Document:

exv10w54

 

Exhibit 10.54

AMENDMENT NUMBER FIVE

TO

LEASE AGREEMENT FOR A GAMMA KNIFE UNIT

     This AMENDMENT NUMBER FIVE TO LEASE AGREEMENT FOR A GAMMA KNIFE UNIT (this “Amendment”) is
dated effective as of the 9th day of May, 2007, and is entered into between GK FINANCING, LLC, a
California limited liability company (“GKF”), and The Regents of the University of California, a
California corporation (“University”), with reference to the following facts:

RECITALS

     A. Reference is made to a certain Lease Agreement for a Gamma Knife Unit (as amended, the
“Lease”) which was dated July 6, 1990, but which first became effective on September 17, 1991,
between University and American Shared Hospital Services, a California corporation (“ASHS”).

     B. The Lease was amended pursuant to a certain Amendment Number One to the Lease Agreement for
a Gamma Knife Unit (the “First Amendment”) dated effective August 1, 1995, between University and
ASHS.

     C. The Lease was subsequently assigned (i) by ASHS to its wholly-owned subsidiary, American
Shared Radiosurgery Services (“ASRS”), and then, by ASRS to GKF, which assignment was consented to
by University pursuant to a certain Estoppel Certificate and Consent to Assignment dated December
21, 1995; and (ii) by University to UCSF-Stanford Health Care, a California non profit public
benefit corporation (“UCSF-SHC”).

     D. Effective February 6, 1998, UCSF-SHC and GKF entered into a certain Amendment Number Two to
the Lease Agreement for a Gamma Knife Unit (the “Second Amendment”).

     E. In 1999, the board of directors of UCSF-SHC resolved to windup the affairs of UCSF-SHC and
to dissolve, and as a component of the winding up of the affairs of UCSF-SHC, the Lease was
assigned by UCSF-SHC back to University. This assignment was consented to by the sole former
members of UCSF-SHC (i.e., the University and the Board of Trustees of Leland Stanford Junior
University), and by GKF.

     F. Effective June 22, 2001, University and GKF entered into a certain Amendment Number Three
to Lease Agreement for a Gamma Knife Unit (the “Third Amendment”).

     G. Effective April 1, 2002, University and GKF entered into a certain Amendment Number Four to
Lease Agreement for a Gamma Knife Unit (the “Fourth Amendment”).

     H. University desires to replace the existing Leksell Gamma Knife, Model 4C (the “Model 4C”)
that is currently being leased by GKF to University pursuant to the Lease, with a Leksell Gamma
Knife Perfexion unit. In furtherance thereof, (i) University intends to purchase

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the Perfexion unit from GKF; (ii) GKF intends to trade-in the Model 4C to the manufacturer to
acquire the Perfexion unit that will be sold to University; (iii) concurrently with the execution
of this Amendment, the parties have entered into or intend to enter into a certain Agreement To
Purchase Gamma Knife Perfexion Unit (the “Purchase Agreement”) pertaining to the purchase of the
Perfexion unit; and (iv) the parties intend to amend the Lease as set forth below.

         NOW THEREFORE, for valuable consideration, the receipt and sufficiency of which are
acknowledged, the parties hereby amend the Lease as follows:

	1.	 	Defined Terms. Unless otherwise defined herein, the capitalized terms used herein
shall have the same meanings set forth in the Lease.
	 
	2.	 	Amendment of the Lease. Notwithstanding any provisions to the contrary set forth in
the Lease, the First Amendment, the Second Amendment, the Third Amendment and/or the Fourth
Amendment, the Lease shall be further amended as follows:

	 	a.	 	In consideration for GKF’s agreement to replace the existing Model 4C with the
Perfexion to be purchased by University from GKF, commencing from the “Equipment
Transition Date” to and including January 20, 2008 (which is the current expiration
date of the Lease), University shall pay to GKF the “Equipment Transition Period
Payments” and the “Remaining Period Payments,” which shall be billed and paid as set
forth below. As used herein:

	 	i.	 	The “Equipment Transition Date” shall mean the date on
which (1) the Model 4C has been de-installed and is unable to perform
procedures; (2) all Permits have been obtained; and (3) the Perfexion has been
delivered to the site and is ready for installation.
	 
	 	ii.	 	The “Equipment Transition Period” shall mean the period
commencing from the Equipment Transition Date to the date on which the
Perfexion has been installed and is ready to perform procedures (which period
is estimated to be approximately 4 to 5 weeks).
	 
	 	iii.	 	The “Equipment Transition Period Payments” shall mean
and be equal to:

	 	(1)	 	The number of weekdays during the Equipment
Transition Period; multiplied by
	 
	 	(2)	 	* procedure per weekday (the “Negotiated
Procedures”), which Negotiated Procedures were agreed upon between the
parties to compensate GKF for the lost number of procedures that would
have otherwise been performed during the Equipment Transition Period
but for the installation of the Perfexion); multiplied by
	 
	 	(3)	 	The lease payment rate that would otherwise be
applicable, assuming (A) the Negotiated Procedures are Procedures
performed under the Lease; (B) all of the Negotiated Procedures are
performed within the same Rate Year in which the Equipment

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	 	 	 	Transition Date falls; and (C) the actual number of Procedures
performed prior to the Equipment Transition Date during that same
Rate Year are counted.

	 	iv.	 	The “Remaining Period” shall mean the period commencing
from the expiration of the Equipment Transition Period to and including January
20, 2008
	 
	 	v.	 	The “Remaining Period Payments” shall mean and be equal
to:

	 	(1)	 	The number of Procedures that are actually
performed from time-to-time during the Remaining Period (the “Remaining
Period Procedures”), multiplied by
	 
	 	(2)	 	The lease payment rate that would otherwise be
applicable, assuming (A) the Remaining Period Procedures are Procedures
performed under the Lease; (B) all of the Remaining Period Procedures
are performed within the same Rate Year in which the Equipment
Transition Date falls; and (C) the actual number of procedures
performed prior to the Equipment Transition Date during that same Rate
Year and the Negotiated Procedures are counted.

	 	vi.	 	“Procedure” shall mean any single fraction
cranial/intracranial radiosurgery treatment that is performed by University or
its representatives or affiliates, irrespective of whether the Procedure is
performed on the Model 4C, the Perfexion or using any other equipment or
devices.

	 	b.	 	University shall be billed on the fifteenth (15th) and last day of each month
for the Equipment Transition Period Payments and the Remaining Period Payments
pertaining to the Negotiated Procedures and the Remaining Period Procedures performed
during the first and second half of the month respectively. University shall pay GKF
within forty-five (45) days after being invoiced. University shall promptly inform GKF
in writing as to the number of Procedures performed during the Remaining Period in
order to facilitate such billing.
	 
	 	c.	 	Within ten (10) days after University’s receipt of written request by GKF, GKF
shall have the right to audit University’s books and records (including, without
limitation, the books and records pertaining to any other radiosurgery equipment or
devices) during normal business hours to verify the number of Procedures that have been
performed by University, and University shall provide GKF with access to such books and
records; provided that any patient names or identifiers shall not be disclosed.
	 
	 	d.	 	It is understood that no portion of the Equipment Transition Period Payments
and/or the Remaining Period Payments shall be applied or credited towards the Purchase
Price of the Perfexion.

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	 	e.	 	Notwithstanding Section 7 of the Third Amendment of the Lease, University will
not (nor have the opportunity to) acquire title to the Model 4C, and title to the Model
4C shall remain with GKF, which will be traded-in for the Perfexion as described above.

	3.	 	Conditions Precedent. The amendment of the Lease as set forth in Section 3 above is
subject to the prior satisfaction of all of the following conditions:

	 	a.	 	The Purchase Agreement shall have been executed by University and GKF, and the
“Purchase Price” and all “Taxes” (as defined in the Purchase Agreement) shall have been
paid in full.
	 
	 	b.	 	University shall not be in breach of the Lease, and no act or omission shall
have occurred which, with the giving of notice and/or the passage of time, would
constitute such a breach under the Lease.
	 
	 	c.	 	At all times prior to the Equipment Transition Date, procedures will continue
to be scheduled on the Model 4C in the ordinary course of business.

	4.	 	Captions. The captions and paragraph headings used herein are for convenience only
and shall not be used in construing or interpreting this Amendment.
	 
	5.	 	Full Force and Effect. Except as amended by this Amendment, all of the terms and
provisions of the Lease, including all prior amendments thereto shall remain in full force and
effect.

     IN WITNESS WHEREOF, the parties have executed this Amendment effective as of the date first
written above.

	 	 	 	 	 	 	 	 	 	 	 
	GKF:	 	 	 	University:	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	GK FINANCING, LLC	 	 	 	THE REGENTS OF THE UNIVERSITY OF

CALIFORNIA	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	By:

	 	/s/ Ernest A. Bates, M.D.
 

Ernest A. Bates, M.D.
	 	 	 	By:
	 	/s/ Ken Jones
 

Ken Jones
	 	 
	 

	 	Policy Committee Member
	 	 	 	 	 	Chief Financial Officer	 	 

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Exhibit 10.55

ADDENDUM THREE

TO LEASE AGREEMENT FOR A GAMMA KNIFE UNIT

     This ADDENDUM THREE TO LEASE AGREEMENT FOR A GAMMA KNIFE UNIT (this “Addendum”) is dated
effective as of June 20, 2007, and is entered into between (i) GK FINANCING, LLC, a California
limited liability company (“GKF”), and (ii) SUNRISE HOSPITAL AND MEDICAL CENTER, LLC, a Delaware
limited liability company that is qualified to do business in the State of Nevada, d/b/a/ Sunrise
Hospital and Medical Center (“Medical Center”), with reference to the following recitals:

Recitals:

     A. Medical Center owns and operates an acute care hospital facility located at 3186 South
Maryland Parkway, Las Vegas, NV 89109.

     B. On June 3, 1999, GKF and Medical Center executed a Lease Agreement for a Gamma Knife Unit,
which Lease Agreement was amended by a certain Addendum dated effective December 1, 1998, and a
certain Addendum Two (“Addendum Two”) dated effective January 17, 2007 (as amended, the “Lease”).

     C. The parties desire to further amend the terms and provisions of the Lease as set forth
herein.

     NOW THEREFORE, in consideration of the mutual covenants and agreements set forth herein, and
for other good and valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties agree as follows:

Agreement:

     1. Defined Terms. Unless otherwise defined herein, the capitalized terms used herein
shall have the same meanings set forth in the Lease.

     2. Cobalt Reload of the Equipment.

          a. Cobalt Reload. Pursuant to Section 14 of the Lease, and subject to the terms and
conditions set forth below, (i) GKF, at GKF’s cost and expense, shall reload the Equipment with new
cobalt-60 (the “Reload”), which Reload shall be performed at the Site and shall include any
required installation and rigging; and (ii) GKF shall use its commercially reasonable efforts to
perform the Reload prior to December 31, 2007. It is anticipated that the Equipment will be
unavailable to perform procedures for approximately three to four weeks due to the Reload process.

          b. Medical Center Support. In connection with the Reload, Medical Center, at Medical
Center’s cost and expense, shall provide GKF with Medical Center personnel (including Medical
Center physicists) and services upon request and as required by GKF, among other things, to
oversee, supervise and assist with construction and compliance with local, state and federal
regulatory requirements and with nuclear regulatory compliance issues.

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          c. Permits. Notwithstanding the foregoing, the Reload shall be performed by GKF only
after all necessary and appropriate licenses, permits, approvals, consents and authorizations,
including, without limitation, the proper handling of the cobalt-60 (collectively, the “Permits”),
have been obtained by Medical Center at Medical Center’s sole cost and expense. The timing and
procedure for the Reload shall be as mutually agreed upon between the parties. Notwithstanding
anything to the contrary contained in the Lease and/or this Addendum, GKF makes no representation
or warranty to Medical Center concerning the Reload, and GKF shall have no obligation or liability
to pay any damages to Medical Center resulting therefrom, including, without limitation, any lost
revenues or profits during the period of time that the Equipment is unavailable to perform
procedures due to the Reload process

     3. Per Procedure Payment.

          Notwithstanding anything to the contrary contained in the Lease, for each of the “Increased
Rent Procedures” (as defined below), the per procedure payment set forth in Section 6 of the Lease
shall be increased to * per procedure. Immediately following the completion of the last Increased
Rent Procedure, the per procedure payment shall return to * per procedure. As used herein, (i) the
term, “Increased Rent Procedures” shall mean * procedures performed from and after the completion
of the Reload; and (ii) the term “procedure” shall mean each individual treatment session
(fraction) that involves stereotactic, external, single fraction, conformal radiation, commonly
called radiosurgery, that may include one or more isocenters during the patient treatment session,
delivered to any site(s) superior to the foramen magnum, whether performed on an inpatient or
outpatient basis, using the Equipment and/or any other equipment or devices that are used in lieu
of, or as an alternative to, the Equipment. It is acknowledged by the parties that the Increased
Rent Procedures are intended to allow GKF to recover its costs to perform the Reload. Nothing set
forth herein shall affect the per case reimbursement rates for medical radiation physicist services
payable to GKF pursuant to Addendum Two.

     4. No Responsibility for Additional Reloading. It is understood by the parties that
GKF is not responsible for any additional cobalt reloading, except as expressly agreed upon in
writing by Medical Center and GKF. However, if Medical Center and GKF mutually agree in writing to
another cobalt reloading of the Equipment, then, the costs for such reloading shall be shared
equally between Medical Center and GKF.

     5. Captions. The captions and paragraph headings used herein are for convenience only
and shall not be used in construing or interpreting this Addendum.

     6. Full Force and Effect. Except as amended by this Addendum, all of the terms and
provisions of the Lease shall remain in full force and effect.

     7. Assignment. Pursuant to Section 24 of the Lease, GKF shall be permitted at any
time to assign any and all of its rights and obligations under the Lease to its wholly-owned
subsidiary, provided that such all of such assigned obligations shall be guaranteed by GKF.

     IN WITNESS WHEREOF, the parties have executed this Addendum effective as of the date first
written above.

	 	 	 	 	 	 	 	 	 	 	 
	GK FINANCING, LLC	 	 	 	SUNRISE HOSPITAL AND MEDICAL

CENTER, LLC	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	By:

	 	/s/ Ernest A. Bates, M.D.
 

Ernest A. Bates, M.D.
	 	 	 	By:
Name:
	 	/s/ Steve Otto
 

Steve Otto
	 	 
	 

	 	Policy Committee Member
	 	 	 	Title: 	COO	 	 

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