Document:

EX-10.4

THIRD AMENDMENT TO PURCHASE AND SALE AGREEMENT

THIS THIRD AMENDMENT TO PURCHASE AND SALE AGREEMENT (this “Third Amendment”) is
entered into as of October 10, 2007, by and between ST. RITA’S MEDICAL CENTER, an Ohio nonprofit
corporation (“Seller”), and TRIPLE NET PROPERTIES, LLC, a Virginia limited liability
company, (“Buyer”), with reference to the following Recitals:

R E C I T A L S

A. Seller and Buyer entered into that certain Purchase and Sale Agreement dated August 14,
2007, as amended by (i) that certain First Amendment to Purchase and Sale Agreement dated September
10, 2007, and (ii) that certain Second Amendment to Purchase and Sale Agreement dated September 28,
2007 (collectively, the “Purchase Agreement”) wherein Seller agreed to sell to Buyer, and
Buyer agreed to purchase from Seller, those certain “Properties” (as defined in the
Purchase Agreement), which include the “Fee Properties”, as legally described on the
attached Exhibit A, and the “Ground Lease Properties”, as legally described on the
attached Exhibit B, pursuant to the terms and conditions set forth in the Purchase
Agreement.

B. Suites 260 is included in Paragraph 1(a)(2) of the Purchase Agreement and is a
combination of Condominium Units 302 and 303 of the Market Street Health Care Condominium. Suite
260 is not a Condominium Unit, but was a suite of offices developed using Condominium Units 302 and
303. It is the intent of Seller to sell and Buyer to purchase Units 302 and 303 Market Street
Health Care Condominium.

C. The description in the Purchase Agreement of the Condominium Units included in the sale
under the Purchase Agreement did not include in Paragraph 1(b)(3) Unit 50 and Unit 490 of
the 750 High Street Professional Building Condominium (MOB 4). Unit 50 is a sub-unit of Unit 400
and is used in conjunction with said Unit. Unit 490 in MOB 4 is used as part of Unit 400 of MOB 4.
It is the intent of the Seller and the Buyer that said Units be part of the sale.

D. The parties also intended that as a part of the sale under the Purchase Agreement that Unit
195 of 750 High Street Professional Building Condominium be included in the sale by Seller to
Buyer, and Paragraph 1(b)(3) should be amended to include Unit 195 in the Purchase
Agreement.

E. Seller and Buyer wish to enter into this Third Amendment to include the Units described in
the Recitals in the sale and purchase contemplated by the Purchase Agreement.

F. Seller and Buyer desire to amend the Purchase Agreement as more particularly set forth
herein.

NOW, THEREFORE, in consideration of the foregoing Recitals (which are incorporated herein by
this reference) and for other good and valuable consideration, the receipt and sufficiency of which
are herby acknowledged, the parties hereto agree as follows:

A G R E E M E N T

1. Definitions. Unless the context clearly indicates otherwise, (a) all initially
capitalized terms not otherwise defined herein shall have the meanings given to such terms in the
Purchase Agreement, and (b) all references to “the Agreement” or “this Agreement”
in the Purchase Agreement or this Third Amendment shall mean and refer to the Purchase Agreement as
amended by this Third Amendment.

2. Closing Date. Notwithstanding anything to the contrary contained in the Purchase
Agreement, the parties acknowledge and agree that the Closing is hereby extended and the Closing
Date is deemed to mean and refer to Monday, October 15, 2007.

3. Units Included. Notwithstanding anything to the contrary contained in the Purchase
Agreement, Seller hereby agrees that Units 302 and 303 Market Street Health Care Condominium are to
be included as Units which are part of the sale contemplated in the Purchase Agreement. Seller and
Buyer hereby agree that Paragraph 1(a)(2) of the Purchase Agreement is amended to include
the purchase and sale of Unit 302 and Unit 303 Market Street Health Care Condominium and to delete
Unit 260 from said paragraph.

4. Additional Units. The parties further agree that Paragraph 1(b)(3) of the
Purchase Agreement should be amended to include additional Units, to-wit: Unit 50; Unit 195; and
Unit 490 of the 750 High Street Professional Building Condominium.

5. Legal Descriptions. Seller and Buyer hereby agree that Exhibit A and
Exhibit B of the Purchase Agreement are hereby deleted and replaced with the Exhibit
A and Exhibit B attached to this Third Amendment.

6. Seller’s Representations. Seller hereby represents and warrants to Buyer that (a)
the legal description of the Fee Properties and Ground Lease Properties contain all of the units
identified on the Rent Roll attached hereto as Exhibit C (the “Rent Roll”) and (b)
the square footage of the units identified in the Rent Roll is correctly stated in the Rent Roll.

7. Indemnification. Seller agrees to indemnify and hold Buyer harmless from and
against any and all claims, actions, charges, expenses (including, without limitation, reasonable
attorney’s fees, and court costs) and liabilities relating to Seller’s representations set forth
herein.

8. Effect of this Third Amendment. Except as amended and/or modified by this Third
Amendment, the Purchase Agreement is hereby ratified and confirmed and all other terms of the
Purchase Agreement are and shall remain in full force and effect, unaltered and unchanged by this
Third Amendment. In the event of any conflict between the provisions of this Third Amendment and
the provisions of the Purchase Agreement, the provisions of this Third Amendment shall control.
Whether or not specifically amended by this Third Amendment, all of the terms and provisions of the
Purchase Agreement are hereby amended to the extent necessary to give effect to the purpose and
intent of this Third Amendment.

9. Further Assurances. Each party will, whenever and as often as it shall be
requested to do so by the other party, execute, acknowledge and deliver, or cause to be executed,
acknowledged and delivered any and all such further conveyances, assignments, approvals, consents
and any and all other documents and do any and all other acts as may be necessary to carry out the
intent and purpose of this Third Amendment.

10. Counterparts. This Third Amendment may be executed in any number of counterparts
with the same effect as if all of the parties had signed the same document. All counterparts shall
be construed together and shall constitute one agreement.

[Signatures on next page]

1

IN WITNESS WHEREOF, the parties hereto have caused this Third Amendment to be executed by
their duly authorized representatives as of the date first referenced above.

	 	 	 
	SELLER:

	 	ST. RITA’S MEDICAL CENTER,

an Ohio nonprofit corporation
	
 
	 	By: /s/ William Roe

Name: William Roe

Title: Vice President
	BUYER:

	 	TRIPLE NET PROPERTIES, LLC,

a Virginia limited liability company
	
 
	 	By: /s/ Jack Maurer

Name: Jack Maurer

Title: Executive Vice President

2EX-10.5

FOURTH AMENDMENT TO PURCHASE AND SALE AGREEMENT

THIS FOURTH AMENDMENT TO PURCHASE AND SALE AGREEMENT (this “Fourth Amendment”) is
entered into as of October 15, 2007, by and between ST. RITA’S MEDICAL CENTER, an Ohio nonprofit
corporation (“Seller”), and TRIPLE NET PROPERTIES, LLC, a Virginia limited liability
company, (“Buyer”), with reference to the following Recitals:

R E C I T A L S

A. Seller and Buyer entered into that certain Purchase and Sale Agreement dated August 14,
2007, as amended by (i) that certain First Amendment to Purchase and Sale Agreement dated September
10, 2007, (ii) that certain Second Amendment to Purchase and Sale Agreement dated September 28,
2007 and (iii) that certain Third Amendment to Purchase and Sale Agreement dated October 10, 2007
(collectively, the “Purchase Agreement”) wherein Seller agreed to sell to Buyer, and Buyer
agreed to purchase from Seller, those certain “Properties” (as defined in the Purchase
Agreement), pursuant to the terms and conditions set forth in the Purchase Agreement.

B. Seller and Buyer wish to enter into this Fourth Amendment to extend the closing date
contemplated by the Purchase Agreement.

C. Seller and Buyer desire to amend the Purchase Agreement as more particularly set forth
herein.

NOW, THEREFORE, in consideration of the foregoing Recitals (which are incorporated herein by
this reference) and for other good and valuable consideration, the receipt and sufficiency of which
are herby acknowledged, the parties hereto agree as follows:

A G R E E M E N T

1. Definitions. Unless the context clearly indicates otherwise, (a) all initially
capitalized terms not otherwise defined herein shall have the meanings given to such terms in the
Purchase Agreement, and (b) all references to “the Agreement” or “this Agreement”
in the Purchase Agreement or this Fourth Amendment shall mean and refer to the Purchase Agreement
as amended by this Fourth Amendment.

2. Closing Date. Notwithstanding anything to the contrary contained in the Purchase
Agreement, the parties acknowledge and agree that the Closing is hereby extended and the Closing
Date is deemed to mean and refer to Monday, November 5, 2007.

3. Effect of this Fourth Amendment. Except as amended and/or modified by this Fourth
Amendment, the Purchase Agreement is hereby ratified and confirmed and all other terms of the
Purchase Agreement are and shall remain in full force and effect, unaltered and unchanged by this
Fourth Amendment. In the event of any conflict between the provisions of this Fourth Amendment and
the provisions of the Purchase Agreement, the provisions of this Fourth Amendment shall control.
Whether or not specifically amended by this Fourth Amendment, all of the terms and provisions of
the Purchase Agreement are hereby amended to the extent necessary to give effect to the purpose and
intent of this Fourth Amendment.

4. Further Assurances. Each party will, whenever and as often as it shall be
requested to do so by the other party, execute, acknowledge and deliver, or cause to be executed,
acknowledged and delivered any and all such further conveyances, assignments, approvals, consents
and any and all other documents and do any and all other acts as may be necessary to carry out the
intent and purpose of this Fourth Amendment.

5. Counterparts. This Fourth Amendment may be executed in any number of counterparts
with the same effect as if all of the parties had signed the same document. All counterparts shall
be construed together and shall constitute one agreement.

[Signatures on next page]

1

IN WITNESS WHEREOF, the parties hereto have caused this Fourth Amendment to be executed by
their duly authorized representatives as of the date first referenced above.

	 	 	 
	SELLER:

	 	ST. RITA’S MEDICAL CENTER,

an Ohio nonprofit corporation
	
 
	 	By: /s/ Brian D. Smith

Name: Brian D. Smith

Title: COO
	BUYER:

	 	TRIPLE NET PROPERTIES, LLC,

a Virginia limited liability company
	
 
	 	By: /s/ Jack Maurer

Name: Jack Maurer

Title: Executive Vice President

2

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