“Debtor” guarantees the free and full ownership of the real estate subject to
      the mortgage to the benefit of the “Bank”, and the absence of any constraints or
      charges of an kind, with the exception of:

    *
      The
      mortgage recorded in Como on 26 November 1996 under numbers 20963/3730 to the
      benefit of Banca Nazionale del Lavoro S.p.A., with registered offices in Rome,
      for Lire 4,425,000,000; 

    *
      The
      mortgage recorded in Como on 1st
      June
      1999 under numbers 11016/2938 to the benefit of Banca Nazionale del Lavoro
      S.p.A., with registered offices in Rome, for Lire 5,040,000,000; 

    *
      The
      mortgage recorded in Como on 23 July 2004 under numbers 26464/5095 to the
      benefit of Banca Nazionale del Lavoro S.p.A., with registered offices in Rome,
      for euro 3,360,040.00.

    Art.
      6

    (Expenses
      and Taxation System)

    3.
      All
      the expenses related to and arising from the present Agreement, as well as
      the
      substitute tax laid down in articles 17 and 18 of Presidential Decree n. 6011
      of
      29 September 1973, and subsequent modifications, are to be charged to the
“Debtor”, who expressly undertakes responsibility for them. In their regard, the
      tax benefits granted in compliance with art. 15 of the aforementioned
      Presidential Decree are applied.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    2.
      In
      particular, the “Debtor” expressly undertakes responsibility for all the
      charges, fees and expenses charged to her arising from the present Agreement
      and
      for the duration of the loan. All the above are shown in the informative sheets
      published by the “Bank” pursuant to article 116 of Law Decree n. 385/1993, on
      the basis of the tariffs applied at the time by the “Bank”. The covenants
      specifications attached to the present Agreement include the tariffs currently
      in force with regard to the above-mentioned charges, fees and expenses. In
      this
      regard, the “Debtor” expressly accepts, pursuant to article 117, fifth point of
      the aforementioned Law Decree, that, during the period of the loan, the
      above-mentioned charges, fees and expenses may vary unfavorably for the
“Debtor”. Any variations shall be communicated by the “Bank” in compliance with
      the terms and conditions laid down in the heading n. 4, paragraph 1 of the
      above-mentioned Law Decree.

    3.
      The
      present Agreement benefits from the reduction of Public Notary fees foreseen
      by
      article 39, last point of Law Decree n. 385 of 1st
      September 1993.

    4.
      Pursuant to article 117,first point of the above-mentioned Law Decree n.
      385/1993, the “Debtor” acknowledges that the sealing Public Notary shall deliver
      to it an authentic copy of the present Agreement and related integrating and
      quittance deeds, complete with the specifications of the formal registration
      and
      recording of the same.

    5.
      The
“Debtor” declares that it has availed itself of the right to obtain a complete
      copy of the contractual text, suitable for the execution of the Agreement,
      before the undersigning of the same. 

    Art.
      7

    (Express
      Approval of Obligation Clauses)-

    1.
      The
“Debtor” declares to have expressly approved the clauses:

    -
      Of the
      present Agreement in regard to default interest (article 4); expenses and
      taxation system (article 6);

    -
      Of the
      covenants specifications attached herewith regarding the investment program
      and
      fee for non-use (article 2); insurance obligations (article 3); obligations
      in
      regard to the assets financed by the loan (article 4); waive of subrogation
      and
      contribution (article 6); payments and fiscal charges (article 7); lapse of
      the
      benefit of term and termination of the agreement (article 9); termination
      clauses of the agreement (article 10); effects of lapse of the benefit of the
      term and termination of the agreement (article 11); accounting of payments
      (article 12) waive to exceptions (article 14); proof of credit (article 15);
      early reimbursement (article 19); charges, fees and expenses (article
      21).

    Art.
      8

    (Election
      of Domicile)

    1.
      For
      the purposes of the mortgage, the “Bank” elects domicile in Como, piazza Cavour
      34, at the local branch, and, for the purposes of the present Agreement and
      any
      judgments, in Milan, piazza San Fedele n. 1/3, at the registered offices of
      its
      Area of the Lombardy Territory.

    2.
      For
      all the purposes of the present Agreement, the “Debtor” elects domicile as
      indicated above.

    DESCRIPTION
      OF THE ASSETS OWNED BY THE DEBTOR 

    BEING
      THE SUBJECT OF THE MORTGAGE

    -
      Development
      for industrial use in the Municipality of VILLA
      GUAR-DIA, cadastral section of CIVELLO, piazza XX Settembre
      n. 2, made up of a three-floor industrial building above ground level (ground,
      first and second floors), plus an appurtenant area on which are located minor
      detached units (pump rooms, tank, meters room, utility room, tank room, tank,
      containing tank and weighing machine. 

    The
      industrial building together with the smaller units is identified as follows
      in
      the Cadastral of Buildings in compliance with change notification n. 118328,
      submitted to the Office of the Territory of Como (pursuant to Ministerial Decree
      n. 701/94) on 27 October 2005, file n. CO0274166:

    Sheet
      2

    Cadastral
      map 2439
      sub.
      701
      (two
      thousand four hundred thirty-nine subordinate seven hundred one) - piazza XX
      Settembre n. 2 - Ground, 1st
      and
      2nd
      floors

    -
      Category D/1 - (proposed) cadastral value euro 40,398.00

    The
      appurtenant covered and uncovered area is identified in the Land Cadastral
      as
      follows:  

    Sheet
      2 -
      automated sheet n. 9

    Cadastral
      map 2439 - Hectares 1.28.20 - urban unit without income

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    Cadastral
      map 18 - sowable land 2 - Hectares 0.32.00 - Desmenial value euro 13.22 -
      Agricultural value euro 13.12

    Cadastral
      map 661 - sowable and arboreus land 2 - Hectares 0.20.40 - Desmenial value
      euro
      9.48 - Agricultural value euro 9.48 

    Cadastral
      map 662 - sowable and arboreus land 2 - Hectares 0.01.90 - Desmenial value
      euro
      0.88 - Agricultural value euro 0.88

    (Cadastral
      maps: two thousand four hundred thirty-nine; eighteen; six hundred sixty-one;
      six hundred sixty-two; for a total of one hectare, eighty-two ares and fifty
      centiares)  

    Borders:
      On
      perimeter borderline from north to east: street, ex premises of railway line
      Nord Como-Varese, cadastral map 123 of Land Cadastral; street, cadastral maps
      55, 1204, 1202, 1206 of Land Cadastral. 

    The
      parties have expressly exonerated me, Public Notary, from the reading of the
      attachments, having declared that they possess full knowledge of
      them.

    I,
      Public
      Notary, have read this deed, drawn up under my responsibility and typewritten
      by
      a person entrusted by me, to the parties before me, who have declared to approve
      it.

    Written
      on 2 (two) sheets, on 6 (six) full sides and part of seventh.

    Signed:
      Bruno Dagostini, Claudio Lunati, Laura Iris Ferro

    Signed:
      Massimo Caspani, Public Notary.

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    
      	
              Banca
                Nazionale del Lavoro S.p.A.

            	
              Attachment
                “A” to 

            
	 	
              Repertory
                No. 49404/18370 

            

    

    

    

    

    SPECIFICATIONS

    Of
      the
      Covenants and Conditions Forming an Integral Part 

    of
      the
      Loan Agreement

    

    

    Art.
      1

    (Conditions
      and Terms of Disbursement)

    1.
      The
      amount of the loan shall be disbursed in one or more installments, as the “Bank”
deems fit, once the warranties have been met and any conditions foreseen by
      the
      granting resolution have been fulfilled, on condition that, after the
      stipulation of the Agreement, no prejudicial events or circumstances have
      occurred. In particular, the disbursement can take place - after the stipulation
      of the related deed of quittance, in case it is not disbursed at the same time
      as the stipulation of the Agreement - after the “Debtor” has produced the
      following documentation under its own responsibility and at its own
      expense:

    a)
      In the
      case of loan agreement stipulated by public deed: authentic copy of the
      agreement issued for all executive purposes, including the final Public Notary
      statement in which it is certified without reservation:

    -
      That
      the mortgage which can guarantee the loan has been regularly recorded; that
      the
      mortgage has the same degree foreseen in the granting resolution and that the
      real estate mortgaged is shown to be under the compete ownership of the “Debtor”
or the possible “Mortgage Providers”;

    -
      That
      the “Debtor” and any possible “Mortgage Providers”, “Constituents” of the lien
      and “Warrantors” have regularly entered the agreement and have been in the full
      and free possession of their rights for at least eleven days from the date
      of
      recording of the above-mentioned mortgage;

    b)
      In the
      case of loan agreement stipulated by recorded private deed: the original
      complete with the registration details, together with documentation, to be
      produced in the format required by the “Bank”, proving that the “Debtor” has
      regularly entered the agreement and is in full and free possession of its
      rights;

    c)
      In
      case of loan guaranteed by mortgage and/or lien, two duplicate copies of the
      certificate of registration of the mortgage, two duplicate copies of the
      certificate of registration of the lien, and a copy of the insurance policy
      of
      the assets offered in guarantee, regularly restricted in favor of the
“Bank”;

    d)
      The
      original documents of any possible warranties provided with deeds separate
      from
      the agreement, as foreseen by the granting resolution of the “Bank”, or any
      original deeds proving the fulfilling of any conditions foreseen by the
      above-mentioned resolution.

    2.
      Should
      the “Debtor” fail to provide all the documentation indicated above within a
      period of three months (or within the shorter period foreseen in article 1
      of
      the agreement) from the date of stipulation of the agreement, the “Bank” shall
      be entitled to consider the agreement terminated, save the faculty of the “Bank”
to defer the aforementioned period (the “Debtor” shall however remain
      responsible for the procedure expenses and any other charges connected to or
      arising from the loan, including any cost related to the cancellation of any
      deeds recorded to warranty the loan). Similarly, the “Bank” is entitled to
      consider the loan agreement terminated should any factual circumstances emerge
      (also before the expiry date of the above-mentioned period) or should the
      aforementioned documents show irregularities of such a nature which, had they
      been known in advance, would have prevented the stipulation of the
      agreement.

    3.
      The
      partial disbursement of the loan, before the fulfillment of one or all of the
      conditions required, does not prejudice the effectiveness of the agreement,
      and
      neither does it constitute a waiving of any possible warranties acquired or
      to
      be acquired.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    Art.
      2

    (Investment
      Program and Fee for Non-Use)

    1.
      The
      Debtor” undertakes to employ the loan sum within the term of use or by the date
      foreseen for the beginning of the amortization established in the agreement,
      exclusively to achieve the objective indicated in the agreement.

    2.
      In the
      case in which the objective of the loan is the realization of an investment
      program, the latter must be completed by the date foreseen for the beginning
      of
      the amortization.

    In
      the
      hypothesis in which by such date, or by the date of the term of use no
      disbursement has been made, for any reason due to the “Debtor”, including the
      absence of request for disbursement, the loan shall be considered to have been
      definitively waived by the “Debtor”.

    3.
      In the
      case in which the program is brought to conclusion without any withdrawing
      of
      the full amount, the loan shall be amortized in any case, starting from the
      date
      agreed, for the lesser sum effectively disbursed, thus reducing the
      reimbursement installments proportionally.

    4.
      In the
      case in which, on the date agreed for the commencement of the amortization,
      the
      amount of the loan is not fully disbursed owing to failure to execute the
      investment program fully, the “Bank” shall have the faculty to terminate the
      agreement or to allow the amortization of the loan for the lesser sum
      disbursed.

    5.
      In any
      case, the “Debtor” undertakes to pay a una
      tantum
      fee
      equal to 0.375%, with regard to the sums which are not utilized by the term
      agreed for the beginning of the amortization. The above fee shall be paid at
      the
      end of the aforementioned term.

    Art.
      3

    (Insurance
      Obligations)

    1.
      The
“Debtor” and any possible “Mortgage Providers” and “Constituents” of the lien
      are jointly and severally obliged to keep insured the assets indicated below
      with primary insurance companies until the total repayment of the debt arising
      from the loan and for a value considered to be fair and just by the “Bank”
itself: 

    a)
      The
      assets possibly subject to mortgage and their related appurtenances, as well
      as
      any plant, machinery, equipment and instrumental assets which may be subject
      to
      lien, against risks of fire, lightening, explosions in general, aircraft crashes
      and any other accessory risks;

    b)
      The
      ships possibly subject to mortgage, against ordinary or war risks of navigation
      and, in the case of ships under construction, against all the construction
      risks
      of the ships and their related propulsion systems (including shop risk,
      launching, fitting, trials, storage, voyages of transfers and deliveries),
      including Protection
      and Indemnity insurance.

    c)
      The
      motor vehicles possibly subject to the mortgage, against risks of civil
      liability towards third parties, both for disasters and injuries and damage
      to
      people and things; against fire and theft risks; stationary risks of
      semi-articulated trailers and similar vehicles, as well as against any accessory
      risks.

    2.
      The
      related policies, which must regard exclusively the assets mentioned above,
      shall be restricted in favor of the “Bank”, in order that the latter, in the
      case of accident or damage, may collect all the sums due from the insurance
      company with absolute privilege.

    3.
      The
“Debtor” and any possible “Mortgage Providers” and “Constituents” of the lien
      are obliged to return the damaged assets to their original condition. The “Bank”
benefiting from this restriction shall authorize the payment of the indemnities
      liquidated by the insurance company in favor of the beneficiaries, always on
      condition that the latter have provided to repair the damage. In the contrary
      case, the indemnities mentioned above shall be employed by the “Bank” for the
      total or partial repayment of the loan.

    4.
      The
“Debtor” and any possible “Mortgage Providers” and “Constituents” of the lien
      are obliged to submit to the “Bank” the receipts of the insurance premiums, on
      each request of the “Bank”. In the case of non-compliance with the above, save
      the faculty of the “Bank” to terminate the agreement, the “Bank” shall have the
      right to enter directly into contracts with companies selected by “Bank” itself,
      or to renew the insurance contracts and pay the related premiums, with the
      right
      to recuperate the principal, interest, expenses and accessory costs from the
      “Debtor” or any possible “Mortgage Providers” and “Constituents” of the lien.
      The “Bank” is furthermore entitled to waive, also on its own initiative, the
      insurance coverage mentioned above.

    5.
      In the
      case of accidents, the “Debtor” and any possible “Mortgage Providers” and
“Constituents” of the lien, undertake to inform the “Bank” regarding the
      accident occurred, within the term of three days. The “Bank” shall have the
      right to intervene in the assessment procedures of the damage or to start such
      procedures at the expense of the “Debtor”.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    

    Art.
      4

    (Obligations
      Regarding the Assets Financed by the Loan)

    The
      “Debtor” and any possible “Mortgage Providers” and “Constituents” of the lien
      are obliged not to alter the purpose of the assets possibly subject to the
      mortgage, and to abstain from removing or disposing of the plant, machinery,
      equipment and instrumental assets possibly subject to lien, without the written
      consent of the “Bank”. The “Debtor” and the “Constituents” of the lien hereby
      undertake to subject to lien, in favor of the “Bank”, any plant, machinery,
      equipment and instrumental assets in substitution of those removed or
      subsequently installed.

    

    Art.
      5

    (Effectiveness
      of the Mortgage and Lien)

    The
      mortgage and lien possibly issued in favor of the “Bank” shall remain in full
      effect both in the case of total or partial waiving by the “Bank” of any other
      warranties already securing or that may secure the loan, and in the case of
      total or partial nullity or voidance of the same.

    

    Art.
      6

    (Waiving
      of Subrogation and Contribution)

    Any
      payment made by any person, giving rise to partial, legal or conventional
      subrogation, as laid down in article 1201 and the following articles of the
      Civil Code, shall not give right to contribution, as laid down in article 1205
      of the Civil Code.

    

    Art.
      7

    (Payments
      and Fiscal Charges)

    1.
      The
      amount of the interest and amortization installments of the loan and of any
      other payment due to the “Bank” must, in any case, be net of any charge or
      burden to the “Bank”.

    2.
      Any
      higher charges arising from taxes, duties or any direct or indirect, personal
      or
      real, present or future charges or burdens of any kind, which may affect the
      “Bank” due to, or as a consequence of, the loan, as well as any possible
      increase in the current fiscal charges, shall be exclusively charged to the
      “Debtor”. The “Debtor” must keep the “Bank” fully guaranteed and indemnified
      providing it, also in advance, with the sum required by the Tax Office. The
      “Debtor” is entitled to conduct, at its own expense, the procedures and
      objections deemed well-founded, of which the “Bank” shall have the right to
      abstain from any involvement of any kind.

    

    Art.
      8

    (Additional
      and Quittance Deeds)

    The
      “Debtor” and any possible “Mortgage Providers” and “Constituents” of the lien or
“Warrantors” are obliged to undersign any additional and quittance deeds or any
      modifications of the loan agreement which the “Bank” may deem
      necessary.

    

    Art.
      9

    (Lapse
      of the Benefit of the Term and Termination of the Agreement due to
      Breach)

    1.
      The
“Debtor” expressly acknowledges and accepts that, in the case of non-payment of
      even a single overdue installment of the repayment of the principal or of the
      interest payment, including any pre-amortization installment, the “Bank” shall
      have the faculty to consider the “Debtor” no longer entitled to the benefit of
      the term pursuant to article 1186 of the Civil Code, or it shall have the right
      to terminate the agreement ipso
      iure, pursuant
      to article 1456 of the Civil Code. In either case without any need to start
      default procedures or judicial requests.

    2.
      In the
      case in which the loan has been granted pursuant to article 38 and following
      of
      Law Decree n. 385/1993, the special norms laid down in article 40, second point
      - which foresee the possibility of terminating the agreement after the
      non-payment of two overdue installments -shall be applied for the termination
      of
      the agreement. Also in this case, the “Bank” shall have the right to terminate
      the agreement ipso
      iure, pursuant
      to article 1456 of the Civil Code, without any need to start default procedures
      or judicial requests.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    3.
      The
      lapse of the benefit of the term or the termination of the agreement shall
      take
      place immediately by law, in the case in which the “Bank” communicates to the
“Debtor” that it intends to avail itself of the present clause. This must be
      communicated by registered letter, telegram or via fax. 

    4.
      Furthermore, the “Bank” shall have the faculty to terminate the loan agreement
      pursuant to article 1456 of the Civil Code, starting from the date of
      effectiveness of the written notice to the “Debtor” also in the following cases
      of breach of contract:

    a)
      Use of
      the loan for objectives other than those indicated in the
      agreement;

    b)
      Failure to provide the documentation requested in article 1 above;

    c)
      Non-completion of the possible investment program which is the object of the
      loan by the date foreseen for the beginning of the amortization;

    d)
      Changes in the juridical status or company structure of the aforesaid “Debtor”,
      or any modifications or cessation of its activity, of such a nature as to
      prevent the completion of the investment program or the achievement of the
      objective which is the subject of the loan;

    e)
      Changes in the end-use of the company assets, or removal, assignment or
      disposal, even partial, of the plant, machinery, equipment and instrumental
      assets possibly subject to the mortgage or lien, without the agreement of the
      “Bank”:

    f)
      Failure to stipulate the policies indicated in article 3 above or non-payment
      of
      the related premiums;

    9)
      Non-completion of any additional or quittance deeds, of any modifications of
      the
      loan agreement, or of any deeds constituting a lien on the assets subsequently
      installed, as deemed necessary by the “Bank”, due to facts under the
      responsibility of the “Debtor”, any possible “Mortgage Providers”,
“Constituents” of the lien or “Warrantors”;

    h)
      Total
      non-execution or delays in the execution of any of the obligations arising
      from
      the agreement on the part of the “Debtor”, unless the “Debtor” remedies the
      breach within fifteen days of the receipt of the request of the “Bank” to remedy
      the breach;

    i)
      In the
      case in which the loan is disbursed with funds of the “B.E.I.”, false statements
      on the part of the “Debtor” to the “Bank” for the purpose of the approval of the
      investment program by the “B.E.I.”, or non-compliance with the obligations
      applied by the “B.E.I” to the “Debtor”, as laid down in the loan agreement and
      in any subsequent additional and quittance deeds;

    l)
      In the
      case of the mortgage being issued on the assets granted on desmenial license,
      revocation, lapse or termination of the desmenial license.

    5.
      In the
      occurrence of one of the events indicated in the above points 1, 2 and 4, the
      “Debtor” and any possible “Warrantors” must pay the sums due, as indicated in
      article 11 below. The sums must be paid within the five day term starting from
      the receipt of the communication made via registered letter, telegram or fax
      in
      which the “Bank” will communicate to the “Debtor” that it intends to avail
      itself of the lapse of the benefit of the term or the termination of the
      agreement.

    

    Art.
      10

    (Termination
      Clauses of the Agreement)

    1.
      The
      following represent termination conditions of the agreement:

    a)
      Protested bills or bank cheques or the filing of provisional or executive
      proceedings against the “Debtor” and any possible “Warrantors”, or should these
      be subject to insolvency procedures, or in the case of voluntary liquidation
      of
      the “Debtor”, or placing of the same into receivership;

    b)
      Executive proceedings against any assets possibly provided in guarantee by
      third
      party “Warrantors” or in the event of insolvency procedures characterized by
      liquidation against the latter;

    c)
      The
      termination of other loan agreements granted by the “Bank”, or the revocation of
      credit lines possibly granted by the same to the “Debtor”;

    d)
      A
      decrease in the value of the collateral securities possibly provided in regard
      to the loan, due to the effect of the general or local depreciation of the
      real
      estate, or due to any other cause, of such an extent so as to reduce the margin
      of warranty assessed at the time of granting, or a decrease in the general
      warranty constituted by the assets of the "Debtor" and any possible
“Warrantors”, of such an extent so as to endanger the satisfaction of the credit
      right of the “Bank”; 

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    e)
      The
      emergence of facts or circumstances with regard to the “Debtor” or any possible
“Warrantors” which, had they been known previously, would have prevented the
      stipulation of the loan agreement;

    f)
      In the
      case in which the loan is disbursed with funds of the “B.E.I.”, the total or
      partial termination of the loan granted by the same;

    g)
      In the
      case in which the loan is disbursed with funds of Mediocredito Centrale S.p.a.
      or Artigiancassa S.p.a., the revocation, or termination of the support of such
      entities:

    h)
      In the
      case of loans supported by benefits regarding interest due, as agreed with
      the
      competent bodies; the non-granting, revocation or termination of the above
      benefits.

    2.
      In the
      occurrence of one of the events indicated above, the “Debtor” and any possible
“Warrantors” must pay the sums due, as indicated in article 11 below. The sums
      must be paid within the five day term starting from the receipt of the written
      communication made by the “Bank”, also by telegram or fax, in which the “Bank”
will communicate to the “Debtor” that it intends to avail itself of the
      termination clause of the agreement.

    3.
      If,
      however, the “Debtor” undergoes bankruptcy proceedings, composition with
      creditors, compulsory winding up or goes into administration, no communication
      by the “Bank” shall be necessary since the loan agreement will be terminated
ope
      legis.

    

    Art.
      11

    (Effects
      of Lapse of the Benefit of Term and Termination of the
      Agreement)

    1.
      Save
      all the legal and conventional warranties possibly given in favor of the “Bank”,
      in all the cases of lapse of the benefit of the term or termination of the
      agreement, as foreseen in the above articles 9 and 10, the “Debtor” or any
      possible “Warrantors” must pay the entire debt arising from any unpaid
      installment, residual principal, contractual or default interest for the amount
      agreed in the contract, accessory costs and expenses, including any judicial
      expenses incurred by the “Bank”, and any other sum for which the “Bank” is
      deemed to be a creditor. This includes any compensation, fees and penalties
      foreseen by the “B.E.I.”, the Mediocredito Centrale S.p.a, or the Artigiancassa
      S.p.a., in the case in which the loan has been disbursed with funds granted
      by
      the aforementioned organizations.

    2.
      In the
      case of loans expressed in foreign currency, the above amounts, as well as
      any
      other cost to be charged to the “Bank” deriving from the consequent early
      payment of the funding operations expressed in foreign currency (including
      any
      operations carried out by the “Bank” itself in order to use the funds collected
      through the issuance of securities, including any securities with a fixed rate,
      to allow the disbursement of the loan), shall be converted by the “Bank” into
      euros, at the foreign exchange rate applied on the date of lapse or
      termination.

    3.
      Default interest shall be due at the rate fixed in the agreement on the total
      amount calculated as specified above.

    

    Art.
      12

    (Accounting
      of Payments)

    Save
      any
      different resolutions by the “Bank”, any payment made by the “Debtor” shall be
      first of all accounted for the reimbursement of expenses and accessory costs,
      then for interest payments and, lastly, for the principal
      repayment.

    

    Art.
      13

    (Essentials,
      Joint Responsibility and Non-Severability of Contractual
      Obligations)

    All
      the
      Obligations undertaken by the “Debtor” and any possible “Mortgage Providers”,
“Constituents” of the lien and “Warrantors” are deemed to be essential and
      undertaken with joint and non-several responsibility, also with regard to each
      of their successors and assigns, also in the case of special
      obligations.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    Art.
      14

    (Waiving
      of Exceptions)

    No
      exception or opposition may release the “Debtor” and any possible “Mortgage
      Providers”, “Constituents” of the lien and “Warrantors” from the obligations
      undertaken by the same, in any place or for any reason towards
      the “Bank, until the credit of the “Bank” arising from the loan has been
      completely repaid.

    

    Art.
      15

    (Proof
      of Credit)

    The
      excerpts from the accounting books of the “Bank” shall always constitute full
      proof, in any forum and for any effect, against the “Debtor” and any possible
“Mortgage Providers”, “Constituents” of the lien and “Warrantors”, their
      successors or assigns, with regard to the amount of the credit of the “Bank”
towards the “Debtor”. The aforementioned parties waive any exception or
      objection with regard to the above on their own behalf, and on behalf of their
      successors or assigns.

    

    Art.
      16

    (Checks)

    1.
      The
“Debtor” agrees to allow inspections, technical, accounting and administrative
      checks at any time on the part of the trusted officers of the “Bank”, and to
      reimburse all the related expenses.

    2.
      In the
      case in which the loan is disbursed by the “B.E.I.”, the “Debtor” undertakes to
      allow any person designated by such European Community Bodies or by the European
      Community Court of Audit to carry out visits, inspections and checks of the
      premises, plant and works subject of the loan, assisting them in their
      task.

    

    Art.
      17

    (Safeguard
      of the Environment)

    The
      “Debtor” undertakes to adopt, in compliance with all the norms and laws in
      force, any technical measures which are necessary to eliminate any form of
      pollution of the natural environment arising from its activities in the premises
      which are subject of the loan agreement.

    

    Art.
      18

    (Application
      of Collective Labor Contracts)

    The
      “Debtor” undertakes to apply conditions that are not inferior to those that
      apply to the Collective Labor Contracts for the category and area in regard
      to
      its own workforce.

    

    Art.
      19

    (Early
      Reimbursement)

    1.
      On
      expiry of the term of eighteen months and one day from the date of disbursement,
      the “Debtor” shall have the faculty to proceed to the early reimbursement or to
      the partial reimbursement of the loan, with advance notice of ninety days with
      respect to the date of reimbursement, which, in any case, must coincide with
      the
      due date of one installment. In the case of early reimbursement, the “Debtor”
must pay the “Bank” an all-inclusive sum (apart from the residual principal
      debt, any possible installment in arrears and the related default interest,
      together with any possible expenses an accessory costs accrued) made up as
      follows:

    
      	1)	
              Loans
                at variable market rates, in euro or foreign
                currency:

            

    

    a)
      A fee
      equal to 0.30% to apply to the debt on capital line subject to early
      reimbursement, multiplied by the number of years or fractions thereof remaining
      to the date of the original reimbursement;

    b)
      Administration fees for the calculation of the reimbursement: euro
      51.65;

    
      	2)	
              Loans
                at fixed market rates, in euro or foreign
                currency:

            

    

    a)
      The
      fee indicated in the previous point 1a);

    b)
      Administration fees for the calculation of the reimbursement indicated in the
      previous point 1b);

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    c)
      An
      amount equal to the difference between the interest share, calculated at the
      investment rate agreed in the loan agreement, which the “Bank” would receive if
      the same was not subject to early reimbursement, and the interest share of
      a
      reinvestment loan, of an amount equal to the early reimbursed principal, of
      a
      duration equal to the residual duration and at a rate equal to the “Rendistato”
(Government Yield) parameter calculated in the calendar month previous to that
      in which the early reimbursement takes place, taken from the table “Titoli di
      Stato Italiani - Rendimenti effettivi” (“Italian Government Securities -
      Effective Yields”) published in the newspaper “Il Sole 24 ore”. The sum due as
      specified above shall be payable to the “Bank” at its effective value on the
      date of early reimbursement, by applying an actualization rate equal to the
      aforementioned reinvestment rate;

    
      	3)	
              Loans
                at all-inclusive facilitated fixed rates by law: 

            

    

    a)
      The
      fee indicated in the previous point 1a);

    b)
      Administration fees for the calculation of the reimbursement indicated in the
      previous point 1b);

    c)
      Amount
      indicated in the previous point 2c);

    d)
      Amount
      equal to the substitute tax which previously remained to the charge of the
      “Bank”, applied to the early reimbursed principal. .

    2.
      In the
      case of a loan disbursed with funds coming from the “B.E.I.” the above faculty
      of early reimbursement is granted to the “Debtor” only if it is foreseen in the
      corresponding loan agreement between the aforesaid body and the “Bank”. The
      early reimbursement can take place only with the consent of the “Bank” and with
      the prior authorization of the aforementioned body, and it must be carried
      out
      within the terms and conditions fixed by the same. An all-inclusive fee made
      up
      as follows must in any case be paid by the “Debtor”: 

    a)
      The
      fee indicated in the previous point 1a);

    b)
      Administration fees for the calculation of the reimbursement indicated in the
      previous point 1b);

    c)
      With
      limitation to the loans regulated at fixed rate: An amount equal to the
      difference between the interest share, calculated at the investment rate agreed
      in the loan agreement, which the “Bank” would receive if the same was not
      subject to early reimbursement, and the interest share of a reinvestment loan,
      of an amount equal to the early reimbursed principal, of a duration equal to
      the
      residual duration and at a rate equal to the rate that shall be communicated
      by
      the “B.E.I.”. The sum due as specified above shall be payable to the “Bank” at
      its effective value on the date of early reimbursement, by applying an
      actualization rate equal to the reinvestment rate communicated by the
“B.E.I.”.

    3.
      No
      other charge shall be payable by the “Debtor” other than those indicated
      above. 

    4.
      As
      foreseen by the
      resolution dated 9
      February 2000 of
      the
      Interdepartmental Committee for Credit and Savings,
      the
      following examples of the application of the calculation formula indicated
      in
      point 3) of the previous point 1 are shown. The examples show the calculation
      of
      the fee due, considering an early reimbursed principal of 1,000 euro and two
      different hypotheses of the residual amortization period of the debt (three
      and
      five years): 

    
 

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    

    

    Example
      of the application of the calculation formula for the fee due in case of early
      reimbursement of a fixed interest rate loan 

    

    
      	 	
              Early
                reimbursement of principal: euro

            
	
              1,000
                 

            
	 	
              Residual
                amortization time of the debt

            
	 	
              3
                years

            	
              5
                years

            
	
              a)
                Fee (1):

            	
              9.00

            	
              15.00.

            
	
              b)
                Difference, calculated installment by installment, between:

              -
                total interest at the investment rate:

            	
               

               

              280.16
                -

            	
               

               

              460.10-
                -

            
	
              14.85%
                (2):

            	
              66.97

            	
              109.99

            
	
              -
                total interest at the reinvestment rate:

            	
              213.19

            	
              350.11

            
	
              3.55%
                (2):

            	 	 
	 	
              203.43

            	
              326.34

            
	
              Actualized
                (3) at the date of early 

            	
              51.65

            	
              51.65

            
	
              Reimbursement
                (4), at a rate of 3.55%:

            	
              2.50

            	
              2.50

            
	
              c)
                Administration expenses for reimbursement calculation:

              d)
                Recovery of substitute tax (5):

            	 	 
	
              Total
                fee for early reimbursement

            	
              euro
                266.58

            	
              euro
                395.49

            

    

    (1)
      Equal to 0.30% of the early reimbursement of debt in capital line, multiplied
      by
      the number of years or fractions thereof remaining to the date of the original
      reimbursement.

    (2)
      Less favorable values for the clientele recorded by the indexes over the last
      three years.

    (3)
      The actualization formula, applied to the difference of interest of each
      installment still due with respect to the original payment date, is the
      following = 1- [(gg x t) : (gg x t + 36,500)], where gg = n. of days between
      the
      date of the early reimbursement and the due date of the individual installment;
      t = actualization rate.

    (4)
      Coinciding with the initial date of the residual period (three or five years)
      of
      amortization. 

    (5)
      Amount equal to the substitute tax (at present 0.25%) applied to the early
      reimbursement of principal (the recovery is applied only in the case of a loan
      with facilitated all-inclusive interest rate by law).

    

    Art.
      20

    (Contribution
      on Interest Account)

    1.
      In the
      case of non-granting, revocation, or termination of any possible facilities
      on
      interest account granted by the competent bodies, the “Debtor” shall be deemed
      no longer eligible to the benefits of law, and it shall pay the “Bank” the
      interest in full measure, respectively from the first pre-amortization
      installment in the first two cases, and from the time of termination of the
      contribution in the latter case.

    2.
      The
      aforementioned rate shall also be applied, with limitation to any amount in
      excess and for the further duration, in the case in which the contribution
      on
      interest account is granted for an amount or duration inferior to those of
      the
      loan granted by the “Bank”.

    3.
      The
      faculty of the “Bank” to terminate the loan agreement, as foreseen under letter
      h), of the previous article 10, is unprejudiced in any case.

    4.
      In the
      hypotheses of non-granting or revocation of the contribution on interest
      account, the substitute tax, as laid down in articles 17 and 18 of Presidential
      Decree n. 601 of 29 September 1973, and subsequent modifications, shall be
      charged to the “Debtor”. The related amount must be reimbursed to the “Bank”, on
      request of the latter”.

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    

    

    Art.
      21

    (Charges,
      Fees and Expenses)

    The
      tariffs currently in force regarding the charges, fees and expenses to be
      charged to the “Debtor” in connection with the agreement for the period of
      duration of the loan are the following:

    
      	 	
              ·

            	
              Procedure
                expenses:

            

    

    Variable
      with respect to the amount of the loan, with a minimum of euro 129.11 and a
      maximum of euro 7,746.85:

    
      	
              -
                Up to euro 500,000.00:

              -
                From euro 500,000.00 to euro 2,500,000.00:

               

              -
                Over euro 2,500,000.00:

            	
              0.20%

              euro
                1,000.00 + 0.15% on the amount exceeding 500,000

              euro
                4,100.00 + 0.15% on the amount exceeding
                2,500,000

            

    

    The
      procedure expenses are due, for an amount equal to half of the sum calculated
      as
      indicated above, also in the case of waiving or filing of the loan procedure
      before the stipulation of the loan agreement.

    The
      procedure expenses are due in full, together with the expenses for the
      cancellation of the mortgage, in the case in which the loan agreement has been
      stipulated.

    
      	
            	·	
              Expert
                assessment expenses (for
                both the expert of the Bank and the external expert applying special
                tariffs):   

            

    

    
      	
              Variable
                with respect to the amount of the loan

            	
              maximum
                euro 1,549.37

            

    

    

    
      	 	
              ·

            	
              Concession
                fee:

            

    

    
      	
              Una
                tantum
                on
                the stipulated amount

            	
              maximum
                2.00%

            

    

    

    
      	 	
              ·

            	
              Fee
                for the negotiation of foreign currency:

            

    

    
      	
              To
                be paid on the loans expressed in foreign currency at the time of
                disbursement, conversion and reimbursement

            	
               

               

              0.15%

            

    

    
      	 	
              ·

            	
              Fee
                for non-use:

            

    

    
      	
              To
                be applied at the beginning of the amortization on the share that
                is not
                disbursed, in the cases in which the disbursements do not reach the
                total
                amount of the loan

            	
               

               

               

              0.375%

            

    

    
      	 	
              ·

            	
              Fee
                for the provision of funds from abroad:

            

    

    
      	
              Any
                possible agency fees, management fees, commitment fees and legal
                fees for
                the stipulation of the agreement with the foreign lending
                Institute

            	 

    

    
      	 	
              ·

            	
              Duties
                and expenses for various services (Excluded
                Public Notary fees):

            

    

    
      	
              -
                Undertaking:

              -
                Company variations, changes in the personal and/or collateral
                securities:

              -
                Changes in the contractual terms:

              -
                Loan division/reduction:

              -
                Loan cancellation, reductions o restrictions:

              -
                Certificate for Audit Companies:

              -
                Statement of credit certification:

              -
                Statement certifying the amount of the residual debt:

            	
              See
                procedure expenses

              euro
                516.46

               

              euro
                516.46

              euro
                516.46

              euro
                516.46

              euro
                154,94

              euro
                103,29

              euro
                51,65

            

    

    

    
      	 	
              ·

            	
              Public
                Notary fees:
                to the charge of the loan borrower; to be paid directly to the Public
                Notary.

            

    

    

    

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    

    Attachment
      "B" to Repertory No. 49404/18370 

    

    BNL

    Nazionale
      del Lavoro

    Gruppo
      BNL

    

     SYNTHETIC
      DOCUMENT Attachment
      “___”

    (Art.
      9
      of the
      resolution dated 4
      March
      2003 of
      the
      Interdepartmental Committee for Credit and Savings)

    Medium
      long-term loan in euro at the market rate in favor of enterprises

    Pursuant
      to articles 10, 38 and following of Law Decree n. 385 of 1/09/93 (Consolidation
      Act of the Laws regulating Bank and Credit Matters)

    

    

    

    
      	
              Borrower

            	
              GENTIUM
                SPA-

            
	
              Amount

            	
              €.
                2,800,000.00-

            
	
              Deed

            	
              Public
                deed

            
	
              Source

            	
              Funds
                from Banca Nazionale del Lavoro S.p.A.

            
	
              Duration

            	
              8
                years, of which 12 months maximum of pre-amortization 

            
	
              Interest
                rate

            	
              Variable
                on a six-monthly basis, in accordance with the 6-month “Euribor"
                parameters increased by 0.15 points, plus 0.85 points spread annually
                in
                favor of the Bank. Calculation method: 365/360.

            
	
              Cost
                Synthetic Indicator (C.S.I.)

            	
              Indicative
                value valid in the hypothesis of the application of the rate calculated
                according to the aforementioned parameter, at the current value date,
                with
                disbursement at the same time of stipulation: 4.23%.

            
	
              Default
                interest rate

            	
              Should
                the default interest rate, calculated as specified above, be equal
                to or
                higher than the threshold rate established pursuant to law n. 108/1996,
                the related threshold rate shall be applied to each calendar quarter
                of
                default. In any case, the default rate shall not be lower than the
                rate
                agreed in the contract. Calculation method: 365/360.

            
	
              Disbursement
                conditions

            	
              In
                a single installment, after the execution of the deed of
                quittance.

            
	
              Reimbursement

              conditions

            	
              By
                n. 14 deferred six-monthly installments, inclusive of constant principal
                share amounting to €. 200,000.00, plus interest on the residual
                debt.

            
	
              Warranties

            	
              Real
                estate mortgage.

            
	
              Fees,
                expenses and charges

            	
              -
                Procedure
                expenses: €.
                1,000.00;

              -
                Granting
                fee:
                0,05% una
                tantum of
                the amount stipulated;

              -
                Public
                Notary fees: to
                be settled directly with the sealing Public Notary;

              -
                Substitute
                tax: 0.25%
                of the amount disbursed, una
                tantum,
                to be settled at the time of disbursement;

              -
                Fee
                for non-use: to
                be applied at the rate of 0.375% at the beginning of the amortization
                on
                the share not disbursed, in cases in which the disbursements do not
                reach
                in total the amount of the loan;

              -
                Various
                expenses:

              a)
                Undertaking: from a minimum of euro 129.11 to a maximum of euro
                7,746.85;

              b)
                Company variations, modification of the guarantees: euro 516.46,
                plus
                Public Notary expenses;

              c)
                Modification of contractual terms: euro 516.46, plus Public Notary
                expenses;

              d)
                Division/reduction of the loan: euro 516.46, plus Public Notary
                expenses;

              e)
                Mortgage cancellation/reduction/restriction: euro 516.46, plus Public
                Notary expenses;

              f)
                Certification for audit company: 154.94;

              g)
                Statement of credit: euro 103.29;

              h)
                Statement certifying the residual debt: euro 51.65;

              i)
                Reimbursement calculation: euro
                51.65.

            

    

     

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	
              All-inclusive
                fee for early reimbursement

            	
              a)
                Fee equal to 0.30% to apply to the residual debt in capital
                line

              multiplied
                by the number of years or fractions thereof remaining to the date
                of the
                original reimbursement; 

              b)
                Administration expenses equal to euro 51.65.

            
	
              Principal
                rights,

              obligations
                and limitations in the relationship with the client

            	
              -
                Amount
                of the mortgage and of any possible lien and surety given
                in favor of the bank: 168% of the loan amount granted; 

              -
                Charges,
                fees and expenses: the
                Bank has the unilateral right to vary, unfavorably for the loan borrower,
                during the period of the loan, the amount of the charges, fees and
                expenses related to the loan (any variations shall be communicated
                by the
                Bank in accordance with the terms and conditions indicated in the
                6th
                heading, 1st
                paragraph of the Bank Consolidation Act);

              -
                Copy
                of the stipulated agreement:
                the client has the right to receive a copy of the stipulated agreement,
                to
                which is attached the present “Synthetic Document” summarizing the
                principal conditions applied;

              -
                Tacit
                renewal of the agreement at the expiry date, acceptance of ancillary
                agreements, bodies and procedures of out-of-court settlement of
                controversies: not
                foreseen;

              -
                Competent
                court:
                as
                foreseen by law (place of conclusion of the agreement);

              -
                Obligations
                and limitations of the loan borrower:

              a)
                Presentation
                of the agreement documentation
                following the stipulation of the agreement, under the responsibility
                and
                at the expense of the borrower (authentic copy issued for all executive
                purposes, or original copy complete with registration details in
                the case
                of stipulation by private deed; final Public Notary statement; two
                duplicate copies of any possible note of mortgage recording and
                registration of the lien; copy of the insurance policy regarding
                the
                assets offered in guarantee, restricted in favor of the Bank; original
                copies of any guarantees possibly given by means of separate deeds).
                Should the debtor fail to provide all the documentation indicated
                above
                within the terms of the agreement, the Bank shall be entitled to
                consider
                the agreement terminated, save the faculty of the “Bank” to defer the
                aforementioned period (the debtor shall however remain responsible
                for the
                procedure expenses, the expenses for the cancellation of any written
                documentation and every other charge related to the loan); b)
                Employment of the loan amount exclusively for the realization of
                the
                objective indicated in the agreement:
                in
                the case in which the loan has the objective of realizing an investment
                program, the latter must be completed by the date foreseen for the
                beginning of the amortization. If, by such date, no amount has been
                disbursed, the loan shall be deemed definitively waived. Vice versa,
                if,
                by such a date the amount of the loan has not been fully disbursed,
                due to
                the failure in executing the program completely, the Bank shall have
                the
                faculty to terminate the agreement or to allow the amortization of
                the
                loan for the sum disbursed; c)
                Insurance of the real estate or other assets possibly
                being the subject of collateral securities, with primary insurance
                companies, until the total reimbursement of the debt, for the value
                and
                against the risks decided by the Bank, with a restriction of the
                related
                policies in favor of the latter; d)
                Restriction regarding the end-use of the real estate and withholding
                of
                permission to remove or dispose of the chattels
                possibly being the subject of collateral security, without the written
                consent of the Bank;

               

               

            

    

     

    
      
         

      

      
         

        
          

        

      

      
         

      

    

    
      	 	 e)
              Exclusion of contribution as laid down
              in 1205 of the Civil Code,
              in
              the case of any payment made by any person, giving rise to partial,
              legal
              or conventional subrogation, as laid down in article 1201 and the
              following articles of the Civil Code; f)
              Undertaking of all fiscal charges
              of
              whatever nature, present or future, which may be charged to the Bank
              in
              connection with the loan, as well as any further increase of the same;
              g)
              Stipulation
              of additional and quittance deeds, or
              any modifications of the loan agreement that the Bank may deem necessary;
              h)
              Lapse of the benefit of the term or termination of the
              agreement
              in
              the case of failure to pay even a single installment overdue in regard
              to
              the reimbursement of the principal or for the payment of interest,
              also
              for pre-amortization, as well as in all the other cases foreseen in
              the
              specifications. In such cases, the loan borrower must pay the full
              debt
              for any unpaid installments, the residual principal, contractual and
              default interest, and judicial and other expenses; i)
              Accounting
              of payments
              first of all with regard to the reimbursement of expenses and accessory
              costs, then for the payment of interest and, finally, the reimbursement
              of
              the principal; l)
              Waiving of exceptions or objections,
              in
              any place and for whatever reason against the Bank, until the credit
              of
              the latter, arising from the loan, has not been completely paid up;
              m)
              Full
              probative effectiveness of the excerpts of the accounting books of
              the
              Bank,
              in
              any place and for any effects, of the amount of the credit towards
              the
              loan borrower; n)
              Right of early reimbursement
              or
              partial reimbursement of the loan, on completion of the term of 18
              months
              and 1 day from the date of disbursement, only with 90 day notice with
              respect to the date of reimbursement, which, in any case, must coincide
              with the due date of an installment, after the payment of the
              all-inclusive fee foreseen.

    

    

    

    °°°°°000°°°°°

    
 

    Registered
      in Como on 14 June 2006 under n. 5451 Sr. 1T - Exempt.

    I,
      the
      undersigned Dr. MASSIMO CASPANI, Public Notary in Como, registered with the
      Public Notary Roll of Como, certify that the present copy, made up of five
      pages, is in conformity with the original and attachments.

    Como,
      19
      June 2006.

    

    Stamped
      and signedExhibit
        10.45

    

     

    EXECUTION
      COPY

     

    FIFTH

    AMENDED
      AND RESTATED 

    CREDIT
      AGREEMENT

     

    dated
      as
      of June 29, 2006

     

    by
      and
      among

     

    NOVAMED,
      INC.

     

    as
      the
      Borrower,

     

    CERTAIN
      COMMERCIAL LENDING INSTITUTIONS,

     

    as
      the
      Lenders,

     

    and

     

    NATIONAL
      CITY BANK OF THE MIDWEST,

    as
      the
      Agent for the Lenders

     

    with

     

    LASALLE
      BANK NATIONAL ASSOCIATION, as Documentation Agent

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    FIFTH
      AMENDED AND RESTATED CREDIT AGREEMENT

     

    THIS
      FIFTH AMENDED AND RESTATED CREDIT AGREEMENT, dated as of June 29, 2006, by
      and
      among NOVAMED, INC., a Delaware corporation (the “Borrower”),
      the
      various financial institutions from time to time party hereto (collectively,
      the
“Lenders”),
      NATIONAL CITY BANK OF THE MIDWEST, as agent (the “Agent”)
      for the
      Lenders and LASALLE BANK NATIONAL ASSOCIATION, as Documentation
      Agent;

     

    W
      I T N E
      S S E T H:

     

    WHEREAS,
      the Borrower, the Lenders and the Agent entered into that certain Credit
      Agreement dated as of June 28, 2000 (the “Original
      Credit Agreement”)
      which
      Original Credit Agreement was amended and restated as of August 29, 2001
      pursuant to an Amended and Restated Credit Agreement, was again amended and
      restated as of October 23, 2001 pursuant to that certain Second Amended and
      Restated Credit Agreement, was again amended and restated as of June 26, 2003
      and was again amended and restated as of October 15, 2004 (the "Fourth
      Amended and Restated Credit Agreement");and

     

    WHEREAS,
      the Borrower has requested that the Lenders and the Agent amend and restate
      the
      Fourth Amended and Restated Credit Agreement; and 

     

    WHEREAS,
      the Lenders are willing, on the terms and subject to the conditions hereinafter
      set forth (including Article
      V),
      to
      amend and restate the Fourth Amended and Restated Credit Agreement;
      and

     

    WHEREAS,
      the proceeds of the Loans hereunder will be used for general corporate purposes
      and working capital purposes of the Borrower and its Subsidiaries and to finance
      Permitted Acquisitions by the Borrower. 

     

    NOW,
      THEREFORE, the parties hereto agree as follows:

     

    ARTICLE
      I  

     

    DEFINITIONS
      AND ACCOUNTING TERMS

     

    SECTION
      1.1   Defined
      Terms.
      The
      following terms (whether or not underscored) when used in this Agreement,
      including its preamble and recitals, shall, except where the context otherwise
      requires, have the following meanings (such meanings to be equally applicable
      to
      the singular and plural forms thereof).

     

    "Affected
      Lender"
      is
      defined in Section
      4.12.

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    “Affiliate”
      of any
      Person means any other Person which, directly or indirectly, controls, is
      controlled by or is under common control with such Person (excluding any trustee
      under, or any committee with responsibility for administering, any Plan). A
      Person shall be deemed to be “controlled by” any other Person if such other
      Person possesses, directly or indirectly, power

     

    (a) to
      vote
      10% or more of the securities (on a fully diluted basis) having ordinary voting
      power for the election of directors or managing general partners;
      or

     

    (b) to
      direct
      or cause the direction of the management and policies of such Person whether
      by
      contract or otherwise.

     

    “Agent”
      means
      National City Bank of The Midwest.

     

    “Agreed
      EBITDA FORM”
      is
      defined in Schedule
      2.

     

    “Agreement”
      means,
      on any date, this Fifth Amended and Restated Credit Agreement as originally
      in
      effect on the Fifth Amended and Restated Effective Date and as thereafter from
      time to time amended, supplemented, amended and restated, or otherwise modified
      and in effect on such date.

     

    “ASC
      Facility”
      means an
      ambulatory surgery center, surgical facility or other form of outpatient
      surgical treatment center (including, without limitation, vision correction
      or
      laser vision correction center), or any business primarily in the business
      of
      owning, operating and/or managing one or more thereof.

     

    "ASC
      Startup"
      means
      any capital expenditure or other amount expended the Borrower or any other
      Credit Party in an ASC Facility which capital expenditure would not by
      definition constitute an Investment or Permitted Acquisition hereunder.

     

    “ASC
      Subsidiary”
      means a
      Subsidiary of the Borrower that is primarily engaged in the business of being
      an
      ASC Facility.

     

    “ASC
      Subsidiary Capital Event”
      means
      the purchase by the Borrower or a Wholly-Owned Subsidiary of the Borrower of
      all
      or a portion of the equity interests in a Non-Wholly-Owned ASC Subsidiary or
      Controlled Minority ASC Entity or the redemption by a Non-Wholly-Owned ASC
      Subsidiary or Minority ASC Subsidiary of the Borrower of all or a portion of
      the
      equity interests in such Non-Wholly-Owned ASC Subsidiary or Minority ASC Entity,
      as applicable.

     

    “Asset
      Disposition”
      means
      any sale, transfer or other disposition of any property of the Borrower or
      any
      Subsidiary in a single transaction or in a series of related transactions (other
      than the sale of inventory and of equipment that is obsolete, worn-out or no
      longer useable by the Borrower or any of its Subsidiaries, in each case in
      the
      ordinary course of business and Permitted Equity Ownership Sales).

     

    “Assignee
      Lender”
      is
      defined in Section
      10.11.1.

     

    
      
        
        

      

      
        2

        
          

        

      

      
        
        

      

    

    “Authorized
      Officer”
      means,
      relative to any Credit Party, those of its officers whose signatures and
      incumbency shall have been certified to the Agent and the Lenders pursuant
      to
Section
      5.1.1.

     

    "Available
      Revolving Commitment":
      means
      at any time, an amount equal to the excess, if any, of (a) the Revolving
      Commitment Amount then in effect over
      (b) the
      sum of all Revolving Extensions of Credit then outstanding.

     

    “Base
      Rate”
      means,
      on any date and with respect to all Base Rate Loans, a fluctuating rate of
      interest per annum equal to the higher of (i) the rate of interest most recently
      announced by the Agent as its prime rate of interest or (ii) 0.50% per annum
      above the Federal Funds Effective Rate. The Base Rate is not necessarily
      intended to be the lowest rate of interest determined by the Agent in connection
      with extensions of credit. Changes in the rate of interest on that portion
      of
      any Loans maintained as Base Rate Loans will take effect simultaneously with
      each change in the Base Rate. The Agent will give notice promptly to the
      Borrower and the Lenders of changes in the Base Rate.

     

    “Base
      Rate Loan”
      means a
      Loan bearing interest at a fluctuating rate determined by reference to the
      Base
      Rate.

     

    “Borrower”
      is
      defined in the preamble.

     

    “Borrower
      Pledge Agreement”
      means
      the Pledge Agreement executed and delivered by the Borrower pursuant to
Section
      5.1.5,
      substantially in the form of Exhibit
      F-1
      hereto,
      as amended, supplemented, restated or otherwise modified from time to
      time.

     

    “Borrower
      Security Agreement”
      means
      the Security Agreement executed and delivered pursuant to Section
      5.1.6,
      substantially in the form of Exhibit
      G-1
      hereto,
      as amended, supplemented, restated or otherwise modified from time to
      time.

     

    “Borrowing”
      means
      the Loans of the same type and, in the case of LIBO Rate Loans, having the
      same
      Interest Period made by all Lenders on the same Business Day and pursuant to
      the
      same Borrowing Request in accordance with Section
      2.1.

     

    “Borrowing
      Request”
      means a
      loan request and certificate duly executed by an Authorized Officer of the
      Borrower, substantially in the form of Exhibit
      B
      hereto.

     

    “Business
      Day”
      means
 

     

    (a) any
      day
      which is neither a Saturday or Sunday nor a legal holiday on which banks are
      authorized or required to be closed in Chicago, Illinois; and

     

    (b) relative
      to the making, continuing, prepaying or repaying of any LIBO Rate Loans, any
      day
      on which dealings in Dollars are carried on in the London interbank
      market.

     

    
      
        
        

      

      
        3

        
          

        

      

      
        
        

      

    

    “Capital
      Expenditures”
      means,
      for any period, the aggregate amount of all expenditures of the Borrower and
      its
      Subsidiaries for fixed or capital assets made during such period which, in
      accordance with GAAP, would be classified as capital expenditures.

     

    “Capitalized
      Lease Liabilities”
      means
      all monetary obligations of any Credit Party under any leasing or similar
      arrangement which, in accordance with GAAP, would be classified as capitalized
      leases, and, for purposes of this Agreement and each other Loan Document, the
      amount of such obligations shall be the capitalized amount thereof, determined
      in accordance with GAAP, and the stated maturity thereof shall be the date
      of
      the last payment of rent or any other amount due under such lease prior to
      the
      first date upon which such lease may be terminated by the lessee without payment
      of a penalty.

     

    “Cash
      Equivalent Investment”
      means,
      at any time:

     

    (a)
      any
      evidence of Indebtedness, maturing not more than eighteen months after such
      time, issued or guaranteed by the United States Government;

     

    (b)
      commercial paper, maturing not more than nine months from the date of issue,
      which is issued by:

     

    (i)
      a
      corporation (other than an Affiliate of any Credit Party) organized under the
      laws of any state of the United States or of the District of Columbia and rated
      A-l by Standard & Poor’s Corporation or P-l by Moody’s Investors Service,
      Inc., or

     

    (ii)
      any
      Lender (or its holding company);

     

    (c)
      any
      certificate of deposit or bankers acceptance, maturing not more than one year
      after such time, which is issued by either:

     

    (i)
      a
      commercial banking institution that is a member of the Federal Reserve System
      and has a combined capital and surplus and undivided profits of not less than
      $500,000,000, or

     

    (ii)
      any
      Lender; or

     

    (d)
      any
      repurchase agreement entered into with any Lender (or other commercial banking
      institution of the stature referred to in clause
      (c)(i))
      which:

     

    (i)
      is
      secured by a fully perfected security interest in any obligation of the type
      described in any of clauses
      (a)
      through
(c);
      and

     

    (ii)
      has
      a market value at the time such repurchase agreement is entered into of not
      less
      than 100% of the repurchase obligation of such Lender (or other commercial
      banking institution) thereunder.

    

    “CERCLA”
      means
      the Comprehensive Environmental Response, Compensation and Liability Act of
      1980, as amended.

     

    
      
        
        

      

      
        4

        
          

        

      

      
        
        

      

    

    “CERCLIS”
      means
      the Comprehensive Environmental Response Compensation Liability Information
      System List.

     

    “Change
      of Control”
      means
      (a) any Person or any two or more Persons acting in concert (in any such case,
      excluding the Original Closing Date Stockholders and their Affiliates) acquiring
      beneficial ownership (within the meaning of Rule 13d-3 of the Securities and
      Exchange Commission under the Exchange Act), directly or indirectly, of capital
      stock (or other securities convertible into such capital stock) of the Borrower
      representing 35% or more of the combined voting power of all capital stock
      of
      the Borrower entitled to vote in the election of directors, or (b) during any
      period of 12 consecutive calendar months, the ceasing of those individuals
      (the
“Continuing
      Directors”)
      who (i)
      were directors of the Borrower, on the first day of each such period or (ii)
      subsequently became directors of the Borrower, and whose initial election or
      initial nomination for election subsequent to that date was approved either
      by
      (A) a majority of the Continuing Directors then on the board of directors of
      the
      Borrower or (B) the shareholders who, in accordance with the provisions of
      the
      Articles of Incorporation of the Borrower, are entitled to elect such director,
      to constitute a majority of the board of directors of the Borrower.

     

    “CMS”
      shall
      mean the Centers for Medicare and Medicaid Services and any successor thereto.
      

     

    “Code”
      means
      the Internal Revenue Code of 1986, and regulations promulgated
      thereunder.

     

    “Collateral”
      means
      all property and interests in property and proceeds thereof now owned or
      hereafter acquired by any Credit Party in or upon which a Lien now or hereafter
      exists in favor of the Agent on behalf of the Lenders, whether under this
      Agreement, Collateral Document or under any other documents executed by any
      such
      Credit Party and delivered to the Agent.

     

    “Collateral
      Documents”
      means,
      collectively, (a) the Borrower Security Agreement, the Guarantor Security
      Agreement, the Guaranty, the Borrower Pledge Agreement, the Guarantor Pledge
      Agreement, the Reaffirmation of Collateral Documents, the Intellectual Property
      Assignments and all other security agreements, pledge agreements, assignments,
      guarantees and other similar agreements between a Credit Party and the Agent
      for
      the benefit of the Lenders now or hereafter delivered to the Lenders or the
      Agent pursuant to or in connection with the transactions contemplated hereby,
      and all financing statements (or comparable documents now or hereafter filed
      in
      accordance with the Uniform Commercial Code or comparable law) against a Credit
      Party as debtor in favor of the Agent, for the benefit of the Lenders, as
      secured party and (b) any amendments, restatements, supplements, modifications,
      renewals, replacements, consolidations, substitutions and extensions of any
      of
      the foregoing.

     

    “Consideration”
      means
      with respect to any Permitted Acquisition, the aggregate of (i) the cash paid
      by
      the Borrower or any of its Subsidiaries, directly or indirectly, to the seller
      in connection therewith, (ii) the Indebtedness incurred or assumed by the
      Borrower or any of its Subsidiaries (including, without limitation, Indebtedness
      of a person becoming a Credit Party in connection with a Permitted Acquisition,
      which Indebtedness continues to exist following the consummation of such
      Permitted Acquisition), whether in favor of the seller or otherwise and whether
      fixed or contingent, in connection therewith, (iii) any guaranty given or
      incurred by the Borrower or any of its Subsidiaries in connection therewith,
      (iv) the fair market value of any equity issued by the Borrower, in connection
      therewith, and (v) any other consideration given or obligation incurred by
      the
      Borrower or any of its Subsidiaries in connection therewith; provided,
      however,
      that
      the amount of any deferred earn-out payments to any seller not required by
      GAAP
      to be reflected as a liability on the consolidated balance sheet of the Borrower
      as of the date of consummation of such Permitted Acquisition shall be excluded
      from the determination under clauses (i) through (v) of this
      definition.

     

    
      
        
        

      

      
        5

        
          

        

      

      
        
        

      

    

    "Consolidated
      Interest Expenses"
      means,
      for any period, the total interest expense (including that attributable to
      capital leases) of the Borrower and its Subsidiaries on a consolidated basis
      with respect to all outstanding Indebtedness of the Borrower and its
      Subsidiaries, including, without limitation, all commissions, discounts and
      other fees and charges owed with respect to letters of credit and unused line
      fees but excluding any of the foregoing to the extent it constitutes a non-cash
      item.

     

    “Contingent
      Liability”
      means
      any agreement, undertaking or arrangement which would be reflected in a footnote
      to a balance sheet as a contingent liability in accordance with
      GAAP.

     

    “Continuation/Conversion
      Notice”
      means a
      notice of continuation or conversion and certificate duly executed by an
      Authorized Officer of the Borrower, substantially in the form of Exhibit
      C
      hereto.

     

    “Controlled
      Group”
      means
      all members of a controlled group of corporations and all members of a
      controlled group of trades or businesses (whether or not incorporated) under
      common control which, together with the Borrower, are treated as a single
      employer under Section 414(b) or 414(c) of the Code or Section 4001 of
      ERISA.

     

    "Controlled
      Minority ASC Entity"
      means,
      as of any date of determination, any Minority ASC Entity in which the Borrower
      or any Credit Party as of such date has operational control over the day to
      day
      business decisions of such Minority ASC Entity including, without limitation,
      veto power over the disposition of the assets of such Minority ASC Entity and
      operational control over the disbursement of funds held by such Minority ASC
      Entity. 

     

    “Credit
      Party”
      means
      the Borrower and any Subsidiary of the Borrower party to a Loan
      Document.

     

    “Default”
      means
      any condition, occurrence or event which, after notice or lapse of time or
      both,
      would constitute an Event of Default.

     

    “Dollar”
      and the
      sign “$”
      mean
      lawful money of the United States.

     

    “Domestic
      Office”
      means,
      relative to any Lender, the office of such Lender designated as such below
      its
      signature hereto or designated in the Lender Assignment Agreement or such other
      office of a Lender (or any successor or assign of such Lender) within the United
      States as may be designated from time to time by notice from such Lender, as
      the
      case may be, to each other Person party hereto. A Lender may have separate
      Domestic Offices for purposes of making, maintaining or continuing, as the
      case
      may be, Base Rate Loans.

     

    
      
        
        

      

      
        6

        
          

        

      

      
        
        

      

    

    “EBITDA”
      means,
      for any applicable computation period, the Borrower’s Net Income on a
      consolidated basis from all continuing operations, plus
      (a)
      income and franchise taxes paid or accrued during such period, (b) interest
      expenses paid or accrued during such period, (c) amortization and depreciation
      deducted in determining Net Income for such period, (d) up to $2.0 million
      over
      the four consecutive quarters comprising the computation period for documented
      tax refund receipts and/or deferred taxes as set forth in Borrower’s
      consolidated statements of cash flows, and (e) non-cash expenses for capital
      stock-based compensation related to capital stock-based compensation plans
      that
      do not represent a cash item in any future period. For the purpose of
      determining compliance with Section
      7.2.4(b), (c) and (d),
      “EBITDA” shall be as adjusted pursuant to the formula described in Schedule
      2.

     

    "Effective
      Maturity Date"
      is
      defined in Section
      3.1.3.

     

    “Environmental
      Laws”
      means
      all applicable federal, state or local statutes, laws, ordinances, codes, rules,
      regulations and guidelines (including consent decrees and administrative orders)
      relating to public health and safety and protection of the
      environment.

     

    “ERISA”
      means
      the Employee Retirement Income Security Act of 1974, as amended, and any
      successor statute of similar import, together with the regulations thereunder,
      in each case as in effect from time to time. References to sections of ERISA
      also refer to any successor sections.

     

    “Event
      of Default”
      is
      defined in Section
      8.1.

     

    "Extension
      Effective Date"
      is
      defined in Section
      3.1.3.

     

    "Extension
      Response Date"
      is
      defined in Section
      3.1.3.

     

    "Extension
      Request"
      is
      defined in Section
      3.1.3.

     

    “Federal
      Funds Effective Rate”
      means,
      for any day, an interest rate per annum equal to the weighted average of the
      rates on overnight Federal funds transactions with members of the Federal
      Reserve System arranged by Federal funds brokers on such day, as published
      for
      such day (or, if such day is not a Business Day, for the immediately preceding
      Business Day) by the Federal Reserve Bank of New York, or, if such rate is
      not
      so published for any day which is a Business Day, the average of the quotations
      at approximately 10:00 a.m. (Chicago time) on such day on such transactions
      received by Agent from three Federal funds brokers of recognized standing
      selected by the Agent in its sole discretion.

     

    “Fiscal
      Quarter”
      means
      any quarter of a Fiscal Year.

     

    “Fiscal
      Year”
      means
      any period of twelve consecutive calendar months ending on December 31;
      references to a Fiscal Year with a number corresponding to any calendar year
      (e.g.
      the
“2006 Fiscal Year”) refer to the Fiscal Year ending on the December 31 occurring
      during such calendar year.

     

    
      
        
        

      

      
        7

        
          

        

      

      
        
        

      

    

    "Fixed
      Charges"
      means,
      with respect to the Borrower and its Subsidiaries on a consolidated basis,
      as of
      any date of determination, (a) Consolidated Interest Expenses for the period
      of
      four fiscal quarters ending on the date of determination plus (b) scheduled
      principal payments on Indebtedness required to be made in such period plus
      (c)
      rent expenses incurred by the Borrower and its Subsidiaries.

     

    "Fifth
      Amended and Restated Effective Date"
      has the
      meaning assigned to it in Section
      5.3.

     

    "Fourth
      Amended and Restated Credit Agreement"
      has the
      meaning given to it in the Recitals.

     

    “Fraud
      and Abuse Laws”
      means
      the federal Anti-kickback Statute, Section 1128B(b) of the Social Security
      Act,
      42 U.S.C. Section 1320a-7b(b) (the “Anti-kickback Statue”), the federal
      Self-Referral Prohibition, Section 1877 of the Social Security Act, 42 U.S.C.
      Section 1395nn (“Stark II”), the federal False Claims Act, 31 U.S.C. Section
      3729 et
      seq.
      (“False Claims Act”), and the federal civil monetary penalties act, Section
      1128A of the Social Security Act, 42 U.S.C. Section 1320a-7a (“CMPA”), each as
      from time to time amended; any successor statute(s) thereto; all rules and
      regulations promulgated thereunder; other similar federal and state laws and
      regulations; and, all other federal or state laws concerning illegal
      remuneration, referral of patients, kickbacks, fee splitting, reassignment
      of
      claims, and false or fraudulent billing for medical items or
      services.

     

    “F.R.S.
      Board”
      means
      the Board of Governors of the Federal Reserve System or any successor
      thereto.

     

    “GAAP”
      means
      generally accepted accounting principles set forth from time to time in the
      opinions and pronouncements of the Accounting Principles Board and the American
      Institute of Certified Public Accountants and statements and pronouncements
      of
      the Financial Accounting Standards Board (or agencies with similar functions
      of
      comparable stature and authority within the U.S. accounting profession), which
      are applicable to the circumstances as of the date of
      determination.

     

    “Guarantor”
      means
      each Person party to a Guaranty.

     

    “Guarantor
      Pledge Agreement”
      means
      the Pledge Agreement substantially in the form of Exhibit
      F-2
      hereto,
      as amended, supplemented, restated or otherwise modified from time to
      time.

     

    “Guarantor
      Security Agreement”
      means
      the Security Agreement substantially in the form of Exhibit
      G-2
      hereto,
      as amended, supplemented, restated or otherwise modified from time to
      time.

     

    “Guaranty”
      means,
      collectively, the Guaranty substantially in the form of Exhibit
      E
      hereto,
      as amended, supplemented, restated or otherwise modified from time to
      time.

     

    
      
        
        

      

      
        8

        
          

        

      

      
        
        

      

    

    “Hazardous
      Material”
      means

     

    (a) any
      “hazardous substance”, as defined by CERCLA;

     

    (b) any
      “hazardous waste”, as defined by the Resource Conservation and Recovery Act, as
      amended;

     

    (c) any
      petroleum product; or

     

    (d) any
      pollutant or contaminant or hazardous, dangerous or toxic chemical, material
      or
      substance within the meaning of any other applicable federal, state or local
      law, regulation, ordinance or requirement (including consent decrees and
      administrative orders) relating to or imposing liability or standards of conduct
      concerning any medical, hazardous, toxic or dangerous waste, substance or
      material, all as amended or hereafter amended.

     

    “Hedging
      Agreements”
      means
      any Interest Rate Agreement, foreign currency exchange agreement, commodity
      price protection agreement or other interest or currency exchange rate or
      commodity price hedging agreement, provided that such agreement is not entered
      into for speculative purposes, is entered into with the Agent or a
      Lender.

     

    “herein”,
      “hereof”,
      “hereto”,
      “hereunder”
      and
      similar terms contained in this Agreement or any other Loan Document refer
      to
      this Agreement or such other Loan Document, as the case may be, as a whole
      and
      not to any particular Section, paragraph or provision of this Agreement or
      such
      other Loan Document.

     

    “HIPAA”
      means
      the Health Insurance Portability and Accountability Act of 1996 and its
      implementing administrative simplification regulations, specifically, the
“Standards for Electronic Transactions,” 65 Fed.
      Reg.
      50,312
      (Aug. 17, 2000); “Standards for Privacy of Individually Identifiable Health
      Information,” 65 Fed.
      Reg.
      82,462
      (Dec. 28, 2000), modified at 67 Fed.
      Reg. 53,182
      (Aug. 14, 2002); and the “Security Standards,” 68 Fed.
      Reg. 8334
      (Feb. 20, 2003), each as from time to time amended.

     

    “Impermissible
      Qualification”
      means,
      relative to the opinion or certification of any independent public accountant
      as
      to any financial statement of any Credit Party, any qualification or exception
      to such opinion or certification:

     

    (a) which
      is
      of a “going concern” or similar nature;

     

    (b) which
      relates to the limited scope of examination of matters relevant to such
      financial statement; or

     

    (c) which
      relates to the treatment or classification of any item in such financial
      statement and which, as a condition to its removal, would require an adjustment
      to such item the effect of which would be to cause such Credit Party to be
      in
      default of any of its obligations under Section
      7.2.4.

     

    “including”
      means
      including without limiting the generality of any description preceding such
      term, and, for purposes of this Agreement and each other Loan Document, the
      parties hereto agree that the rule of ejusdem generis
      shall
      not be applicable to limit a general statement, which is followed by or
      referable to an enumeration of specific matters, to matters similar to the
      matters specifically mentioned.

     

    
      
        
        

      

      
        9

        
          

        

      

      
        
        

      

    

    “Indebtedness”
      of any
      Person means, without duplication:

     

    (a) all
      obligations of such Person for borrowed money and all obligations of such Person
      evidenced by bonds, debentures, notes or other similar instruments;

     

    (b) all
      obligations, contingent or otherwise, relative to the face amount of all letters
      of credit (including Letters of Credit), whether or not drawn, and banker’s
      acceptances issued for the account of such Person;

     

    (c) all
      obligations of such Person as lessee under leases which have been or should
      be,
      in accordance with GAAP, recorded as Capitalized Lease Liabilities;

     

    (d) all
      other
      liabilities for borrowed money in accordance with GAAP included on the liability
      side of the balance sheet of such Person as of the date at which Indebtedness
      is
      to be determined;

     

    (e) net
      liabilities of such Person under all Hedging Agreements;

     

    (f) whether
      or not so included as liabilities in accordance with GAAP, all obligations
      of
      such Person to pay the deferred purchase price of property or services, and
      indebtedness (excluding prepaid interest thereon) secured by a Lien on property
      owned or being purchased by such Person (including indebtedness arising under
      conditional sales or other title retention agreements), whether or not such
      indebtedness shall have been assumed by such Person or is limited in recourse;
      and

     

    (g) all
      Contingent Liabilities of such Person in respect of any of the
      foregoing.

     

    For
      all
      purposes of this Agreement, the Indebtedness of any Person shall include the
      Indebtedness of any partnership or joint venture in which such Person is a
      general partner or a joint venturer, except to the extent payments have been
      made or are required to be made with respect to such Indebtedness solely by
      a
      general partner or a joint venture partner other than a Subsidiary.

     

    “Indemnified
      Liabilities”
      is
      defined in Section
      10.4.

     

    “Indemnified
      Parties”
      is
      defined in Section
      10.4.

     

    “Intercompany
      Loans”
      is
      defined in Section
      7.2.2.

     

    “Intercompany
      Notes”
      is
      defined in Section
      7.2.2.

     

    “Intellectual
      Property Assignment”
      means
      that certain Intellectual Property Assignment in form and substance satisfactory
      to the Agent, duly executed and delivered by a Credit Party in favor of the
      Agent, for the benefit of itself and the Lenders, as the same may be amended,
      supplemented or otherwise modified from time to time.

     

    
      
        
        

      

      
        10

        
          

        

      

      
        
        

      

    

    “Interest
      Period”
      means,
      relative to any LIBO Rate Loans, the period beginning on (and including) the
      date on which such LIBO Rate Loan is made or continued as, or converted into,
      a
      LIBO Rate Loan pursuant to Section
      2.3
      or
2.4
      and
      shall end on (but exclude) either (i) the day one week subsequent to such day,
      or (ii) the day which numerically corresponds to such date one, two, three
      or
      six months thereafter (or, if such month has no numerically corresponding day,
      on the last Business Day of such month), as the Borrower may select in its
      relevant notice pursuant to Section
      2.3
      or
2.4;
      provided,
      however,
      that

     

    (a) the
      Borrower shall not be permitted to select Interest Periods to be in effect
      at
      any one time which have expiration dates occurring on more than ten different
      dates;

     

    (b) Interest
      Periods commencing on the same date for Loans comprising part of the same
      Borrowing shall be of the same duration;

     

    (c) if
      such
      Interest Period would otherwise end on a day which is not a Business Day, such
      Interest Period shall end on the next following Business Day (unless such next
      following Business Day is the first Business Day of the immediately succeeding
      calendar month, in which case such Interest Period shall end on the Business
      Day
      next preceding such numerically corresponding day);

     

    (d) no
      Interest Period with respect to Loans made prior to the Revolving Commitment
      Termination Date may end later than the date set forth in clause
      (a)
      of the
      definition of “Revolving Commitment Termination Date”;

     

    (e) no
      Interest Period for any Loan outstanding on and after the Revolving Commitment
      Termination Date shall extend beyond the Maturity Date; and

     

    (f) no
      Interest Period applicable to a Loan outstanding on and after the Revolving
      Commitment Termination Date, or portion thereof, shall extend beyond any date
      upon which is due any scheduled principal payment in respect of the Loans unless
      the aggregate principal amount of Loans represented by LIBO Rate Loans having
      Interest Periods that will expire on or before such date, equals or exceeds
      the
      amount of such principal payment.

     

    “Interest
      Rate Agreement”
      means
      any interest rate swap agreement, interest rate cap agreement, interest rate
      collar agreement or other similar agreement or arrangement designed to protect
      the Borrower or any of its Subsidiaries against fluctuations in interest
      rates.

     

    “Investment”
      means,
      relative to any Person,

     

    (a) any
      loan
      or advance made by such Person to any other Person (excluding commission, travel
      and similar advances to officers and employees of the Borrower and any other
      Credit Party made in the ordinary course of business);

     

    (b) any
      Contingent Liability of such Person; and

     

    
      
        
        

      

      
        11

        
          

        

      

      
        
        

      

    

    (c) any
      ownership or similar interest held by such Person in any other
      Person.

     

    The
      amount of any Investment shall be the original principal or capital amount
      thereof less all returns of principal or equity thereon (and without adjustment
      by reason of the financial condition of such other Person) and shall, if made
      by
      the transfer or exchange of property other than cash, be deemed to have been
      made in an original principal or capital amount equal to the fair market value
      of such property.

     

    “LC
      Notice”
      has the
      meaning specified in Section
      2.7.

     

    “Lender
      Assignment Agreement”
      means a
      Lender Assignment Agreement substantially in the form of Exhibit
      D
      hereto.

     

    “Lenders”
      is
      defined in the preamble.

     

    “Letter
      of Credit”
      shall
      mean a Letter of Credit that is issued pursuant to Section
      2.7.

     

    “Letter
      of Credit Cash Collateral Account”
      has the
      meaning specified in Section 8.4.

     

    “Letter
      of Credit Expiry Date”
      shall
      mean the date which is five Business Days prior to the Revolving Commitment
      Termination Date.

     

    “Letter
      of Credit Issuer”
      shall
      mean National City.

     

    “Letter
      of Credit Obligations”
      shall
      mean, as at the time of determination thereof, the sum of (a) the aggregate
      amount of all unpaid and outstanding reimbursement obligations and (b) without
      duplication, the aggregate stated amount at such time of Letters of Credit
      then
      outstanding and undrawn (as such aggregate stated amount shall be adjusted,
      from
      time to time, as a result of drawings, the issuance of Letters of Credit, or
      otherwise).

     

    “Letter
      of Credit Sublimit”
      shall
      mean an aggregate amount of $5,000,000.

     

    “LIBO
      Rate”
      is
      defined in Section
      3.2.1.

     

    “LIBO
      Rate Loan”
      means a
      Loan bearing interest, at all times during an Interest Period applicable to
      such
      Loan, at a fixed rate of interest determined by reference to the LIBO Rate
      (Reserve Adjusted).

     

    “LIBO
      Rate (Reserve Adjusted)”
      is
      defined in Section
      3.2.1.

     

    “LIBOR
      Office”
      means,
      relative to any Lender, the office of such Lender designated as such below
      its
      signature hereto or designated in the Lender Assignment Agreement or such other
      office of a Lender as designated from time to time by notice from such Lender
      to
      the Borrower and the Agent, whether or not outside the United States, which
      shall be making or maintaining LIBO Rate Loans of such Lender
      hereunder.

     

    “LIBOR
      Reserve Percentage”
      is
      defined in Section
      3.2.1.

     

    
      
        
        

      

      
        12

        
          

        

      

      
        
        

      

    

    “Lien”
      means
      any security interest, mortgage, pledge, hypothecation, assignment, deposit
      arrangement, encumbrance, lien (statutory or otherwise), charge against or
      interest in property to secure payment of a debt or performance of an obligation
      or other priority or preferential arrangement of any kind or nature
      whatsoever.

     

    “Loan”
      is
      defined in Section
      2.1.1.

     

    “Loan
      Document”
      means
      this Agreement, the Notes, each Collateral Document, each Hedging Agreement
      and
      each other document delivered pursuant to Section
      7.1.11.

     

    “Material
      Adverse Effect”
      means a
      material adverse effect on the financial condition, operations, assets,
      business, properties or prospects of the Borrower, its Subsidiaries and Minority
      ASC Entities taken as a whole.

     

    “Maturity
      Date”
      means
      the earliest of:

     

    (a) June
      29,
      2009; or

     

    (b) the
      date
      on which any Termination Event occurs.

     

    "Medicaid"
      means
      the medical assistance program established by Title XIX of the Social Security
      Act.

     

    “Medicaid
      Certification”
      means a
      certification by a state agency or other entity responsible for certifying
      Medicaid providers and suppliers that a health care provider or supplier is
      in
      compliance with all the conditions of participation set forth in the Medicaid
      Regulations.

     

    “Medicaid
      Provider Agreement”
      means an
      agreement entered into between CMS or a state agency or other such entity
      administering the Medicaid program and a health care provider or supplier under
      which the health care provider or supplier agrees to provide services for
      Medicaid patients in accordance with the terms of the agreement and Medicaid
      Regulations.

     

    “Medicaid
      Regulations”
      means,
      collectively, (i) all federal statutes (whether set forth in Title XIX of the
      Social Security Act or elsewhere) affecting the medical assistance program
      established by Title XIX of the Social Security Act and any successor
      statute(s); (ii) all applicable provisions of all federal rules,
      regulations, manuals and orders of all governmental authorities promulgated
      pursuant to or in connection with the statutes described in clause (i) above
      and
      all federal administrative, reimbursement and other guidelines of all
      governmental authorities having the force of law promulgated pursuant to or
      in
      connection with the statutes described in clause (i) above; (iii) all state
      statutes and plans for medical assistance enacted in connection with the
      statutes and provisions described in clauses (i) and (ii) above; and (iv) all
      applicable provisions of all rules, regulations, manuals and orders of all
      governmental authorities promulgated pursuant to or in connection with the
      statutes described in clause (iii) above and all state administrative,
      reimbursement and other guidelines of all governmental authorities having the
      force of law promulgated pursuant to or in connection with the statutes
      described in clause (iii) above, in each case as may be amended, supplemented
      or
      other wise modified from time to time.

     

    
      
        
        

      

      
        13

        
          

        

      

      
        
        

      

    

    "Medicare"
      means
      the health insurance program for the aged and disabled established by Title
      XVIII of the Social Security Act.

     

    “Medicare
      Certification”
      means
      certification by CMS or a state agency or entity under contract with CMS that
      the health care operation is in compliance with all the conditions of
      participation set forth in the Medicare Regulation.

     

    “Medicare
      Provider Agreement”
      means an
      agreement entered into between CMS or a state agency or other such entity
      administering the Medicare program and a health care provider or supplier under
      which the health care provider or supplier agrees to provide services for
      Medicare patients in accordance with the terms of the agreement and Medicare
      Regulations.

     

    “Medicare
      Regulations”
      means,
      collectively, all federal statutes (whether set forth in Title XVIII of the
      Social Security Act or elsewhere) affecting the health insurance program for
      the
      aged and disabled established by Title XVIII of the Social Security Act and
      any
      successor statute(s); together with all applicable provisions of all rules,
      regulations, manuals and orders and administrative, reimbursement and other
      guidelines of all governmental authorities (including without limitation, the
      United States Department of Health and Human Services (“HHS”), CMS, the Office
      of the Inspector General for HHS, or any person succeeding to the functions
      of
      any of the foregoing) promulgated pursuant to or in connection with any of
      the
      foregoing having the force of law, as each may be amended, supplemented or
      otherwise modified from time to time.

     

    "Minority
      ASC Entity"
      means
      any ASC Facility which is not a Subsidiary into which the Borrower or a
      Subsidiary of the Borrower has made an Investment, including, without
      limitation, by way of a Permitted Acquisition.

     

    “National
      City”
      means
      National City Bank Of The Midwest, acting in its individual
      capacity.

     

    “Net
      Available Proceeds”
      means
      (a) with respect to any Asset Disposition, the sum of cash or readily marketable
      cash equivalents received (including by way of a cash generating sale or
      discounting of a note or account receivable) therefrom, whether at the time
      of
      such disposition or subsequent thereto, or (b) with respect to any sale or
      issuance of any debt or equity securities of the Borrower or any Subsidiary,
      cash or readily marketable cash equivalents received therefrom, whether at
      the
      time of such disposition or subsequent thereto, net, in either case, of all
      legal, title and recording tax expenses, commissions and other fees and all
      costs and expenses incurred and all federal, state, local and other taxes
      required to be accrued as a liability as a consequence of such transactions
      and,
      in the case of an Asset Disposition, net of all payments made by the Borrower
      or
      any of its Subsidiaries, including any prepayment premiums, on any Indebtedness
      which is secured by such assets pursuant to a Permitted Lien upon or with
      respect to such assets or which must, by the terms of such Lien, in order to
      obtain a necessary consent to such Asset Disposition, or by applicable law,
      be
      repaid out of the proceeds from such Asset Disposition.

     

    “Net
      Income”
      means,
      for any computation period, with respect to the Borrower, on a consolidated
      basis, cumulative net income earned during such period as determined in
      accordance with GAAP (other than net income from any Minority ASC Entity which
      is restricted from declaring or paying dividends, distributions or otherwise
      advancing funds to its equityholders whether by contract or otherwise, except
      to
      the extent of any such net income actually received which is not in violation
      of
      the applicable restriction);
      provided,
      however,
      there
      shall not be included for purposes of calculating Net Income of the Borrower,
      net income attributable to Minority ASC Entities in excess of 25% of total
      Net
      Income. Net Income shall be determined without giving effect to any non-cash,
      non-recurring loss. 

     

    
      
        
        

      

      
        14

        
          

        

      

      
        
        

      

    

    “Net
      Worth”
      means,
      for any computation period, the consolidated shareholders’ equity of the
      Borrower determined in accordance with GAAP, which consolidated shareholders’
equity shall be deemed to include the preferred stock of the Borrower and the
      value of Borrower’s treasury stock, at cost.

     

    “Non-Wholly-Owned
      ASC Subsidiary”
      means an
      ASC Subsidiary in which the Borrower or a Subsidiary of the Borrower owns less
      than 100% of the equity interests but at least 50.1% of the equity
      interests.

     

    “Note”
      means a
      promissory note of the Borrower payable to any Lender, in the form of
Exhibit
      A
      hereto
      (as such promissory note may be amended, endorsed or otherwise modified from
      time to time), evidencing the aggregate Indebtedness of the Borrower to such
      Lender resulting from outstanding Loans, and also means all other promissory
      notes accepted from time to time in substitution therefor or renewal
      thereof.

     

    “NovaMed
      of New Albany”
means
      NovaMed Eye Surgery Center of New Albany, LLC, a Delaware limited liability
      company.

     

    “Obligations”
      means
      all obligations (monetary or otherwise) of each Credit Party arising under
      or in
      connection with this Agreement, the Notes, the Letters of Credit and each other
      Loan Document.

     

    “Organizational
      Document”
      means,
      relative to any Subsidiary, its certificate of incorporation, its by-laws,
      its
      limited liability company agreement, partnership agreement and all shareholder
      agreements, voting trusts and similar arrangements applicable to any of its
      authorized shares of capital stock, partnership interests, or membership
      interests, as the case may be.

     

    “Original
      Closing Date” means
      June 28, 2000.

     

    “Original
      Closing Date Stockholders” means,
      collectively, the stockholders of record of the Borrower as of the Original
      Closing Date listed on Schedule
      1.

     

    “Original
      Credit Agreement” has
      the
      meaning specified in the Recitals hereto.

     

    “Participant”
      is
      defined in Section
      10.11.

     

    “PBGC”
      means
      the Pension Benefit Guaranty Corporation and any entity succeeding to any or
      all
      of its functions under ERISA.

     

    
      
        
        

      

      
        15

        
          

        

      

      
        
        

      

    

    “Pension
      Plan”
      means a
“pension plan”, as such term is defined in section 3(2) of ERISA, which is
      subject to Title IV of ERISA (other than a multiemployer plan as defined in
      section 4001(a)(3) of ERISA), and to which the Borrower or any corporation,
      trade or business that is, along with the Borrower, a member of a Controlled
      Group, may have liability, including any liability by reason of having been
      a
      substantial employer within the meaning of section 4063 of ERISA at any time
      during the preceding five years, or by reason of being deemed to be a
      contributing sponsor under section 4069 of ERISA.

     

    “Percentage”
      means,
      relative to any Lender, the percentage set forth opposite its name on
Schedule
      10.1
      hereto
      or set forth in the Lender Assignment Agreement, as such percentage may be
      adjusted from time to time pursuant to Lender Assignment Agreement(s) executed
      by such Lender and its Assignee Lender(s) and delivered pursuant to Section
      10.11.

     

    “Permitted
      Acquisition”
      means
      the purchase (by asset purchase, stock purchase, membership interest purchase,
      other equity interest purchase, merger or otherwise, subject to the other
      requirements of this definition set forth below) by the Borrower or a
      Wholly-Owned Subsidiary of the Borrower (or, in the case of the purchase of
      an
      ASC Facility, by the Borrower or a Subsidiary of the Borrower) of the assets,
      stock, membership interests or other equity interests of a Target or Practice
      (it being acknowledged that medical records and certain other professional
      assets that are required by law to be owned by a Provider are not acquired
      in
      these transactions), which purchase meets the following criteria (or is
      otherwise approved by the Required Lenders):

     

    (a)
      no
      Default or Event of Default shall have occurred or be continuing both before
      and
      after giving effect to such acquisition;

     

    (b)
      in
      the event the Borrower's Total Leverage Ratio on a pro forma basis (after giving
      effect to the Permitted Acquisition) is less than 2.75:1.0, the Borrower must
      be
      able to comply on a pro forma basis with all of the covenants in this
      Agreement;

     

    (c)
      in
      the event the Borrower's Total Leverage Ratio on a pro forma basis (after giving
      effect to the Permitted Acquisition) is greater than or equal to 2.75:1.0,
      (i)
      the Borrower must be able to comply on a pro forma basis with all of the
      covenants in this Agreement and (ii) the aggregate Consideration (including
      any
      Indebtedness pursuant to Section
      7.2.2(h), (i), (j) and (k)
      relating
      to such Permitted Acquisitions) in connection with such Permitted Acquisition
      shall not exceed (unless otherwise consented to by the Required Lenders)
      $15,000,000 individually and $30,000,000 for all Permitted Acquisitions
      consummated within the previous twelve (12) month period when aggregated with
      Investments made by the Borrower or any of its Subsidiaries permitted under
      Section
      7.2.5(n)
      during
      such period; provided,
      further,
      that of
      such $30,000,000 permitted above, in the case of Permitted Acquisitions
      involving (i) Minority ASC Entities, the aggregate Consideration (including
      any
      Indebtedness pursuant to Section
      7.2.2(h), (i), (j) and (k)
      relating
      to such Permitted Acquisitions) shall not exceed (unless otherwise consented
      to
      by the Required Lenders) $9,600,000 individually and $16,800,000 for all
      Permitted Acquisitions involving Minority ASC Entities consummated within the
      previous twelve (12) month period; provided, further,
      that       
*          and any Permitted
      Acquisition consummated prior to June 30, 2006 shall not count towards any
      of
      the limits set forth in this subparagraph (c) and (ii) Practices, the aggregate
      Consideration (including any Indebtedness pursuant to Section
      7.2.2(h), (i) and (j)
      relating
      to such Permitted Acquisitions) shall not exceed (unless consented to by the
      Required Lenders) $2,000,000 in the aggregate for all Permitted Acquisitions
      involving Practices provided, further, that any Permitted Acquisition involving
      a Practice described on Schedule
      3
      shall
      not count towards any of the limits set forth in this subparagraph
      (c);

     

    *
      Confidentiality portion omitted and filed separately with the
      Commission.

    
      
        
        

      

      
        16

        
          

        

      

      
        
        

      

    

    (d)
      the
      acquisition shall have been of the assets and/or working capital of a Target
      or,
      if for stock or other equity interest in a Target, shall be for not less than
      20.0% of the equity interest therein, shall (other than with respect to an
      ASC
      Facility) either, to the extent permitted by applicable law, be merged with
      and
      into the Borrower or a Wholly-Owned Subsidiary of the Borrower, or be a
      Wholly-Owned Subsidiary of the Borrower; provided,
      however ̧
with
      respect to an ASC Facility which is not merged with or into a Borrower or a
      Wholly-Owned Subsidiary of the Borrower, the stock or other equity interests
      of
      the ASC Facility so acquired shall be pledged to the Agent on behalf of the
      Lenders (and, in the case of any equity interest in a limited liability company
      or limited partnership, the agreement governing such Person shall not prohibit
      a
      collateral assignment of such equity interest);

     

    (e) the
      acquired Target, on a pro forma basis shall have positive EBITDA for the period
      of four fiscal quarters ending on the date of any such acquisition;

     

    (f)
      the
      Borrower shall have delivered to the Agent, not later than 30 days after the
      closing of the acquisition (i) pro forma financial statements or certificates
      demonstrating continued compliance with all covenants in this Agreement
      following the inclusion of the target in the Borrower’s consolidated enterprise,
      (ii) a copy of the related acquisition agreement provided,
      however,
      in the
      event the approval of the Lenders is required for any acquisition, the Borrower
      shall have delivered to the Agent the documents contemplated by clauses
      (i) and (ii)
      of this
clause
      (f)
      not
      later than 15 days prior to the closing of such acquisition (with the documents
      contemplated in (ii) being in draft form); 

     

    (g)
      the
      Borrower shall have delivered to the Agent, not later than 30 days after the
      closing of the acquisition a fully executed Agreed EBITDA Form; 

     

    (h)
      the
      Borrower's Total Leverage Ratio on a pro forma basis (after giving effect to
      the
      Permitted Acquisition) is equal to or less than 3.25:1.0; and

     

    (i)
      after
      giving effect to such acquisition, the sum of the Available Revolving
      Commitments shall not be less than $5,000,000. 

     

    “Permitted
      Asset Disposition”
      has the
      meaning specified on Exhibit
      K
      hereto.

     

    “Permitted
      Equity Ownership Sale”
      means
      the sale, transfer or other disposition of the outstanding capital stock,
      membership interest or other equity interests in an ASC Subsidiary (or Minority
      ASC Entity) or the issuance of additional equity interests in an ASC Subsidiary
      (or Minority ASC Entity), so long as:

     

    
      
        
        

      

      
        17

        
          

        

      

      
        
        

      

    

    (i) after
      giving effect to such sale, a Credit Party shall own not less than 20.0% of
      the
      equity interests (including securities convertible into equity interests) of
      such ASC Facility;

     

    (ii) the
      equity interests in such ASC Subsidiary (or Minority ASC Entity) which are
      held
      by the Borrower or a Subsidiary of the Borrower after such sale continue to
      be
      pledged to the Lenders pursuant to either the Borrower Pledge Agreement or
      Subsidiary Guarantor Pledge Agreement, as the case may be; 

     

    (iii) the
      chief
      financial officer or chief executive officer of the Borrower shall have
      delivered a certificate, dated the date of such sale, to the Agent certifying
      (a) that no Default or Event of Default exists or would result from such sale
      and (b) pro forma financial statements demonstrating compliance with
Section
      7.2.4
      for the
      trailing twelve-month period prior to such sale; ; and 

     

    (iv) the
      proceeds (other than any proceeds received by a Person who is not the Borrower
      or a Subsidiary of the Borrower) of any such sale are applied in the manner
      set
      forth in Section
      2.2.2(c).

     

    Upon
      the
      consummation of any Permitted Equity Ownership Sale and at the request of the
      Borrower (to comply with a requirement in the purchase and sale documents
      evidencing such Permitted Equity Ownership Sale), the ASC Subsidiary or Minority
      ASC Entity which has become a Non-Wholly Owned ASC Subsidiary or Minority ASC
      Entity as a result of such Permitted Equity Ownership Sale shall be released
      from the Guaranty, the Guarantor Pledge Agreement and Guarantor Security
      Agreement and the liens of the Lenders on the assets of such ASC Subsidiary
      shall be released (except to the extent of the pledge to the Lenders of the
      equity interests of such ASC Subsidiary retained by the Borrower or a Subsidiary
      of the Borrower) and the Agent is hereby authorized to execute and file the
      necessary release documentation to reflect such release.

     

    “Permitted
      Liens”
      means
      those liens listed in Section
      7.2.3.

     

    “Permitted
      Seller Debt”
      means
      Indebtedness owed to the Borrower which is incurred by purchasers of the
      Borrower’s assets in connection with a Permitted Asset Disposition.

     

    “Permitted
      Seller Equity” means
      common stock of the Borrower that is used as consideration payable to the
      Borrower or any of its Subsidiaries by any party to a Permitted Asset
      Disposition.

    

    “Person”
      means
      any natural person, corporation, partnership, limited liability company, firm,
      association, trust, government, governmental agency or any other entity, whether
      acting in an individual, fiduciary or other capacity.

     

    “Plan”
      means
      any Pension Plan or Welfare Plan.

     

    “Pledged
      Collateral”
      has the
      meaning specified in the Borrower Pledge Agreement and the Guarantor Pledge
      Agreement.

     

    
      
        
        

      

      
        18

        
          

        

      

      
        
        

      

    

    “Practice”
      means
      any medical or ophthalmology practice, optometry practice or optical dispensory
      at a single location or various locations. 

     

    “Provider”
      means
      any Person who performs professional medical services for a Practice that is
      either managed by a Subsidiary or the assets of which are owned by a
      Subsidiary.

     

    “Quarterly
      Payment Date”
      means
      the last day of each March, June, September, and December or, if any such day
      is
      not a Business Day, the next succeeding Business Day.

     

    “Reaffirmation
      of Collateral Documents”
      means
      that certain Reaffirmation of Collateral Documents substantially in the form
      attached hereto as Exhibit
      I.

     

    “Release”
      means a
“release”, as such term is defined in CERCLA.

     

    "Replacement
      Lender"
      is
      defined in Section
      4.12.

     

    “Required
      Lenders” means
      Lenders holding at least 51.0% of the then aggregate outstanding principal
      amount of all of the Notes then held by the Lenders, or, if no such principal
      amount is then outstanding, Lenders having at least 51.0% of the Revolving
      Commitments.

     

    “Resource
      Conservation and Recovery Act”
      means
      the Resource Conservation and Recovery Act, 42 U.S.C. Section 6901, et seq.,
      as in
      effect from time to time.

     

    “Revolver
      Increase”
has
      the
      meaning set forth in Section
      2.1.3.

     

    “Revolver
      Increase Notice”
has
      the
      meaning set forth in Section
      2.1.3.

    

                    “Revolving
      Commitment”
      means,
      relative to any Lender, such Lender’s obligation to make Loans pursuant to
Section
      2.1.1.

     

    “Revolving
      Commitment Amount”
      means
      $80,000,000 plus the amount, if any, of any increase permitted by Section
      2.1.3.
      (after
      which increase, the Revolving Commitment Amount shall not exceed $100,000,000).
      The Revolving Commitment Amount at any time in effect may also be reduced from
      time to time pursuant to Section
      2.2.

    

    “Revolving
      Commitment Termination Date”
      means
      the earliest of

     

    (a) June
      29,
      2009;

     

    (b) the
      date
      on which the Revolving Commitment Amount is terminated in full or reduced to
      zero pursuant to Section
      2.2;
      and

     

    (c) the
      date
      on which any Termination Event occurs.

     

    Upon
      the
      occurrence of any event described in clause
      (b)
      or
(c),
      the
      Revolving Commitments shall terminate automatically and without further
      action.

     

    
      
        
        

      

      
        19

        
          

        

      

      
        
        

      

    

    "Revolving
      Extensions of Credit":
      as to
      any Revolving Lender at any time, an amount equal to the sum, without
      duplication, of (a) the aggregate principal amount of all Revolving Loans held
      by such Lender then outstanding and (b) an amount equal to such Lender's
      Percentage of the Letter of Credit Obligations then outstanding.

     

    “Senior
      Debt”
      shall
      mean Indebtedness of the type described in clauses
      (a),
      (c)
      and
(d)
      of the
      definition “Indebtedness” (other than Subordinated Debt) of the Borrower on a
      consolidated basis.

     

    “Solvent”
      means,
      when used with respect to a Person, that (a) the fair saleable value of the
      assets of such Person is in excess of the total amount of the present value
      of
      its liabilities (including for purposes of this definition all liabilities
      whether or not reflected on a balance sheet prepared in accordance with GAAP
      and
      whether direct or indirect, fixed or contingent, secured or unsecured, disputed
      or undisputed), (b) such Person is able to pay its debts or obligations in
      the
      ordinary course as they mature and (c) such Person does not have unreasonably
      small capital to carry out its business as conducted and as proposed to be
      conducted. “Solvency” shall have a correlative meaning.

     

    “Subordinated
      Debt”
      means
      all Indebtedness the repayment of which is subordinated, upon terms satisfactory
      to the Required Lenders, in right of payment to the payment in full in cash
      of
      all Obligations.

     

    *         
      .

     

    *          .

     

    *         
      .

     

    “Subsidiary”
      of a
      Person means any corporation, association, partnership, limited liability
      company, joint venture or other business entity of which more than 50% of the
      voting stock, membership interests or other equity interests (in the case of
      Persons other than corporations), is owned or controlled directly or indirectly
      by the Person, or one or more of the Subsidiaries of the Person, or a
      combination thereof.

     

    “Target”
      means
      (i) any business that sells, leases or provides medical equipment to doctors,
      hospitals or other health organizations, (ii) ambulatory surgery centers,
      surgical facilities or other form of outpatient surgical treatment centers
      (including, without limitation, vision correction or laser vision correction
      centers), regardless of the specialty or specialties involved therein, or any
      business that owns, operates and/or manages one or more thereof, (iii) any
      management service center, optical laboratory, buying group or group purchasing
      organization, companies that own, operate and/or manage vision correction
      centers (including, without limitation, laser vision correction centers),
      marketing products and services organization, or reasonable extensions thereof
      (including any company which leases or sells equipment or provides services
      to
      any of the foregoing), at a single location or various locations, or (iv)
      reasonable extensions of any of the foregoing. Whenever in this Agreement
“Target” is used in describing an acquisition by the Borrower or a Subsidiary of
      the Borrower of equity interests, such reference is to the acquisition of the
      assets used in the operation of the Target that can lawfully be acquired by
      the
      Borrower or a Subsidiary of the Borrower or to the acquisition of the equity
      interests of a Person that owns, as of the time of purchase, only those assets
      that can be lawfully acquired by the Borrower or a Subsidiary of the Borrower.
      

     

    
      
        *
          Confidentiality portion omitted and filed separately with the
          Commission.

      

      
        
        

      

      
        20

        
          

        

      

      
        
        

      

    

    “Taxes”
      is
      defined in Section
      4.6.

     

    “Termination
      Event”
      means 

     

    (a) the
      occurrence of any Default described in clauses
      (a)
      through
(e)
      of
Section
      8.1.9;
      or

     

    (b) the
      occurrence and continuance of any other Event of Default and either

     

    (i) the
      declaration of the Loans to be due and payable pursuant to Section
      8.3,
      or

     

    (ii) in
      the
      absence of such declaration, the giving of notice by the Agent, acting at the
      direction of the Required Lenders, to the Borrower that the Revolving
      Commitments have been terminated.

     

    “Total
      Funded Debt"
      of any
      Person means all Indebtedness of such Person except Indebtedness specified
      in
clause
      (g)
      of the
      definition of Indebtedness;     
*         .

     

    "Total
      Leverage Ratio"
      has the
      meaning assigned to it in Section
      3.2.1.

     

    “Type”
      means,
      relative to any Loan, the portion thereof, if any, being maintained as a Base
      Rate Loan or a LIBO Rate Loan.

     

    “United
      States”
      or
“U.S.”
      means
      the United States of America, its fifty States and the District of
      Columbia.

     

    “Welfare
      Plan”
      means a
“welfare plan”, as such term is defined in Section 3(1) of ERISA.

     

    “Wholly-Owned
      Subsidiary”
      means
      any Person in which (other than directors’ qualifying shares required by law)
      100% of the equity interests of each class having ordinary voting power, and
      100% of the equity interests of every other class, in each case, at the time
      as
      of which any determination is being made, is owned, beneficially and of record,
      by the Borrower or by one or more of the other Wholly-Owned Subsidiaries, or
      both.

     

    
      *
        Confidentiality portion omitted and filed separately with the
        Commission.

    

    
      
        
        

      

      
        21

        
          

        

      

      
        
        

      

    

    SECTION
      1.2   Use
      of
      Defined Terms.
      Unless
      otherwise defined or the context otherwise requires, terms for which meanings
      are provided in this Agreement shall have such meanings when used in the
      Schedules and in each Note, Borrowing Request, Continuation/Conversion Notice,
      Loan Document, notice and other communication delivered from time to time in
      connection with this Agreement or any other Loan Document.

     

    SECTION
      1.3   Cross-References.
      Unless
      otherwise specified, references in this Agreement and in each other Loan
      Document to any Article or Section are references to such Article or Section
      of
      this Agreement or such other Loan Document, as the case may be, and, unless
      otherwise specified, references in any Article, Section or definition to any
      clause are references to such clause of such Article, Section or
      definition.

     

    SECTION
      1.4   Accounting
      Principles.
      Unless
      the context otherwise clearly requires, all accounting terms not expressly
      defined herein shall be construed, and all financial computations required
      under
      this Agreement shall be made, in accordance with GAAP, consistently applied.
      For
      purposes of clarification, it shall be understood that the financial results
      of
      Non-Wholly Owned Subsidiaries and Minority ASC Entities will be reflected in
      Borrower’s consolidated financial statements in accordance with
      GAAP.

     

    ARTICLE
      II  

     

    REVOLVING
      COMMITMENTS, BORROWING PROCEDURES AND NOTES

     

    SECTION
      2.1   Revolving
      Commitments.
      On the
      terms and subject to the conditions of this Agreement (including Article
      V),
      each
      Lender severally agrees to make Loans pursuant to the Revolving Commitments
      described in this Section
      2.1.

     

    SECTION
      2.1.1   Revolving
      Commitment of Each Lender.
      From
      time to time on any Business Day occurring prior to the Revolving Commitment
      Termination Date, each Lender will make loans (relative to such Lender, and
      of
      any type, its “Loans”)
      to the
      Borrower, which, when added to the Letter of Credit Obligations at such time,
      equal to such Lender’s Percentage of the aggregate amount of the Borrowing
      requested by the Borrower to be made on such day. The commitment of each Lender
      described in this Section
      2.1.1
      is
      herein referred to as its “Revolving
      Commitment”.
      On the
      terms and subject to the conditions hereof, the Borrower may from time to time
      borrow, prepay and reborrow Loans.

     

    SECTION
      2.1.2   Lenders
      Not Permitted or Required To Make Loans.
      No
      Lender shall be permitted or required to make any Loan if, after giving effect
      thereto, the aggregate outstanding principal amount of all Loans plus Letter
      of
      Credit Obligations then outstanding

     

    
      	(a)  	
              of
                all Lenders would exceed the Revolving Commitment Amount,
                or

            

    

     

    
      	(b)  	
              of
                such Lender would exceed such Lender’s Percentage of the Revolving
                Commitment Amount.

            

    

     

    
      
        
        

      

      
        22

        
          

        

      

      
        
        

      

    

    SECTION
      2.1.3   Revolver
      Increase.
      On and
      after the Fifth Amended and Restated Effective Date, Borrower may, at its option
      at any time in increments of not less than $5,000,000, seek to increase (the
      "Revolver
      Increase")
      the
      Revolving Commitment Amount by up to an aggregate of $20,000,000 (after giving
      effect to all such increases the Revolving Commitment Amount shall not exceed
      $100,000,000) upon at least 30 days (but not more than 45 days) written notice
      (“Revolver
      Increase Notice”)
      to the
      Agent (which notice Agent shall promptly deliver to the Lenders). The Revolver
      Increase Notice shall (a) specify the date upon which the Revolver Increase
      is
      requested to occur, (b) be delivered at a time when no Default or Event of
      Default has occurred and is continuing (and the effectiveness of the Revolver
      Increase shall be subject to no Default or Event of Default existing of the
      time
      of the Revolver Increase) and (c) certify that the Revolver Increase will not
      violate or conflict with the terms of any Indebtedness or any other contract,
      agreement, instrument or obligation of any Credit Party. Borrower shall, after
      giving a Revolver Increase Notice, offer the Revolver Increase (i) first on
      a
      pro-rata basis to the Lenders, which each Lender may in its sole and absolute
      discretion accept or decline (it being understood that any Lender not
      affirmatively committing in writing to its pro-rata portion shall be deemed
      to
      have declined), (ii) second, if any Lender has declined its pro rata share
      or
      any part thereof, such remaining amounts on a non pro-rata basis to the Lenders
      accepting their pro rata share of the Revolver Increase and (iii) third, to
      other commercial banks or financial institutions. No increase in the Revolving
      Commitment Amount shall become effective until all existing and new Lenders
      committing to the Revolver Increase have delivered to the Agent a writing in
      form reasonably satisfactory to the Agent pursuant to which such existing
      Lenders state the amount of their Revolver Increase and any such new Lenders
      state the amount of their Revolver Commitment and agree to assume and accept
      the
      obligations and rights of a Lender hereunder and any such new and increasing
      Lenders agree to make a Loan such that the outstanding Loans of such new Lender
      or increasing Lender constitute a proportional amount of the aggregate
      outstanding Loans and Letter of Credit Obligations based on the Revolver
      Commitment of such new Lender. Any Loan as a result of an increase to the
      Revolver Commitment pursuant to this Section
      2.1.3
      shall be
      subject to the terms and conditions contained in this Agreement. Upon the
      increase of the Revolving Commitment Amount pursuant to this Section
      2.1.3,
      Schedule
      10.1
      shall be
      deemed amended and replaced with a new Schedule
      10.1
      reflecting the new Revolver Commitments hereunder. Notwithstanding the
      foregoing, in the event that Borrower elects to permanently reduce or terminate
      the Revolving Commitment Amount pursuant to Section
      2.2.1,
      the
      Revolver Increase, to the extent not already utilized by the Borrower, shall
      be
      terminated and cease to be available to the Borrower. Unless otherwise agreed
      to
      by the Borrower, Agent and Lenders providing any Revolver Increase, no closing
      fees or other transaction costs (other than those expressly called for under
      this Agreement) shall be required by the Lender in connection with a Revolver
      Increase.

     

    SECTION
      2.2   Reduction
      of Revolving Commitment Amount.
      The
      Revolving Commitment Amount is subject to reduction from time to time pursuant
      to this Section
      2.2.

     

    SECTION
      2.2.1   Optional.
      The
      Borrower may, from time to time on any Business Day occurring after the time
      of
      the initial Borrowing hereunder, voluntarily reduce the Revolving Commitment
      Amount; provided,
      however,
      that
      all such reductions shall require at least three Business Days’ prior notice to
      the Agent and be permanent, and any partial reduction of the Revolving
      Commitment Amount shall be in a minimum amount of $5,000,000 and in an integral
      multiple of $1,000,000.

     

    
      
        
        

      

      
        23

        
          

        

      

      
        
        

      

    

    SECTION
      2.2.2   Mandatory
      Reductions and Prepayments.
      The
      Revolving Commitment Amount shall, without any further action, automatically
      and
      permanently be reduced to zero on the Revolving Commitment Termination Date
      and:

     

    (a) The
      Borrower shall prepay Loans in an amount equal to 100% of the insurance proceeds
      received by the Borrower or any Subsidiary following a casualty involving such
      Person’s Property, to the extent not applied (or intended to be applied) within
      90 days after the consummation or receipt thereof, as applicable, to the
      purchase of replacement assets or repair of damaged assets;

     

    (b) The
      Borrower shall prepay Loans in an amount equal to 100% of the sum of the Net
      Available Proceeds realized upon all Asset Dispositions to the extent not
      applied (or committed to be applied) within 180 days of such Asset Disposition
      to the purchase of other assets that are not classified as current assets under
      GAAP and are used or useful in the business of the Company and its Subsidiaries;
      

     

    (c) The
      Borrower shall prepay Loans in an amount equal to 100% of the sum of the Net
      Available Proceeds realized upon all debt issuances (other than in connection
      with a Permitted Acquisition) by the Borrower and its Subsidiaries;

     

    (d) 
      The
      Borrower shall notify the Agent of the amount of any required prepayment at
      least three (3) Business Days before it is made. The Borrower shall pay any
      accrued interest on the Loans which are being prepaid pursuant to this
Section
      2.2.2
      and
      shall pay any break funding costs associated with such required prepayment;
      and

     

    (e) Notwithstanding
      anything contained herein to the contrary, Borrower shall prepay Loans in an
      amount equal to 100% of the sum of the Net Available Proceeds realized upon
      all
      Permitted Asset Dispositions.

     

    Any
      prepayments pursuant to Sections
      2.2.1 or 2.2.2
      hereof
      shall be without penalty or premium of any kind other than break funding and
      other charges expressly provided by this Agreement with respect to LIBOR
      breakage costs; provided,
      however,
      at the
      reasonable request of the Borrower and to avoid any break funding charges with
      respect to LIBOR breakage costs associated with any prepayment, any amounts
      to
      be prepaid pursuant to Section
      2.2.2
      shall be
      deposited by the Borrower in an escrow account under the control of the Agent
      to
      return an interest rate equal to the average deposit rate payable by the Agent
      for commercial deposits of like size and duration as determined by the Agent
      in
      its sole discretion, such amounts to be applied in the manner set forth in
      this
Section
      2.2.2.
      at the
      expiration of the Interest Period for the Loans as to which break funding
      charges would otherwise have applied.

     

    SECTION
      2.3   Borrowing
      Procedure.
      By
      delivering a Borrowing Request to the Agent on or before 11:00 a.m., Chicago
      time, on a Business Day, the Borrower may from time to time irrevocably request,
      on notice on the date of the requested Borrowing in the case of Base Rate Loans
      and on not less than three nor more than five Business Days’ notice in the case
      of LIBO Rate Loans, that a Borrowing be made in a minimum amount of (i) $500,000
      if such Loan is a LIBO Rate Loan or (ii) the lesser of the unused amount of
      the
      Revolving Commitments or $100,000, if such Loan is a Base Rate Loan and an
      integral multiple of $100,000, to the extent such additional amount is permitted
      to be borrowed hereunder. On the terms and subject to the conditions of this
      Agreement, each Borrowing shall be comprised of the type of Loans, and shall
      be
      made on the Business Day, specified in such Borrowing Request. On or before
      1:00
      p.m. (Chicago time) on such Business Day, each Lender shall deposit with the
      Agent same day funds in an amount equal to such Lender’s Percentage of the
      requested Borrowing. Such deposit will be made to an account which the Agent
      shall specify from time to time by notice to the Lenders. To the extent funds
      are received from the Lenders, the Agent shall make such funds available to
      the
      Borrower by wire transfer to the accounts the Borrower shall have specified
      in
      its Borrowing Request. No Lender’s obligation to make any Loan shall be affected
      by any other Lender’s failure to make any Loan.

     

    
      
        
        

      

      
        24

        
          

        

      

      
        
        

      

    

    SECTION
      2.4   Continuation
      and Conversion Elections.
      By
      delivering a Continuation/Conversion Notice to the Agent on or before 10:00
      a.m., Chicago time, on a Business Day, the Borrower may from time to time
      irrevocably elect, on not less than three nor more than five Business Days’
notice that all, or any portion in an aggregate minimum amount of $500,000
      and
      an integral multiple of $100,000, of any Loans be, in the case of Base Rate
      Loans, converted into LIBO Rate Loans or, in the case of LIBO Rate Loans, be
      converted into a Base Rate Loan or continued as a LIBO Rate Loan (in the absence
      of delivery of a Continuation/ Conversion Notice with respect to any LIBO Rate
      Loan at least three Business Days before the last day of the then current
      Interest Period with respect thereto, such LIBO Rate Loan shall, on such last
      day, automatically convert to a Base Rate Loan); provided,
      however,
      that
      (i) each such conversion or continuation shall be pro rated among the applicable
      outstanding Loans of all Lenders, and (ii) no portion of the outstanding
      principal amount of any Loans may be continued as, or be converted into, LIBO
      Rate Loans when any Event of Default has occurred and is
      continuing.

     

    SECTION
      2.5   Funding.
      Each
      Lender may, if it so elects, fulfill its obligation to make, continue or convert
      LIBO Rate Loans hereunder by causing one of its foreign branches or Affiliates
      (or an international banking facility created by such Lender) to make or
      maintain such LIBO Rate Loan; provided,
      however,
      that
      such LIBO Rate Loan shall nonetheless be deemed to have been made and to be
      held
      by such Lender, and the obligation of the Borrower to repay such LIBO Rate
      Loan
      shall nevertheless be to such Lender for the account of such foreign branch,
      Affiliate or international banking facility. In addition, the Borrower hereby
      consents and agrees that, for purposes of any determination to be made for
      purposes of Sections
      4.1,
      4.2,
      4.3
      or
4.4,
      it
      shall be conclusively assumed that each Lender elected to fund all LIBO Rate
      Loans by purchasing Dollar deposits in its LIBOR Office’s interbank eurodollar
      market.

     

    SECTION
      2.6   Notes.
      Each
      Lender’s Loans under its Revolving Commitment shall be evidenced by a Note
      payable to the order of such Lender in a maximum principal amount equal to
      such
      Lender’s Percentage of the original Revolving Commitment Amount. The Borrower
      hereby irrevocably authorizes each Lender to make (or cause to be made)
      appropriate notations on the grid attached to such Lender’s Note (or on any
      continuation of such grid), which notations, if made, shall evidence,
inter alia,
      the
      date of, the outstanding principal of, and the interest rate and Interest Period
      applicable to the Loans evidenced thereby. Such notations shall be conclusive
      and binding on the Borrower absent manifest error; provided,
      however,
      that
      the failure of any Lender to make any such notations shall not limit or
      otherwise affect any Obligations of the Borrower or any other Credit
      Party.

     

    
      
        
        

      

      
        25

        
          

        

      

      
        
        

      

    

    SECTION
      2.7   Letters
      of Credit.

     

    SECTION
      2.7.1   Issuance
      of Letters of Credit.
      From
      and after the date hereof, the Letter of Credit Issuer agrees, upon the terms
      and conditions set forth in this Agreement, and subject to the satisfaction
      of
      such policy standards and conditions relating to the issuance of standby letters
      of credit generally as may be established by the Letter of Credit Issuer from
      time to time, to issue standby letters of credit, for the account of the
      Borrower, from time to time from the Original Closing Date to the Letter of
      Credit Expiry Date; provided
      that the
      Borrower shall not request and the Letter of Credit Issuer shall not issue,
      any
      Letter of Credit which would cause the aggregate Letter of Credit Obligations
      (after giving effect to the issuance of such Letter of Credit) to exceed the
      amount of the lesser of (i) the Letter of Credit Sublimit and (ii) the unused
      aggregate Revolving Commitment.

     

    SECTION
      2.7.2   Participating
      Interests.
      Immediately upon the issuance by the Letter of Credit Issuer of a Letter of
      Credit, each Lender shall be deemed to have irrevocably and unconditionally
      purchased and received from the Letter of Credit Issuer, without recourse,
      representation or warranty, an undivided participation interest equal to its
      Percentage of the face amount of such Letter of Credit and each draw paid by
      the
      Letter of Credit Issuer thereunder. Each Lender’s obligation to pay its
      proportionate share of all draws under the Letters of Credit, absent gross
      negligence or willful misconduct by the Letter of Credit Issuer in honoring
      any
      such draw, shall be absolute, unconditional and irrevocable and in each case
      shall be made without counterclaim or set-off by such Lender.

     

    SECTION
      2.7.3   Reimbursement
      Upon Drawing.
      (a) The
      Borrower agrees to reimburse the Letter of Credit Issuer for the amount of
      each
      draft drawn on a Letter of Credit within one Business Day after the date such
      draft is so drawn. The Borrower agrees to reimburse the Letter of Credit Issuer
      immediately when due, under all circumstances, including, without limitation,
      any of the following circumstances: (w) any lack of validity or enforceability
      of this Agreement or any instrument executed pursuant hereto; (x) the existence
      of any claim, set-off, defense or other right which the Borrower may have at
      any
      time against a beneficiary named in a Letter of Credit, any transferee of any
      Letter of Credit (or any Person for whom any such transferee may be acting),
      any
      Lender or any other Person, whether in connection with this Agreement, any
      Letter of Credit, the transactions contemplated herein or any unrelated
      transactions (including any underlying transaction between the Borrower and
      the
      beneficiary named in any Letter of Credit); (y) the validity, sufficiency or
      genuineness of any document which the Letter of Credit Issuer reasonably has
      determined in good faith complies on its face with the terms of the applicable
      Letter of Credit, even if such document should later prove, without the
      knowledge of the Letter of Credit Issuer, to have been forged, fraudulent,
      invalid or insufficient in any respect or any statement therein shall have
      been
      untrue or inaccurate in any respect; or (z) the surrender or material impairment
      of any security for the performance or observance of any of the terms
      hereof.

     

    (b) If
      the
      Borrower does not pay any such reimbursement obligations when due, the Borrower
      shall be deemed to have immediately requested that the Lenders make a Base
      Rate
      Loan under this Agreement in a principal amount equal to such unreimbursed
      reimbursement obligations. The Agent shall promptly notify the Lenders of such
      deemed request and, without the necessity of compliance with the requirements
      of
Sections
      2.1
      and
5.2,
      each
      Lender shall make available to the Agent its Loan. The proceeds of such Loans
      shall be paid over by the Agent to the Letter of Credit Issuer for the account
      of the Borrower in satisfaction of such unreimbursed reimbursement obligations,
      which shall thereupon be deemed satisfied by the proceeds of, and replaced
      by,
      such Loan.

     

    
      
        
        

      

      
        26

        
          

        

      

      
        
        

      

    

    (c) If
      the
      Letter of Credit Issuer makes a payment on account of any Letter of Credit
      and
      is not concurrently reimbursed therefor by the Borrower and if for any reason
      a
      Loan may not be made pursuant to Section
      2.7.3(b),
      then as
      promptly as practical during normal banking hours on the date of its receipt
      of
      such notice or, if not practicable on such date, not later than 12:00 noon
      (Chicago time) on the Business Day immediately succeeding such date of
      notification, each Lender shall deliver to the Agent for the account of the
      Letter of Credit Issuer, in immediately available funds, the purchase price
      for
      such Lender’s interest in such unreimbursed reimbursement obligations, which
      shall be an amount equal to such Lender’s pro-rata share of such payment. Each
      Lender shall, upon demand by the Letter of Credit Issuer, pay the Letter of
      Credit Issuer interest on such Lender’s pro-rata share of such draw from the
      date of payment by the Letter of Credit Issuer on account of such Letter of
      Credit until the date of delivery of such funds to the Letter of Credit Issuer
      by such Lender at a rate per annum, computed for actual days elapsed based
      on a
      360-day year, equal to the Federal Funds Effective Rate for such period;
provided,
      that
      such payments shall be made by the Lenders only in the event and to the extent
      that the Letter of Credit Issuer is not reimbursed in full by the Borrower
      for
      interest on the amount of any draw on the Letters of Credit.

     

    SECTION
      2.7.4   Request
      for Letter of Credit.
      Each
      Letter of Credit shall be issued upon receipt by the Letter of Credit Issuer
      and
      the Agent from the Borrower of an irrevocable request thereof (an “LC
      Notice”)
      not
      later than 11:00 a.m. (Chicago time) three (3) Business Days prior the issuance
      date. Each LC Notice for a Letter of Credit issued shall be in form and
      substance satisfactory to the Letter of Credit Issuer.

     

    ARTICLE
      III  

     

    REPAYMENTS,
      PREPAYMENTS, INTEREST AND FEES

     

    SECTION
      3.1   Repayments
      and Prepayments.

     

    SECTION
      3.1.1   Prior
      to the Revolving Commitment Termination Date.
      The
      Borrower

     

    (a) may,
      from
      time to time on any Business Day prior to the Revolving Commitment Termination
      Date, make a voluntary prepayment, in whole or in part, of the outstanding
      principal amount of any Loans; provided,
      however,
      that:

     

    (i)
      any such
      prepayment shall be made pro rata
      among
      Loans of the same type and, if applicable, having the same Interest Period
      of
      all Lenders;

     

    (ii)
      unless
      the Borrower complies with Section
      4.4,
      no such
      prepayment of any LIBO Rate Loan may be made on any day other than the last
      day
      of the Interest Period for such Loan; and

     

    
      
        
        

      

      
        27

        
          

        

      

      
        
        

      

    

    (b) shall,
      immediately upon any acceleration of the Maturity Date of any Loans pursuant
      to
Section
      8.2
      or
Section
      8.3,
      repay
      all Loans, unless, pursuant to Section
      8.3,
      only a
      portion of all Loans is so accelerated.

     

    Each
      prepayment of any Loans made pursuant to this Section
      3.1.1
      shall be
      without premium or penalty, except as may be required by Section
      4.4.
      No
      voluntary prepayment of principal of any Loans pursuant to this Section
      3.1.1
      shall
      cause a reduction in the Revolving Commitment Amount.

     

    SECTION
      3.1.2   On
      the
      Maturity Date.
      On the
      Maturity Date, the Borrower shall repay the principal of the Loans then
      outstanding.

     

    SECTION
      3.1.3   Extension
      of Maturity Date.
      The
      Borrower may, by written request to the Agent and the Lenders given not later
      than one hundred eighty (180) days prior to the Maturity Date then in effect
      (the “Effective
      Maturity Date”)
      request
      (an “Extension
      Request”)
      that
      such Effective Maturity Date be extended to a date which is twenty-four (24)
      months after such Effective Maturity Date. No later than the date (the
“Extension
      Response Date”)
      which
      is 30 days after such Extension Request has been delivered to each of the
      Lenders, each Lender will notify the Borrower in writing (with a copy to the
      Agent) whether or not it consents to such Extension Request (which consent
      may
      be granted or denied by each Lender in its sole discretion and may be
      conditioned on receipt of such financial information or other documentation
      as
      may be specified by such Lender); provided, that any Lender that fails to so
      advise the Borrower on or prior to the Extension Response Date shall be deemed
      to have denied such Extension Request. The extension of the Maturity Date
      contemplated by an Extension Request shall become effective as of the applicable
      Effective Maturity Date; provided, that (i) all of the Lenders shall have
      consented to such Extension Request; and (ii) (x) each of the representations
      and warranties made by the Borrower in or pursuant to the Loan Documents shall
      be true and correct in all material respects on and as of each of the date
      of
      such Extension Request and such Effective Maturity Date as if made on and as
      of
      such date, except to the extent relating to an earlier date, (y) no Default
      or
      Event of Default shall have occurred and be continuing on the date of such
      Extension Request or on such Effective Maturity Date and (z) on each of the
      date
      of such Extension Request and such Effective Maturity Date, the Agent shall
      have
      received a certificate of the Borrower as to the matters set forth in clauses
      (x) and (y) above.

     

    SECTION
      3.2   Interest
      Provisions.
      Interest on the outstanding principal amount of Loans shall accrue and be
      payable in accordance with this Section
      3.2.

     

    SECTION
      3.2.1   Rates.
      Pursuant to an appropriately delivered Borrowing Request or
      Continuation/Conversion Notice, the Borrower may elect that Loans comprising
      a
      Borrowing accrue interest at a rate per annum:

     

    (a) on
      that
      portion maintained from time to time as a Base Rate Loan, equal to the sum
      of
      the Base Rate from time to time in effect plus the Applicable Margin for Base
      Rate Loans; or

     

    
      
        
        

      

      
        28

        
          

        

      

      
        
        

      

    

    (b) on
      that
      portion maintained as a LIBO Rate Loan, during each Interest Period applicable
      thereto, equal to the sum of the LIBO Rate (Reserve Adjusted) for such Interest
      Period plus the Applicable Margin for LIBO Rate Loans.

     

    The
      “LIBO
      Rate (Reserve Adjusted)”
      means,
      relative to any Loan to be made, continued or maintained as, or converted into,
      a LIBO Rate Loan for any Interest Period, a rate per annum (rounded upwards,
      if
      necessary, to the nearest 1/16 of 1%) determined pursuant to the following
      formula:

     

    LIBO
      Rate
      =           LIBO
      Rate      

    (Reserve
      Adjusted) 1.00 - LIBOR Reserve Percentage

     

    The
      LIBO
      Rate (Reserve Adjusted) for any Interest Period for LIBO Rate Loans will be
      determined by the Agent on the basis of the LIBOR Reserve Percentage in effect
      on, and the applicable rates furnished to and received by the Agent from
      National City, two Business Days before the first day of such Interest
      Period.

     

    “LIBO
      Rate”
      means,
      relative to any Interest Period for LIBO Rate Loans, the rate of interest equal
      to the average (rounded upwards, if necessary, to the nearest 1/16 of 1%) of the
      rates per annum at which Dollar deposits in immediately available funds are
      offered to National City’s LIBOR Office in the London interbank market as at or
      about 10:00 a.m. London time two Business Days prior to the beginning of such
      Interest Period for delivery on the first day of such Interest Period, and
      in an
      amount approximately equal to the amount of National City’s LIBO Rate Loan and
      for a period approximately equal to such Interest Period.

     

    “LIBOR
      Reserve Percentage”
      means,
      relative to any Interest Period for LIBO Rate Loans, the reserve percentage
      (expressed as a decimal) equal to the maximum aggregate reserve requirements
      (including all basic, emergency, supplemental, marginal and other reserves
      and
      taking into account any transitional adjustments or other scheduled changes
      in
      reserve requirements) specified under regulations issued from time to time
      by
      the F.R.S. Board and then applicable to assets or liabilities consisting of
      and
      including “Eurocurrency Liabilities”, as currently defined in Regulation D of
      the F.R.S. Board, having a term approximately equal or comparable to such
      Interest Period.

     

    All
      LIBO
      Rate Loans shall bear interest from and including the first day of the
      applicable Interest Period to (but not including) the last day of such Interest
      Period at the interest rate determined as applicable to such LIBOR Rate
      Loan.

     

    “Applicable
      Margin”
      means on
      any date the applicable percentage set forth below based upon the Level as
      shown
      in the certificate then most recently delivered to the Lenders pursuant to
      Section
      7.1.1(d):

     

    
      	
              Level

            	
              Base
                Rate

            	
              LIBOR
                Rate

            	
              Commitment
                Fee

            
	
               I

            	
              .50%

            	
              2.25%

            	
              .250%

            
	
              II

            	
              .50%

            	
              2.00%

            	
              .250%

            
	
              III

            	
              .25%

            	
              1.75%

            	
              .250%

            
	
              IV

            	
              0%

            	
              1.50%

            	
              .200%

            
	
              V

            	
              0%

            	
              1.25%

            	
              .175%

            

    

    

    
      
        
        

      

      
        29

        
          

        

      

      
        
        

      

    

    ;
      provided,
      however
      that if
      the Borrower shall have failed to deliver to the Lenders by the date required
      hereunder any certificate pursuant to Section
      7.1.1(d),
      then
      from the date such certificate was required to be delivered until the date
      of
      such delivery the Applicable Margin shall be deemed to be Level I. Each change
      in the Applicable Margin shall take effect with respect to all outstanding
      Loans
      on the third Business Day immediately succeeding the day on which such
      certificate is received by the Agent. Notwithstanding the foregoing, no
      reduction in the Applicable Margin shall be effected if a Default or an Event
      of
      Default shall have occurred and be continuing on the date when such change
      would
      otherwise occur, it being understood that on the third Business Day immediately
      succeeding the day on which such Default or Event of Default is either waived
      or
      cured (assuming no other Default or Event of Default shall be then pending),
      the
      Applicable Margin shall be reduced (on a prospective basis) in accordance with
      the then most recently delivered certificate.

     

    “Level”
      means,
      and includes, Level I, Level II, Level III, Level IV or Level V, whichever
      is in
      effect at the relevant time.

     

    “Level
      I”
      shall
      exist at any time the Total Leverage Ratio is equal to or greater than
      3.00:1.0.

     

    “Level
      II”
      shall
      exist at any time the Total Leverage Ratio is less than 3.00:1.0 but equal
      to or
      greater than 2.50:1.0.

     

    “Level
      III”
      shall
      exist at any time the Total Leverage Ratio is less than 2.50:1.0 but equal
      to or
      greater than 1.75:1.0.

     

    “Level
      IV”
      shall
      exist at any time the Total Leverage Ratio is less than 1.75:1.0 but equal
      to or
      greater than 1.00:1.0.

     

    "Level
      V"
      shall
      exist at any time the Total Leverage Ratio is less than 1.00:1.0.

     

    “Total
      Leverage Ratio”
      means,
      with respect to any period, the ratio of (i) Total Funded Debt to (ii) EBITDA,
      as of the end of the relevant period.

    SECTION
      3.2.2   Post-Maturity
      Rates.
      After
      the date any principal amount of any Loan is due and payable (whether on the
      Revolving Commitment Termination Date, upon acceleration or otherwise), or
      after
      any other monetary Obligation of the Borrower shall have become due and payable,
      the Borrower shall pay, but only to the extent permitted by law, interest (after
      as well as before judgment) on such amounts at a rate per annum equal to the
      Base Rate plus a margin of 2.00%.

    

    SECTION
      3.2.3   Payment
      Dates.
      Interest accrued on each Loan shall be payable, without
      duplication:

     

    (a) on
      the
      Revolving Commitment Termination Date;

    

    (b) on
      the
      date of any payment or prepayment, in whole or in part, of principal outstanding
      on such Loan;

    

    
      
        
        

      

      
        30

        
          

        

      

      
        
        

      

    

    (c) with
      respect to Base Rate Loans, on each Quarterly Payment Date occurring after
      the
      Original Closing Date;

    

    (d) with
      respect to LIBO Rate Loans, the last day of each applicable Interest Period
      and,
      in the case of an Interest period in excess of three months, on the dates which
      are successively three months after the commencement of such Interest
      Period;

     

    (e) with
      respect to any Base Rate Loans converted into LIBO Rate Loans on a day when
      interest would not otherwise have been payable pursuant to clause
      (c),
      on the
      date of such conversion; and

     

    (f) on
      that
      portion of any Loans the Maturity Date of which is accelerated pursuant to
      Section
      8.2
      or
Section
      8.3,
      immediately upon such acceleration.

     

    Interest
      accrued on Loans or other monetary Obligations arising under this Agreement
      or
      any other Loan Document after the date such amount is due and payable (whether
      on the Maturity Date, upon acceleration or otherwise) shall be payable upon
      demand.

     

    SECTION
      3.2.4   Fees.
      The
      Borrower agrees to pay the fees set forth in this Section
      3.3.
      All
      such fees shall be non-refundable.

     

    SECTION
      3.2.5   Revolving
      Commitment Fee.
      The
      Borrower agrees to pay to the Agent for the account of each Lender, for the
      period (including any portion thereof when its Revolving Commitment is suspended
      by reason of the Borrower’s inability to satisfy any condition of Article
      V)
      commencing on the Fifth Amended and Restated Effective Date and continuing
      through the Revolving Commitment Termination Date, a commitment fee at the
      rate
      equal to the Applicable Margin for Commitment Fees per annum on such Lender’s
      Percentage of the sum of the average daily unused portion of the Revolving
      Commitment Amount. Such commitment fees shall be payable by the Borrower in
      arrears on each Quarterly Payment Date, commencing with the first such day
      following the Fifth Amended and Restated Effective Date and on the Revolving
      Commitment Termination Date.

     

    SECTION
      3.2.6   Letter
      of Credit Fees.
      (a) The
      Borrower agrees to pay the Agent, for the account of each Lender pro-rata on
      the
      basis of its Revolving Commitment, a fee in respect of each Letter of Credit
      computed at the Applicable Margin for LIBO Rate Loans on the average daily
      stated amount of such Letter of Credit (computed on the basis of a 360-day
      year
      for the actual days elapsed), such fee to be due and payable quarterly in
      arrears on each Quarterly Payment Date and on the Revolving Commitment
      Termination Date.

     

    (b)
      The
      Borrower shall pay to the Letter of Credit Issuer a letter of credit fronting
      fee for each Letter of Credit issued by the Letter of Credit Issuer equal to
      1/4
      of 1% of the face amount (or increased face amount) of such Letter of Credit.
      Such Letter of Credit fronting fee shall be due and payable on each date of
      issuance (or date of increase) of a Letter of Credit.

     

    (c)
      The
      Borrower agrees to pay directly to the Letter of Credit Issuer upon each
      issuance of, drawing under, and/or amendment of, a Letter of Credit issued
      by it
      in such amount as shall at the time of such issuance, drawing or amendment
      be
      the administrative charge which the Letter of Credit Issuer is customarily
      charging for issuances of, drawing under or amendments of, letters of credit
      issued by it.

     

    
      
        
        

      

      
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    SECTION
      3.2.7   Agency
      Fees.
      The
      Borrower shall pay to the Agent (x) on the Fifth Amended and Restated Effective
      Date for its own account and/or for distribution to the Lenders such fees as
      heretofore agreed by the Borrower and the Agent and (y) for its own account
      such
      other fees as may be agreed to from time to time between the Borrower and the
      Agent, when and as due.

     

    ARTICLE
      IV  

     

    LIBO
      RATE
      AND OTHER PROVISIONS

     

    SECTION
      4.1   LIBO
      Rate Lending Unlawful.
      If any
      Lender shall determine (which determination shall, upon notice thereof to the
      Borrower and the Lenders, be conclusive and binding on the Borrower) that the
      introduction of or any change in or in the interpretation of any law makes
      it
      unlawful, or any central bank or other governmental authority asserts that
      it is
      unlawful, for such Lender to make, continue or maintain any Loan as, or to
      convert any Loan into, a LIBO Rate Loan of a certain type, subject to the
      provisions of Section
      4.11
      hereof,
      the obligations of all Lenders to make, continue, maintain or convert any such
      Loans shall, upon such determination, forthwith be suspended until such Lender
      shall notify the Agent that the circumstances causing such suspension no longer
      exist, and all LIBO Rate Loans of such type shall automatically convert into
      Base Rate Loans at the end of the then current Interest Periods with respect
      thereto or sooner, if required by such law or assertion.

     

    SECTION
      4.2   Deposits
      Unavailable.
      If the
      Agent shall have determined that

     

    (a) Dollar
      certificates of deposit or Dollar deposits, as the case may be, in the relevant
      amount and for the relevant Interest Period are not available to a Lender in
      its
      relevant market; or

     

    (b) by
      reason
      of circumstances affecting a Lender’s relevant market, adequate means do not
      exist for ascertaining the interest rate applicable hereunder to LIBO Rate
      Loans
      of such type,

     

    then,
      upon notice from the Agent to the Borrower and the Lenders, subject to the
      provisions of Section
      4.11
      hereof,
      the obligations of all Lenders under Section
      2.3
      and
Section
      2.4
      to make
      or continue any Loans as, or to convert any Loans into, LIBO Rate Loans of
      such
      type shall forthwith be suspended until the Agent shall notify the Borrower
      and
      the Lenders that the circumstances causing such suspension no longer
      exist.

     

    SECTION
      4.3   Increased
      LIBO Rate Loan Costs, etc.
      The
      Borrower agrees to reimburse each Lender for any increase in the cost to such
      Lender of, or any reduction in the amount of any sum receivable by such Lender
      in respect of, making, continuing or maintaining (or of its obligation to make,
      continue or maintain) any Loans as, or of converting (or of its obligation
      to
      convert) any Loans into, LIBO Rate Loans, subject to the provisions of
Section
      4.11
      hereof.
      Such Lender shall promptly notify the Agent and the Borrower in writing of
      the
      occurrence of any such event, such notice to state, in reasonable detail, the
      reasons therefor and the additional amount required fully to compensate such
      Lender for such increased cost or reduced amount. Such additional amounts shall
      be payable by the Borrower directly to such Lender within five days of its
      receipt of such notice, and such notice shall, in the absence of manifest error,
      be conclusive and binding on the Borrower; provided,
      however,
      in no
      event shall Borrower be obligated to pay increased costs for a period greater
      than 180 days prior to the date of receipt of such notice.

     

    
      
        
        

      

      
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    SECTION
      4.4   Funding
      Losses.
      In the
      event any Lender shall incur any loss or expense (including any loss or expense
      incurred by reason of the liquidation or reemployment of deposits or other
      funds
      acquired by such Lender to make, continue or maintain any portion of the
      principal amount of any Loan as, or to convert any portion of the principal
      amount of any Loan into, a LIBO Rate Loan) as a result of;

     

    (a) any
      conversion or repayment or prepayment of the principal amount of any LIBO Rate
      Loans on a date other than the scheduled last day of the Interest Period
      applicable thereto, whether pursuant to Section
      3.1
      or
      otherwise;

     

    (b) any
      Loans
      not being made as LIBO Rate Loans in accordance with the Borrowing Request
      therefor; or

     

    (c) any
      Loans
      not being continued as, or converted into, LIBO Rate Loans in accordance with
      the Continuation/ Conversion Notice therefor;

     

    then,
      subject to the provisions of Section
      4.11
      hereof,
      upon the written notice of such Lender (which notice shall be delivered within
      thirty days of the incurrence thereof by such Lender) to the Borrower (with
      a
      copy to the Agent), the Borrower shall, within five days of its receipt thereof,
      pay directly to such Lender such amount as will (in the reasonable determination
      of such Lender) reimburse such Lender for such loss or expense. Such written
      notice (which shall include calculations in reasonable detail) shall, in the
      absence of manifest error, be conclusive and binding on the
      Borrower.

     

    SECTION
      4.5   Increased
      Capital Costs.
      If any
      change in, or the introduction, adoption, effectiveness, interpretation,
      reinterpretation or phase-in of, any law or regulation, directive, guideline,
      decision or request (whether or not having the force of law) of any court,
      central bank, regulator or other governmental authority affects or would affect
      the amount of capital required or expected to be maintained by any Lender or
      any
      Person controlling such Lender, and such Lender determines (in its sole and
      absolute discretion) that the rate of return on its or such controlling Person’s
      capital as a consequence of its Revolving Commitment or the Loans made by such
      Lender is reduced to a level below that which such Lender or such controlling
      Person could have achieved but for the occurrence of any such circumstance,
      then, in any such case upon notice from time to time by such Lender to the
      Borrower, subject to the provisions of Section
      4.11
      hereof,
      the Borrower shall immediately pay directly to such Lender additional amounts
      sufficient to compensate such Lender or such controlling Person for such
      reduction in rate of return. A statement of such Lender as to any such
      additional amount or amounts (including calculations thereof in reasonable
      detail) shall, in the absence of manifest error, be conclusive and binding
      on
      the Borrower. In determining such amount, such Lender may use any method of
      averaging and attribution that it (in its sole and absolute discretion) shall
      deem applicable; provided,
      however,
      in no
      event shall Borrower be obligated to pay increased costs for a period greater
      than 180 days prior to the date of receipt of the notice required by this
Section
      4.5.

     

    
      
        
        

      

      
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    SECTION
      4.6   Taxes.
      All
      payments by the Borrower of principal of, and interest on, the Loans and all
      other amounts payable hereunder shall be made free and clear of and without
      deduction for any present or future income, excise, stamp or franchise taxes
      and
      other taxes, fees, duties, withholdings or other charges of any nature
      whatsoever imposed by any taxing authority, but excluding franchise taxes and
      taxes imposed on or measured by any Lender’s net income or receipts (such
      non-excluded items being called “Taxes”).
      In the
      event that any withholding or deduction from any payment to be made by the
      Borrower hereunder is required in respect of any Taxes pursuant to any
      applicable law, rule or regulation, then the Borrower will:

     

    (a) pay
      directly to the relevant authority the full amount required to be so withheld
      or
      deducted;

     

    (b) promptly
      forward to the Agent an official receipt or other documentation satisfactory
      to
      the Agent evidencing such payment to such authority; and

     

    (c) pay
      to
      the Agent for the account of the Lenders such additional amount or amounts
      as is
      necessary to ensure that the net amount actually received by each Lender will
      equal the full amount such Lender would have received had no such withholding
      or
      deduction been required.

     

    Moreover,
      if any Taxes are directly asserted against the Agent or any Lender with respect
      to any payment received by the Agent or such Lender hereunder, the Agent or
      such
      Lender may pay such Taxes and the Borrower will promptly pay such additional
      amounts (including any penalties, interest or expenses, other than those
      penalties, interest or expenses which are due to any delay by Agent or any
      Lender) as is necessary in order that the net amount received by such person
      after the payment of such Taxes (including any Taxes on such additional amount)
      shall equal the amount such person would have received had not such Taxes been
      asserted.

     

    If
      the
      Borrower fails to pay any Taxes when due to the appropriate taxing authority
      or
      fails to remit to the Agent, for the account of the respective Lenders, the
      required receipts or other required documentary evidence, the Borrower shall
      indemnify the Lenders for any incremental Taxes, interest or penalties that
      may
      become payable by any Lender as a result of any such failure. For purposes
      of
      this Section
      4.6,
      a
      distribution hereunder by the Agent or any Lender to or for the account of
      any
      Lender shall be deemed a payment by the Borrower.

     

    Upon
      the
      request of the Borrower or the Agent, each Lender that is organized under the
      laws of a jurisdiction other than the United States shall, prior to the due
      date
      of any payments under the Notes, execute and deliver to the Borrower and the
      Agent, on or about the first scheduled payment date in each Fiscal Year, one
      or
      more (as the Borrower or the Agent may reasonably request) United States
      Internal Revenue Service Forms 4224 or Forms 1001 or such other forms or
      documents (or successor forms or documents), appropriately completed, as may
      be
      applicable to establish the extent, if any, to which a payment to such Lender
      is
      exempt from withholding or deduction of Taxes.

     

    
      
        
        

      

      
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    SECTION
      4.7   Payments,
      Computations, etc.
      Unless
      otherwise expressly provided, all payments by the Borrower pursuant to this
      Agreement, the Notes or any other Loan Document shall be made by the Borrower
      to
      the Agent for the pro rata
      account
      of the Lenders entitled to receive such payment. All such payments required
      to
      be made to the Agent shall be made, without setoff, deduction or counterclaim,
      not later than 11:00 a.m., Chicago time, on the date due, in same day or
      immediately available funds, to such account as the Agent shall specify from
      time to time by notice to the Borrower. Funds received after that time shall
      be
      deemed to have been received by the Agent on the next succeeding Business Day.
      The Agent shall promptly remit in same day funds to each Lender its share,
      if
      any, of such payments received by the Agent for the account of such Lender.
      All
      interest and fees shall be computed on the basis of the actual number of days
      (including the first day but excluding the last day) occurring during the period
      for which such interest or fee is payable over a year comprised of 360 days
      (or,
      in the case of interest on a Base Rate Loan, 365 days or, if appropriate, 366
      days). Whenever any payment to be made shall otherwise be due on a day which
      is
      not a Business Day, such payment shall (except as otherwise required by
clause
      (c)
      of the
      definition of the term “Interest
      Period”
with
      respect to LIBO Rate Loans) be made on the next succeeding Business Day and
      such
      extension of time shall be included in computing interest and fees, if any,
      in
      connection with such payment.

     

    SECTION
      4.8   Sharing
      of Payments.
      If any
      Lender shall obtain any payment or other recovery (whether voluntary,
      involuntary, by application of setoff or otherwise) on account of any Loan
      (other than pursuant to the terms of Sections
      4.3,
      4.4
      and
4.5)
      in
      excess of its pro rata
      share of
      payments then or therewith obtained by all Lenders, such Lender shall purchase
      from the other Lenders such participations in Loans made by them as shall be
      necessary to cause such purchasing Lender to share the excess payment or other
      recovery ratably with each of them; provided,
      however,
      that if
      all or any portion of the excess payment or other recovery is thereafter
      recovered from such purchasing Lender, the purchase shall be rescinded and
      each
      Lender which has sold a participation to the purchasing Lender shall repay
      to
      the purchasing Lender the purchase price to the ratable extent of such recovery
      together with an amount equal to such selling Lender’s ratable share (according
      to the proportion of:

     

    (a) the
      amount of such selling Lender’s required repayment to the purchasing
      Lender

     

    to

     

    (b) the
      total
      amount so recovered from the purchasing Lender);

     

    of
      any
      interest or other amount paid or payable by the purchasing Lender in respect
      of
      the total amount so recovered. The Borrower agrees that any Lender so purchasing
      a participation from another Lender pursuant to this Section may, to the fullest
      extent permitted by law, exercise all its rights of payment (including pursuant
      to Section
      4.9)
      with
      respect to such participation as fully as if such Lender were the direct
      creditor of the Borrower in the amount of such participation. If under any
      applicable bankruptcy, insolvency or other similar law, any Lender receives
      a
      secured claim in lieu of a setoff to which this Section applies, such Lender
      shall, to the extent practicable, exercise its rights in respect of such secured
      claim in a manner consistent with the rights of the Lenders entitled under
      this
      Section to share in the benefits of any recovery on such secured
      claim.

     

    
      
        
        

      

      
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    SECTION
      4.9   Setoff.
      Each
      Lender shall, upon the occurrence of any Default described in clauses
      (a)
      through
(d)
      of
Section
      8.1.9
      or, with
      the consent of the Required Lenders, upon the occurrence of any other Event
      of
      Default, have the right to appropriate and apply to the payment of the
      Obligations owing to it (whether or not then due), and (as security for such
      Obligations) the Borrower hereby grants to each Lender a continuing security
      interest in, any and all balances, credits, deposits, accounts or moneys of
      the
      Borrower then or thereafter maintained with such Lender; provided,
      however,
      that
      any such appropriation and application shall be subject to the provisions of
      Section
      4.8.
      Each
      Lender agrees promptly to notify the Borrower and the Agent after any such
      setoff and application made by such Lender; provided,
      however,
      that
      the failure to give such notice shall not affect the validity of such setoff
      and
      application. The rights of each Lender under this Section are in addition to
      other rights and remedies (including other rights of setoff under applicable
      law
      or otherwise) which such Lender may have.

     

    SECTION
      4.10   Use
      of
      Proceeds.
      The
      Borrower shall apply the proceeds of each Borrowing in accordance with the
      fourth recital;
      without
      limiting the foregoing, no proceeds of any Loan will be used to acquire any
      equity security of a class which is registered pursuant to Section 12 of the
      Securities Exchange Act of 1934 or any “margin stock”, as defined in F.R.S.
      Board Regulation U.

     

    SECTION
      4.11   Changes
      to Other Branches; Equal Treatment of Borrower.
      If a
      Lender claims any additional amounts payable or that its is unable to make
      LIBOR
      Loans available, as described more fully in Sections
      4.1
      through
4.5
      hereof,
      such Lender shall (i) use its reasonable efforts (consistent with legal and
      regulatory restrictions) to avoid the need for paying such additional amounts
      or
      such unavailability, including changing the jurisdiction of its applicable
      lending office or moving the applicable Loan(s) to an Affiliate or Subsidiary;
      provided,
      that
      the taking of any such action would not, in the reasonable judgment of such
      Lender, be disadvantageous to such Lender and (ii) treat the Borrower, with
      respect to all such issues, in a manner consistent with the treatment of other
      similarly situated borrowers with respect to such issues.

     

    SECTION
      4.12   Replacement
      of Lenders.
      Within
      fifteen (15) days after receipt by Borrower of written notice and demand from
      any Lender for payment pursuant to Section
      4.5 or 4.6
      (any
      such Lender demanding such payment being referred to herein as an “Affected
      Lender”),
      Borrower may, at its option, notify Agent and such Affected Lender of its
      intention to do one of the following:

     

    (A) Borrower
      may obtain, at Borrower's expense, a replacement Lender (“Replacement
      Lender”)
      for
      such Affected Lender, which Replacement Lender shall be reasonably satisfactory
      to Agent. In the event Borrower obtains a Replacement Lender that will refinance
      all outstanding Obligations owed to such Affected Lender and assume its
      Commitments hereunder within ninety (90) days following notice of Borrower's
      intention to do so, the Affected Lender shall sell and assign all of its rights
      and delegate all of its obligations under this Agreement to such Replacement
      Lender in accordance with the provisions of Section
      10.11.1,
      provided
      that
      Borrower has reimbursed such Affected Lender for any administrative fee payable
      pursuant to Section
      10.11.1
      and, in
      any case where such replacement occurs as the result of a demand for payment
      pursuant to Section
      4.5 or 5.6,
      paid
      all amounts required to be paid to such Affected Lender pursuant to subsection
      4.5 or 4.6
      through
      the date of such sale and assignment; or

     

    
      
        
        

      

      
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    (B) Borrower
      may, upon consent of the Required Lenders (other than the Affected Lender),
      prepay in full all outstanding Obligations owed to such Affected Lender and
      terminate such Affected Lender’s Revolving Commitment, in which case the
      Revolving Commitment Amount will be reduced by the amount of such Affected
      Lender's Revolving Commitment. Borrower shall, within ninety (90) days following
      notice of its intention to do so, prepay in full all outstanding Obligations
      owed to such Affected Lender (including, in any case where such replacement
      occurs as the result of a demand for payment for increased costs, such Affected
      Lender’s increased costs for which it is entitled to reimbursement under this
      Agreement through the date of such prepayment), and terminate such Affected
      Lender’s obligations under the Revolving Commitment Amount.

     

    ARTICLE
      V  

     

    CONDITIONS
      TO BORROWING

     

    SECTION
      5.1   Initial
      Borrowing.
      The
      obligations of the Lenders to fund the initial Borrowing and the Letter of
      Credit Issuer to issue, and the Lenders to participate in, any letter of Credit,
      shall be subject to the prior or concurrent satisfaction of each of the
      conditions precedent set forth in this Section
      5.1.

     

    SECTION
      5.1.1   Resolutions,
      etc.
      The
      Agent shall have received from each Credit Party a certificate, dated the date
      of the initial Borrowing, of its Secretary or Assistant Secretary as
      to:

     

    (a) resolutions
      of its Board of Directors then in full force and effect authorizing the
      execution, delivery and performance of this Agreement, the Notes and each other
      Loan Document to be executed by it; and

    

    (b) the
      incumbency and signatures of those of its officers authorized to act with
      respect to this Agreement, the Notes and each other Loan Document executed
      by
      it;

    

    upon
      which certificate each Lender may conclusively rely until it shall have received
      a further certificate of the Secretary of such Credit Party canceling or
      amending such prior certificate.

     

    SECTION
      5.1.2   Delivery
      of Notes.
      The
      Agent shall have received, for the account of each Lender, its Notes duly
      executed and delivered by the Borrower.

     

    SECTION
      5.1.3   Applicable
      Margin.
      The
      Agent shall receive a certificate, executed by an Authorized Officer of the
      Borrower, delineating the Applicable Margin after giving pro forma effect to
      the
      Loans to be incurred on the Original Closing Date.

     

    
      
        
        

      

      
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    SECTION
      5.1.4   Guaranty.
      The
      Agent shall have received the Guaranty, dated the date hereof, duly executed
      by
      each Subsidiary of the Borrower.

     

    SECTION
      5.1.5   Pledge
      Agreements.
      The
      Agent shall have received executed counterparts of the Borrower Pledge Agreement
      and the Guarantor Pledge Agreement, each dated as of the date hereof, duly
      executed by each Credit Party party thereto, together with stock certificates,
      accompanied by undated stock powers duly executed in blank, and promissory
      notes, duly endorsed in blank, required to be delivered to the Agent pursuant
      to
      the Borrower Pledge Agreement and the Guarantor Pledge Agreement.

     

    SECTION
      5.1.6   Security
      Agreements.
      The
      Agent shall have received executed counterparts of the Borrower Security
      Agreement and the Guarantor Security Agreement, each dated as of the date
      hereof, duly executed by each Credit Party thereto, together with:

     

    (a) acknowledgment
      copies of properly filed Uniform Commercial Code financing statements naming
      the
      relevant Credit Party as the debtor and the Agent as the secured party, or
      other
      similar instruments or documents, filed under the Uniform Commercial Code of
      all
      jurisdictions as may be necessary or, in the opinion of the Agent, desirable
      to
      perfect the security interest of the Agent pursuant to such Security
      Agreement;

    

    (b) executed
      copies of proper Uniform Commercial Code Form UCC-3 termination statements,
      if
      any, necessary to release all Liens and other rights of any Person:

    

    (i)
      in any
      collateral described in such Security Agreement previously granted by any
      Person, and

    

    (ii)
      securing
      any of the Indebtedness identified in Part A of Schedule
      6.17,
      together with such other Uniform Commercial Code Form UCC-3 termination
      statements as the Agent may reasonably request from such Credit Party;
      and

    

    (c) copies
      of
      Uniform Commercial Code Requests for Information or Copies (Form UCC-11), or
      a
      similar search report certified by a party acceptable to the Agent, dated a
      date
      reasonably near to the date of the initial Borrowing, listing all effective
      financing statements which name each Credit Party (under its present name and
      any previous names) as the debtor and which are filed in the jurisdictions
      in
      which filings were made pursuant to clause
      (a)
      above,
      together with copies of such financing statements (none of which (other than
      those described in clause
      (a),
      if such
      Form UCC-11 or search report, as the case may be, is current enough to list
      such
      financing statements described in clause
      (a))
      shall
      cover any collateral described in such Security Agreement).

    

    SECTION
      5.1.7   Intellectual
      Property Assignment.
      The
      Agent shall have received executed counterparts of an Intellectual Property
      Assignment, dated the date hereof, duly executed by each Credit
      Party.

     

    
      
        
        

      

      
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    SECTION
      5.1.8   Opinions
      of Counsel.
      The
      Agent shall have received opinions, dated the date of the initial Borrowing
      and
      addressed to the Agent and all Lenders, from Katten Muchin Zavis Rosenman,
      counsel to the Borrower and its Subsidiaries, substantially in the form of
      Exhibit
      H
      hereto.

     

    SECTION
      5.1.9   Agreements.
      The
      Agent shall have received true and correct copies, certified as such by an
      Authorized Officer of the Borrower, of each agreement governing Indebtedness
      listed on Schedule
      6.17.

     

    SECTION
      5.1.10   Closing
      Fees, Expenses, etc.
      The
      Agent shall have received for its own account, or for the account of each
      Lender, as the case may be, all fees, costs and expenses due and payable on
      the
      Original Closing Date pursuant to Section
      3.3
      and, to
      the extent invoiced on such date, Section
      10.3.

     

    SECTION
      5.2   All
      Borrowings and Letters of Credit.
      The
      obligation of each Lender to fund any Loan on the occasion of any Borrowing
      (including the initial Borrowing) and the obligation of the Letter of Credit
      Issuer to issue any Letter of Credit shall be subject to the satisfaction of
      each of the conditions precedent set forth in this Section
      5.2.

     

    SECTION
      5.2.1   Compliance
      with Warranties, No Default, etc.
      Both
      before and after giving effect to any Borrowing (but, if any Default of the
      nature referred to in Section
      8.1.5
      shall
      have occurred with respect to any other Indebtedness, without giving effect
      to
      the application, directly or indirectly, of the proceeds thereof) the following
      statements shall be true and correct:

     

    (a) the
      representations and warranties set forth in Article
      VI
      shall be
      true and correct with the same effect as if then made (unless stated to relate
      solely to an early date, in which case such representations and warranties
      shall
      be true and correct as of such earlier date); 

    

    (b) no
      Default or Event of Default shall have then occurred and be continuing;
      and

     

    (c) the
      Borrower shall have been in compliance with the minimum EBITDA requirements
      of
Section
      7.2.4(d)
      for the
      Fiscal Quarter most recently ended.

    

    SECTION
      5.2.2   Borrowing
      Request; LC Notice.
      The
      Agent shall have received a Borrowing Request for such Borrowing or LC Notice
      for the issuance of a Letter of Credit. Each of the delivery of a Borrowing
      Request or LC Notice, as the case may be, and the acceptance by the Borrower
      of
      the proceeds of such Borrowing or the issuance of such Letter of Credit, as
      the
      case may be, shall constitute a representation and warranty by the Borrower
      that
      on the date of such Borrowing or the issuance of such Letter of Credit, as
      the
      case may be (both immediately before and after giving effect to such Borrowing
      and the application of the proceeds thereof or the issuance of such Letter
      of
      Credit, as the case may be,) the statements made in Section
      5.2.1
      are true
      and correct.

     

    SECTION
      5.2.3   Satisfactory
      Legal Form.
      All
      documents executed or submitted pursuant hereto by or on behalf of each Credit
      Party shall be reasonably satisfactory in form and substance to the Agent and
      its counsel; the Agent and its counsel shall have received all information,
      approvals, opinions, documents or instruments as the Agent or its counsel may
      reasonably request.

     

    
      
        
        

      

      
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    SECTION
      5.3   Conditions
      to Fifth Amended and Restated Effective Date.
      This
      Agreement shall become effective upon the later of June __, 2006 and the date
      of
      the satisfaction of each of the following (the “Fifth
      Amended and Restated Effective Date”):

     

    SECTION
      5.3.1   Executed
      Signature Pages to Agreement.
      Execution of this Agreement and delivery of executed signature pages to this
      Agreement by the Borrower, each Lender and the Agent.

     

    SECTION
      5.3.2   Executed
      Reaffirmation of Collateral Documents.
      Execution
      of the Reaffirmation of Collateral Documents by the Borrower and each Subsidiary
      Guarantor and delivery of the signature pages executed by the Borrower and
      each
      Subsidiary Guarantor to the Reaffirmation of Collateral Documents to the
      Agent.

     

    SECTION
      5.3.3   Payment
      of Fees and Expenses.
      Payment
      by the Borrower to the Agent of all reasonable out of pocket fees and expenses
      (including, without limitation, the reasonable fees and expenses of Winston
      & Strawn) of the Agent and the Lenders in connection with this
      Agreement.

     

    SECTION
      5.3.4   Resolutions,
      etc.
      The
      Agent shall have received from each Credit Party a certificate, dated as of
      the
      Fifth Amended and Restated Effective Date, of its Secretary or Assistant
      Secretary as to:

     

    (a) resolutions
      of its Board of Directors then in full force and effect authorizing the
      execution, delivery and performance of this Agreement and each other Loan
      Document to be executed by it; and

    

    (b) the
      incumbency and signatures of those of its officers authorized to act with
      respect to this Agreement and each other Loan Document executed by
      it;

    

    upon
      which certificate each Lender may conclusively rely until it shall have received
      a further certificate of the Secretary of such Credit Party canceling or
      amending such prior certificate.

     

    SECTION
      5.3.5   Certificate.

     

    A
      certificate signed by the chief financial officer or chief executive officer
      of
      the Borrower, dated as of the Fifth Amended and Restated Effective Date and
      after giving effect to this Agreement:

     

    (i) stating
      that the representations and warranties contained in Article
      VI
      are true
      and correct on and as of such date as though made on and as of such date;
      and

    (ii)
stating
      that no Default or Event of Default exists.

     

                        SECTION
      5.3.6   Updated
      Disclosure Schedules. 

     

    
      
        
        

      

      
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    A
      certificate signed by the chief financial officer or chief executive officer
      of
      the Borrower dated as of the Fifth Amended and Restated Effective Date,
      proposing any necessary changes to the Schedules to this Agreement in form
      and
      substance reasonably satisfactory to the Agent occurring after the Original
      Closing Date.

     

    SECTION
      5.3.7   Officer's
      Certificate of In-House Counsel.

     

    An
      officer's certificate of the in-house legal counsel of the Borrower on behalf
      of
      the Borrower and other Credit Parties dated as of the Fifth Amended and Restated
      Effective Date in form and substance satisfactory to the Agent.

     

    SECTION
      5.3.8   Amended
      and Restated Promissory Notes.
      Borrower shall have delivered to Agent on behalf of each of the Lenders,
      executed amended and restated promissory notes reflecting such Lender's
      Revolving Commitment Amount as of the Fifth Amended and Restated Effective
      Date.

     

    SECTION
      5.3.9   Other
      Documents.

     

    Such
      other customary approvals, opinions, documents or materials as the Agent may
      reasonably request.

     

    ARTICLE
      VI  

     

    REPRESENTATIONS
      AND WARRANTIES

     

    In
      order
      to induce the Lenders and the Agent to enter into this Agreement and to make
      Loans hereunder, the Borrower represents and warrants unto the Agent and each
      Lender as set forth in this Article
      VI.

     

    SECTION
      6.1   Organization,
      etc.
      The
      Borrower and each of its Subsidiaries is validly organized and existing and
      in
      good standing under the laws of the State of its organization, is duly qualified
      to do business and is in good standing as a foreign corporation in each
      jurisdiction where the nature of its business requires such qualification,
      and
      has full power and authority and holds all requisite governmental licenses,
      permits and other approvals to enter into and perform its Obligations under
      this
      Agreement, the Notes and each other Loan Document to which it is a party and
      to
      own and hold under lease its property and to conduct its business substantially
      as currently conducted by it.

     

    SECTION
      6.2   Due
      Authorization, Non-Contravention, etc.
      The
      execution, delivery and performance by the Borrower and each of its Subsidiaries
      of this Agreement, the Notes and each other Loan Document executed or to be
      executed by it, are within each such Credit Party’s powers, have been duly
      authorized by all necessary corporate action, and do not:

     

    (a) contravene
      such Credit Party’s Organizational Documents;

     

    (b) contravene
      any contractual restriction, law or governmental regulation or court decree
      or
      order binding on or affecting such Credit Party, which contravention reasonably
      would be expected to have a Material Adverse Effect; or

     

    
      
        
        

      

      
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    (c) result
      in, or require the creation or imposition of, any Lien on any of such Credit
      Party’s properties other than a Permitted Lien.

     

    SECTION
      6.3   Government
      Approval, Regulation, etc.
      No
      authorization or approval or other action by, and no notice to or filing with,
      any governmental authority or regulatory body or other Person is required for
      the due execution, delivery or performance by any Credit Party, including,
      without limitation, the Borrower, of this Agreement, the Notes or any other
      Loan
      Document to which it is a party, other than as described in Schedule
      6.3
      which
      have been obtained or delivered on or prior to the Fifth Amended and Restated
      Effective Date. Neither the Borrower nor any of its Subsidiaries, is an
“investment company” within the meaning of the Investment Company Act of 1940,
      as amended, or a “holding company”, or a “subsidiary company” of a “holding
      company”, or an “affiliate” of a “holding company” or of a “subsidiary company”
of a “holding company”, within the meaning of the Public Utility Holding Company
      Act of 2005, as amended.

     

    SECTION
      6.4   Validity,
      etc.
      This
      Agreement constitutes, and the Notes and each other Loan Document executed
      by
      each Credit Party thereto will, on the due execution and delivery thereof,
      constitute, the legal, valid and binding obligations of such Credit Party
      enforceable in accordance with their respective terms, except that the validity
      or enforceability of any such Loan Document may be limited by bankruptcy,
      insolvency, reorganization, moratorium or other similar laws affecting the
      enforceability of creditors’ rights generally or by equitable principles,
      whether enforcement thereof is sought in a court of law or equity.

     

    SECTION
      6.5   Financial
      Information.
      The
      audited financial statements of the Borrower and its Subsidiaries on a
      consolidated basis as of December 31, 2005, and the unaudited financial
      statements of the Borrower and its Subsidiaries on a consolidated basis as
      of
      March 31, 2006, copies of which have been furnished to the Agent and each
      Lender, have been prepared in accordance with GAAP consistently applied (subject
      to ordinary, good faith year end audit adjustments), and present fairly the
      consolidated financial position of the Persons covered thereby as at the dates
      thereof and the results of their operations for the periods then
      ended.

     

    SECTION
      6.6   No
      Material Adverse Change.
      Since
      December 31, 2005, there has been no material adverse change in the financial
      condition, operations, assets, business, properties or prospects of the Borrower
      and its Subsidiaries taken as a whole.

     

    SECTION
      6.7   Litigation,
      Labor Controversies, etc.
      There
      is no pending or, to the knowledge of the Borrower, threatened litigation,
      action, proceeding, or labor controversy affecting any Credit Party, or any
      of
      their respective properties, businesses, assets or revenues, or any Person
      who
      provided health care services under contract with any Credit Party, which
      reasonably would be expected to have a Material Adverse Effect or which purports
      to affect the legality, validity or enforceability of this Agreement, the Notes
      or any other Loan Document. 

     

    SECTION
      6.8   Subsidiaries.
      (a) The
      Borrower has no Subsidiaries, except those Subsidiaries:

     

    (i) which
      are
      identified in Schedule
      6.8;
      or

    

    
      
        
        

      

      
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    (ii) which
      are
      permitted to have been formed or acquired by the Borrower in accordance with
      Section
      7.1.12, 7.2.5
      or
7.2.8.

    

    SECTION
      6.9   Ownership
      of Properties.
      The
      Borrower and each of its Subsidiaries owns good and marketable title (or valid
      leasehold title, with respect to leasehold estates) to all of its properties
      and
      assets, real and personal, tangible and intangible, of any nature whatsoever
      (including patents, trademarks, trade names, service marks and copyrights),
      free
      and clear of all Liens, charges or claims (including infringement claims with
      respect to patents, trademarks, copyrights and the like) except as permitted
      pursuant to Section
      7.2.3.

     

    SECTION
      6.10   Taxes.
      Except
      as described on Schedule 6.10, the Borrower and each of its Subsidiaries has
      filed all tax returns and reports required by law to have been filed by it
      and
      has paid all taxes and governmental charges thereby shown to be owing, except
      any such taxes or charges which are being diligently contested in good faith
      by
      appropriate proceedings and for which adequate reserves in accordance with
      GAAP
      shall have been set aside on its books.

     

    SECTION
      6.11   Pension
      and Welfare Plans.
      During
      the twelve-consecutive-month period prior to the Fifth Amended and Restated
      Effective Date and prior to the date of any Borrowing hereunder, no steps have
      been taken to terminate any Pension Plan, and no contribution failure has
      occurred with respect to any Pension Plan sufficient to give rise to a Lien
      under Section 302(f) of ERISA. No condition exists or event or transaction
      has
      occurred with respect to any Pension Plan which reasonably would be expected
      to
      result in the incurrence by the Borrower or any member of the Controlled Group
      of any material liability, fine or penalty. Neither the Borrower nor any member
      of the Controlled Group has any contingent liability with respect to any
      post-retirement benefit under a Welfare Plan, other than liability for
      continuation coverage described in Part 6 of Title I of ERISA.

     

    SECTION
      6.12   Environmental
      Warranties.
      (a)
      All
      facilities and property (including underlying groundwater) owned or leased
      by
      the Borrower or any of its Subsidiaries have been, and continue to be, owned
      or
      leased by the Borrower and its Subsidiaries in material compliance with all
      applicable Environmental Laws.

     

    (b) There
      have been no past (which have not been remedied or resolved), and there are
      no
      pending or, to the best knowledge of the Borrower, threatened:

     

    (i)
      claims,
      complaints, notices or requests for information received by the Borrower or
      any
      of its Subsidiaries with respect to any alleged material violation of any
      Environmental Law, or

     

    (ii)
      complaints, notices or inquiries to the Borrower or any of its Subsidiaries
      regarding potential material liability under any Environmental Law.

     

    (c) There
      have been no Releases of Hazardous Materials at, on or under any property now
      or
      previously owned or leased by the Borrower or any of its Subsidiaries that,
      singly or in the aggregate, have, or would reasonably be expected to have,
      a
      Material Adverse Effect.

     

    
      
        
        

      

      
        43

        
          

        

      

      
        
        

      

    

    (d) The
      Borrower and its Subsidiaries have been issued and are in material compliance
      with all material permits, certificates, approvals, licenses and other material
      authorizations relating to environmental matters and necessary or desirable
      for
      their businesses.

     

    (e) No
      property now or previously owned or leased by the Borrower or any of its
      Subsidiaries is listed or proposed for listing (with respect to owned property
      only) on the National Priorities List pursuant to CERCLA, on the CERCLIS or
      on
      any similar state list of sites requiring investigation or
      clean-up.

     

    (f) There
      are
      no underground storage tanks, active or abandoned, including petroleum storage
      tanks, on or under any property now or previously owned or leased by the
      Borrower or any of its Subsidiaries.

     

    (g) Neither
      the Borrower nor any of its Subsidiaries has directly transported or directly
      arranged for the transportation of any Hazardous Material to any location which
      is listed or proposed for listing on the National Priorities List pursuant
      to
      CERCLA, on the CERCLIS or on any similar state list or which is the subject
      of
      federal, state or local enforcement actions or other investigations which
      reasonably would be expected to lead to material claims against the Borrower
      or
      such Subsidiary thereof for any remedial work, damage to natural resources
      or
      personal injury, including claims under CERCLA.

     

    (h) To
      the
      best of the Borrower’s knowledge after due inquiry, there are no polychlorinated
      biphenyls or friable asbestos present at any property now or previously owned
      or
      leased by the Borrower or any of its Subsidiaries.

     

    (i) No
      conditions exist at, on or under any property now or previously owned or leased
      by the Borrower or any of its Subsidiaries which, with the passage of time,
      or
      the giving of notice or both, reasonably would be expected to give rise to
      any
      material liability under any Environmental Law.

     

    SECTION
      6.13   Regulations
      T, U and X.
      Neither
      the Borrower nor any of its Subsidiaries is engaged in the business of extending
      credit for the purpose of purchasing or carrying margin stock, and no proceeds
      of any Loans or any Letter of Credit will be used for a purpose which violates,
      or would be inconsistent with, F.R.S. Board Regulation U or X. Terms for which
      meanings are provided in F.R.S. Board Regulation T, U or X or any regulations
      substituted therefor, as from time to time in effect, are used in this Section
      with such meanings.

     

    SECTION
      6.14   Accuracy
      of Information.
      All
      factual information heretofore or contemporaneously furnished by or on behalf
      of
      any Credit Party in writing to the Agent or any Lender for purposes of or in
      connection with this Agreement or any transaction contemplated hereby is, and
      all other such factual information hereafter furnished by or on behalf of any
      Credit Party to the Agent or any Lender will be, true and accurate in every
      material respect on the date as of which such information is dated or certified
      and as of the date of execution and delivery of this Agreement by the Agent
      and
      such Lender, and such information is not, or shall not be, as the case may
      be,
      incomplete by omitting to state any material fact necessary to make such
      information not misleading.

     

    
      
        
        

      

      
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    SECTION
      6.15   Solvency.
      As of
      the Fifth Amended and Restated Effective Date, after giving effect to the
      consummation of the transaction contemplated by the Loan Documents and the
      payment of all fees, costs and expenses payable by the Borrower with respect
      to
      the transactions contemplated by the Loan Documents, the Borrower and its
      Subsidiaries are Solvent on a consolidated basis.

     

    SECTION
      6.16   Collateral
      Documents.
      (a)
      Subject to the provisions of clause (b) below with respect to the requirement
      of
      the Agent to maintain possession as the Pledged Collateral, the provisions
      of
      each of the Collateral Documents are effective to create in favor of the Agent
      for the benefit of the Lenders and the Agent, a legal, valid and enforceable
      first priority security interest in all right, title and interest of each Credit
      Party in the Collateral described therein; and financing statements have been
      filed in the offices in all of the jurisdictions listed in the schedule to
      the
      Borrower Security Agreement and the Guarantor Security Agreement, and each
      Intellectual Property Assignment has been filed in the U.S. Patent and Trademark
      Office and the U.S. Copyright Office.

     

    (b) The
      provisions of the Borrower Pledge Agreement and the Guarantor Pledge Agreement
      are effective to create, in favor of the Agent for the benefit of the Lenders
      and the Agent, a legal, valid and enforceable first priority security interest
      in all of the Collateral described therein; and the Pledged Collateral was
      delivered to the Agent or its nominee in accordance with the terms thereof.
      The
      Lien of the Borrower Pledge Agreement and the Guarantor Pledge Agreement
      constitutes a perfected, first priority security interest in all right, title
      and interest of the Credit Party thereto in the Pledged Collateral described
      therein, prior and superior to all other Liens and interests, provided the
      Agent
      maintains possession of the Pledged Collateral for the term of each such
      Borrower Pledge Agreement or Guarantor Pledge Agreement, as
      applicable.

     

    (c) All
      representations and warranties of each Credit Party contained in the Collateral
      Documents are true and correct as of the date on which made, except to the
      extent such representations pertain to a prior date, in which case such
      representations and warranties are true and correct as of such prior
      date.

     

    SECTION
      6.17   Indebtedness.
      Attached hereto as Schedule
      6.17
      is a
      complete and correct list of all Indebtedness of the Borrower and its
      Subsidiaries outstanding on the Fifth Amended and Restated Effective Date,
      showing the aggregate principal amount which was outstanding on such date.
      The
      Borrower has delivered or caused to be delivered to the Agent a true and
      complete copy of each instrument evidencing any Indebtedness listed on
Schedule
      6.17
      and of
      each document pursuant to which any of such Indebtedness was
      issued.

     

    SECTION
      6.18   Other
      Agreements/Program Eligibility.
      Neither
      the Borrower nor any of its Subsidiaries (and to the knowledge of the Borrower's
      officers, no Minority ASC Entity) is in default in the performance, observance
      or fulfillment of any obligation, covenant or condition contained in or
      applicable with respect to any Medicaid Provider Agreement, Medicare Provider
      Agreement, other agreement or instrument to which the Borrower or a Subsidiary
      is a party with a third party payor, or participation in Medicare, Medicaid
      or
      any other third-party payor program in which the Borrower or a Subsidiary
      participates, which default, if not remedied within any applicable grace period,
      reasonably would be expected to (A) in the case of any Medicaid Provider
      Agreement or third party payor agreement other than a national third party
      payor
      agreement (i) result in the revocation, termination, cancellation,
      suspension or non-renewal of Medicaid Certification, any similar certification
      of a material third party not involved in a national third party payor
      agreement, if any, a Medicaid Provider Agreement or agreement with a third
      party
      payor which is not party to a national third party payor program with the
      Borrower or any Subsidiary of the Borrower, or eligibility to participate,
      directly or indirectly, in Medicaid or material third party payor programs
      which
      are not national third party payor programs of the Borrower and its
      Subsidiaries, and (ii) have a Material Adverse Effect, or (B) in the case
      of any Medicare Provider Agreement or material national third party payor
      agreement, (i) result in the revocation, termination, cancellation,
      suspension or non-renewal of Medicare Certification, any similar certification
      of a material national third party payor contract or agreement, a Medicare
      Provider Agreement or material national agreement with a third party payor,
      or
      eligibility to participate, directly or indirectly, in Medicare or material
      national third party payor programs and (ii) have a Material Adverse
      Effect.

     

    
      
        
        

      

      
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    SECTION
      6.19   Reimbursement
      from Third Party Payors.
      The
      accounts receivable of the Borrower and each of its Subsidiaries (and to the
      knowledge of the Borrower's officers, each Minority ASC Entity) have been and
      will continue to be adjusted reasonably to reflect reimbursement experiences
      with and policies of third party payors such as Medicare, Medicaid, Blue
      Cross/Blue Shield, private insurance companies, health maintenance
      organizations, preferred provider organizations, alternative delivery systems,
      managed care systems, government contracting agencies and other third party
      payors. In particular, accounts receivable relating to such third party payors
      do not and shall not exceed amounts any obligee is entitled to receive under
      any
      capitation arrangement, fee schedule, discount formula, cost-based reimbursement
      or other adjustment or limitation to its usual charges.

     

    SECTION
      6.20   Legal
      Compliance.
      The
      Borrower and each of its Subsidiaries (and to the knowledge of the Borrower's
      officers, each Minority ASC Entity) have duly complied and are in compliance
      with all Fraud and Abuse Laws; all applicable state laws and regulations
      regarding certificate of need and state licensure; HIPAA and state laws and
      regulations regarding privacy; and all other requirements, restrictions and
      prohibitions of law, including, without limitation, any statute, law, treaty,
      rule, regulation, manual, guideline, rule of professional conduct, or order,
      decree, writ, injunction or other determination of an arbitrator, court or
      other
      governmental authority, in each case applicable to or binding upon such Person
      or any of its property or to which such person or its property is subject and
      having the force of law, other than those noncompliance with which would not
      reasonably be expected to have a Material Adverse Effect. 

     

    SECTION
      6.21   Licensing
      and Accreditation.
      Each of
      the Borrower and each of its Subsidiaries (and to the knowledge of the
      Borrower's officers, each Minority ASC Entity) has, to the extent applicable
      (A), (i) obtained (or been duly assigned) all required certificates of need
      (other than as described on Schedule
      6.21)
      or
      determinations of need, as required by the relevant state governmental
      authority, for the acquisition, construction, expansion of, investment in or
      operation of its businesses or facilities as currently operated;
      (ii) obtained and maintains in good standing all required licenses; (iii)
      to the extent customary in the industry and geographic market in which it is
      engaged, obtained and maintains accreditation from all generally recognized
      accrediting agencies; (iv) obtained and maintains Medicaid Certification,
      Medicare Certification and any similar third party payor certification, if
      any;
      and (v) entered into and maintains in good standing, if applicable, its Medicaid
      Provider Agreement and its agreements with third party payors, the failure
      of
      any of which has, or could reasonably be expected to have, a Material Adverse
      Effect; and (B) (i) obtained and maintains Medicare Certification where the
      failure to obtain or maintain could reasonably be expected to have a Material
      Adverse Effect and (ii) entered into and maintains in good standing its Medicare
      Provider Agreement where the failure to enter into and maintain has, or could
      reasonably be expected to have a Material Adverse Effect.

     

    
      
        
        

      

      
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    SECTION
      6.22   Subordination
      Provisions.
      The
      subordination provisions contained in all notes, debentures and other
      instruments entered into or issued in respect of Subordinated Debt are
      enforceable against the issuer of the respective security and the holders
      thereof in accordance with their respective terms, and the Loans and all other
      Obligations are within the definitions of “Senior Indebtedness”, or other
      comparable definition, included in such provisions.

     

    SECTION
      6.23   RICO.
      None of
      the Borrower nor any of its Subsidiaries is engaged in or has engaged in any
      course of conduct that reasonably would be expected to subject any of their
      respective properties to any Lien, seizure or other forfeiture under any
      criminal law, racketeer influenced and corrupt organizations law, civil or
      criminal, or other similar laws.

     

    ARTICLE
      VII

     

    COVENANTS

     

    SECTION
      7.1   Affirmative
      Covenants.
      The
      Borrower agrees with the Agent and each Lender that, until all Revolving
      Commitments have terminated and all Obligations have been paid and performed
      in
      full, each Credit Party will perform the obligations set forth in this
Section
      7.1
      applicable to such Credit Party.

     

    SECTION
      7.1.1   Financial
      Information, Reports, Notices, etc.
      The
      Borrower will furnish, or will cause to be furnished, to each Lender and the
      Agent copies of the following financial statements, reports, notices and
      information:

     

    (a) as
      soon
      as available and in any event within 45 days after the end of each of the first
      three Fiscal Quarters (commencing with the Fiscal Quarter ending June 30, 2003)
      of each Fiscal Year of the Borrower, to the extent prepared to comply with
      SEC
      requirements, a copy of the SEC Form 10-Qs filed by the Borrower with the SEC
      for each such quarterly period, or if no such Form 10-Q was so filed by the
      Borrower with respect to any such quarterly period, consolidated balance sheets
      of the Borrower and its Subsidiaries as of the end of such Fiscal Quarter and
      consolidated statements of earnings and cash flow of the Borrower and its
      Subsidiaries for such Fiscal Quarter and for the period commencing at the end
      of
      the previous Fiscal Year and ending with the end of such Fiscal Quarter,
      certified by the Authorized Officer of the Borrower;

     

    (b) as
      soon
      as available and in any event within 90 days after the end of each Fiscal Year
      of the Borrower, to the extent prepared to comply with SEC requirements, a
      copy
      of the SEC Form 10-K filed by the Borrower with the SEC for such fiscal year,
      or, if no such Form 10-K was so filed by the Borrower for such fiscal year,
      a
      copy of the annual audit report for such Fiscal Year for the Borrower and its
      Subsidiaries including therein consolidated balance sheets of the Borrower
      and
      its Subsidiaries as of the end of such Fiscal Year and consolidated statements
      of earnings and cash flow of the Borrower and its Subsidiaries for such Fiscal
      Year, certified (without any Impermissible Qualification) by Borrower’s
      independent public accountants;

     

    
      
        
        

      

      
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    (c) within
      five business days of becoming available and in any event within 200 days after
      the end of each Fiscal Year, a copy of the management letter (or other
      correspondence from Borrower's independent public accountants reasonably
      satisfactory to Agent) delivered to Borrower by Borrower’s independent public
      accountants in connection with the audit of Borrower’s financial statements for
      such previous Fiscal Year;

     

    (d) as
      soon
      as available and in any event within 45 days after the end of each of the first
      three Fiscal Quarters during a Fiscal Year, and within 90 days after the end
      of
      each Fiscal Year, a certificate, executed by the chief financial officer and/or
      principal accounting officer of the Borrower, showing (in reasonable detail
      and
      with appropriate calculations and computations in all respects satisfactory
      to
      the Agent) compliance with the financial covenants set forth in Section
      7.2.4.;

     

    (e) as
      soon
      as possible and in any event within three Business Days after the occurrence
      of
      each Default, a statement of the chief financial officer and/or principal
      accounting officer of the Borrower setting forth details of such Default and
      the
      action which the Borrower has taken and proposes to take with respect
      thereto;

     

    (f) as
      soon
      as possible and in any event within three Business Days after (x) the occurrence
      of any adverse development with respect to any litigation, action, proceeding,
      or labor controversy described in Section
      6.7
      or (y)
      the commencement of any labor controversy, litigation, action, proceeding of
      the
      type described in Section
      6.7,
      any of
      which reasonably would be expected to have a Material Adverse Effect, notice
      thereof and copies of all documentation relating thereto;

     

    (g) promptly,
      but not later than five days after the date of filing with the SEC, copies
      of
      all financial statements and reports that Borrower sends to its shareholders,
      and copies of all financial statements and regular, periodical or special
      reports (including Forms 10-K and 10-Q) that Borrower or any of its Subsidiaries
      may make to, or file with, the SEC (including, without limitation, pursuant
      to
Section
      7.2.9(b))
      or any
      national securities exchange;

     

    (h) immediately
      upon becoming aware of the institution of any steps by the Borrower or any
      other
      Person to terminate any Pension Plan, or the failure to make a required
      contribution to any Pension Plan if such failure is sufficient to give rise
      to a
      Lien under Section 302(f) of ERISA, or the taking of any action with respect
      to
      a Pension Plan which reasonably would be expected to result in the requirement
      that the Borrower furnish a bond or other security to the PBGC or such Pension
      Plan, or the occurrence of any event with respect to any Pension Plan which
      reasonably would be expected to result in the incurrence by the Borrower of
      any
      material liability, fine or penalty, or any material increase in the contingent
      liability of the Borrower with respect to any post-retirement Welfare Plan
      benefit, notice thereof and copies of all documentation relating
      thereto;

     

    
      
        
        

      

      
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    (i) immediately
      upon becoming aware of any dispute, litigation or other proceedings being
      instituted against any Credit Party to suspend, revoke or terminate any Medicaid
      Provider Agreement, Medicaid Certification, Medicare Provider Agreement,
      Medicare Certification, eligibility to participate in Medicare or Medicaid,
      or
      agreement with or certification by, if any, or eligibility to participate in
      a
      program of a third party payor, or any subpoena or investigation by a
      governmental authority, including without limitation CMS, the Office of
      Inspector General of the Department of Health and Human Services, and the
      Department of Justice, which suspension, revocation, termination or the results
      of such subpoena or investigation reasonably would be expected to have a
      Material Adverse Effect, promptly deliver to the Agent written notice thereof
      stating the nature and status of such litigation, dispute, proceeding, levy,
      execution, subpoena or investigation or other process; or any proceeding
      instituted against any Credit Party, or any of their respective officers,
      directors, members or managers to exclude any of them from participation in
      any
      Federal or State healthcare program; and

     

    (j) such
      other information respecting the condition or operations, financial or
      otherwise, of the Borrower or any of its Subsidiaries as any Lender through
      the
      Agent may from time to time reasonably request. To the extent that any
      information to be disclosed hereunder is “protected health information” as
      defined under HIPAA, the Borrower and its Subsidiaries shall disclose such
      information pursuant to the Business Associate Agreement between it and the
      Lenders to which it is a party and under its “health care operations” (as
      defined in HIPAA and no Credit Party that is a “covered entity" under HIPAA
      shall by contract prohibit disclosure of its protected Health Information to
      Lenders that is not otherwise prohibited by HIPAA.

     

    SECTION
      7.1.2   Compliance
      with Laws, etc.
      (a) The
      Borrower will, and will cause each of its Subsidiaries to, comply in all
      material respects with all Fraud and Abuse Laws; all applicable laws, rules,
      regulations and orders (including, without limitation, Medicare Regulations,
      Medicaid Regulations and the rules and regulations established by any third
      party payor), and all applicable corporate laws including without
      limitation:

     

    (i)  the
      maintenance and preservation of its corporate existence and qualification as
      a
      foreign corporation, except to the extent no longer necessary within the
      reasonable business judgment of the Borrower or such Subsidiary, as applicable,
      or if otherwise terminated pursuant to a transaction consummated in accordance
      with the provisions of Section
      7.2.8;
      and

     

    (ii)  the
      payment, before the same become delinquent, of all taxes, assessments and
      governmental charges imposed upon it or upon its property except to the extent
      being diligently contested in good faith by appropriate proceedings and for
      which adequate reserves in accordance with GAAP shall have been set aside on
      its
      books.

     

    
      
        
        

      

      
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    (iii) compliance
      in all material respects with all federal and state laws and regulations
      applicable to health care including, all Fraud and Abuse Laws, all laws relating
      to licensure, certificate of need, state privacy laws and HIPAA.

     

    (b)
      the
      Borrower will further use its commercially reasonable efforts, subject to
      applicable laws to assure the compliance in all material respects by all
      Minority ASC Entities with all applicable laws, including, but not limited
      to
      all federal and state laws and regulations applicable to health care including,
      all Fraud and Abuse Laws, all laws relating to licensure, certificate of need
      and HIPAA.

     

    SECTION
      7.1.3   Maintenance
      of Properties.
      The
      Borrower will, and will cause each of its Subsidiaries to, maintain, preserve,
      protect and keep its properties in good repair, working order and condition,
      and
      make necessary and proper repairs, renewals and replacements so that its
      business carried on in connection therewith may be properly conducted at all
      times unless the Borrower determines in good faith that the continued
      maintenance of any of its properties is no longer economically
      desirable.

     

    SECTION
      7.1.4   Insurance.
      (a)
Schedule
      7.1.4
      sets
      forth as of the date of this Agreement a true and complete listing of all
      insurance maintained by the Borrower and each of its Subsidiaries and each
      Minority ASC Entity. The Borrower will, and will cause each of its Subsidiaries
      to, maintain or cause to be maintained with responsible insurance companies
      insurance with respect to its properties and business (including professional
      liability insurance, comprehensive liability insurance and business interruption
      insurance) against at least such casualties and contingencies and of at least
      such types and in at least such amounts as are commercially reasonable which
      insurance shall name the Agent as loss payee and an additional insured, and
      will, upon request of the Agent, furnish to each Lender at reasonable intervals
      (provided that, so long as no Event of Default shall have occurred and be
      continuing, no such certification shall be required to be delivered more than
      once in any Fiscal Year) a certificate of an Authorized Officer of the Borrower
      setting forth the nature and extent of all insurance maintained by the Borrower
      and its Subsidiaries in accordance with this Section.

     

    (b)
      The
      Borrower will use commercially reasonable efforts to cause each Practice to
      maintain medical malpractice insurance at commercially reasonable
      levels.

     

    SECTION
      7.1.5   Books
      and Records.
      The
      Borrower will, and will cause each of its Subsidiaries to, keep books and
      records which accurately reflect all of its business affairs and transactions
      and permit the Agent and each Lender or any of their respective representatives,
      at reasonable times and intervals, upon, so long as no Event of Default shall
      exist and be continuing, reasonable prior notice delivered during regular
      business hours, to visit all of its offices, to discuss its financial matters
      with its officers and independent public accountant (and the Borrower hereby
      authorizes such independent public accountant to discuss the Borrower’s
      financial matters with each Lender or its representatives, provided, so long
      as
      no Event of Default shall exist or be continuing, a representative of the
      Borrower is present) and to examine (and, at the expense of the Borrower,
      photocopy extracts from) any of its books or other corporate records. The
      Borrower shall pay any fees of such independent public accountant incurred
      in
      connection with the Agent’s or any Lender’s exercise of its rights pursuant to
      this Section provided, however, that so long as no Event of Default shall exist
      and be continuing, the Borrower shall not be liable for the fees and expenses
      of
      such independent public accountant related to more than one visit during any
      Fiscal Year. All visits conducted pursuant to this Section
      7.1.5
      shall be
      conducted in such a manner so as not to disrupt the business operations of
      the
      applicable office. All information obtained during any such visit shall be
      subject to the provisions of Section
      10.12.

     

    
      
        
        

      

      
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    SECTION
      7.1.6   Environmental
      Covenant.
      The
      Borrower will, and will cause each of its Subsidiaries to:

     

    (a) use
      and
      operate all of its facilities and properties in material compliance with all
      Environmental Laws, keep all necessary material permits, approvals,
      certificates, licenses and other authorizations relating to environmental
      matters in effect and remain in material compliance therewith, and handle all
      Hazardous Materials in material compliance with all applicable Environmental
      Laws;

     

    (b) immediately
      notify the Agent and provide copies upon receipt of all written material claims,
      complaints, notices or inquiries relating to, the condition of its facilities
      and properties or compliance with Environmental Laws, and shall promptly cure
      and have dismissed with prejudice to the reasonable satisfaction of the Agent
      any actions and proceedings relating to compliance with Environmental Laws;
      and

     

    (c) provide
      such information and certifications which the Agent may reasonably request
      from
      time to time to evidence compliance with this Section
      7.1.6.

    

    SECTION
      7.1.7   Changes
      to Certain Agreements.
      Without
      the prior written consent of the Required Lenders, no Credit Party shall make
      any amendment, supplement or modification to any agreements evidencing
      Subordinated Debt; provided, however, that any such amendment which conforms
      with applicable law in all material respects and is not materially adverse
      to
      the interests of the Lenders as Lenders under the Loan Documents shall be
      permitted without any consent. Copies of such amended agreements shall be
      delivered promptly to the Agent by the Borrower.

     

    SECTION
      7.1.8   Governmental
      Licenses.
      The
      Borrower will, and will cause each of its Subsidiaries to, obtain and maintain
      all material licenses, certificates of need, other applicable permits,
      agreements, certifications and approvals of all applicable governmental
      authorities as are required for the conduct of its business as currently
      conducted and herein contemplated, Medicaid Certifications and Medicaid Provider
      Agreements and Medicare Certifications and Medicare Provider Agreements and
      certifications of third party payors the failure of which has, or could
      reasonably be expected to have, a Material Adverse Effect.

     

    SECTION
      7.1.9   Covenants
      Extending to Other Persons.
      The
      Borrower will, and will cause each of its Subsidiaries to, use its commercially
      reasonable efforts, in accordance with applicable law (which shall include,
      without limitation, the exercise of contractual rights and remedies available
      to
      the Borrower and its Subsidiaries) to cause each Non-Wholly Owned ASC
      Subsidiary, Minority ASC Entity, Practice or Provider, as appropriate to do
      with
      respect to itself, its business and its assets, each of the things required
      of a
      Credit Party in Sections
      7.1.2
      through
7.1.8
      inclusive, subject, however, in the case of Section
      7.1.5
      to any
      laws, rules or regulations concerning the confidentiality of medical
      records.

     

    
      
        
        

      

      
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    SECTION
      7.1.10   Solvency.
      The
      Borrower and its Subsidiaries on a consolidated basis shall at all times be
      Solvent.

     

    SECTION
      7.1.11   Further
      Assurances.
      (a)
      The
      Borrower shall ensure that all written information, exhibits and reports
      furnished to the Agent or the Lenders do not and will not contain any untrue
      statement of a material fact and do not and will not omit to state any material
      fact or any fact necessary to make the statements contained therein not
      misleading in light of the circumstances in which made, and will promptly
      disclose to the Agent and the Lenders and correct any defect or error that
      may
      be discovered therein or in any Loan Document or in the execution,
      acknowledgment or recordation thereof.

     

    (b) Promptly
      upon request of the Agent or the Required Lenders, the Borrower shall (and
      shall
      cause any of its Subsidiaries to) execute, acknowledge, deliver, record,
      re-record, file, re-file, register and re-register, any and all such further
      acts, deeds, conveyances, security agreements, mortgages, assignments, estoppel
      certificates, financing statements and continuations thereof, termination
      statements, notices of assignment, transfers, certificates, assurances and
      other
      instruments the Agent or such Lenders, as the case may be, may reasonably
      require from time to time in order (i) to carry out more effectively the
      purposes of this Agreement or any other Loan Document, (ii) to subject any
      of
      the properties, rights or interests covered by any of the Collateral Documents
      to the Liens intended to be created by any of the Collateral Documents, (iii)
      to
      perfect and maintain the validity, effectiveness and priority of any of the
      Collateral Documents and the Liens intended to be created thereby, and (iv)
      to
      better assure, convey, grant, assign, transfer, preserve, protect and confirm
      to
      the Agent and the Lenders the rights granted or now or hereafter intended to
      be
      granted to the Agent and the Lenders under any Loan Document or under any other
      document executed in connection therewith.

     

    SECTION
      7.1.12   New
      Subsidiaries.
      Within
      30 Business Days after the date of the acquisition or creation of any Subsidiary
      by the Borrower or a Subsidiary of the Borrower or in the case of a Minority
      ASC
      Entity or Non-Wholly Owned ASC Subsidiary which becomes a Wholly-Owned
      Subsidiary, such Person will cause to be delivered to the Agent for the benefit
      of the Lenders each of the following:

     

    (i)
      in
      the case of a Subsidiary other than a Non-Wholly-Owned ASC Subsidiary, a joinder
      to the Guaranty, the Guarantor Pledge Agreement and the Guarantor Security
      Agreement;

     

    (ii)
      in
      the case of a Subsidiary other than a Non-Wholly-Owned ASC Subsidiary, if such
      Subsidiary is a corporation, a limited liability company or a partnership that
      has issued certificates evidencing ownership of interests therein, the capital
      stock or, if applicable, certificates of ownership of such limited liability
      company or partnership, as the case may be, of such Person pertaining thereto,
      together with duly executed stock powers or powers of assignment in blank
      affixed thereto;

     

    
      
        
        

      

      
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    (iii)
      in
      the case of a Subsidiary other than a Non-Wholly-Owned ASC Subsidiary, if such
      Subsidiary is a limited liability company or a partnership not described in
      clause (ii) immediately above, an acknowledgment of security interest of such
      limited liability company or partnership, as the case may be, with respect
      to
      the registration of the Lien on membership or partnership interests in such
      Subsidiary, as the case may be, of such Person which acknowledgment shall be
      in
      form and substance satisfactory to the Agent;

     

    (iv)
      a
      supplement to the appropriate schedules attached to the Collateral Documents
      to
      reflect the acquisition by the Borrower or, a Subsidiary (other than a
      Non-Wholly-Owned ASC Subsidiary) of the Borrower, of such Subsidiary, certified
      as true, correct and complete by the Authorized Officer of the relevant Credit
      Party (provided that the failure to deliver such supplement shall not impair
      the
      rights conferred under the Collateral Documents in after acquired Collateral
      and
      Pledged Collateral);

     

    (v)
      to
      the extent requested by Agent in its reasonable discretion, an opinion or
      opinions of counsel to the Borrower and such Subsidiary (other than a
      Non-Wholly-Owned ASC Subsidiary), dated as of the date of delivery of any of
      the
      documents provided in the foregoing clause (i) and addressed to the Agent and
      the Lenders, in form and substance reasonably acceptable to the Agent (which
      opinion may include assumptions and qualifications of similar effect to those
      contained in the opinions of counsel delivered pursuant to Section
      5.1.8),
      to the
      effect that:

     

    (A)
      such
      Subsidiary is duly organized, validly existing and in good standing in the
      jurisdiction of its organization, has the requisite power and authority to
      own
      its properties and conduct its business as then owned and then proposed to
      be
      conducted and is duly qualified to transact business and is in good standing
      in
      each jurisdiction listed on the schedule attached to such opinion;

     

    (B)
      the
      execution, delivery and performance of the Guaranty, the Guarantor Pledge
      Agreement and the Guarantor Security Agreement, as applicable, described in
      clause (i) of this Section
      7.1.11,
      have
      been duly authorized by all requisite action (including any required
      shareholder, member or partner approval), such agreement has been duly executed
      and delivered and constitutes the valid and binding obligation of such
      Subsidiary, enforceable against such Subsidiary in accordance with its terms,
      except to the extent such enforceability may be limited by applicable
      bankruptcy, insolvency, reorganization, moratorium or similar laws relating
      to
      creditors’ rights and remedies generally, or to general principles of equity,
      whether enforcement thereof is considered in a court of law or equity;
      and

     

    (C)
      all
      financing statements, instruments and documents are in a form which is
      sufficient to create a security interest in favor of the Agent in the Pledged
      Collateral and the Collateral, as the case may be;

     

    (vi)
      current copies of the charter documents, including, limited liability agreements
      and certificates of formation, partnership agreements and certificates of
      limited partnership, if applicable, and bylaws of such Subsidiary, minutes
      of
      duly called and conducted meetings (or duly effected consent actions) of the
      Board of Directors, members, partners, or appropriate committees thereof (and,
      if required by such charter documents, bylaws or by applicable laws, of the
      shareholders, members or partners) of such Subsidiary authorizing the actions
      and the execution and delivery of documents described in this Section
      7.1.11
      and
      evidence satisfactory to the Agent (confirmation of the receipt of which will
      be
      provided by the Agent to the Lenders) that such Subsidiary is Solvent as of
      such
      date and after giving effect to the execution of any of the documents required
      by clause (i) above.

     

    
      
        
        

      

      
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    SECTION
      7.2   Negative
      Covenants.
      The
      Borrower agrees with the Agent and each Lender that, until all Revolving
      Commitments have terminated and all Obligations have been paid and performed
      in
      full, each Credit Party will perform the obligations set forth in this
Section
      7.2.

     

    SECTION
      7.2.1   Business
      Activities.
      The
      Borrower will not, and will not permit any of its Subsidiaries, including,
      without limitation, any New Subsidiary, to, engage in any business activity,
      except in (a) the fields of enterprise that fall within the definition of
“Target” herein; and (b) reasonable extensions of the businesses being engaged
      in by the Borrower and its Subsidiaries on the Fifth Amended and Restated
      Effective Date.

     

    SECTION
      7.2.2   Indebtedness.
      The
      Borrower will not, and will not permit any of its Subsidiaries to, create,
      incur, assume or suffer to exist or otherwise become or be liable in respect
      of
      any Indebtedness, other than, without duplication, the following:

     

    (a) Indebtedness
      in respect of the Loans and other Obligations;

     

    (b) until
      the
      date of the initial Borrowing, Indebtedness identified in Part A of Schedule
      6.17;

     

    (c) Indebtedness,
      including Subordinated Debt, existing as of the Fifth Amended and Restated
      Effective Date which is identified in Part B of Schedule
      6.17,
      but
      without giving effect to any extensions, renewals or refinancing
      thereof;

     

    (d) Indebtedness
      in respect of Liens to the extent permitted in Section
      7.2.3(c);

     

    (e) unsecured
      Indebtedness incurred in the ordinary course of business (including open
      accounts extended by suppliers on normal trade terms in connection with
      purchases of goods and services, but excluding Indebtedness incurred through
      the
      borrowing of money or Contingent Liabilities);

     

    (f) Indebtedness,
      in respect of Capitalized Lease Liabilities, at any one time not to exceed
      in
      the aggregate $13,000,000 less the amount of any Indebtedness which is
      outstanding and permitted solely under subsection
      7.2.3.(c);

     

    (g) Indebtedness
      consisting of intercompany loans, guarantees and advances made by the Borrower
      to any Credit Party or by such Credit Party to the Borrower or another Credit
      Party (“Credit
      Party Intercompany Loans”),
      provided
      that (i)
      if requested by the Agent, the payor Credit Party shall have executed and
      delivered to the payee Credit Party a demand note (the “Credit
      Party Intercompany Note”)
      to
      evidence any such Credit Party Intercompany Loan, which Credit Party
      Intercompany Note shall be in form and substance satisfactory to Agent pledged
      to the Agent pursuant to the relevant Collateral Documents as additional
      collateral security for the Obligations, (ii) the payee Credit Party shall
      record all Credit Party Intercompany Loans on its books and records in a manner
      satisfactory to Agent, and (iii) at the time any such Credit Party Intercompany
      Loan is made by a payee Credit Party and after giving effect thereto, each
      of
      the payee Credit Party and the payor Credit Party shall be Solvent;

     

    
      
        
        

      

      
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    (h) Subordinated
      Debt of the Borrower issued to the seller of a Target in connection with a
      Permitted Acquisition, such Indebtedness to be on terms and conditions
      reasonably satisfactory to the Agent (the Agent hereby acknowledges and agrees
      that the subordination provisions contained in the Subordinated Debt existing
      as
      of the date hereof are satisfactory);

     

    (i) Subordinated
      Debt of the Borrower, such Subordinated Debt to mature no earlier than one
      year
      after the Maturity Date and shall otherwise be on terms and conditions
      reasonably satisfactory to the Agent (the Agent hereby acknowledges and agrees
      that the subordination provisions contained in the Subordinated Debt existing
      as
      of the date hereof are satisfactory);

     

    (j) Indebtedness
      of the Borrower constituting unpaid minority interests to a Provider in
      connection with a Permitted Acquisition, such Indebtedness to be on terms and
      conditions reasonably satisfactory to the Agent;

     

    (k) Indebtedness
      of a Target which exists at the time such Target is the subject of a Permitted
      Acquisition, which Indebtedness is assumed by the Credit Party which is a party
      to such Permitted Acquisition and is otherwise permitted pursuant to this
Section
      7.2.2;
      

     

    (l) Indebtedness
      represented by the Investments described in Section
      7.2.5(h); and 

     

    (m)
       Indebtedness
      in an amount not to exceed $16,000,000 in the aggregate at any one time
      outstanding and $3,000,000 to any individual Minority ASC Entity or Non-Wholly
      Owned Subsidiary (other
      than NovaMed of New Albany) at
      any
      one time outstanding, in each case when aggregated with amounts outstanding
      pursuant to clause
      (o)
      below,
      consisting of intercompany loans and advances made by the Borrower or any
      Subsidiary to any Minority ASC Entity or Non-Wholly Owned Subsidiary or by
      a
      Minority ASC Entity or Non-Wholly Owned Subsidiary to the Borrower or any other
      Subsidiary (“Non-Credit
      Party Intercompany Loans”),
      provided
      that (i)
      the payor shall have executed and delivered to the payee a note (the
“Non-Credit
      Party Intercompany Note”)
      to
      evidence any such Non-Credit Party Intercompany Loan, which Non-Credit Party
      Intercompany Note shall be in form and substance satisfactory to Agent pledged
      to the Agent pursuant to the relevant Collateral Documents as additional
      collateral security for the Obligations, (ii) the payee shall record all
      Non-Credit Party Intercompany Loans on its books and records in a manner
      satisfactory to Agent, and (iii) at the time any such Non-Credit Party
      Intercompany Loan is made by a payee and after giving effect thereto, each
      of
      the payee and the payor shall be Solvent;

     

    
      
        
        

      

      
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    (n) Indebtedness
      consisting of Non-Credit Party Intercompany Loans in excess of the amounts
      permitted by clauses
      (m) or (o)
      of this
Section
      7.2.2,
      but in
      any event not to exceed $24,000,000 in the aggregate when aggregated with
      amounts outstanding and permitted by clauses
      (m) or (o)
      of this
Section
      7.2.2;
      provided,
      that
      any such Non-Credit Party Intercompany Note permitted pursuant to this
clause
      (n)
      shall be
      secured by a perfected first priority lien on the assets of such Minority ASC
      Entity or Non-Wholly Owned Subsidiary, as applicable, the scope of which lien
      shall be satisfactory to the Agent and which lien shall be assigned to the
      Agent;

     

    (o)
      Indebtedness consisting of guarantees by the Borrower or any Credit Party of
      the
      obligations of any Non-Wholly Owned Subsidiary or Minority ASC Entity (other
      than NovaMed of New Albany), in any event not to exceed $24,000,000 in the
      aggregate at any one time outstanding and $3,000,000 to any individual
      Non-Wholly Owned Subsidiary or Minority ASC Entity (other than NovaMed of New
      Albany), in each case when aggregated with Indebtedness outstanding under
clause
      (m)
      above;

     

    (p)
      Indebtedness of Borrower or any ASC Subsidiary owing to the seller of the equity
      interests of a Non-Wholly-Owned ASC Subsidiary or Minority ASC Subsidiary of
      the
      Borrower as part of the purchase price with respect to an ASC Subsidiary Capital
      Event otherwise permitted hereunder;

     

    (q)        
      *         ;

     

    (r)          
      *        ;

     

    provided,
      however,
      that no
      Indebtedness otherwise permitted by clauses
      (d),
      (e),
      (f),
      (g), (h), (i),
      (j),
      (k),
      (l),
      (m),
      (n),
      (o)
      or
(p)
      shall be
      permitted if, after giving effect to the incurrence thereof, any Default shall
      have occurred and be continuing.

     

    SECTION
      7.2.3   Liens.
      The
      Borrower will not, and will not permit any of its Subsidiaries to, create,
      incur, assume or suffer to exist any Lien upon any of its property, revenues
      or
      assets, whether now owned or hereafter acquired, except:

     

    (a) Liens
      securing payment of the Obligations, granted pursuant to any Loan
      Document;

     

    (b) until
      the
      date of the initial Borrowing; Liens securing payment of Indebtedness of the
      type permitted and described in clause
      (b)
      of
Section
      7.2.2;

     

    
      *
        Confidentiality portion omitted and filed separately with the
        Commission.

    

    
      
        
        

      

      
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    (c) purchase
      money security interests, in addition to, and not in limitation of, the
      Capitalized Lease Liabilities described in clause (j) hereof, on any property
      acquired or held by any Subsidiary in the ordinary course of business, securing
      Indebtedness incurred or assumed for the purpose of financing all or any part
      of
      the cost of acquiring such property; provided that
      (i) any
      such Lien attaches to such property concurrently with or within 20 days after
      the acquisition thereof, (ii) such Lien attaches solely to the property so
      acquired in such transaction, and (iii) the principal amount of the Indebtedness
      which is outstanding and which is secured by any and all such purchase money
      security interests shall not at any time exceed $13,000,000 less the amount
      of
      Indebtedness outstanding and permitted solely under subsection
      7.2.2(f);

     

    (d) Liens
      for
      taxes, assessments or other governmental charges or levies not at the time
      delinquent or thereafter payable without penalty or being diligently contested
      in good faith by appropriate proceedings and for which adequate reserves in
      accordance with GAAP shall have been set aside on its books;

     

    (e) Liens
      of
      carriers, warehousemen, mechanics, materialmen and landlords incurred in the
      ordinary course of business for sums not overdue or being diligently contested
      in good faith by appropriate proceedings and for which adequate reserves in
      accordance with GAAP shall have been set aside on its books;

     

    (f) Liens
      (other than any Lien imposed by ERISA) incurred in the ordinary course of
      business in connection with workmen’s compensation, unemployment insurance or
      other forms of governmental insurance or benefits, or to secure performance
      of
      tenders, statutory obligations, leases and contracts (other than for borrowed
      money) entered into in the ordinary course of business or to secure obligations
      on surety or appeal bonds;

     

    (g) judgment
      Liens in existence less than 30 days after the entry thereof or with respect
      to
      which execution has been stayed or the payment of which is bonded or covered
      in
      full (subject to a customary deductible) by insurance maintained with
      responsible insurance companies;

     

    (h) Liens
      in
      existence on the Fifth Amended and Restated Effective Date and listed on
Schedule
      7.2.3,
      but
      without giving effect to any extensions or renewals thereof; and

     

    (i) easements,
      rights-of-way, restrictions and other similar encumbrances incurred in the
      ordinary course of business which, in the aggregate, do not materially detract
      from the value of the property subject thereto or interfere with the ordinary
      conduct of the business of the property of the Person which is subject
      thereto;

     

    (j) Liens
      in
      connection with Capitalized Lease Liabilities in the amount and to the extent
      permitted by subsection
      7.2.2(f);

     

    (k) Liens
      on
      property leased by the Borrower or any Subsidiary or other interest or title
      of
      the lessor under operating leases securing obligations of the Borrower or such
      Subsidiary to the lessor under such leases; 

     

    
      
        
        

      

      
        57

        
          

        

      

      
        
        

      

    

    (l) Liens
      on
      property of a Target which exist at the time such Target becomes the subject
      of
      a Permitted Acquisition to the extent such Liens are otherwise permitted
      pursuant to this Section
      7.2.3;
      and

     

    (m)       
      *          . 

     

    SECTION
      7.2.4   Financial
      Condition.
      The
      Borrower will not permit:

     

    (a) Its
      Net
      Worth as of the last day of each Fiscal Quarter to be less than 75% of the
      amount of its Net Worth existing on June 29, 2006, plus
      50% of
      Net Income (without giving effect to any losses) for each Fiscal Quarter
      occurring after June 30, 2006, plus
      50% of
      the net proceeds from any equity issuance by the Borrower or any of its
      Subsidiaries occurring since June 30, 2006, plus
      50% of
      any incremental additive equity associated with any Permitted
      Acquisition.

     

    (b) the
      Total
      Leverage Ratio as of the end of each Fiscal Quarter for the twelve month period
      preceding such date to be greater than 3.50:1.00.

    

    (c) as
      of the
      last day of any Fiscal Quarter the ratio of (a) EBITDA plus
      rent
      expenses incurred by the Borrower and its Subsidiaries, minus
      Capital
      Expenditures incurred by the Borrower and its Subsidiaries, minus
      cash
      taxes paid by the Borrower and its Subsidiaries, in each case for the period
      of
      four fiscal quarters then ending, to (b) Fixed Charges for such four fiscal
      quarter period to be less than 1.40:1.0. 

    

    SECTION
      7.2.5   Investments.
      The
      Borrower will not, and will not permit any of its Subsidiaries to, make, incur,
      assume or suffer to exist any Investment in any other Person,
      except:

     

    (a) Investments
      existing on the Fifth Amended and Restated Effective Date and identified in
      Schedule
      7.2.5;

     

    (b) Cash
      Equivalent Investments and cash, provided,
      however,
      that
      the balance maintained in any deposit account other than a deposit account
      listed on Schedule
      7.2.5(b)
      hereto
      not subject to a Lien of the Agent shall (i) not exceed $100,000 for a period
      of
      seven consecutive days with respect to deposit accounts of Borrower and any
      other Credit Party and (ii) in the case of deposit accounts of any Non-Wholly
      Owned Subsidiary or Minority ASC Entity, be, in an amount equal to the Borrower
      or any Subsidiary's rights therein, transferred to a deposit account subject
      to
      a Lien of the Agent as frequently as practicable but on a no less frequent
      basis
      than monthly; 

     

    (c) without
      duplication, Investments permitted as Indebtedness pursuant to Section
      7.2.2;

     

    (d) without
      duplication, Investments permitted as Capital Expenditures in the Borrower
      and
      its Subsidiaries which are Credit Parties;

     

    
      *
        Confidentiality portion omitted and filed separately with the
        Commission.

    

    
      
        
        

      

      
        58

        
          

        

      

      
        
        

      

    

    (e) in
      the
      ordinary course of business, (1) Investments by the Borrower in any of its
      Wholly-Owned Subsidiaries, or in any new Wholly-Owned Subsidiary created or
      acquired after the Fifth Amended and Restated Effective Date in connection
      with
      a Permitted Acquisition, (2) Investments by the Borrower or any Wholly-Owned
      Subsidiary in any Non-Wholly-Owned ASC Subsidiary in the form of Indebtedness
      permitted by Section
      7.2.2(m) and (n)
      and (3)
      other cash investments in Non-Wholly-Owned ASC Subsidiaries in the aggregate
      at
      any time outstanding not to exceed $8,000,000 when aggregated with Investments
      outstanding and permitted by Section
      7.2.5(p);
       

     

    (f) Permitted
      Acquisitions by the Borrower or a Wholly-Owned Subsidiary of the Borrower (or,
      in the case of the purchase of an ASC Facility, by the Borrower or a Subsidiary
      of the Borrower);

     

    (g) the
      acquisition by the Borrower or a Wholly-Owned Subsidiary of the Borrower of
      100%
      of the minority interests held by a Provider in a non-Wholly-Owned Subsidiary,
      provided
      that any
      such acquisition is made solely in connection with the merger of such
      non-Wholly-Owned Subsidiary into the Borrower or a Wholly-Owned Subsidiary
      of
      the Borrower as permitted by Section
      7.2.8;

     

    (h) Investments
      by the Borrower or any Subsidiary consisting of loans to Providers in an amount
      not to exceed $500,000 individually or $3,200,000 in the aggregate outstanding
      at any one time;

     

    (i) Investments
      constituting Hedging Agreements of the Borrower; 

     

    (j) Investments
      by a Target which exist at the time such Target is the subject of a Permitted
      Acquisition to the extent such Investments are otherwise permitted pursuant
      to
      this Section
      7.2.5;

     

    (k) Investments
      by the Borrower or a Subsidiary of the Borrower pursuant to ASC Subsidiary
      Capital Events provided that (1) no Default or Event of Default shall have
      occurred or be continuing both before and after giving effect to such ASC
      Subsidiary Capital Event, (2) the Borrower must be able to comply on a pro
      forma
      basis after giving effect to such ASC Subsidiary Capital Event with all of
      the
      covenants of this Agreement; and (3) in the event that the Borrower’s Total
      Leverage Ratio on a pro forma basis (after giving effect to the ASC Subsidiary
      Capital Event) is greater than 2.75:1.0 the aggregate consideration in
      connection with such ASC Subsidiary Capital Event shall not exceed $18,000,000
      individually and $42,000,0000 for all ASC Subsidiary Capital Events consummated
      within the previous twelve (12) month period when aggregated with the
      Consideration paid for Permitted Acquisitions permitted by Section
      7.2.5(f)
      during
      such period, without duplication; 

     

    (l) Permitted
      Seller Debt in connection with Part A of Exhibit K;

     

    
      
        
        

      

      
        59

        
          

        

      

      
        
        

      

    

     

    (m)
      Investments (not including Investments constituting Permitted Acquisitions)
      by
      the Borrower or a Subsidiary of the Borrower in Minority ASC Entities in an
      amount not to exceed $800,000 in any individual Minority ASC Entity provided
      that the Borrower is in compliance on a pro forma basis after giving effect
      to
      such Investment with all of the covenants contained in this Agreement provided
      that in the case of all such Investments pursuant to this clause
      (m)
      ("Minority
      ASC Investments"),
      (i)
      the Minority ASC Entity shall have executed and delivered to the Person making
      the Investment a demand note (the “Minority
      ASC Intercompany Note”)
      to
      evidence any such Minority ASC Investment, which Minority ASC Intercompany
      Note
      shall be in form and substance satisfactory to Agent and pledged to the Agent,
      (ii) the payee shall record all Minority ASC Investments on its books and
      records in a manner satisfactory to Agent, and (iii) at the time any such
      Minority ASC Investment is made and after giving effect thereto, each of the
      Person making the Investment and the payor shall be Solvent;

     

    (n) Investments
      consisting of Minority ASC Investments in excess of the amounts permitted by
      clause
      (m)
      above,
      but in any event not to exceed $3,200,000 in the aggregate when aggregated
      with
      amounts outstanding and permitted by clause
      (m)
      above
provided,
      that
      any such Minority ASC Investments permitted pursuant to this clause
      (n)
      shall be
      secured by a perfected first priority lien on the assets of such Minority ASC
      Entity, the scope of which lien shall be satisfactory to the Agent and which
      lien shall be assigned to the Agent;

     

    (o)
      Investments by the Borrower and its Subsidiaries in ASC Startups in an amount
      not to exceed $8,000,000 (unless consented to by the Required Lenders) at any
      one time outstanding; provided,
      once
      the Borrower has sold an equity interest in an ASC Startup as permitted under
      Section
      7.2.9(c),
      the
      Investment in the ASC Startup shall no longer be considered as "outstanding"
      for
      purposes of this clause
      (n);

     

     

    (p)
      other
      Investments in Minority ASC Entities of the type not listed above in an amount
      not to exceed $8,000,000 in the aggregate outstanding for any such Investments
      permitted pursuant to this clause
      (p)
      when
      aggregated with any Investments outstanding and permitted under Section
      7.2.5(e)(3)
      above;

     

    provided,
      however,
      that

     

    (q) any
      Investment which when made complies with the requirements of the definition
      of
      the term “Cash
      Equivalent Investment”
      may
      continue to be held notwithstanding that such Investment if made thereafter
      would not comply with such requirements; and

     

    (r) no
      Investment otherwise permitted by clauses
      (e),
      (f),
      (g),
      (h),
      (i),
      (j)
      (m),
      (n),
      (o)
      or
(p)
      shall be
      permitted to be made if, immediately before or after giving effect thereto,
      any
      Default shall exist and be continuing;

    

    (s)       
      *          .
      

     

    
      
        *
          Confidentiality portion omitted and filed separately with the
          Commission.

      

      
        
        

      

      
        60

        
          

        

      

      
        
        

      

    

    SECTION
      7.2.6   Restricted
      Payments, etc.
      On and
      at all times after the Original Closing Date:

     

    (a) The
      Borrower will not, and will not permit any of its Subsidiaries to, declare,
      pay
      or make any dividend or distribution (in cash, property or obligations) on
      any
      shares of any class of capital stock (now or hereafter outstanding) of the
      Borrower or such Subsidiary or on any warrants, options or other rights with
      respect to any shares of any class of capital stock (now or hereafter
      outstanding) of the Borrower or such Subsidiary (other than in the case of
      (I)
      the Borrower (x) dividends or distributions payable in its common stock or
      warrants to purchase its common stock or splitups or reclassifications of its
      stock into additional or other shares of its common stock, (y) scheduled
      dividend payments on its preferred stock so long as no Default or Event of
      Default has occurred and is continuing both before and after giving effect
      to
      the payment of such dividend and (z) distributions to any Subsidiary which
      is a
      limited liability company of the Borrower solely to permit the members thereof
      to make payment of its federal and state income tax liability attributable
      to
      such limited liability company’s taxable income, whether or not a Default or an
      Event of Default then or (II) any Subsidiary which is a limited liability
      company or limited partnership, distributions to members of any such Subsidiary
      solely to permit such members to make payment of their federal and state income
      tax liability attributably to such member’s taxable income of such Subsidiary
      whether or not a Default or an Event of Default than exists) or apply, or permit
      any of its Subsidiaries to apply, any of its funds, property or assets to the
      purchase, redemption, sinking fund or other retirement of, or agree or permit
      any of its Subsidiaries to purchase or redeem, any shares of any class of
      capital stock (now or hereafter outstanding) of the Borrower, or warrants,
      options or other rights with respect to any shares of any class of capital
      stock
      (now or hereafter outstanding) of the Borrower, except that, (A), in addition
      to
      distributions permitted pursuant to clause
      (a)(II) above,
      any
      Subsidiary of the Borrower may declare and pay cash dividends and distributions
      to its equity holders and (B) so long as no Default or Event of Default
      then exists or would result therefrom and so long as the Borrower would be
      able
      to comply on a pro forma basis, assuming such redemption or purchase occurred,
      with all of the covenants contained in this Agreement, the Borrower may redeem
      or purchase shares of its stock (i) held by former employees of the Borrower
      or
      any of its Subsidiaries following their death, disability or the termination
      of
      their employment or (ii) as otherwise permitted pursuant to the stock-based
      compensation plans of Borrower or any of its Subsidiaries;

     

    (b) Borrower
      will not, and will not permit any of its Subsidiaries to:

     

    (i)
      make any
      payment or prepayment of principal of, or make any payment of interest on,
      any
      Subordinated Debt or on any put option granted to a holder of Subordinated
      Debt
      on any day other than the stated, scheduled date for such payment or prepayment
      set forth in the documents and instruments memorializing such Subordinated
      Debt
      or such put option, or which would violate the subordination provisions of
      such
      Subordinated Debt or such put option, or while any Default or Event of Default
      exists and is continuing both before and after giving effect to such payment;
      or

     

    
      
        
        

      

      
        61

        
          

        

      

      
        
        

      

    

    (ii)
      redeem,
      purchase or defease any Subordinated Debt other than Subordinated Debt held
      by a
      Target, so long as no Default or Event of Default exists or is continuing both
      before and after giving effect to such redemption, purchase or defeasance;
      and

     

    (c) Borrower
      will not, and will not permit any Subsidiary to, make any sinking fund payment
      or deposit for any of the foregoing purposes.

    

    (d) Notwithstanding
      anything else herein to the contrary, Borrower may redeem or receive Permitted
      Seller Equity in connection with a Permitted Asset Disposition.

    

    (e) Notwithstanding
      anything else herein to the contrary, Borrower may repurchase and redeem its
      common stock provided that (i) the aggregate amount of all such repurchases
      shall made on and after the Fifth Amended and Restated Effective Date shall
      not
      exceed $8,000,000, (ii) any offer to repurchase and any such repurchase shall
      be
      conducted in compliance with all applicable federal and state securities laws,
      and (iii) upon completion of such repurchase, such common stock repurchased
      shall be retired into treasury by Borrower. In addition to using cash to
      effectuate such repurchases, such repurchases of Borrower’s common stock may
      also include common stock received by Borrower or its Subsidiaries as
      consideration for Permitted Equity Ownership Sales. For purposes of measuring
      the effect of such repurchases on the aforementioned $8,000,000 cap, the value
      of the common stock retired in a Permitted Equity Ownership Sale will be the
      average closing price of Borrower’s common stock during the 30-trading day
      period immediately preceding such Permitted Equity Ownership Sale.

     

    SECTION
      7.2.7   Intentionally
      Omitted.

     

    SECTION
      7.2.8   Consolidation,
      Merger, etc.
      (a) The
      Borrower will not, and will not permit any of its Subsidiaries to, liquidate
      or
      dissolve, consolidate with, or merge into or with, any other corporation, or
      purchase or otherwise acquire all or substantially all of the assets of any
      Person (or of any division thereof) except:

     

    (a) any
      such
      Subsidiary may liquidate or dissolve voluntarily into, and may merge with and
      into, the Borrower or any Wholly-Owned Subsidiary of the Borrower or any
      Guarantor, and the assets or stock of any Subsidiary may be purchased or
      otherwise acquired by the Borrower or any Wholly-Owned Subsidiary of the
      Borrower or any Guarantor provided,
      however,
      that
      the Subsidiaries listed on Schedule
      7.2.8
      hereto
      may dissolve to the extent that the assets and liabilities of such Subsidiaries
      are de-minimus; 

     

    (b) so
      long
      as no Default or Event of Default exists and is continuing or would occur after
      giving effect thereto, the Borrower or any Wholly-Owned Subsidiary of the
      Borrower (or in the case of the purchase of an ASC Facility, the Borrower or
      any
      Subsidiary of the Borrower) may consummate a Permitted Acquisition;
      and

     

    (c) any
      Subsidiary may liquidate or dissolve into or merge with or into any other
      Person, provided that, after giving effect thereto (i) no Default or Event
      of
      Default shall exist or be continuing; (ii) the Net Worth of the surviving Person
      shall be at least equal to the Net Worth of the applicable Subsidiary
      immediately prior to the consummation of any such liquidation, dissolution
      or
      merger and (iii) the surviving Person shall assume all Obligations of the
      applicable Subsidiary under the Loan Documents.

     

    
      
        
        

      

      
        62

        
          

        

      

      
        
        

      

    

    SECTION
      7.2.9   Asset
      and Capital Stock Dispositions, etc.(a)
      The
      Borrower will not, and will not permit any of its Subsidiaries to, sell,
      transfer, lease, contribute or otherwise convey, or grant options, warrants
      or
      other rights with respect to, all or any substantial part of its assets
      (including accounts receivable and capital stock of Subsidiaries) to any Person,
      unless:

     

    (i)
      such
      sale, transfer, lease, contribution or conveyance is in the ordinary course
      of
      its business or is permitted by Section
      7.2.9(b);
      

     

    (ii)
      the net
      book value of such assets, together with the net book value of all other assets
      sold, transferred, leased, contributed or conveyed otherwise than in the
      ordinary course of business by the Borrower or any of its Subsidiaries pursuant
      to this clause since the Fifth Amended and Restated Effective Date, does not
      exceed $2,500,000 (exclusive
      of the value of any transaction described in the preceding clause (i));
      or

     

    (iii)
      the
      Borrower or any Subsidiary of the Borrower may consummate a Permitted Asset
      Disposition.

     

    (b) the
      Borrower will not, and will not permit any of its Subsidiaries to, issue, sell,
      assign, pledge or otherwise encumber or dispose of any shares of capital stock
      or other equity securities in the Borrower or any such Subsidiary (other than
      pursuant to this Agreement or any other Loan Document), including warrants,
      rights or options to acquire shares or other equity securities of the Borrower
      or any of its Subsidiaries; provided
      that,
      notwithstanding the foregoing, and so long as no Default or Event of Default
      will result therefrom:

     

    (i)
      (x)
      the Borrower may issue capital stock (or warrants, rights or options to purchase
      capital stock) of the Borrower in connection with a Permitted Acquisition and
      (y) a Subsidiary of the Borrower may undertake a Permitted Equity Ownership
      Sale;

     

    (ii)
      the
      Borrower may issue common stock of the Borrower to a Provider upon the
      conversion of Subordinated Debt held by such Provider into common stock of
      the
      Borrower pursuant to the terms and conditions contained in the documentation
      governing such Subordinated Debt;

     

    (iii)
      the
      Borrower may issue common stock of the Borrower in connection with a registered
      offering, provided, however, that the Borrower shall have delivered a certified
      copy of each agreement, document or other instrument (including, without
      limitation, any registration statement and underwriting agreement) entered
      into
      by the Borrower in connection with such registered offering; 

     

    
      
        
        

      

      
        63

        
          

        

      

      
        
        

      

    

    (iv)
      the
      Borrower may issue capital stock, and related options, of the Borrower to any
      permitted participant under Borrower’s stock incentive plans or to any permitted
      participant under any future stock incentive plans established by the Borrower
      and reasonably acceptable to the Agent;

     

    (v)
      the
      Borrower may issue capital stock (or warrants, rights or options to purchase
      capital stock) of the Borrower so long as in connection with a private placement
      of its capital stock the consideration received by the Borrower in connection
      with such sale is (x) for fair market value (as determined by the Board of
      Directors of the Borrower) and (y) paid in immediately available
      funds;

     

    (vi) the
      Borrower or any Subsidiary may consummate a Permitted Asset
      Disposition.

     

    (c)
      The
      Borrower or any Subsidiary may consummate Permitted Equity Ownership Sales
      consisting of interests in ASC Startups. 

     

    To
      the
      extent the Required Lenders waive the provisions of this Section
      7.2.9
      with
      respect to the sale of any Collateral, or any Collateral is sold as permitted
      by
      this Section
      7.2.9,
      such
      Collateral shall be sold free and clear of the Liens created by the Collateral
      Documents and, if requested by the Borrower, the Guarantor owner of such
      Collateral shall be released from the Guaranty, and the portion of the
      Collateral owned by such Guarantor shall be released from the Guarantor Security
      Agreement and the Agent shall be authorized to take any actions deemed
      appropriate in order to effect the foregoing.

     

    SECTION
      7.2.10   Modification
      of Certain Agreements.
      Except
      as otherwise permitted pursuant to a Permitted Asset Disposition or Section
      7.1.7
      hereof,
      the Borrower will not, and will not permit any of its Subsidiaries to, consent
      to any amendment, supplement or other modification of any of the terms or
      provisions contained in, or applicable to, its Organizational Documents, any
      document, once entered into, relating to a Permitted Acquisition, other than
      any
      amendment, supplement or other modification that conforms with applicable laws
      in all material respects and is not material or does not have an adverse effect
      on the Lenders as Lenders under the Loan Documents, or any document or
      instrument evidencing or applicable to any Subordinated Debt or any put option
      granted to the holders of Subordinated Debt, other than any amendment,
      supplement or other modification which extends the date or reduces the amount
      of
      any required repayment or redemption. Notwithstanding anything else in this
      Section
      7.2.10
      to the
      contrary, the Borrower and its Subsidiaries may terminate or make any necessary
      modification to the Organizational Documents which is the subject of a Permitted
      Asset Disposition. 

     

    SECTION
      7.2.11   Transactions
      with Affiliates.
      The
      Borrower will not, and will not permit any of its Subsidiaries to, enter into,
      or cause, suffer or permit to exist any arrangement or contract with any of
      its
      other Affiliates (other than a Subsidiary Guarantor) unless such arrangement
      or
      contract is (i) is entered into in connection with a Permitted Asset Disposition
      or (ii) fair and equitable to the Borrower or such Subsidiary and is an
      arrangement or contract of the kind which would be entered into by a prudent
      Person in the position of the Borrower or such Subsidiary with a Person which
      is
      not one of its Affiliates.

     

    
      
        
        

      

      
        64

        
          

        

      

      
        
        

      

    

    SECTION
      7.2.12   Negative
      Pledges, Restrictive Agreements, etc.
      The
      Borrower will not, and will not permit any of its Subsidiaries to, enter into
      any agreement (excluding this Agreement, any other Loan Document and any
      agreement governing any Indebtedness permitted either by clause
      (b)
      of
Section
      7.2.2
      as in
      effect on the Fifth Amended and Restated Effective Date or by clause
      (d)
      of
Section
      7.2.2
      as to
      the assets financed with the proceeds of such Indebtedness)
      prohibiting:

     

    (a) the
      creation or assumption of any Lien upon the properties, revenues or assets
      of
      Borrower or any of its Wholly-Owned Subsidiaries, whether now owned or hereafter
      acquired, or the ability of any Credit Party to amend or otherwise modify this
      Agreement or any other Loan Document; or

     

    (b) the
      ability of any Subsidiary to make any payments, directly or indirectly, to
      the
      Borrower by way of dividends, distributions, advances, repayments of loans
      or
      advances, reimbursements of management and other intercompany charges, expenses
      and accruals or other returns on investments, or any other agreement or
      arrangement which restricts the ability of any such Subsidiary to make any
      payment, directly or indirectly, to the Borrower.

    

    ARTICLE
      VIII

     

    EVENTS
      OF
      DEFAULT

     

    SECTION
      8.1   Listing
      of Events of Default.
      Each of
      the following events or occurrences described in this Section
      8.1
      shall
      constitute an “Event
      of Default”.

     

    SECTION
      8.1.1   Non-Payment
      of Obligations.
      The
      Borrower shall default in the payment or prepayment when due of any principal
      of
      or interest on any Loan or any reimbursement obligation when due, or the
      Borrower shall default (and such default shall continue unremedied for a period
      of five days) in the payment when due of any commitment fee or other fee or
      of
      any other Obligation.

     

    SECTION
      8.1.2   Breach
      of Warranty.
      Any
      representation or warranty of any Credit Party made or deemed to be made
      hereunder or in any other Loan Document executed by it, any Letter of Credit
      or
      any other writing or certificate furnished by or on behalf of any Credit Party
      to the Agent or any Lender for the purposes of or in connection with this
      Agreement or any such other Loan Document or Letter of Credit (including any
      certificates delivered pursuant to Article
      V)
      is or
      shall be incorrect when made in any material respect.

     

    SECTION
      8.1.3   Non-Performance
      of Certain Covenants and Obligations.
      Any
      Credit Party shall default in the due performance and observance of any of
      its
      obligations under Sections
      7.1.1,
      7.1.7,
      7.1.8,
      7.1.11,
      7.1.12
      or
Section
      7.2
      (exclusive of Section
      7.2.4(d)).

     

    SECTION
      8.1.4   Non-Performance
      of Other Covenants and Obligations.
      Any
      Credit Party shall default in the due performance and observance of any other
      agreement (other than Section
      7.2.4(d))
      contained herein or in any other Loan Document executed by it, and such default
      shall continue unremedied for a period of 30 days after notice thereof shall
      have been given to the Borrower by the Agent or any Lender.

     

    
      
        
        

      

      
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    SECTION
      8.1.5   Default
      on Other Indebtedness.
      A
      default shall occur in the payment when due (subject to any applicable grace
      period), whether by acceleration or otherwise, of any Indebtedness (other than
      Indebtedness described in Section
      8.1.1)
      of any
      Subsidiary having a principal amount, individually or in the aggregate, in
      excess of $1,600,000, or a default shall occur in the performance or observance
      of any obligation or condition with respect to such Indebtedness if the effect
      of such default is to accelerate the maturity of any such Indebtedness or such
      default shall continue unremedied for any applicable period of time sufficient
      to permit the holder or holders of such Indebtedness, or any trustee or agent
      for such holders, to cause such Indebtedness to become due and payable prior
      to
      its expressed maturity.

     

    SECTION
      8.1.6   Judgments.
      Any
      judgment or order for the payment of money in excess of $1,600,000 shall be
      rendered against any Subsidiary (which judgment is not covered by insurance
      and
      with respect to such judgment an insurance carrier has not accepted
      responsibility for coverage) and either:

     

    (a) enforcement
      proceedings shall have been commenced by any creditor upon such judgment or
      order; or

     

    (b) there
      shall be any period of 10 consecutive days during which a stay of enforcement
      of
      such judgment or order, by reason of a pending appeal or otherwise, shall not
      be
      in effect.

     

    SECTION
      8.1.7   Pension
      Plans.
      Any of
      the following events shall occur with respect to any Pension Plan:

     

    (a) the
      institution of any steps by the Borrower, any member of its Controlled Group
      or
      any other Person to terminate a Pension Plan if, as a result of such
      termination, the Borrower or any such member reasonably would be expected to
      be
      required to make a contribution to such Pension Plan, or would reasonably expect
      to incur a liability or obligation to such Pension Plan, in excess of
      $2,000,000; or

     

    (b) a
      contribution failure occurs with respect to any Pension Plan sufficient to
      give
      rise to a Lien under Section 302(f) of ERISA.

     

    SECTION
      8.1.8   Change
      of Control.
      Any
      Change of Control shall occur.

     

    SECTION
      8.1.9   Bankruptcy,
      Insolvency, etc.
      The
      Borrower or any Subsidiary shall:

     

    (a) become
      insolvent or generally fail to pay, or admit in writing its inability or
      unwillingness to pay, its debts as they become due;

     

    (b) apply
      for, consent to, or acquiesce in, the appointment of a trustee, receiver,
      sequestrator or other custodian for such Person or any property of such Person,
      or make a general assignment for the benefit of creditors;

     

    (c) in
      the
      absence of such application, consent or acquiescence, permit or suffer to exist
      the appointment of a trustee, receiver, sequestrator or other custodian for
      such
      Person or for a substantial part of the property of such Person, and such
      trustee, receiver, sequestrator or other custodian shall not be discharged
      within 60 days, provided
      that the
      Borrower hereby expressly authorizes the Agent and each Lender to appear in
      any
      court conducting any relevant proceeding during such 60-day period to preserve,
      protect and defend their rights under the Loan Documents;

     

    
      
        
        

      

      
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    (d) permit
      or
      suffer to exist the commencement of any bankruptcy, reorganization, debt
      arrangement or other case or proceeding under any bankruptcy or insolvency
      law,
      or any dissolution, winding up or liquidation proceeding, in respect of such
      Person, and, if any such case or proceeding is not commenced by such Person,
      such case or proceeding shall be consented to or acquiesced in by such Person
      or
      shall result in the entry of an order for relief or shall remain for 60 days
      undismissed, provided
      that the
      Borrower hereby expressly authorizes the Agent and each Lender to appear in
      any
      court conducting any such case or proceeding during such 60-day period to
      preserve, protect and defend their rights under the Loan Documents;
      or

     

    (e) take
      any
      action authorizing, or in furtherance of, any of the foregoing.

     

    SECTION
      8.1.10   Impairment
      of Security, etc.
      Any
      Loan Document, or any Lien granted thereunder, shall (except in accordance
      with
      its terms or pursuant to Section
      7.2.9),
      in
      whole or in part, terminate, cease to be effective or cease to be the legally
      valid, binding and enforceable obligation of any Credit Party thereto; any
      Credit Party or any other party shall, directly or indirectly, contest in any
      manner the effectiveness, validity, binding nature or enforceability of any
      Loan
      Document or Lien granted thereunder; or any Lien securing any Obligation shall,
      in whole or in part, cease to be a perfected first priority Lien, subject only
      to those exceptions expressly permitted by such Loan Document.

     

    SECTION
      8.1.11   Fraud
      and Abuse Laws.
      Receipt
      by the Borrower or any Subsidiary of a notice from a governmental authority
      or
      third party payor that it intends to disallow requested reimbursements, or
      intends to demand or demands adjustment or repayment of past reimbursements
      in
      excess of, either individually or in the aggregate with any other disallowed
      reimbursements, ten percent (10%) of the net revenues of the Borrower for the
      previous fiscal quarter respecting amounts submitted for reimbursement or
      collected by such Person from participation in the Medicare, Medicaid or third
      party payor programs.

     

    SECTION
      8.1.12   Certifications.
      (i)
      Revocation, suspension or involuntary cancellation or termination of any
      Medicare Certification, Medicare Provider Agreement, Medicaid Certification,
      Medicaid Provider Agreement or third party payor certification, if any, or
      agreement of or affecting the Borrower or any Subsidiary or notice of any
      investigation or notice of any proceeding being instituted against any Credit
      Party, any of the Minority ASC Entities, or any of their respective officers,
      directors, members or managers by any governmental authority which could
      reasonably be expected to result in any of the foregoing actions, or (ii) the
      loss of any other permits, licenses, authorizations, certifications or approval
      from any federal, state or local governmental authority or termination of any
      contract with any such authority by the Borrower or any Subsidiary, in either
      case which cancellation, revocation, suspension or termination, (x) continues
      for a period greater than 60 days and (y) results in the suspension or
      termination of operations of the Borrower or any Subsidiary or in the failure
      of
      the Borrower or any Subsidiary to be eligible to participate in Medicare,
      Medicaid or third party payor programs or to accept assignments of rights to
      reimbursement under Medicaid Regulations, Medicare Regulations or guidelines
      established by a third party payor; or (z) results in the exclusion of Borrower,
      or any Subsidiary, or any Minority ASC Entities, or any of their respective
      officers, directors, members or managers from participation in any Federal
      or
      State healthcare program, provided
      that any
      such events described in this Section
      8.1.12
      shall
      result or reasonably be expected to, either singly or in the aggregate, in
      the
      termination, cancellation, revocation, suspension or material impairment of
      operations or rights to reimbursement which produce ten percent (10%) or more
      of
      the Borrower’s net revenues (determined in accordance with GAAP).

    

    
      
        
        

      

      
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    SECTION
      8.2   Action
      if Bankruptcy.
      If any
      Event of Default described in clauses
      (a)
      through
(e)
      of
Section
      8.1.9
      shall
      occur, the Revolving Commitments (if not theretofore terminated) and the
      obligation of the Letter of Credit Issuer to issue Letters of Credit shall
      automatically terminate and the outstanding principal amount of all outstanding
      Loans and all other Obligations shall automatically be and become immediately
      due and payable, without notice or demand.

     

    SECTION
      8.3   Action
      if Other Event of Default.
      If any
      Event of Default (other than any Event of Default described in clauses
      (a)
      through
(e)
      of
Section
      8.1.9)
      shall
      occur for any reason, whether voluntary or involuntary, and be continuing,
      the
      Agent, upon the direction of the Required Lenders, shall by notice to the
      Borrower declare all or any portion of the outstanding principal amount of
      the
      Loans and other Obligations to be due and payable and/or the Revolving
      Commitments (if not theretofore terminated) and/or the obligation of the Letter
      of Credit Issuer to issue Letters of Credit to be terminated, whereupon the
      full
      unpaid amount of such Loans and other Obligations which shall be so declared
      due
      and payable shall be and become immediately due and payable, without further
      notice, demand or presentment, and/or, as the case may be, the Revolving
      Commitments shall terminate.

     

    SECTION
      8.4   Letters
      of Credit.
      In
      addition to the foregoing, following the occurrence and during the continuance
      of an Event of Default, so long as any Letter of Credit has not been fully
      drawn
      and has not been canceled or expired by its terms, upon demand by the Lenders,
      the Borrower shall deposit in an account (the “Letter
      of Credit Cash Collateral Account”)
      maintained with National City in the name of the Agent, for the benefit of
      itself and the Lenders, cash in an amount equal to the aggregate undrawn face
      amount of all outstanding Letters of Credit and all fees and other amounts
      due
      or which may become due with respect thereto. The Borrower shall have no control
      over funds in the Letter of Credit Cash Collateral Account, which funds shall
      be
      invested by the Agent from time to time in its discretion in certificates of
      deposit of National City having a maturity not exceeding thirty days. Such
      funds
      shall be promptly applied by the Agent to reimburse the Letter of Credit Issuer
      for drafts drawn from time to time under the Letters of Credit. Such funds,
      if
      any, remaining in the Letter of Credit Cash Collateral Account following the
      payment of all Obligations in full or the earlier termination of all Events
      of
      Default shall, unless the Agent is otherwise directed by a court of competent
      jurisdiction, be promptly paid over to the Borrower.

     

    
      
        
        

      

      
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    ARTICLE
      IX

     

    THE
      AGENT

     

    SECTION
      9.1   Actions.
      Each
      Lender hereby appoints National City as its Agent under and for purposes of
      this
      Agreement, the Notes and each other Loan Document. Each Lender authorizes the
      Agent to act on behalf of such Lender under this Agreement, the Notes and each
      other Loan Document and, in the absence of other written instructions from
      the
      Required Lenders received from time to time by the Agent (with respect to which
      the Agent agrees that it will comply, except as otherwise provided in this
      Section or as otherwise advised by counsel), to exercise such powers hereunder
      and thereunder as are specifically delegated to or required of the Agent by
      the
      terms hereof and thereof, together with such powers as may be reasonably
      incidental thereto. Each Lender hereby indemnifies (which indemnity shall
      survive any termination of this Agreement) the Agent, pro rata
      according to such Lender’s Percentage, from and against any and all liabilities,
      obligations, losses, damages, claims, costs or expenses of any kind or nature
      whatsoever which may at any time be imposed on, incurred by, or asserted
      against, the Agent in any way relating to or arising out of this Agreement,
      the
      Notes and any other Loan Document, including reasonable attorneys’ fees, and as
      to which the Agent is not reimbursed by the Borrower; provided,
      however,
      that no
      Lender shall be liable for the payment of any portion of such liabilities,
      obligations, losses, damages, claims, costs or expenses which are determined
      by
      a court of competent jurisdiction in a final proceeding to have resulted solely
      from the Agent’s gross negligence or willful misconduct. The Agent shall not be
      required to take any action hereunder, under the Notes or under any other Loan
      Document, or to prosecute or defend any suit in respect of this Agreement,
      the
      Notes or any other Loan Document, unless it is indemnified hereunder to its
      satisfaction. If any indemnity in favor of the Agent shall be or become, in
      the
      Agent’s determination, inadequate, the Agent may call for additional
      indemnification from the Lenders and cease to do the acts indemnified against
      hereunder until such additional indemnity is given.

     

    SECTION
      9.2   Funding
      Reliance, etc.
      Unless
      the Agent shall have been notified by telephone, confirmed in writing, by any
      Lender by 5:00 p.m., Chicago time, on the day prior to a Borrowing that such
      Lender will not make available the amount which would constitute its Percentage
      of such Borrowing on the date specified therefor, the Agent may assume that
      such
      Lender has made such amount available to the Agent and, in reliance upon such
      assumption, make available to the Borrower a corresponding amount. If and to
      the
      extent that such Lender shall not have made such amount available to the Agent,
      such Lender and the Borrower severally, without duplication, agree to repay
      the
      Agent forthwith on demand such corresponding amount together with interest
      thereon, for each day from the date the Agent made such amount available to
      the
      Borrower to the date such amount is repaid to the Agent, at the interest rate
      applicable at the time to Loans comprising such Borrowing.

     

    SECTION
      9.3   Exculpation.
      Neither
      the Agent nor any of its directors, officers, employees or agents shall be
      liable to any Lender for any action taken or omitted to be taken by it under
      this Agreement or any other Loan Document, or in connection herewith or
      therewith, except for its own willful misconduct or gross negligence, nor
      responsible for any recitals or warranties herein or therein, nor for the
      effectiveness, enforceability, validity or due execution of this Agreement
      or
      any other Loan Document, nor for the creation, perfection or priority of any
      Liens purported to be created by any of the Loan Documents, or the validity,
      genuineness, enforceability, existence, value or sufficiency of any collateral
      security, nor to make any inquiry respecting the performance by the Borrower
      of
      its obligations hereunder or under any other Loan Document. Any such inquiry
      which may be made by the Agent shall not obligate it to make any further inquiry
      or to take any action. The Agent shall be entitled to rely upon advice of
      counsel concerning legal matters and upon any notice, consent, certificate,
      statement or writing which the Agent believes to be genuine and to have been
      presented by a proper Person.

     

    
      
        
        

      

      
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    SECTION
      9.4   Successor.
      The
      Agent may resign as such at any time upon at least 30 days’ prior notice to the
      Borrower and all Lenders. If the Agent at any time shall resign, the Required
      Lenders, with, so long as no Default or Event of Default exists and is
      continuing, the consent of the Borrower, may appoint another Lender as a
      successor Agent which shall thereupon become the Agent hereunder. If no
      successor Agent shall have been so appointed by the Required Lenders, and shall
      have accepted such appointment, within 30 days after the retiring Agent’s giving
      notice of resignation, then the retiring Agent may, on behalf of the Lenders,
      appoint a successor Agent, which shall be one of the Lenders or a commercial
      banking institution organized under the laws of the U.S. (or any State thereof)
      or a U.S. branch or agency of a commercial banking institution, and having
      a
      combined capital and surplus of at least $500,000,000. Upon the acceptance
      of
      any appointment as Agent hereunder by a successor Agent, such successor Agent
      shall be entitled to receive from the retiring Agent such documents of transfer
      and assignment as such successor Agent may reasonably request, and shall
      thereupon succeed to and become vested with all rights, powers, privileges
      and
      duties of the retiring Agent, and the retiring Agent shall be discharged from
      its duties and obligations under this Agreement. After any retiring Agent’s
      resignation hereunder as the Agent, the provisions of

     

    (i) this
      Article
      IX
      shall
      inure to its benefit as to any actions taken or omitted to be taken by it while
      it was the Agent under this Agreement; and

     

    (ii) Section
      10.3
      and
Section
      10.4
      shall
      continue to inure to its benefit.

     

    SECTION
      9.5   Loans
      by National City.
      National City shall have the same rights and powers with respect to (x) the
      Loans made by it or any of its Affiliates, and (y) the Notes held by it or
      any
      of its Affiliates as any other Lender and may exercise the same as if it were
      not the Agent. National City and its Affiliates may accept deposits from, lend
      money to, and generally engage in any kind of business with the Borrower or
      any
      Subsidiary or Affiliate of Borrower as if National City were not the Agent
      hereunder.

     

    SECTION
      9.6   Credit
      Decisions.
      Each
      Lender acknowledges that it has, independently of the Agent and each other
      Lender, and based on such Lender’s review of the financial information of each
      Credit Party, this Agreement, the other Loan Documents (the terms and provisions
      of which being satisfactory to such Lender) and such other documents,
      information and investigations as such Lender has deemed appropriate, made
      its
      own credit decision to extend its Revolving Commitment. Each Lender also
      acknowledges that it will, independently of the Agent and each other Lender,
      and
      based on such other documents, information and investigations as it shall deem
      appropriate at any time, continue to make its own credit decisions as to
      exercising or not exercising from time to time any rights and privileges
      available to it under this Agreement or any other Loan Document.

     

    SECTION
      9.7   Copies,
      etc.
      The
      Agent shall give prompt notice to each Lender of each notice or request required
      or permitted to be given to the Agent by any Credit Party pursuant to the terms
      of this Agreement (unless concurrently delivered to the Lenders by such Credit
      Party). The Agent will distribute to each Lender each document or instrument
      received for its account and copies of all other communications received by
      the
      Agent from any Credit Party for distribution to the Lenders by the Agent in
      accordance with the terms of this Agreement.

     

    
      
        
        

      

      
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    ARTICLE
      X

     

    MISCELLANEOUS
      PROVISIONS

     

    SECTION
      10.1   Waivers,
      Amendments, etc.
      The
      provisions of this Agreement and of each other Loan Document may from time
      to
      time be amended, modified or waived, if such amendment, modification or waiver
      is in writing and consented to by the Borrower and the Required Lenders;
provided,
      however,
      that no
      such amendment, modification or waiver which would:

     

    (a) modify
      any requirement hereunder that any particular action be taken by all the Lenders
      or by the Required Lenders shall be effective unless consented to by each
      Lender;

     

    (b) modify
      this Section
      10.1,
      change
      the definition of “Required
      Lenders”,
      increase the Revolving Commitment Amount or the Percentage of any Lender, reduce
      any fees described in Article
      III,
      change
      the schedule of repayments of Loans provided for in Section
      3.1.2,
      release
      any Guarantor from its obligations pursuant to any Guaranty (except in
      connection with a Permitted Asset Disposition or as otherwise permitted hereby,
      in which such cases no consent of any Lender is required), release all or
      substantially all of the collateral security (except in connection with a
      Permitted Asset Disposition or as otherwise permitted hereby, in which such
      cases no consent of any Lender is required), except as otherwise specifically
      provided in any Loan Document or extend the Revolving Commitment Termination
      Date or Maturity Date shall be made without the consent of each Lender and
      each
      holder of a Note;

     

    (c) extend
      the due date for, or reduce the amount of, any scheduled repayment or prepayment
      of principal of or interest on any Loan or any fee payable to a Lender (or
      reduce the principal amount of or rate of interest on any Loan) shall be made
      without the consent of the holder of that Note evidencing such Loan or Lender
      entitled to such fee;

     

    (d) affect
      adversely the interests, rights or obligations of the Agent qua
      the
      Agent shall be made without consent of the Agent; or

     

    (e) modify
      Section
      2.7
      or
8.4
      shall be
      made without the consent of the Letter of Credit Issuer.

     

    No
      failure or delay on the part of the Agent, any Lender or the holder of any
      Note
      in exercising any power or right under this Agreement or any other Loan Document
      shall operate as a waiver thereof, nor shall any single or partial exercise
      of
      any such power or right preclude any other or further exercise thereof or the
      exercise of any other power or right. No notice to or demand on any Credit
      Party
      in any case shall entitle it to any notice or demand in similar or other
      circumstances. No waiver or approval by the Agent, any Lender or the holder
      of
      any Note under this Agreement or any other Loan Document shall, except as may
      be
      otherwise stated in such waiver or approval, be applicable to subsequent
      transactions. No waiver or approval hereunder shall require any similar or
      dissimilar waiver or approval thereafter to be granted hereunder.

     

    
      
        
        

      

      
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    SECTION
      10.2   Notices.
      All
      notices and other communications provided to any party hereto under this
      Agreement or any other Loan Document shall be in writing or by facsimile
      transmission and addressed, delivered or transmitted to such party at its
      address, facsimile number transmission set forth below in Schedule
      10.2
      hereto
      or set forth in the Lender Assignment Agreement or at such other address, or
      facsimile transmission number as may be designated by such party in a notice
      to
      the other parties. Any notice, if mailed and properly addressed with postage
      prepaid or if properly addressed and sent by pre-paid courier service, shall
      be
      deemed given when received; any notice, if transmitted by facsimile
      transmission, shall be deemed given when transmitted, provided such notice
      is
      delivered or facsimile transmitted during regular business hours on a Business
      Day.

     

    SECTION
      10.3   Payment
      of Costs and Expenses.
      The
      Borrower agrees to pay on demand all reasonable expenses of the Agent (including
      the reasonable fees and out-of-pocket expenses of counsel to the Agent and
      of
      local counsel, if any, who may be retained by counsel to the Agent) in
      connection with:

     

    (i) the
      negotiation, preparation, execution and delivery of this Agreement and of each
      other Loan Document, including schedules and exhibits, and any amendments,
      waivers, consents, supplements or other modifications to this Agreement or
      any
      other Loan Document as may from time to time hereafter be required, whether
      or
      not the transactions contemplated hereby are consummated, and

     

    (ii) the
      filing, recording, refiling or rerecording of any Security Document and/or
      any
      Uniform Commercial Code financing statements relating thereto and all
      amendments, supplements and modifications to any thereof and any and all other
      documents or instruments of further assurance required to be filed or recorded
      or refiled or rerecorded by the terms hereof or of such Security Document,
      and

     

    (iii) the
      preparation and review of the form of any document or instrument required by
      this Agreement or any other Loan Document.

     

    The
      Borrower further agrees to pay, and to save the Agent and the Lenders harmless
      from all liability for, any stamp or other taxes which may be payable in
      connection with the execution or delivery of this Agreement, the borrowings
      hereunder, or the issuance of the Notes or any other Loan Documents. The
      Borrower also agrees to reimburse the Agent and each Lender upon demand for
      all
      reasonable out-of-pocket expenses (including reasonable attorneys’ fees and
      legal expenses) incurred by the Agent or such Lender in connection with (x)
      the
      negotiation of any restructuring or “work-out”, whether or not consummated, of
      any Obligations and (y) the enforcement of any Obligations. Notwithstanding
      anything contained herein to the contrary, the Borrower shall not be responsible
      for any costs or expenses incurred by the Agent or any Lender in connection
      with
      the transactions contemplated by either of Section
      10.11(a)
      or
10.11(b)
      hereof.

     

    
      
        
        

      

      
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    SECTION
      10.4   Indemnification.
      In
      consideration of the execution and delivery of this Agreement by each Lender
      and
      the extension of the Revolving Commitments and the making of the Loans, the
      Borrower hereby indemnifies, exonerates and holds the Agent and each Lender
      and
      each of their respective officers, directors, employees and agents
      (collectively, the “Indemnified
      Parties”)
      free
      and harmless from and against any and all actions, causes of action, suits,
      losses, costs, liabilities and damages, and expenses incurred in connection
      therewith (irrespective of whether any such Indemnified Party is a party to
      the
      action for which indemnification hereunder is sought), including reasonable
      attorneys’ fees and disbursements (collectively, the “Indemnified
      Liabilities”),
      incurred by the Indemnified Parties or any of them as a result of, or arising
      out of, or relating to:

     

    

    (i) any
      transaction financed or to be financed in whole or in part, directly or
      indirectly, with the proceeds of any Loan;

     

    (ii) the
      entering into and performance of this Agreement and any other Loan Document
      by
      any of the Indemnified Parties (including any action brought by or on behalf
      of
      the Borrower as the result of any determination by the Required Lenders pursuant
      to Article
      V
      not to
      fund any Borrowing);

     

    (iii) any
      investigation, litigation or proceeding related to any acquisition or proposed
      acquisition by the Borrower of all or any portion of the stock or assets of
      any
      Person, whether or not the Agent or such Lender is party thereto;

     

    (iv) any
      investigation, litigation or proceeding related to any environmental cleanup,
      audit, compliance or other matter relating to the protection of the environment
      or the Release by Borrower or any of its Subsidiaries of any Hazardous Material;
      or

     

    (v) the
      presence on or under, or the escape, seepage, leakage, spillage, discharge,
      emission, discharging or releases from, any real property owned or operated
      by
      the Borrower or any Subsidiary thereof of any Hazardous Material (including
      any
      losses, liabilities, damages, injuries, costs, expenses or claims asserted
      or
      arising under any Environmental Law), regardless of whether caused by, or within
      the control of, the Borrower or such Subsidiary,

     

    except
      for any such Indemnified Liabilities arising for the account of a particular
      Indemnified Party by reason of the relevant Indemnified Party’s gross negligence
      or willful misconduct. If and to the extent that the foregoing undertaking
      may
      be unenforceable for any reason, the Borrower hereby agrees to make the maximum
      contribution to the payment and satisfaction of each of the Indemnified
      Liabilities which is permissible under applicable law.

     

    SECTION
      10.5   Survival.
      The
      obligations of the Borrower under Sections
      4.3,
      4.4,
      4.5,
      4.6
      and
10.3
      and
10.4,
      and the
      obligations of the Lenders under Section
      9.1,
      shall
      in each case survive any termination of this Agreement, the payment in full
      of
      all Obligations and the termination of all Revolving Commitments. The
      representations and warranties made by the Borrower in this Agreement and in
      each other Loan Document shall survive the execution and delivery of this
      Agreement and each such other Loan Document.

     

    
      
        
        

      

      
        73

        
          

        

      

      
        
        

      

    

    SECTION
      10.6   Severability.
      Any
      provision of this Agreement or any other Loan Document which is prohibited
      or
      unenforceable in any jurisdiction shall, as to such provision and such
      jurisdiction, be ineffective to the extent of such prohibition or
      unenforceability without invalidating the remaining provisions of this Agreement
      or such Loan Document or affecting the validity or enforceability of such
      provision in any other jurisdiction.

     

    SECTION
      10.7   Headings.
      The
      various headings of this Agreement and of each other Loan Document are inserted
      for convenience only and shall not affect the meaning or interpretation of
      this
      Agreement or such other Loan Document or any provisions hereof or
      thereof.

     

    SECTION
      10.8   Execution
      in Counterparts, Effectiveness, etc.
      This
      Agreement may be executed by the parties hereto in several counterparts, each
      of
      which shall be executed by the Borrower and the Agent and be deemed to be an
      original and all of which shall constitute together but one and the same
      agreement. This Agreement shall become effective when counterparts hereof
      executed on behalf of the Borrower and each Lender (or notice thereof
      satisfactory to the Agent) shall have been received by the Agent and notice
      thereof shall have been given by the Agent to the Borrower and each
      Lender.

     

    SECTION
      10.9   Governing
      Law; Entire Agreement.
      THIS
      AGREEMENT, THE NOTES AND EACH OTHER LOAN DOCUMENT SHALL EACH BE DEEMED TO BE
      A
      CONTRACT MADE UNDER AND GOVERNED BY THE INTERNAL LAWS OF THE STATE OF ILLINOIS.
      This Agreement, the Notes and the other Loan Documents constitute the entire
      understanding among the parties hereto with respect to the subject matter hereof
      and supersede any prior agreements, written or oral, with respect
      thereto.

     

    SECTION
      10.10   Successors
      and Assigns.
      This
      Agreement shall be binding upon and shall inure to the benefit of the parties
      hereto and their respective successors and assigns; provided,
      however,
      that:

     

    (i) the
      Borrower may not assign or transfer its rights or obligations hereunder without
      the prior written consent of the Agent and all Lenders; and

     

    (ii) the
      rights of sale, assignment and transfer of the Lenders are subject to
Section
      10.11.

     

    SECTION
      10.11   Sale
      and Transfer of Loans and Note; Participations in Loans and Note.
      Each
      Lender may assign, or sell participations in, its Loans and Revolving Commitment
      to one or more other Persons in accordance with this Section
      10.11.

     

    SECTION
      10.11.1   Assignments.
      Any
      Lender:

     

    (i) with
      the
      written consent of the Agent and, provided no Event of Default then shall exist
      or be continuing, the Borrower (which consent shall not be unreasonably delayed
      or withheld) may at any time assign and delegate to one or more commercial
      banks
      or other financial institutions, and

     

    
      
        
        

      

      
        74

        
          

        

      

      
        
        

      

    

    (ii) with
      notice to the Borrower and the Agent, but without the consent of the Borrower
      or
      the Agent, may assign and delegate to any of its Affiliates or to any other
      Lender,

     

    (each
      Person described in either of the foregoing clauses as being the Person to
      whom
      such assignment and delegation is to be made, being hereinafter referred to
      as
      an “Assignee
      Lender”),
      all or
      any fraction of such Lender’s total Loans and Revolving Commitment (which
      assignment and delegation shall be of a constant, and not a varying, percentage
      of all the assigning Lender’s Loans and Revolving Commitment) in a minimum
      aggregate amount of $5,000,000 (or such lesser amount to the extent that after
      giving effect to such assignment such Lender’s total Loans and Revolving
      Commitment is reduced to zero); provided,
      however,
      that
      any such Assignee Lender will comply, if applicable, with the provisions
      contained in the penultimate sentence of Section
      4.6,
      and
provided further,
      however,
      that,
      the Borrower and the Agent shall be entitled to continue to deal solely and
      directly with such Lender in connection with the interests so assigned and
      delegated to an Assignee Lender until:

     

    (iii) written
      notice of such assignment and delegation, together with payment instructions,
      addresses and related information with respect to such Assignee Lender, shall
      have been given to the Borrower and the Agent by such Lender and such Assignee
      Lender,

     

    (iv) such
      Assignee Lender shall have executed and delivered to the Borrower and the Agent
      a Lender Assignment Agreement, accepted by the Agent, and

     

    (v) the
      processing fees described below shall have been paid.

     

    From
      and
      after the date that the Agent accepts such Lender Assignment Agreement, (x)
      the
      Assignee Lender thereunder shall be deemed automatically to have become a party
      hereto and to the extent that rights and obligations hereunder have been
      assigned and delegated to such Assignee Lender in connection with such Lender
      Assignment Agreement, shall have the rights and obligations of a Lender
      hereunder and under the other Loan Documents, and (y) the assignor Lender,
      to
      the extent that rights and obligations hereunder have been assigned and
      delegated by it in connection with such Lender Assignment Agreement, shall
      be
      released from its obligations hereunder and under the other Loan Documents.
      Within five Business Days after its receipt of notice that the Agent has
      received an executed Lender Assignment Agreement, the Borrower shall execute
      and
      deliver to the Agent (for delivery to the relevant Assignee Lender) a new Note
      evidencing such Assignee Lender’s assigned Loans and Revolving Commitment and,
      if the assignor Lender has retained Loans and a Revolving Commitment hereunder,
      a replacement Note in the principal amount of the Loans and Revolving Commitment
      retained by the assignor Lender hereunder (such Note to be in exchange for,
      but
      not in payment of, that Note then held by such assignor Lender). Each such
      Note
      shall be dated the date of the predecessor Note. The assignor Lender shall
      mark
      the predecessor Note “exchanged” and deliver it to the Borrower. Accrued
      interest on that part of the predecessor Note evidenced by the new Note, and
      accrued fees, shall be paid as provided in the Lender Assignment Agreement.
      Accrued interest on that part of the predecessor Note evidenced by the
      replacement Note shall be paid to the assignor Lender. Accrued interest and
      accrued fees shall be paid at the same time or times provided in the predecessor
      Note and in this Agreement. Such assignor Lender or such Assignee Lender must
      also pay a processing fee to the Agent upon delivery of any Lender Assignment
      Agreement in the amount of $3,500. Any attempted assignment and delegation
      not
      made in accordance with this Section
      10.11.1
      shall be
      null and void.

     

    
      
        
        

      

      
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    SECTION
      10.11.2   Participations.
      Any
      Lender may at any time sell to one or more commercial banks or other Persons
      (each of such commercial banks and other Persons being herein called a
“Participant”)
      participating interests in any of the Loans, its Revolving Commitment, or other
      interests of such Lender hereunder; provided,
      however,
      that:

     

    (i) no
      participation contemplated in this Section
      10.11
      shall
      relieve such Lender from its Revolving Commitment or its other obligations
      hereunder or under any other Loan Document,

     

    (ii) such
      Lender shall remain solely responsible for the performance of its Revolving
      Commitment and such other obligations,

     

    (iii) the
      Borrower and the Agent shall continue to deal solely and directly with such
      Lender in connection with such Lender’s rights and obligations under this
      Agreement and each of the other Loan Documents,

     

    (iv) no
      Participant, unless such Participant is an Affiliate of such Lender, or is
      itself a Lender, shall be entitled to require such Lender to take or refrain
      from taking any action hereunder or under any other Loan Document, except that
      such Lender may agree with any Participant that such Lender will not, without
      such Participant’s consent, take any actions of the type described in
clause
      (b)
      or
(c)
      of
Section
      10.1,
      and

     

    (v) the
      Borrower shall not be required to pay any amount under Section
      4.6
      that is
      greater than the amount which it would have been required to pay had no
      participating interest been sold.

     

    The
      Borrower acknowledges and agrees that each Participant, for purposes of
Sections
      4.3,
      4.4,
      4.5,
      4.6,
      4.8,
      4.9,
      10.3
      and
10.4,
      shall
      be considered a Lender.

     

    SECTION
      10.11.3   Confidentiality.
      The
      Lenders shall hold all non-public information (which has been identified as
      such
      by Borrower) obtained pursuant to the requirements of this Agreement in
      accordance with their customary procedures for handling confidential information
      of this nature and in accordance with safe and sound banking practices and
      in
      any event may make disclosure to any of their examiners, Affiliates, outside
      auditors, counsel and other professional advisors in connection with this
      Agreement or as reasonably required by any bona fide
      transferee, participant or assignee or as required or requested by any
      governmental agency or representative thereof or pursuant to legal process;
      provided,
      however,
      that:

     

    (i) unless
      specifically prohibited by applicable law or court order, each Lender shall
      notify the Borrower of any request by any governmental agency or representative
      thereof (other than any such request in connection with an examination of the
      financial condition of such Lender by such governmental agency) for disclosure
      of any such non-public information prior to disclosure of such
      information;

     

    
      
        
        

      

      
        76

        
          

        

      

      
        
        

      

    

    (ii) prior
      to
      any such disclosure pursuant to this Section
      10.12,
      each
      Lender shall require any such bona fide transferee, participant and assignee
      receiving a disclosure of non-public information to agree in
      writing:

     

    (1) to
      be
      bound by this Section
      10.12;
      and

     

    (2) to
      require such Person to require any other Person to whom such Person discloses
      such non-public information to be similarly bound by this Section
      10.12;
      and

     

    (iii) except
      as
      may be required by an order of a court of competent jurisdiction and to the
      extent set forth therein, no Lender shall be obligated or required to return
      any
      materials furnished by any Credit Party.

     

    (iv) to
      the
      extent necessary to comply with HIPAA, the Lenders and Borrower and each of
      the
      other Credit Parties that is a "covered entity" under HIPAA shall execute a
      Business Associate Agreement pursuant to HIPAA attached hereto as Exhibit L,
      to
      protect the Borrower’s disclosure of individually identifiable health
      information to the Lenders. 

     

    SECTION
      10.12   Other
      Transactions.
      Nothing
      contained herein shall preclude the Agent or any other Lender from engaging
      in
      any transaction, in addition to those contemplated by this Agreement or any
      other Loan Document, with the Borrower or any of its Affiliates in which
      Borrower or such Affiliate is not restricted hereby from engaging with any
      other
      Person.

     

    SECTION
      10.13   Amendment
      and Restatement. 

     

    On
      the
      Fifth Amended and Restated Effective Date, the Original Credit Agreement (as
      previously amended, restated or otherwise modified including in connection
      with
      the Fourth Amended and Restated Credit Agreement) shall be amended, restated
      and
      superseded in its entirety. The parties hereto acknowledge and agree that (i)
      this Agreement, any Notes delivered pursuant hereto and the other Loan Documents
      executed and delivered in connection herewith do not constitute a novation,
      payment and reborrowing, or termination of the "Obligations" (as defined in
      the
      Original Credit Agreement (as previously amended, restated or otherwise modified
      including in connection with the Fourth Amended and Restated Credit Agreement))
      under the Original Credit Agreement (as previously amended, restated or
      otherwise modified including in connection with the Fourth Amended and Restated
      Credit Agreement) as in effect prior to the Fifth Amended and Restated Effective
      Date; (ii) such "Obligations" are in all respects continuing with only the
      terms
      thereof being modified as provided in this Agreement; (iii) the Liens as granted
      under the Collateral Documents securing payment of such "Obligations" are in
      all
      respects continuing and in full force and effect and secure the payment of
      the
      Obligations (as defined in this Agreement) and are hereby fully ratified and
      affirmed; and (iv) upon the effectiveness of this Agreement all loans and
      letters of credit outstanding under the Original Credit Agreement (as previously
      amended, restated or otherwise modified including in connection with the Fourth
      Amended and Restated Credit Agreement) immediately before the effectiveness
      of
      this Agreement will be part of the Loans and Letters of Credit hereunder on
      the
      terms and conditions set forth in this Agreement. Without limitation of the
      foregoing, Borrower hereby fully and unconditionally ratifies and affirms all
      Collateral Documents and agrees that all collateral granted thereunder shall
      from and after the Fifth Amended and Restated Effective Date secure all
      Obligations hereunder. 

     

    
      
        
        

      

      
        77

        
          

        

      

      
        
        

      

    

    Notwithstanding
      the modifications effected by this Agreement of the representations, warranties
      and covenants of the Loan Parties contained in the Original Credit Agreement
      (as
      previously amended, restated or otherwise modified including in connection
      with
      the Fourth Amended and Restated Credit Agreement), Borrower acknowledges and
      agrees that any causes of action or other rights created in favor of any Lender
      and its successors arising out of the representations and warranties of any
      Credit Party contained in or delivered (including representations and warranties
      delivered in connection with the making of the loans or other extensions of
      credit thereunder) in connection with the Original Credit Agreement (as
      previously amended, restated or otherwise modified including in connection
      with
      the Fourth Amended and Restated Credit Agreement) or any other Loan Document
      executed in connection therewith shall survive the execution and delivery of
      this Agreement, provided,
      further,
      that
      the Obligations under the other Loan Documents shall also continue in full
      force
      and effect including, without limitation, the Obligations of each Credit Party
      pursuant to the Collateral Documents. All indemnification obligations of each
      Credit Party pursuant to the Original Credit Agreement (as previously amended,
      restated or otherwise modified including in connection with the Fourth Amended
      and Restated Credit Agreement) (including any arising from a breach of the
      representations thereunder) shall survive the amendment and restatement of
      the
      Original Credit Agreement (as previously amended, restated or otherwise modified
      including in connection with the Fourth Amended and Restated Credit Agreement)
      pursuant to this Agreement. 

     

    On
      and
      after the Fifth Amended and Restated Effective Date, (i) each reference in
      the
      Loan Documents to the "Credit Agreement", "thereunder", "thereof" or similar
      words referring to the Credit Agreement shall mean and be a reference to this
      Agreement and (ii) each reference in the Loan Documents to a "Note" shall mean
      and be a Note as defined in this Agreement. 

     

    SECTION
      10.14   Forum
      Selection and Consent to Jurisdiction.
      ANY
      LITIGATION BASED HEREON, OR ARISING OUT OF, UNDER, OR IN CONNECTION WITH, THIS
      AGREEMENT OR ANY OTHER LOAN DOCUMENT, OR ANY COURSE OF CONDUCT, COURSE OF
      DEALING, STATEMENTS (WHETHER VERBAL OR WRITTEN) OR ACTIONS OF THE AGENT, THE
      LENDERS OR ANY CREDIT PARTY SHALL BE BROUGHT AND MAINTAINED EXCLUSIVELY IN
      THE
      COURTS OF THE STATE OF ILLINOIS OR IN THE UNITED STATES DISTRICT COURT FOR
      THE
      NORTHERN DISTRICT OF ILLINOIS; PROVIDED,
      HOWEVER,
      THAT
      ANY SUIT SEEKING ENFORCEMENT AGAINST ANY COLLATERAL OR OTHER PROPERTY MAY BE
      BROUGHT, AT THE AGENT’S OPTION, IN THE COURTS OF ANY JURISDICTION WHERE SUCH
      COLLATERAL OR OTHER PROPERTY MAY BE FOUND. THE BORROWER HEREBY EXPRESSLY AND
      IRREVOCABLY SUBMITS TO THE JURISDICTION OF THE COURTS OF THE STATE OF ILLINOIS
      AND OF THE UNITED STATES DISTRICT COURT FOR THE NORTHERN DISTRICT OF ILLINOIS
      FOR THE PURPOSE OF ANY SUCH LITIGATION AS SET FORTH ABOVE AND IRREVOCABLY AGREES
      TO BE BOUND BY ANY JUDGMENT RENDERED THEREBY IN CONNECTION WITH SUCH LITIGATION.
      BORROWER FURTHER IRREVOCABLY CONSENTS TO THE SERVICE OF PROCESS BY REGISTERED
      MAIL, POSTAGE PREPAID, OR BY PERSONAL SERVICE WITHIN OR WITHOUT THE STATE OF
      ILLINOIS. THE BORROWER HEREBY EXPRESSLY AND IRREVOCABLY WAIVES, TO THE FULLEST
      EXTENT PERMITTED BY LAW, ANY OBJECTION WHICH IT MAY HAVE OR HEREAFTER MAY HAVE
      TO THE LAYING OF VENUE OF ANY SUCH LITIGATION BROUGHT IN ANY SUCH COURT REFERRED
      TO ABOVE AND ANY CLAIM THAT ANY SUCH LITIGATION HAS BEEN BROUGHT IN AN
      INCONVENIENT FORUM. TO THE EXTENT THAT THE BORROWER HAS OR HEREAFTER MAY ACQUIRE
      ANY IMMUNITY FROM JURISDICTION OF ANY COURT OR FROM ANY LEGAL PROCESS (WHETHER
      THROUGH SERVICE OR NOTICE, ATTACHMENT PRIOR TO JUDGMENT, ATTACHMENT IN AID
      OF
      EXECUTION OR OTHERWISE) WITH RESPECT TO ITSELF OR ITS PROPERTY, EACH SUCH CREDIT
      PARTY HEREBY IRREVOCABLY WAIVES SUCH IMMUNITY IN RESPECT OF ITS OBLIGATIONS
      UNDER THIS AGREEMENT AND THE OTHER LOAN DOCUMENTS.

     

    
      
        
        

      

      
        78

        
          

        

      

      
        
        

      

    

    SECTION
      10.15   Waiver
      of Jury Trial.
      THE
      AGENT, THE LENDERS AND THE BORROWER HEREBY KNOWINGLY, VOLUNTARILY AND
      INTENTIONALLY WAIVE ANY RIGHTS THEY MAY HAVE TO A TRIAL BY JURY IN RESPECT
      OF
      ANY LITIGATION BASED HEREON, OR ARISING OUT OF, UNDER, OR IN CONNECTION WITH,
      THIS AGREEMENT OR ANY OTHER LOAN DOCUMENT, OR ANY COURSE OF CONDUCT, COURSE
      OF
      DEALING, STATEMENTS (WHETHER VERBAL OR WRITTEN) OR ACTIONS OF THE AGENT, THE
      LENDERS OR THE BORROWER. THE BORROWER ACKNOWLEDGES AND AGREES THAT IT HAS
      RECEIVED FULL AND SUFFICIENT CONSIDERATION FOR THIS PROVISION (AND EACH OTHER
      PROVISION OF EACH OTHER LOAN DOCUMENT TO WHICH IT IS A PARTY) AND THAT THIS
      PROVISION IS A MATERIAL INDUCEMENT FOR THE AGENT AND THE LENDERS ENTERING INTO
      THIS AGREEMENT AND EACH SUCH OTHER LOAN DOCUMENT.

     

    SECTION
      10.16   USA
      Patriot Act Notice. 

     

    Each
      of
      the Agent and each Lender hereby notifies the Borrower that pursuant to the
      requirements of the USA Patriot Act (Title III of Pub. L. 107-56 (signed into
      law on October 26, 2001)) (the “Patriot Act”), each of the Agent and each Lender
      is required to obtain, verify and record information that identifies the
      Borrower, which information includes the name and address of the Borrower and
      other information that will allow the Lender to identify the Borrower in
      accordance with the Patriot Act.

    

    

    *
      *
      *

    

    
      
        
        

      

      
        79

        
          

        

      

      
        
        

      

    

     

    IN
      WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed
      by
      their respective officers thereunto duly authorized as of the day and year
      first
      above written.

     

    NOVAMED,
      INC.

     

    By:
      /s/ Scott
      T. Macomber

    Title:
      EVP and CFO

     

    NATIONAL
      CITY BANK OF THE
      MIDWEST,

    Individually
      as a Lender, as Letter of Credit

    Issuer
      and as Agent

    By:
      /s/ James
      M. Kershner

    Title:
      Vice President

     

    LASALLE
      BANK NATIONAL ASSOCIATION 

    Individually
      as a Lender

    By:
      /s/
      Sam L. Dendrinos

    Title:
      First Vice President

     

    THE
      NORTHERN TRUST COMPANY 

    Individually
      as a Lender

    By:
      /s/
      Matthew Anderson

    Title: Second
      Vice President

    

    ASSOCIATED
      BANK, N.A.

    Individually
      as a Lender

    By
/s/
      Viktor Gottlieb

    Title:
      Corporate Banking

    

    CHARTER
      ONE BANK

    Individually
      as a Lender

    By
/s/
      Craig Brzezinski

    Title:
      Vice President

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    TABLE
      OF CONTENTS

     

     

    
      	SCHEDULE 1	 --	Original Closing Date
              Stockholders
	SCHEDULE 2 	 --	Agreed EBITDA Formula
	SCHEDULE 6.3	 --	Approvals
	SCHEDULE 6.8	 --	Subsidiaries
	SCHEDULE 6.10	 --	Tax Matters
	SCHEDULE 6.17	 --	Existing Indebtedness
	SCHEDULE 6.18	 --	Service Agreements; Employment
              Agreements
	SCHEDULE 6.21 	 --	Required Certificates
	SCHEDULE 7.1.4 	 --	Insurance
	SCHEDULE 7.2.3	 --	Existing Liens
	SCHEDULE 7.2.5	 --	Existing Investments 
	SCHEDULE 7.2.8	 --	Subsidiaries
              to be Dissolved
	SCHEDULE 10.1	 --	Commitment Percentages
	SCHEDULE 10.2	 --	Notice Information
	 	 	  
	EXHIBIT A 	 	Form of Note
	EXHIBIT
              B 	 	Form of Borrowing Request
	EXHIBIT C 	 	Form
              of Continuation/Conversion Notice
	EXHIBIT
              D 	 	Form of Lender Assignment
              Agreement
	EXHIBIT E 	 	Form
              of Guaranty
	EXHIBIT F-1	 	Form
              of Borrower Pledge Agreement
	EXHIBIT F-2 	 	Form
              of Guarantor Pledge Agreement
	EXHIBIT G-1	 	Form
              of Borrower Security Agreement 
	EXHIBIT G-2   	 	Form of Guarantor Security
              Agreement
	EXHIBIT H	 	Form of Opinion of Counsel to the
              Borrower
	EXHIBIT I	 	Form
              of Reaffirmation of Collateral Documents
	EXHIBIT J	 	Form of Adjusted Equity ownership EBITDA
              Certificate
	EXHIBIT K	 	Permitted Asset
              Dispositions

    

     

    *
      NovaMed, Inc. agrees to furnish supplementally a copy of any omitted schedule
      to
      the Securities and Exchange Commission upon request.

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