Document:

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EXHIBIT 10.1

                AMENDMENT NO. 1 TO SECURITIES PURCHASE AGREEMENT

         This Amendment No. 1 to Securities Purchase Agreement (this "SPA
AMENDMENT") is dated effective as of January 30, 2009, among Integrated
Healthcare Holdings, Inc., a Nevada corporation ("COMPANY"), Kali P. Chaudhuri,
M.D., an individual ("INVESTOR"), and William E. Thomas, an individual
("THOMAS") (for purposes of amendments to Articles IV and VI only). Capitalized
terms used herein and not otherwise defined herein have the meanings set forth
in the SPA (as defined below).

                                 R E C I T A L S

         WHEREAS, on July 18, 2008, the parties entered into the SPA, pursuant
to which, among other things, the Company sold to Investor a purchase right to
purchase shares of the Company's Common Stock ("PREVIOUS PURCHASE RIGHT") and
granted to Investor and Thomas certain pre-emptive rights, releases and waivers,
as more fully described in the SPA.

         WHEREAS, as a condition and inducement to Investor entering into the
SPA and incurring the obligations and taking the actions set forth therein,
concurrently with the execution and delivery of the SPA, the Company, Lenders,
Healthcare Financial and the Subsidiary Borrowers entered into the Payoff
Agreement. In addition, Investor exercised the Exercised Warrants and entered
into the Option and Standstill Agreement concurrent with his entry into the SPA.

         WHEREAS, the Previous Purchase Right expired on January 10, 2009, the
market price of shares of the Company's Common Stock has declined since July 18,
2008, the Company was unable to resolve certain litigation in satisfaction of a
condition to closing of the Previous Purchase Right, and the Company desires to
sell an additional 33,333,333 shares of Common Stock ("ADDITIONAL SHARES"), at a
purchase price of $0.03 per share and to grant a new purchase right as set forth
herein.

         WHEREAS, Investor desires to purchase the Additional Shares and obtain
a new purchase right on the terms and subject to the conditions of this
Agreement.

                                A G R E E M E N T

         NOW, THEREFORE, IN CONSIDERATION of the mutual covenants contained in
this Amendment and the Agreement, and for other good and valuable consideration,
the receipt and adequacy of which are hereby acknowledged, the Company and
Investor (and Thomas for purposes of Articles IV and VI of the Agreement, as
amended hereby) agree as follows:

         1. DEFINED TERMS.

         (a) The following defined terms contained in Article I of the SPA are
hereby amended and restated as follows:

                  "AGREEMENT" means the SPA, as amended by the SPA Amendment.

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                  "CLOSING" means an Additional Shares Closing or SPR Closing,
         each of which shall take place at the offices of Rutan & Tucker, LLP,
         611 Anton Boulevard, Suite 1400, Costa Mesa, California 92626 or at
         such other location as the parties may agree.

                  "CLOSING DATE" means an Additional Shares Closing Date or an
         SPR Closing Date.

                  "INVESTMENT AMOUNT" means the portion of the Maximum
         Investment Amount elected to be paid by Investor at an SPR Closing.

                  "OPTION AND STANDSTILL AGREEMENT" means the Option and
         Standstill Agreement dated effective as of July 18, 2008, among MPFC I,
         MPFC II, Healthcare Financial and Investor, as amended from time to
         time in a manner satisfactory to Investor in his sole discretion.

                  "OUTSIDE DATE" means 5:00 p.m. California time on January 30,
         2010.

                  "PAYOFF AGREEMENT" means the Early Loan Payoff Agreement dated
         effective as of July 18, 2008, among the Company, the Subsidiary
         Borrowers, Healthcare Financial and Lenders, as amended from time to
         time in a manner satisfactory to Investor in his sole discretion.

                  "SECURITIES" means the Shares, the Warrants, the Warrant
         Shares and the Additional Shares.

                  "TRANSACTION DOCUMENTS" means the SPA, the Payoff Agreement,
         the SPA Amendment and any other documents or agreements executed in
         connection with the transactions contemplated hereunder and thereunder.

         (b) The following defined terms are hereby added to Article I of the
SPA in appropriate alphabetical order:

                  "ADDITIONAL SHARES" has the meaning set forth in the recitals
         to the SPA Amendment.

                  "ADDITIONAL SHARES CLOSING" means the closing of the purchase
         and sale of Additional Shares as contemplated by the SPA Amendment.

                  "ADDITIONAL SHARES CLOSING DATE" means the date of the
         Additional Shares Closing, which shall occur, subject to the terms and
         conditions of this Agreement, on or before the later of (i) January 30,
         2009 and (ii) the tenth Business Day after full execution and delivery
         of the SPA Amendment and the documents referred to in Section 5.1(h) of
         this Agreement.

                  "CAPITAL INCREASE EFFECTIVE TIME" means the date upon which
         the Company's authorized capital is increased to 500,000,000 shares of
         Common Stock as contemplated by Section 4.12 of this Agreement.

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                  "MAXIMUM INVESTMENT AMOUNT" means $5,968,268.01, except that
         prior to the Capital Increase Effective Time, only an aggregate of up
         to $4,468,268.00 of this amount may be invested at SPR Closings.

                  "SPA" means the Securities Purchase Agreement dated as of July
         18, 2008, among the Company, Investor and Thomas.

                  "SPA AMENDMENT" means Amendment No. 1 to the SPA, among the
         Company, Investor and Thomas.

                  "SPR CLOSING" means a closing, if any, of the purchase and
         sale of some or all of the SPR Shares.

                  "SPR CLOSING DATE" means the date of any SPR Closing, which
         shall occur, if at all, on or prior to 5:00 p.m. California time on the
         Outside Date.

                  "SPR SHARES" means Shares purchased at the Per Share Purchase
         Price at an SPR Closing pursuant to the Purchase Right.

         (c) The defined term "Company Deliverables" is hereby deleted in its
entirety.

         2. EXECUTION OF SPA AMENDMENT. Section 2.1 of the SPA is hereby amended
by inserting the following new Section 2.1(c) immediately following Section
2.1(b):

                  "(c) Effective January 30, 2009, the Company hereby grants to
         Investor a new Purchase Right on the terms described in the SPA
         Amendment, and Investor shall deliver to the Company on or prior to
         January 30, 2009 the balance, if any, of $30,000.00 being paid by
         Investor in consideration for Investor's receipt of the new Purchase
         Right."

         3. SPR CLOSINGS. Section 2.2 of the SPA is hereby amended and restated
to read in its entirety as follows:

                  "2.2 SPR CLOSINGS AND SPR CLOSING DELIVERIES. Subject to the
         terms and conditions set forth in this Agreement (including, without
         limitation, the conditions set forth in Article V), on each SPR Closing
         Date, the Company shall issue and sell to Investor, and Investor shall
         purchase from the Company, the number of Shares equal to the Investment
         Amount divided by the Per Share Purchase Price, and:

                           (a) The Company shall deliver or cause to be
                  delivered to Investor the following:

                                    (i) irrevocable instructions to the
                           Company's transfer agent to promptly deliver a
                           certificate or certificates in denominations
                           requested by Investor evidencing an aggregate number
                           of Shares equal to the portion of the Investment
                           Amount elected to be paid by Investor at the SPA
                           Closing divided by the Per Share Purchase Price,
                           registered in the name of Investor;

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                                    (ii) the legal opinions of Company Counsel
                           addressed to Investor and in such forms as are
                           reasonably requested by Investor; and

                                    (iii) certificates of officers as required
                           under Sections 5.1(b) and 5.1(c) of this Agreement;
                           and

                           (b) Investor shall deliver or cause to be delivered
                  to the Company:

                                    (i) the Investment Amount, in United States
                           dollars and in immediately available funds, by wire
                           transfer to an account designated in writing by the
                           Company for such purpose; and

                                    (ii) A duly executed investor certification
                           required pursuant to Section 3.2(b) of this
                           Agreement."

         4. ADDITIONAL SHARES CLOSING. Article II of the SPA is hereby amended
by inserting the following new Section 2.3 immediately following revised Section
2.2:

                  "2.3 ADDITIONAL SHARES CLOSING AND DELIVERIES. Subject to the
         terms and conditions set forth in this Agreement (including, without
         limitation, the conditions set forth in Article V), on the Additional
         Shares Closing Date:

                  (a) The Company shall deliver or cause to be delivered to
         Investor:

                           (i) irrevocable instructions to the Company's
                  transfer agent to promptly deliver a certificate or
                  certificates in denominations requested by Investor evidencing
                  the Additional Shares, registered in the name of Investor;

                           (ii) a copy of an amendment to the Payoff Agreement,
                  duly executed by the Company, the Subsidiary Borrowers,
                  Healthcare Financial and Lenders, in form and substance
                  satisfactory to Investor;

                           (iii) the legal opinions of Company Counsel addressed
                  to Investor and Thomas and in such forms as are reasonably
                  requested by Investor and Thomas;

                           (iv) certifications acknowledging and agreeing that
                  the execution of the Transaction Documents, the consummation
                  of the transactions contemplated thereby, and/or the exercise
                  of the Exercised Warrants or the Warrants will not give rise
                  to or trigger any severance, termination or other rights or
                  obligations of the Company under any employment, consulting or
                  similar agreements or arrangements to which the Company, any
                  member of the Board of Directors of the Company, Ken
                  Westbrook, Steve Blake, Dan Brothman, Scott Schoeffel or Jerry
                  Kanaly is a party or is otherwise bound, duly executed by each
                  party to such agreements or arrangements;

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                           (v) resolutions of the Board of Directors authorizing
                  and approving the SPA Amendment and the transactions
                  contemplated thereby, including without limitation the
                  increase in authorized capital contemplated by Section 4.12,
                  which resolutions are certified by the Secretary of the
                  Company;

                           (vi) resolutions of the Board of Directors or
                  Compensation Committee of the Board of Directors of the
                  Company, as appropriate, ensuring that no awards under the
                  Company's 2006 Stock Incentive Plan are accelerated by the
                  execution of the Transaction Documents, the consummation of
                  the transactions contemplated hereby and thereby, and/or the
                  exercise of the Exercised Warrants or Warrants, which
                  resolutions are certified by the Secretary of the Company; and

                           (vii) certificates of officers as required under
                  Sections 5.1(b) and 5.1(c) of this Agreement.

                  (b) Investor shall deliver or cause to be delivered to the
         Company:

                           (i) $1,000,000 in United States dollars, representing
                  the purchase price of the Additional Shares; and

                           (ii) A duly executed investor certification required
                  pursuant to Section 3.2(b) of this Agreement."

         5. REPRESENTATIONS AND WARRANTIES OF THE COMPANY. Section 3.1 of the
SPA is hereby amended as follows:

                  (a) Section 3.1(g) is hereby amended by amended and restated
         in its entirety as follows:

                           "(g) CAPITALIZATION. The only class of capital stock
                  that the Company is authorized to issue is Common Stock. The
                  total number of shares of Common Stock outstanding is
                  161,973,929, excluding the issuances of Additional Shares
                  being made hereunder. The total number of shares of Common
                  Stock issuable upon full exercise of options outstanding under
                  the Company's option plan (whether or not vested or
                  exercisable) is 9,445,000. Other than rights granted to
                  Investor and Thomas pursuant to Section 4.9 of this Agreement,
                  no securities of the Company are entitled to preemptive or
                  similar rights, and no Person has any right of first refusal,
                  preemptive right, right of participation, or any similar right
                  to participate in the transactions contemplated by the
                  Transaction Documents. Other than the Warrants, the Exercised
                  Warrants, the 9,445,000 options, the $10.7 Million Note and
                  the Purchase Right and right to purchase Additional Shares
                  granted hereunder, there are no outstanding options, warrants,
                  scrip rights to subscribe to, calls or commitments of any
                  character whatsoever relating to, or securities, rights or
                  obligations convertible into or exchangeable for, or giving
                  any Person any right to subscribe for or acquire, any shares

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                  of Common Stock, or contracts, commitments, understandings or
                  arrangements by which the Company or any Subsidiary is or may
                  become bound to issue additional shares of Common Stock, or
                  securities or rights convertible or exchangeable into shares
                  of Common Stock. The issue and sale of the Securities will
                  not, immediately or with the passage of time, obligate the
                  Company to issue shares of Common Stock or other securities to
                  any Person (other than Investor) and will not result in a
                  right of any holder of Company securities to adjust the
                  exercise, conversion, exchange or reset price under such
                  securities, except as set forth in the first paragraph of
                  Section 3 of each of the Warrants."

                  (b) Section 3.1(i)(v) is hereby amended and restated in its
         entirety as follows:

                           "(v) the Company has not issued any equity securities
                  to any officer, director or Affiliate, except pursuant to
                  existing Company stock option plans or pursuant to this
                  Agreement."

                  (c) Section 3.1(j) is hereby amended by inserting the words
         "or any current report on Form 8-K or quarterly report on Form 10-Q
         filed by the Company for any subsequent period" immediately after the
         words "Latest Form 10-K" in each of the three places where the words
         "Latest Form 10-K" appear.

                  (d) Section 3.1(k) is hereby amended by inserting the words
         "or any current report on Form 8-K or quarterly report on Form 10-Q
         filed by the Company for any subsequent period" immediately after the
         words "Latest Form 10-K".

                  (e) Section 3.1(q) is hereby amended and restated in its
         entirety as follows:

                           "(q) INTERNAL ACCOUNTING CONTROLS. The Company and
                  the Subsidiaries maintain a system of internal accounting
                  controls sufficient to provide reasonable assurance that (i)
                  transactions are executed in accordance with management's
                  general or specific authorizations, (ii) transactions are
                  recorded as necessary to permit preparation of financial
                  statements in conformity with GAAP and to maintain asset
                  accountability, (iii) access to assets is permitted only in
                  accordance with management's general or specific
                  authorization, and (iv) the recorded accountability for assets
                  is compared with the existing assets at reasonable intervals
                  and appropriate action is taken with respect to any
                  differences. The Company has established disclosure controls
                  and procedures (as defined in Exchange Act Rules 13a-15 and
                  15d-15) for the Company and designed such disclosure controls
                  and procedures to ensure that material information relating to
                  the Company, including its Subsidiaries, is made known to the
                  certifying officers by others within those entities,
                  particularly during the period in which the Company's Form
                  10-K or 10-Q, as the case may be, is being prepared. The
                  Company's certifying officers have evaluated the effectiveness
                  of the Company's controls and procedures in accordance with
                  Item 307 of Regulation S-K under the Exchange Act for the year
                  ended March 31, 2008 and for each subsequent quarter ended
                  after that date for which a Form 10-Q has been filed (each
                  such date, the "EVALUATION DATE"). The Company presented in

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                  the Latest Form 10-K and each subsequent Form 10-Q the
                  conclusions of the certifying officers about the effectiveness
                  of the disclosure controls and procedures based on their
                  evaluations as of the Evaluation Date. Except as disclosed in
                  the Latest Form 10-K and each subsequent Form 10-Q, since the
                  Evaluation Date, there have been no changes in the Company's
                  internal controls (as such term is defined in Item 308(c) of
                  Regulation S-K under the Exchange Act) that have materially
                  affected or are reasonably likely to materially affect, the
                  Company's internal controls."

                  (f) Section 3.1(s) is hereby amended by replacing "$30,000"
         with "$60,000".

         6. OTHER AGREEMENTS OF THE PARTIES. Article IV of the SPA is hereby
amended as follows:

                  (a) Section 4.1(b) is hereby amended by deleting the words
         "Except as set forth in Section 4.1(c), certificates" and replacing
         them with the word "Certificates".

                  (b) Section 4.1(c) is hereby deleted in its entirety.

                  (c) The introductory clause to Section 4.2 is hereby amended
         by deleting the words "At the Closing" and replacing them with the
         words "On July 18, 2008,".

                  (d) Section 4.5 is hereby amended and restated in its entirety
         as follows:

                           "4.5 SECURITIES LAWS DISCLOSURE; PUBLICITY. By 6:00
                  a.m. (California time) on the Trading Day following the
                  execution of the SPA, and by 6:00 a.m. (California time) on
                  the Trading Day following each Closing Date (other than the
                  Additional Shares Closing Date), the Company shall issue press
                  releases disclosing the transactions contemplated hereby and
                  the Closing. On the Trading Day following the execution of the
                  SPA, and no later than the second Trading Day following the
                  execution of the SPA Amendment, the Company will file a
                  Current Report on Form 8-K disclosing the material terms of
                  the Transaction Documents (and attach or incorporate by
                  reference as exhibits thereto the Transaction Documents), and
                  on the Trading Day following each Closing Date (other than the
                  Additional Shares Closing Date), the Company will file an
                  additional Current Report on Form 8-K to disclose the Closing.
                  In addition, the Company will make such other filings and
                  notices in the manner and time required by the Commission and
                  the Trading Market on which the Common Stock is listed.
                  Notwithstanding the foregoing, the Company shall not publicly
                  disclose the name of Investor, or include the name of Investor
                  in any filing with the Commission (other than in a
                  registration statement filed pursuant to Section 4.2 and any
                  exhibits to filings made in respect of this transaction in
                  accordance with periodic filing requirements under the
                  Exchange Act) or any regulatory agency or Trading Market,
                  without the prior written consent of Investor, except to the
                  extent such disclosure is required by law or Trading Market
                  regulations."

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                  (e) Section 4.8 is hereby amended and restated in its entirety
         as follows:

                           "4.8 USE OF PROCEEDS. The Company will use all of the
                  proceeds from the exercise of the Exercised Warrants to repay
                  a portion of the $10.7 Million Note concurrent with the
                  exercise of the Exercised Warrants, in accordance with the
                  terms of the Payoff Agreement. The Company will use all of the
                  proceeds from the sale of Additional Shares and the sale or
                  sales, if any, of SPR Shares hereunder to repay a portion of
                  the $10.7 Million Note equal to such proceeds concurrent with
                  each Closing in accordance with the terms of the Payoff
                  Agreement. Concurrent with the SPR Closing, if any, at which
                  the aggregate Investment Amounts paid on or prior to that SPR
                  Closing Date equal the Maximum Investment Amount, the Company
                  will pay such additional funds of the Company as needed to
                  repay the balance of the $10.7 Million Note and any then
                  outstanding obligations under the $10.7 Million Credit
                  Facility in accordance with the terms of the Payoff
                  Agreement."

                  (f) Section 4.9 is hereby amended and restated in its entirety
         as follows:

                           "4.9 PRE-EMPTIVE RIGHTS. Effective July 18, 2008, the
                  Company hereby grants to Investor and Thomas pre-emptive
                  rights with respect to issuances, on or after July 18, 2008,
                  by the Company of its equity securities or securities or
                  rights convertible into or exercisable for equity securities
                  (other than issuances of Additional Shares, SPR Shares, or
                  shares of Common Stock issued on July 18, 2008 upon exercise
                  of the Exercised Warrants), where issuance of those securities
                  or rights would result in dilution of Investor's or Thomas's
                  beneficial ownership (as calculated by Investor or Thomas for
                  purposes of Section 13(d) of the Exchange Act) of the Common
                  Stock of the Company on a fully-diluted basis taking into
                  account all Common Stock Equivalents (each a "POST-TRANSACTION
                  PERCENTAGE") to less than his respective beneficial ownership
                  of the Common Stock of the Company on a fully-diluted basis
                  taking into account all Common Stock Equivalents immediately
                  prior to the consummation of the proposed issuance (each a
                  "PRE-TRANSACTION PERCENTAGE"). Each time the Company proposes
                  to issue or offer any shares of, or securities or rights
                  convertible into or exercisable for any shares of, any class
                  of the Company's equity securities (the "NEW SHARES") that
                  would reduce Investor's or Thomas's Post-Transaction
                  Percentage to below his respective Pre-Transaction Percentage,
                  the Company shall first make a written offer (the "OFFER
                  NOTICE") to Investor and Thomas of such portion of the New
                  Shares that would maintain Investor's and Thomas's
                  Post-Transaction Percentage at a minimum of their respective
                  Pre-Transaction Percentage (the "PRO RATA SHARE"). The Offer
                  Notice would state the Company's (A) bona fide intention to
                  issue or offer the New Shares, (B) the identity of the
                  Person(s) to whom the New Shares are to be issued or offered,
                  (C) the number of New Shares to be issued or offered, and (D)
                  the price and terms upon which it proposes to issue or offer
                  the New Shares. Investor and/or Thomas may, by written notice
                  to the Company delivered within thirty (30) days of their
                  respective receipt of the Offer Notice, elect to purchase, at
                  the price and on the terms specified in the Offer Notice, up
                  to the Pro Rata Share. The closing of the sale of such portion

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                  of the Pro Rata Share as Investor and/or Thomas elect to
                  purchase shall occur simultaneously with the issuance or sale
                  of the New Shares to other Person(s) identified in the Offer
                  Notice, no earlier than forty-five (45) days following
                  Investor's and Thomas's receipt of the Offer Notice (unless a
                  shorter period of time is agreed to by Investor and Thomas in
                  their sole discretion), and the Pro Rata Share shall be priced
                  equal to the lowest price paid by any of the other Person(s)
                  identified in the Offer Notice, including any who may be
                  receiving or purchasing New Shares by virtue of similar
                  pre-emptive or other purchase rights. If the Company does not
                  consummate the issuance or sale of the New Shares within sixty
                  (60) days following Investor's and Thomas's receipt of the
                  Offer Notice, then the New Shares shall not be offered, issued
                  or sold unless again offered to Investor and Thomas in
                  accordance with this Section 4.9. Effective July 18, 2008, the
                  pre-emptive rights contained in this Section 4.9 shall
                  supersede and replace the pre-emptive rights contained or
                  incorporated by reference in the Rescission Agreement. For the
                  avoidance of doubt, the parties acknowledge and agree that
                  unless and until this Section 4.9 is specifically terminated
                  in a writing signed by Investor and Thomas that explicitly
                  refers to and provides for the termination of this Section
                  4.9, this Section 4.9 shall survive each Closing and the
                  Outside Date, regardless of whether any Additional Shares or
                  SPR Shares are purchased by Investor and notwithstanding any
                  other termination, expiration or lapse of this Agreement or
                  the Purchase Right."

                  (g) Section 4.11 is hereby amended (x) to insert the words
         "and amendment" after the words "entry into" in the first sentence
         thereof and (y) to insert the following sentence at the end thereof:
         "The receipt by Company of funds or other accommodations made by
         Investor or Thomas in connection with the Transaction Documents and the
         transactions contemplated thereby on any date on or after July 18, 2008
         shall constitute a ratification, adoption, and confirmation by Company
         and all other Releasing Parties of the provisions of Section 4.11,
         which are hereby reiterated in their entirety as of each such date."

                  (h) The following new Section 4.12 is hereby inserted
         immediately following Section 4.11:

                           "4.12 AUTHORIZED CAPITAL. The Company covenants and
                  agrees to promptly use all commercially reasonable efforts in
                  good faith to increase the Company's authorized capital from
                  time to time as and to the extent necessary to ensure there
                  are sufficient authorized shares of Common Stock reserved and
                  available for issuance as contemplated under this Agreement,
                  subject to Investor's cooperation in approving by vote or
                  written consent from time to time resolutions approving such
                  increases in authorized capital. The Company will procure at
                  its sole expense upon each such authorization and reservation
                  of shares the listing thereof (subject to issuance or notice
                  of issuance) on all stock exchanges on which the Common Stock
                  is then listed or inter-dealer trading systems or markets on
                  which the Common Stock is then traded. The Company will take
                  all such actions as may be necessary to assure that such
                  shares of Common Stock may be so issued without violation of
                  any applicable law or regulation, or of any requirements of

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                  any national securities exchange upon which the Common Stock
                  may be listed or inter-dealer trading system on which the
                  Common Stock is then traded. In furtherance, and not in
                  limitation, of the foregoing, the Company covenants and agrees
                  to prepare and file with the Securities and Exchange
                  Commission preliminary and definitive versions of a Schedule
                  14C Information Statement and make such other filings and
                  mailings to the Company's stockholders as Investor reasonably
                  requests and/or as otherwise are necessary or appropriate to
                  cause an increase in the Company's authorized capital to
                  500,000,000 shares of Common Stock to become effective as soon
                  as practicable after the Additional Shares Closing Date, with
                  the goal of obtaining effectiveness of the increase in
                  authorized capital by March 31, 2009."

         7. CONDITIONS PRECEDENT TO CLOSING. Article V of the SPA is hereby
amended as follows:

                  (a) The introductory clause to Section 5.1 is hereby amended
         and restated in its entirety as follows:

                  "7. CONDITIONS PRECEDENT TO THE OBLIGATION OF INVESTOR TO
         PURCHASE THE SHARES. The obligation of Investor to acquire the Shares
         at the Closing is subject to the satisfaction or waiver by Investor, at
         or before the Closing, of each of the following conditions:"

                  (b) Section 5.1(a) is hereby amended and restated in its
         entirety as follows:

                           "(a) ELECTION TO EXERCISE PURCHASE RIGHT. In
                  connection with an SPR Closing, Investor shall have elected,
                  in his sole discretion, to exercise the Purchase Right, as
                  follows:

                                     (i) at any time or from time to time on or
                  after August 1, 2008, Investor may provide written notice to
                  the Company of his intention to purchase any or all of the SPR
                  Shares pursuant to the Purchase Right ("ELECTION NOTICE");

                                     (ii) if Investor provides to the Company an
                  Election Notice pursuant to Section 5.1(a)(i), then the
                  Closing shall occur on a date mutually acceptable to Investor
                  and the Company, which date shall be within 30 days after the
                  Company's receipt of the Election Notice and shall be subject
                  to the fulfillment of the conditions precedent to Closing
                  contained in this Article V."

                  (c) Section 5.1(f) is hereby amended and restated in its
         entirety as follows:

                           "(f) COMPANY DELIVERABLES. The Company shall have
                  delivered the Company deliverables required in accordance with
                  Section 2.2 or 2.3, as appropriate."

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                  (d) Section 5.1(h) is hereby amended and restated in its
         entirety as follows:

                  (e) "(h) OTHER AGREEMENTS. In the case of the Additional
         Shares Closing, Investor shall have received duly executed copies of
         amendments to the Option and Standstill Agreement and the Payoff
         Agreement in form and substance satisfactory to Investor in his sole
         discretion. The Payoff Agreement and the Option and Standstill
         Agreement (as amended thereby) shall be in full force and effect and
         the parties thereto shall be in compliance with their obligations
         thereunder.

                  (f) The following new Section 5.1(j) is hereby inserted
         immediately following Section 5.1(i):

                           "(j) AVAILABLE SHARES. The Company's authorized
                  capital must be sufficient to cover the issuance of the Shares
                  at the Closing."

                  (g) Section 5.2(d) is hereby amended and restated in its
         entirety as follows:

                           "(d) INVESTOR DELIVERABLE. Investor shall have
                  delivered the Investor deliverables required in accordance
                  with Section 2.2 or 2.3, as appropriate."

                  (h) The following new Section 5.2(e) is hereby inserted
         immediately following Section 5.2(d):

                           "(e) AVAILABLE SHARES. The Company's authorized and
                  unreserved capital must be sufficient to cover the issuance of
                  the Shares at the Closing. To the extent the Company's
                  authorized and unreserved capital is insufficient to cover the
                  issuance of all Shares desired to be purchased by Investor at
                  the Closing, the Company shall, at Investor's election, be
                  obligated to issue at the Closing up to the maximum number of
                  shares of Common Stock that are then available for issuance
                  without causing the Company's fully-diluted capital stock to
                  exceed its authorized and unreserved capital. Notwithstanding
                  the foregoing, however, this condition precedent does not
                  eliminate or diminish the Company's obligations under Section
                  4.12 of the Agreement."

         8. MISCELLANEOUS. Article VI of the SPA is hereby amended as follows:

                  (a) Section 6.5 is hereby deleted in its entirety and replaced
         with the following:

                   "6.5    INTENTIONALLY OMITTED."

                  (b) Section 6.8 is hereby deleted in its entirety and replaced
         with the following:

                           "6.8 NO THIRD-PARTY BENEFICIARIES. This Agreement is
                  intended for the benefit of the parties hereto and their
                  respective successors and permitted assigns and is not for the
                  benefit of, nor may any provision hereof be enforced by, any

                                       11

<PAGE>

                  other Person, except for Thomas and except as otherwise set
                  forth in Section 4.6 (as to each Investor Party) and Section
                  4.11 (as to each of the Released Parties)."

                  (c) Section 6.13 is hereby amended by inserting the words "or
         Thomas" after the word "Investor" in each place it occurs.

                  (d) Section 6.15 is hereby amended by inserting ",Thomas"
         after the word "Investor".

                  (e) A new Section 6.17 is hereby inserted immediately
         following Section 6.16 as follows:

                           "6.17 EFFECT OF AMENDMENT. Except as specifically
                  amended hereby or as provided herein, all terms, conditions,
                  covenants, representations and warranties contained in the SPA
                  remain in full force and effect."

                   [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK
                             SIGNATURE PAGES FOLLOW]

                                       12

<PAGE>

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

                                    INTEGRATED HEALTHCARE HOLDINGS, INC.

                                    By: /S/ KEN WESTBROOK
                                        ----------------------------------------
                                    Name: Ken Westbrook
                                    Title:  President and CEO

                                    INVESTOR

                                    /S/ KALI P. CHAUDHURI
                                    --------------------------------------------
                                    Kali P. Chaudhuri, M.D.

                                    SHARE ISSUANCE AND DELIVERY INSTRUCTIONS

                                    CERTIFICATES SHOULD BE ISSUED AS FOLLOWS:

                                    Kali P. Chaudhuri, M.D.
                                    3322 Loma Linda Lane
                                    Las Vegas, NV 89121-5716

                                    CERTIFICATES SHOULD BE DELIVERED TO:

                                    Kali P. Chaudhuri, M.D.
                                    c/o Strategic Global Management, Inc.
                                    6800 Indiana Avenue, Suite 130
                                    Riverside, CA 92506

                                    WITH A COPY OF THE FRONT AND BACK OF EACH
                                    CERTIFICATE SENT TO INVESTOR'S COUNSEL AT
                                    THE ADDRESS SET FORTH IN SECTION 6.3

                                       13

<PAGE>

         For purposes of Articles IV and VI of the Agreement, I hereby agree to
the rights and obligations as set forth in Article IV and the miscellaneous
provisions set forth in Article VI, as amended hereby. Except as expressly set
forth in the preceding sentence, I am not a party to the Agreement and have
given no representations, warranties or assurances to any person.

                                    THOMAS

                                    /S/ WILLIAM E. THOMAS
                                    --------------------------------------------
                                    William E. Thomas

                                       14<PAGE>

EXHIBIT 10.2

                 AMENDMENT NO. 1 TO EARLY LOAN PAYOFF AGREEMENT

         This AMENDMENT NO. 1 TO EARLY LOAN PAYOFF AGREEMENT (this "PAYOFF
AMENDMENT"), dated effective as of January 30, 2009, is made by and among
Integrated Healthcare Holdings, Inc., a Nevada corporation (the "Company"),
WMC-SA, Inc., a California corporation ("WMC-SA"), WMC-A, Inc., a California
corporation ("WMC-A"), Chapman Medical Center, Inc., a California corporation
("CHAPMAN"), Coastal Communities Hospital, Inc., a California corporation
("COASTAL"), Medical Provider Financial Corporation I, a Nevada corporation
("MPFC I"), Medical Provider Financial Corporation II, a Nevada corporation
("MPFC II"), Medical Provider Financial Corporation III, a Nevada corporation
("MPFC III") and Healthcare Financial Management & Acquisitions, Inc., a Nevada
corporation ("HFMA"). Capitalized terms used herein and not otherwise defined
herein have the meanings set forth in the ELPA (as defined below).

                                 R E C I T A L S

         WHEREAS, the parties entered into an Early Loan Payoff Agreement
("ELPA") effective July 18, 2008, pursuant to which Lenders granted to Borrowers
the right and option to extend the Maturity Dates under the $80 Million Credit
Agreement and the $50 Million Credit Agreement for one additional year, and HFMA
agreed to amend the 4.95% Warrant and the 31.09% Warrant in the manner set forth
therein.

         WHEREAS, Borrowers have requested that Lenders agree to modify certain
terms of the ELPA in order to facilitate Borrower's ability to consummate the
early payoff contemplated thereby.

         WHEREAS, Lenders and HFMA have agreed to Borrowers' request, on the
terms and conditions set forth below.

                                A G R E E M E N T

         NOW, THEREFORE, IN CONSIDERATION of the mutual covenants contained in
this Payoff Amendment and the ELPA, and for other good and valuable
consideration the receipt and adequacy of which are hereby acknowledged, the
parties agree as follows:

         1. DEFINED TERMS.

                  (a) The following defined terms contained in the ELPA are
         hereby amended and restated as follows:

                           "AGREEMENT" means the ELPA, as amended effective as
                  of the effective date of the Payoff Amendment.

                           "FIRST CLOSING DATE" means July 18, 2008.

                                       1

<PAGE>

                           "SECOND CLOSING DATE" means the Additional Shares
                  Closing Date (as defined in the Securities Purchase Agreement)
                  or the first Business Day thereafter.

                           "SECOND PAYOFF AMOUNT" means $1,000,000.

                           "SECURITIES PURCHASE AGREEMENT" means that certain
                  Securities Purchase Agreement dated effective as of July 18,
                  2008, as amended from time to time, among the Company, Kali P.
                  Chaudhuri, M.D. ("DR. CHAUDHURI"), and William E. Thomas, an
                  individual ("MR. THOMAS").

                  (b) The following defined term is added to the ELPA in
         appropriate alphabetical order:

                           "FULL PAYOFF AMOUNT" means all outstanding principal,
                  accrued and unpaid interest, and other payment obligations
                  then due and owing under the $10.7 Million Credit Agreement
                  and $10.7 Million Note.

                           "SPR CLOSING" means an SPR Closing (as defined in the
                  Securities Purchase Agreement).

                           "SPR CLOSING DATE" means an SPR Closing Date (as
                  defined in the Securities Purchase Agreement) or the first
                  Business Day thereafter, or such other date as all of the
                  parties and Dr. Chaudhuri may agree.

         2. EARLY PAYOFF OF $10.7 MILLION CREDIT AGREEMENT. Section 2.1(b) of
the ELPA is hereby amended and restated in its entirety as follows:

                  "(b) (i) On the Second Closing Date, the Company shall pay or
         cause to be paid to MPFC III, in immediately available funds, the
         Second Payoff Amount. MPFC III confirms that the rate of interest
         applicable to the $10.7 Million Note as of the Second Closing Date is
         the Interest Rate defined in the $10.7 Million Credit Agreement, and
         that the outstanding principal balance of the $10.7 Million Note as of
         the date of execution of the Payoff Amendment is $6,968,268.05 and the
         Stated Maturity Date of the $10.7 Million Note is October 8, 2010.

                           (ii) On each SPR Closing Date, if any, the Company
         shall pay or cause to be paid to MPFC III, in immediately available
         funds, the Investment Amount (as defined in the Securities Purchase
         Agreement) paid to the Company at the SPR Closing.

                           (iii) On the SPR Closing Date, if any, at which the
         aggregate Investment Amount paid on or prior to that SPR Closing Date
         equals the Maximum Investment Amount (as defined in the Securities
         Purchase Agreement), the Company will pay or cause to be paid to MPFC
         III, in immediately available funds, the Full Payoff Amount.

                                       2

<PAGE>

                           (iv) Regardless of whether one or more SPR Closings
         occurs and regardless of whether the Company receives the Maximum
         Investment Amount at one or more SPR Closings, the Company may elect to
         pay or cause to be paid to MPFC III, in immediately available funds,
         the Full Payoff Amount prior to the Maturity Date (as defined in the
         $10.7 Million Credit Agreement) in accordance Section 1.4(a)(iii) of
         the $10.7 Million Credit Agreement.

         3. OPTION TO EXTEND MATURITY DATES UNDER $80 MILLION CREDIT AGREEMENT
AND $50 MILLION CREDIT AGREEMENT; AMENDMENT OF 4.95% WARRANT AND 31.09% WARRANT.
The introductory clause of Section 2.2(a) of the ELPA, which currently reads
"(a) On condition that payment of the First Payoff Amount has been made pursuant
to Section 2.1(a) hereof," is hereby amended and restated to read in its
entirety as follows:

                           "(a) On condition that payment of the Full Payoff
                  Amount has been made on or prior to January 30, 2010,".

         4. NO THIRD-PARTY BENEFICIARIES. Section 3.7 of the ELPA is hereby
amended and restated to read in its entirety as follows:

                           "3.7 NO THIRD-PARTY BENEFICIARIES. This Agreement is
                  intended for the benefit of the parties hereto and their
                  respective successors and permitted assigns and is not for the
                  benefit of, nor may any provision hereof be enforced by, any
                  other Person, other than Dr. Chaudhuri with respect to the
                  definitions of First Closing Date, Second Closing Date and SPR
                  Closing Date."

         5 EFFECT OF AMENDMENT. A new Section 3.14 is hereby inserted
immediately following Section 3.13 as follows:

                           "3.14 EFFECT OF AMENDMENT. Except as specifically
                  amended by the Payoff Amendment, all terms, conditions,
                  covenants, representations and warranties contained in this
                  Agreement remain in full force and effect."

                  [REMAINDER OF PAGE INTENTIONALLY LEFT BLANK]
                            [SIGNATURE PAGES FOLLOW]

                                       3

<PAGE>

         IN WITNESS WHEREOF, the parties hereto have caused this Payoff
Amendment to be duly executed by their respective authorized signatories as of
the date first indicated above.

INTEGRATED HEALTHCARE HOLDINGS, INC.,      WMC-A, INC., a California
a Nevada corporation                       corporation

By: /S/ KEN WESTBROOK                      By: /S/ KEN WESTBROOK
    ----------------------------------         ---------------------------------
Ken Westbrook, President and CEO           Ken Westbrook, President and CEO

WMC-SA, INC., a California                 CHAPMAN MEDICAL CENTER, INC.,
corporation                                a California corporation

By: /S/ KEN WESTBROOK                      By: /S/ KEN WESTBROOK
    ----------------------------------         ---------------------------------
Ken Westbrook, President and CEO           Ken Westbrook, President and CEO

COASTAL COMMUNITIES HOSPITAL, INC.,        MEDICAL PROVIDER FINANCIAL
a California corporation                   CORPORATION I, a Nevada corporation

By: /S/ KEN WESTBROOK                      By: /S/ JOSEPH J. LAMPARIELLO
    ----------------------------------         ---------------------------------
Ken Westbrook, President and CEO           Joseph J. Lampariello, President
                                             and COO

MEDICAL PROVIDER FINANCIAL                 MEDICAL PROVIDER FINANCIAL
CORPORATION II, a Nevada corporation       CORPORATION III, a Nevada corporation

By: /S/ JOSEPH J. LAMPARIELLO              By: /S/ JOSEPH J. LAMPARIELLO
    ----------------------------------         ---------------------------------
Joseph J. Lampariello, President           Joseph J. Lampariello, President
  and COO                                    and COO

HEALTHCARE FINANCIAL MANAGEMENT
& ACQUISITIONS, INC.

By: /S/ JOSEPH J. LAMPARIELLO
    ----------------------------------
Joseph J. Lampariello, President
  and COO

                                       4

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