Document:

LIBOR Addendum to Second Amended and Restated Loan and Security Agreement

 Exhibit 10.5 
 LIBOR Addendum 
 to Second Amended and Restated Loan and Security Agreement

 This LIBOR Addendum to Second Amended and Restated Loan and Security Agreement (this “Addendum”) is entered into as of
this 31st day of August, 2005, by and between COMERICA BANK (“Bank”) and INPATIENT CONSULTANTS MANAGEMENT, INC. (“Borrower”). This Addendum supplements the terms of the Second Amended and Restated Loan and Security Agreement (the
“Loan Agreement”) of even date herewith. 
 1. Definitions. 
 (a) Advance. As used herein, “Advance” means a borrowing requested by Borrower and made by Bank under the Loan Agreement,
including a LIBOR Option Advance and/or a Prime Rate Option Advance. 
 (b) Business Day. As used herein,
“Business Day” means any day except a Saturday, Sunday or any other day designated as a holiday under Federal or California statute or regulation. 
 (c) LIBOR. As used herein, “LIBOR” means the rate per annum (rounded upward if necessary, to the nearest whole 1/8 of 1%)
and determined pursuant to the following formula: 
  

			
	LIBOR =	  	            Prime
LIBOR                    
		  	 100% - LIBOR Reserve Percentage

 (1) “Prime LIBOR” means the rate per annum determined by Bank at which
deposits for the relevant LIBOR Period would be offered to Bank in the approximate amount of the relevant LIBOR Option Advance in the inter-bank LIBOR market selected by Bank, upon request of Bank at 10:00 a.m. California time, on the day that is
the first day of such LIBOR Period. 
 (2) “LIBOR Reserve Percentage” means the reserve percentage prescribed by the
Board of Governors of the Federal Reserve System (or any successor) for “Eurocurrency Liabilities” (as defined in Regulation D of the Federal Reserve Board, as amended), adjusted by Bank for expected changes in such reserve percentage
during the applicable LIBOR Period. 
 (d) LIBOR Business Day. As used herein, “LIBOR Business Day” means a
Business Day on which dealings in Dollar deposits may be carried out in the interbank LIBOR market. 
 (e) LIBOR
Period. As used herein, “LIBOR Period” means, with respect to a LIBOR Option Advance: 
 (1) initially, the
period commencing on, as the case may be, the date the Advance is made or the date on which the Advance is converted to a LIBOR Option Advance, and continuing for, in every case, a 30-, 60-, 90- or 180 day period thereafter so long as the LIBOR
Option is quoted for such period in the applicable interbank LIBOR market, as such period is selected by Borrower in the notice of Advance as provided in the Loan Agreement or in the notice of conversion as provided in this Addendum; and 

(2) thereafter, each period commencing on the last day of the next preceding LIBOR Period applicable to such LIBOR Option Advance and
continuing for, in every case, a 30-, 60-, 90- or 180 day period thereafter so long as the LIBOR Option is quoted for such period in the applicable interbank LIBOR market, as such period is selected by Borrower in the notice of continuation as
provided in this Addendum. 
 (f) Regulation D. As used herein, “Regulation D” means Regulation D of the
Board of Governors of the Federal Reserve System as amended or supplemented from time to time. 
 (g) Regulatory
Development. As used herein, “Regulatory Development” means any or all of the following: (i) any change in any law, regulation or interpretation thereof by any public authority (whether or not having the force of law);
(ii) the application of any existing law, regulation or the interpretation thereof by any public authority (whether or not having the force of law); and (iii) compliance by Bank with any request or directive (whether or not having the
force of law) of any public authority. 
  

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 2. Interest Rate Options. Borrower shall have the following options regarding the interest rate to
be paid by Borrower on the Advances under the Loan Agreement, depending on the ratio of Borrower’s Funded Debt to Trailing Twelve (12) Month EBITDA (as set forth in Section 6.7 of the Loan Agreement): 
  

						
	 Ratio of Funded Debt to Trailing Twelve Month EBITDA
	  	LIBOR plus
(the “LIBOR Option”)	 	 	Prime plus
(the “Prime Rate Option”)
	 X > 2.00
	  	2.00	%	 	0.25
	 3 1.50 X < 2.00
	  	1.75	%	 	0.00
	 X < 1.50
	  	1.50	%	 	0.00

 As used herein, the LIBOR rate plus the applicable margin above is referred to as the “LIBOR
Option” as in effect during the relevant LIBOR Period, and an Advance at the LIBOR Option during such period is a “LIBOR Option Advance.” As used herein, the Prime rate plus the applicable margin above, if any, is referred to as the
“Prime Rate Option,” and an Advance at the Prime Rate Option is a “Prime Rate Advance.” 
 3. LIBOR Option
Advance. The minimum LIBOR Option Advance will not be less than One Million Dollars ($1,000,000) for any LIBOR Option Advance. 
 4.
Payment of Interest on LIBOR Option Advances. Interest on each LIBOR Option Advance shall be payable pursuant to the terms of the Loan Agreement. Interest on such LIBOR Option Advance shall be computed on the basis of a 360-day year and shall
be assessed for the actual number of days elapsed from the first day of the LIBOR Period applicable thereto but not including the last day thereof. 
 5. Bank’s Records Re: LIBOR Option Advances. With respect to each LIBOR Option Advance, Bank is hereby authorized to Loan Agreement the date, principal amount, interest rate and LIBOR Period applicable thereto and any payments
made thereon on Bank’s books and records (either manually or by electronic entry) and/or on any schedule attached to the Loan Agreement, which notations shall be prima facie evidence of the accuracy of the information Loan Agreement.

 6. Selection/Conversion of Interest Rate Options. At the time any Advance is requested under the Loan Agreement and/or Borrower
wishes to select the LIBOR Option for all or a portion of the outstanding principal balance of the Loan Agreement, and at the end of each LIBOR Period, Borrower shall give Bank notice specifying (a) the interest rate option selected by
Borrower; b) the principal amount subject thereto; and (c) if the LIBOR Option is selected, the length of the applicable LIBOR Period. Any such notice may be given by telephone so long as, with respect to each LIBOR Option selected by Borrower,
(i) Bank receives written confirmation from Borrower not later than three (3) LIBOR Business Days after such telephone notice is given; and (ii) such notice is given to Bank prior to 10:00 a.m., California time, on the first day of
the LIBOR Period. For each LIBOR Option requested hereunder, Bank will quote the applicable fixed LIBOR Rate to Borrower at approximately 10:00 a.m., California time, on the first day of the LIBOR Period. If Borrower does not immediately accept the
rate quoted by Bank, any subsequent acceptance by Borrower shall be subject to a redetermination of the rate by Bank; provided, however, that if Borrower fails to accept any such quotation given, then the quoted rate shall expire and Bank shall have
no obligation to permit a LIBOR Option to be selected on such day. If no specific designation of interest is made at the time any Advance is requested under the Loan Agreement or at the end of any LIBOR Period, Borrower shall be deemed to have
selected the Prime Rate Option for such Advance or the principal amount to which such LIBOR Period applied. At any time the LIBOR Option is in effect, Borrower may, at the end of the applicable LIBOR Period, convert to the Prime Rate Option. At any
time the Prime Rate Option is in effect, Borrower may convert to the LIBOR Option, and shall designate a LIBOR Period. 
  

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 7. Default Interest Rate. From and after the maturity date of the Loan Agreement, or such earlier
date as all principal owing hereunder becomes due and payable by acceleration or otherwise, the outstanding principal balance of the Loan Agreement shall bear interest until paid in full at an increased rate per annum (computed on the basis of a
360-day year, actual days elapsed) equal to five percent (5.00%) above the rate of interest from time to time applicable to the Loan Agreement. 
 8. Prepayment. In the event that the LIBOR Option is the applicable interest rate for all or any part of the outstanding principal balance of the Loan Agreement, and any payment or prepayment of any such
outstanding principal balance of the Loan Agreement shall occur on any day other than the last day of the applicable LIBOR Period (whether voluntarily, by acceleration, required payment, or otherwise), or if Borrower elects the LIBOR Option as the
applicable interest rate for all or any part of the outstanding principal balance of the Loan Agreement in accordance with the terms and conditions hereof, and, subsequent to such election, but prior to the commencement of the applicable LIBOR
Period, Borrower revokes such election for any reason whatsoever, or if the applicable interest rate in respect of any outstanding principal balance of the Loan Agreement hereunder shall be changed, for any reason whatsoever, from the LIBOR Option
to the Prime Rate Option prior to the last day of the applicable LIBOR Period, or if Borrower shall fail to make any payment of principal or interest hereunder at any time that the LIBOR Option is the applicable interest rate hereunder in respect of
such outstanding principal balance of the Loan Agreement, Borrower shall reimburse Bank, on demand, for any resulting loss, cost or expense incurred by Bank as a result thereof, including, without limitation, any such loss, cost or expense incurred
in obtaining, liquidating, employing or redeploying deposits from third parties. Such amount payable by Borrower to Bank may include, without limitation, an amount equal to the excess, if any, of (a) the amount of interest which would have
accrued on the amount so prepaid, or not so borrowed, refunded or converted, for the period from the date of such prepayment or of such failure to borrow, refund or convert, through the last day of the relevant LIBOR Period, at the applicable rate
of interest for such outstanding principal balance of the Loan Agreement, as provided under this Loan Agreement, over (b) the amount of interest (as reasonably determined by Bank) which would have accrued to Bank on such amount by placing such
amount on deposit for a comparable period with leading banks in the interbank LIBOR market. Calculation of any amounts payable to Bank under this paragraph shall be made as though Bank shall have actually funded or committed to fund the relevant
outstanding principal balance of the Loan Agreement hereunder through the purchase of an underlying deposit in an amount equal to the amount of such outstanding principal balance of the Loan Agreement and having a maturity comparable to the relevant
LIBOR Period; provided, however, that Bank may fund the outstanding principal balance of the Loan Agreement hereunder in any manner it deems fit and the foregoing assumptions shall be utilized only for the purpose of the calculation of amounts
payable under this paragraph. Upon the written request of Borrower, Bank shall deliver to Borrower a certificate setting forth the basis for determining such losses, costs and expenses, which certificate shall be conclusively presumed correct,
absent manifest error. Any prepayment hereunder shall also be accompanied by the payment of all accrued and unpaid interest on the amount so prepaid. Any outstanding principal balance of the Loan Agreement which is bearing interest at such time at
the Prime Rate Option may be prepaid without penalty or premium. Partial prepayments hereunder shall be applied to the installments hereunder in the inverse order of their maturities. 
 BY INITIALING BELOW, BORROWER ACKNOWLEDGE(S) AND AGREE(S) THAT: (A) THERE IS NO RIGHT TO PREPAY ANY LIBOR OPTION ADVANCE , IN WHOLE OR IN PART,
WITHOUT PAYING THE PREPAYMENT AMOUNT, EXCEPT AS OTHERWISE REQUIRED UNDER APPLICABLE LAW; (B) BORROWER SHALL BE LIABLE FOR PAYMENT OF THE PREPAYMENT AMOUNT IF BANK EXERCISES ITS RIGHT TO ACCELERATE PAYMENT OF ANY LIBOR OPTION ADVANCE AS PART OR
ALL OF THE OBLIGATIONS OWING UNDER THE LOAN AGREEMENT, INCLUDING WITHOUT LIMITATION, ACCELERATION UNDER A DUE-ON-SALE PROVISION; (C) BORROWER WAIVES ANY RIGHTS UNDER SECTION 2954.10 OF THE CALIFORNIA CIVIL CODE, OR ANY SUCCESSOR STATUTE; AND
(D) BANK HAS MADE EACH LIBOR OPTION ADVANCE PURSUANT TO THE LOAN AGREEMENT IN RELIANCE ON THESE AGREEMENTS. 
  

	
	/s/ DS
	BORROWER’S INITIALS

  

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 9. Hold Harmless and Indemnification. Borrower agrees to indemnify Bank and to hold Bank harmless
from, and to reimburse Bank on demand for, all losses and expenses which Bank sustains or incurs as a result of (i) any payment of a LIBOR Option Advance prior to the last day of the applicable LIBOR Period for any reason, including, without
limitation, termination of the Loan Agreement, whether pursuant to this Addendum or the occurrence of an Event of Default; (ii) any termination of a LIBOR Period prior to the date it would otherwise end in accordance with this Addendum; or
(iii) any failure by Borrower, for any reason, to borrow any portion of a LIBOR Option Advance. 
 10. Funding Losses. The
indemnification and hold harmless provisions set forth in this Addendum shall include, without limitation, all losses and expenses arising from interest and fees that Bank pays to lenders of funds it obtains in order to fund the loans to Borrower on
the basis of the LIBOR Option(s) and all losses incurred in liquidating or re-deploying deposits from which such funds were obtained and loss of profit for the period after termination. A written statement by Bank to Borrower of such losses and
expenses shall be conclusive and binding, absent manifest error, for all purposes. This obligation shall survive the termination of this Addendum and the payment of the Loan Agreement. 
 11. Regulatory Developments Or Other Circumstances Relating To Illegality or Impracticality of LIBOR. If any Regulatory Development or other
circumstances relating to the interbank Euro-dollar markets shall, at any time, in Bank’s reasonable determination, make it unlawful or impractical for Bank to fund or maintain, during any LIBOR Period, to determine or charge interest rates
Primed upon LIBOR, Bank shall give notice of such circumstances to Borrower and: 
 (i) In the case of a LIBOR Period in
progress, Borrower shall, if requested by Bank, promptly pay any interest which had accrued prior to such request and the date of such request shall be deemed to be the last day of the term of the LIBOR Period; and 
 (ii) No LIBOR Period may be designated thereafter until Bank determines that such would be practical. 
 12. Additional Costs. Borrower shall pay to Bank from time to time, upon Bank’s request, such amounts as Bank determines are needed to
compensate Bank for any costs it incurred which are attributable to Bank having made or maintained a LIBOR Option Advance or to Bank’s obligation to make a LIBOR Option Advance, or any reduction in any amount receivable by Bank hereunder with
respect to any LIBOR Option or such obligation (such increases in costs and reductions in amounts receivable being herein called “Additional Costs”), resulting from any Regulatory Developments, which (i) change the basis of taxation
of any amounts payable to Bank hereunder with respect to taxation of any amounts payable to Bank hereunder with respect to any LIBOR Option Advance (other than taxes imposed on the overall net income of Bank for any LIBOR Option Advance by the
jurisdiction where Bank is headquartered or the jurisdiction where Bank extends the LIBOR Option Advance; (ii) impose or modify any reserve, special deposit, or similar requirements relating to any extensions of credit or other assets of, or
any deposits with or other liabilities of, Bank (including any LIBOR Option Advance or any deposits referred to in the definition of LIBOR); or (iii) impose any other condition affecting this Addendum (or any of such extension of credit or
liabilities). Bank shall notify Borrower of any event occurring after the date hereof which entitles Bank to compensation pursuant to this paragraph as promptly as practicable after it obtains knowledge thereof and determines to request such
compensation. Determinations by Bank for purposes of this paragraph, shall be conclusive, provided that such determinations are made on a reasonable basis. 
 13. Legal Effect. Except as specifically modified hereby, all of the terms and conditions of the Loan Agreement remain in full force and effect. 
  

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 IN WITNESS WHEREOF, the parties have agreed to the foregoing as of the date first set forth above.

  

									
	INPATIENT CONSULTANTS MANAGEMENT, INC.	 		 	COMERICA BANK
					
	By:	 	/s/ Adam Singer M.D.	 		 	By:	 	/s/ Bonnie Kehl
	Title:	 	Adam Singer M.D. Chief Executive Officer	 		 	Title:	 	Senior Vice President
					
	By:	 	/s/ Devra Shapiro	 		 		 	
	Title:	 	Devra Shapiro Chief Financial Officer	 		 		 	

 [Signature Page to LIBOR Addendum to Second Amended and Restated Loan and Security Agreement]First Amendment to Second Amended and Restated Loan and Security Agreement

 Exhibit 10.6 
 FIRST AMENDMENT TO 
 SECOND AMENDED AND RESTATED LOAN AND SECURITY AGREEMENT 
 This First Amendment to Second Amended and Restated Loan and Security Agreement (this “Amendment”) is entered into as of March 30, 2006,
by and between COMERICA BANK (“Bank”) and INPATIENT CONSULTANTS MANAGEMENT, INC. (“Borrower”). 
 RECITALS

 Borrower and Bank are parties to that certain Second Amended and Restated Loan and Security Agreement dated as of August 31,
2005, as amended from time to time (the “Agreement”). The parties desire to amend the Agreement in accordance with the terms of this Amendment. 
 NOW, THEREFORE, the parties agree as follows: 
 1. The following defined term in Section 1.1 of the
Agreement is hereby amended and restated as follows: 
 “Consolidated Net Income (or Deficit)” means the
consolidated net income (or deficit) of any Person and its Subsidiaries (and, with respect to Borrower, the other Affiliate Guarantors), after deduction of all expenses, taxes, and other proper charges, determined in accordance with GAAP, after
eliminating therefrom all extraordinary non-cash nonrecurring items of income or expense and excluding approximately Three Million Twenty Five Thousand Dollars ($3,025,000) of extraordinary cash expense incurred in connection with the Guilford vs.
IPC litigation described in the Schedule. 
 “Letter of Credit Sublimit” means a sublimit for Letters of Credit
under the Revolving Line not to exceed Four Million Five Hundred Thousand Dollars ($4,500,000). 
 “Permitted
Indebtedness” means: 
 (a) Indebtedness of Borrower in favor of Bank arising under this Agreement or any other Loan
Document; 
 (b) Indebtedness existing on the Closing Date and disclosed in the Schedule; 
 (c) Indebtedness for leases or structured loans for previously purchased Equipment, not to exceed Five Million Dollars ($5,000,000) in the
aggregate at any time; 
 (d) Subordinated Debt; 
 (e) Indebtedness to trade creditors incurred in the ordinary course of business; 
 (f) Indebtedness relating to the financing of insurance premiums not to exceed Four Million Dollars ($4,000,000) per year: 
 (g) a surety bond issued in connection with the Guilford vs. IPC litigation described in the Schedule in the approximate amount of Four
Million Six Hundred Thousand Dollars ($4,600,000); 
 (h) Extensions, refinancings and renewals of any items of Permitted
Indebtedness, provided that the principal amount is not increased or the terms modified to impose more burdensome terms upon Borrower or the Guarantor, as the case may be. 
  

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 “Permitted Investment” means: 
 (a) Investments existing on the Closing Date disclosed in the Schedule and Investments in the Subsidiaries listed on Annex II hereto;

 (b) (i) Marketable direct obligations issued or unconditionally guaranteed by the United States of America or any agency or
any State thereof maturing within one (1) year from the date of acquisition thereof, (ii) commercial paper maturing no more than one (1) year from the date of creation thereof and currently having rating of at least A-2 or P-2 from
either Standard & Poor’s Corporation or Moody’s Investors Service, (iii) Bank’s certificates of deposit maturing no more than one year from the date of investment therein, and (iv) Bank’s money market accounts;

 (c) Repurchases of stock from former employees or directors of Borrower under the terms of applicable repurchase agreements
(i) in an aggregate amount not to exceed Five Hundred Thousand Dollars ($500,000) in any fiscal year, provided that no Event of Default has occurred, is continuing or would exist after giving effect to the repurchases, or (ii) in any
amount where the consideration for the repurchase is the cancellation of indebtedness owed by such former employees to Borrower regardless of whether an Event of Default exists; 
 (d) Investments accepted in connection with Permitted Transfers; and 
 (e) Investments (including debt obligations) received in connection with the bankruptcy or reorganization of customers or suppliers and in
settlement of delinquent obligations of, and other disputes with, customers or suppliers arising in the ordinary course of Borrower’s business. 
 2. Section 6.7 of the Agreement is hereby amended and restated in its entirety to read as follows: 
 “Financial Covenants. Borrower shall at all times maintain the following financial ratios and covenants: 
 (a) Funded Debt to EBITDA. A ratio of Funded Debt to trailing twelve (12) month EBITDA, measured monthly, not to exceed (i) 4.50 to 1.00 for the period from March 31, 2006 through June 29,
2006; (ii) 4.00 to 1.00 for the period from June 30, 2006 through September 29, 2006; (iii) 3.50 to 1.00 for the period from September 30, 2006 through December 30, 2006; (iv) 2.75 to 1.00 for the period from
December 31, 2006 through March 30, 2007; (v) 2.50 to 1.00 for the period from March 31, 2007 through September 29, 2007 and (vi) 2.25 to 1.00 thereafter. For purposes of determining Borrower’s trailing twelve
(12) month EBITDA under this Section 6.7(a), Borrower shall be permitted to include the trailing twelve (12) month EBITDA of any entity or entities acquired by Borrower in accordance with the terms and conditions of Section 7.3,
provided Bank is provided audited financial information with respect to such acquired entity/entities to verify the trailing twelve (12) month EBITDA to Bank’s reasonable satisfaction. 
 (b) Liquidity Ratio. A ratio of Liquidity to all Indebtedness to Bank, measured monthly, of at least (i) 1.50 to 1.00 for the
period from March 31, 2006 through March 30, 2007; (ii) 1.25 to 1.00 for the period from March 31, 2007 through December 30, 2007; and (iii) 1.50 to 1.00 thereafter. 
 3. Section 8.9 of the Agreement is hereby amended and restated in its entirety to read as follows: 
 “Judgments. Except for a judgment of approximately Three Million Twenty Five Thousand Dollars ($3,025,000) in the
Guilford case described in the Schedule, if a judgment or judgments, not covered by insurance, for the payment of money in an amount, individually or in the aggregate, of at least Five Hundred Thousand Dollars ($500,000) shall be rendered
against Borrower and shall remain unsatisfied and unstayed for a period of ten (10) days (provided that no Credit Extensions will be made prior to the satisfaction or stay of such judgment); or” 
 4. All references in the Loan Documents (except the Warrant) to Bank’s address at 2321 Rosecrans Ave., Suite 5000, El Segundo, CA 90245 shall mean
and refer to 75 East Trimble Road, M/C 4770, San Jose, California 95131, Attn: Manager, FAX: (408) 556-5091. The reference in the Warrants to Bank’s address(es) shall mean and refer to 500 Woodward Avenue, 32nd Floor, MC 3379, Detroit, MI
48226. 
  

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 5. Section 11 of the Agreement hereby is amended and restated in its entirety to read as follows:

 “11. CHOICE OF LAW AND VENUE; JURY TRIAL WAIVER. 
 This Agreement shall be governed by, and construed in accordance with, the internal laws of the State of California, without regard to
principles of conflicts of law. Each of Borrower and Bank hereby submits to the exclusive jurisdiction of the state and Federal courts located in the County of Santa Clara, State of California. THE UNDERSIGNED ACKNOWLEDGE THAT THE RIGHT TO TRIAL BY
JURY IS A CONSTITUTIONAL ONE, BUT THAT IT MAY BE WAIVED UNDER CERTAIN CIRCUMSTANCES. TO THE EXTENT PERMITTED BY LAW, EACH PARTY, AFTER CONSULTING (OR HAVING HAD THE OPPORTUNITY TO CONSULT) WITH COUNSEL OF ITS, HIS OR HER CHOICE, KNOWINGLY AND
VOLUNTARILY, AND FOR THE MUTUAL BENEFIT OF ALL PARTIES, WAIVES ANY RIGHT TO TRIAL BY JURY IN THE EVENT OF LITIGATION ARISING OUT OF OR RELATED TO THIS AGREEMENT OR ANY OTHER DOCUMENT, INSTRUMENT OR AGREEMENT BETWEEN THE UNDERSIGNED PARTIES.”

 6. Section 12 of the Agreement hereby is amended and restated in its entirety to read as follows:] 
 “12 REFERENCE PROVISION. 
 In the event the Jury Trial Waiver set forth above is not enforceable, the parties elect to proceed under this Judicial Reference Provision. 
 12.1 Mechanics. 
 (a) With the exception of the items specified in clause (c), below, any controversy, dispute or claim (each, a “Claim”) between the parties arising out of or relating to this Agreement or any other document,
instrument or agreement between the undersigned parties (collectively in this Section, the “Comerica Documents”), will be resolved by a reference proceeding in California in accordance with the provisions of Sections 638 et seq. of the
California Code of Civil Procedure (“CCP”), or their successor sections, which shall constitute the exclusive remedy for the resolution of any Claim, including whether the Claim is subject to the reference proceeding. Except as otherwise
provided in the Comerica Documents, venue for the reference proceeding will be in the state or federal court in the county or district where the real property involved in the action, if any, is located or in the state or federal court in the county
or district where venue is otherwise appropriate under applicable law (the “Court”). 
 (b) The matters that shall
not be subject to a reference are the following: (i) nonjudicial foreclosure of any security interests in real or personal property, (ii) exercise of self-help remedies (including, without limitation, set-off), (iii) appointment of a
receiver and (iv) temporary, provisional or ancillary remedies (including, without limitation, writs of attachment, writs of possession, temporary restraining orders or preliminary injunctions). This reference provision does not limit the right
of any party to exercise or oppose any of the rights and remedies described in clauses (i) and (ii) or to seek or oppose from a court of competent jurisdiction any of the items described in clauses (iii) and (iv). The exercise of, or
opposition to, any of those items does not waive the right of any party to a reference pursuant to this reference provision as provided herein. 
 (c) The referee shall be a retired judge or justice selected by mutual written agreement of the parties. If the parties do not agree within ten (10) days of a written request to do so by any party, then, upon
request of any party, the referee shall be selected by the Presiding Judge of the Court (or his or her representative). A request for appointment of a referee may be heard on an ex parte or expedited basis, and the parties agree that irreparable
harm would result if ex parte relief is not granted. Pursuant to CCP § 170.6, each party shall have one peremptory challenge to the referee selected by the Presiding Judge of the Court (or his or her representative). 
 (d) The parties agree that time is of the essence in conducting the reference proceedings. Accordingly, the referee shall be requested,
subject to change in the time periods specified herein for good cause shown, to 

  

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(i) set the matter for a status and trial-setting conference within fifteen (15) days after the date of selection of the referee, (ii) if
practicable, try all issues of law or fact within one hundred twenty (120) days after the date of the conference and (iii) report a statement of decision within twenty (20) days after the matter has been submitted for decision.

 (e) The referee will have power to expand or limit the amount and duration of discovery. The referee may set or extend
discovery deadlines or cutoffs for good cause, including a party’s failure to provide requested discovery for any reason whatsoever. Unless otherwise ordered based upon good cause shown, no party shall be entitled to “priority” in
conducting discovery, depositions may be taken by either party upon seven (7) days written notice, and all other discovery shall be responded to within fifteen (15) days after service. All disputes relating to discovery which cannot be
resolved by the parties shall be submitted to the referee whose decision shall be final and binding. 
 12.2
Procedures. Except as expressly set forth herein, the referee shall determine the manner in which the reference proceeding is conducted including the time and place of hearings, the order of presentation of evidence, and all other questions
that arise with respect to the course of the reference proceeding. All proceedings and hearings conducted before the referee, except for trial, shall be conducted without a court reporter, except that when any party so requests, a court reporter
will be used at any hearing conducted before the referee, and the referee will be provided a courtesy copy of the transcript. The party making such a request shall have the obligation to arrange for and pay the court reporter. Subject to the
referee’s power to award costs to the prevailing party, the parties will equally share the cost of the referee and the court reporter at trial. 
 12.3 Application of Law. The referee shall be required to determine all issues in accordance with existing case law and the statutory laws of the State of California. The rules of evidence applicable to
proceedings at law in the State of California will be applicable to the reference proceeding. The referee shall be empowered to enter equitable as well as legal relief, enter equitable orders that will be binding on the parties and rule on any
motion which would be authorized in a court proceeding, including without limitation motions for summary judgment or summary adjudication. The referee shall issue a decision at the close of the reference proceeding which disposes of all claims of
the parties that are the subject of the reference. Pursuant to CCP § 644, such decision shall be entered by the Court as a judgment or an order in the same manner as if the action had been tried by the Court and any such decision will be final,
binding and conclusive. The parties reserve the right to appeal from the final judgment or order or from any appealable decision or order entered by the referee. The parties reserve the right to findings of fact, conclusions of laws, a written
statement of decision, and the right to move for a new trial or a different judgment, which new trial, if granted, is also to be a reference proceeding under this provision. 
 12.4 Repeal. If the enabling legislation which provides for appointment of a referee is repealed (and no successor statute is
enacted), any dispute between the parties that would otherwise be determined by reference procedure will be resolved and determined by arbitration. The arbitration will be conducted by a retired judge or justice, in accordance with the California
Arbitration Act §1280 through §1294.2 of the CCP as amended from time to time. The limitations with respect to discovery set forth above shall apply to any such arbitration proceeding. 
 12.5 THE PARTIES RECOGNIZE AND AGREE THAT ALL CONTROVERSIES, DISPUTES AND CLAIMS RESOLVED UNDER THIS REFERENCE PROVISION WILL BE DECIDED
BY A REFEREE AND NOT BY A JURY. AFTER CONSULTING (OR HAVING HAD THE OPPORTUNITY TO CONSULT) WITH COUNSEL OF ITS, HIS OR HER OWN CHOICE, EACH PARTY KNOWINGLY AND VOLUNTARILY, AND FOR THE MUTUAL BENEFIT OF ALL PARTIES, AGREES THAT THIS REFERENCE
PROVISION WILL APPLY TO ANY CONTROVERSY, DISPUTE OR CLAIM BETWEEN OR AMONG THEM ARISING OUT OF OR IN ANY WAY RELATED TO, THIS AGREEMENT OR THE OTHER COMERICA DOCUMENTS.” 
 7. Exhibit D to the Agreement is hereby replaced with Exhibit D attached hereto. 
  

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 8. No course of dealing on the part of Bank or its officers, nor any failure or delay in the exercise of
any right by Bank, shall operate as a waiver thereof, and any single or partial exercise of any such right shall not preclude any later exercise of any such right. Bank’s failure at any time to require strict performance by Borrower of any
provision shall not affect any right of Bank thereafter to demand strict compliance and performance. Any suspension or waiver of a right must be in writing signed by an officer of Bank. 
 9. Unless otherwise defined, all initially capitalized terms in this Amendment shall be as defined in the Agreement. The Agreement, as amended hereby,
shall be and remain in full force and effect in accordance with its respective terms and hereby is ratified and confirmed in all respects. Except as expressly set forth herein, the execution, delivery, and performance of this Amendment shall not
operate as a waiver of, or as an amendment of, any right, power, or remedy of Bank under the Agreement, as in effect prior to the date hereof. 
 10. Borrower represents and warrants that the Representations and Warranties contained in the Agreement are true and correct as of the date of this Amendment, and that no Event of Default has occurred and is continuing. 
 11. As a condition to the effectiveness of this Amendment, Bank shall have received, in form and substance satisfactory to Bank, the following:

 (a) this Amendment, duly executed by Borrower; 
 (b) a Certificate of the Secretary of Borrower with respect to incumbency and resolutions authorizing the execution and delivery of this
Amendment; 
 (c) an amendment fee in the amount of $5,000, which may be debited from any of Borrower’s accounts;

 (d) an Affirmation of Guaranty executed by each Guarantor; 
 (e) all reasonable Bank Expenses incurred through the date of this Amendment, which may be debited from any of Borrower’s accounts;
and 
 (f) such other documents, and completion of such other matters, as Bank may reasonably deem necessary or appropriate.

 12. This Amendment may be executed in two or more counterparts, each of which shall be deemed an original, but all of which together shall
constitute one instrument. 
  

 - 5 - 

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

  

			
	INPATIENT CONSULTANTS MANAGEMENT, INC.
		
	By:	 	/s/ Adam Singer, M.D.
	Title:	 	Chief Executive Officer
	
	COMERICA BANK
		
	By:	 	/s/ Bonnie Kehl
	Title:	 	Senior Vice President

 [Signature Page to Amendment to Loan & Security Agreement]

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