Document:

Exhibit 10.26b

  

Confidential material appearing in this document
has been omitted and filed separately with the Securities and Exchange Commission in accordance with Rule 24b-2, promulgated under
the Securities and Exchange Act of 1934, as amended. Omitted information has been replaced with asterisks.

  

SECOND AMENDMENT TO LEASE AGREEMENT FOR
A GAMMA KNIFE UNIT

 

This SECOND AMENDMENT TO LEASE AGREEMENT
FOR A GAMMA KNIFE UNIT (this “Second Amendment”) is dated as of the 16th day of May, 2013, and is entered
into between GK FINANCING, LLC, a California limited liability company (“GKF”), and FROEDTERT MEMORIAL LUTHERAN HOSPITAL,
INC., a non-profit Wisconsin corporation (“Medical Center”), with reference to the following facts:

 

RECITALS

 

		A.	GKF and Medical Center are parties to a certain Lease Agreement for a Gamma Knife United dated May 28, 1999, which Lease Agreement
was amended by letter addendums and by a First Amendment dated December 29, 2008 (as amended, the “Agreement”).

 

WHEREAS, the parties desire to further amend
the terms and provisions of the Agreement as set forth herein.

 

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

 

AGREEMENT

 

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

 

2.           Per Procedure Payment. In consideration
of implementation of the American Tax Payer Relief Act of 2012, effective on May 1, 2013, Exhibit 1 of the Agreement (Per Procedure
Payments) shall be deleted in its entirety and replaced with Exhibit 1 attached hereto. Provided, however, if Section 634 is modified
or repealed, Medical Center shall pay to GKF the non-Medicare fee per procedure payment for Medicare procedures effective the date
of the modification or repeal of Section 634.

 

3.           Full Force and Effect. Except
as amended by this Second Amendment, all of the terms and provisions of the Agreement shall remain in full force and effect. Notwithstanding
the foregoing, to the extent of any conflict or inconsistency between the terms and provisions of this Second Amendment and that
of the Agreement, the terms and provisions of this Second Amendment shall prevail and control.

  

[Signatures continued on next page]

 

    	 

    	 

    

  

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

 

	GKF:	Medical Center:
	 	 
	GK FINANCING, LLC	FROEDTERT MEMORIAL LUTHERAN  HOSPITAL, INC.
	 	 
	By: /s/ Ernest A. Bates, MD	By: /s/ Jeffrey Van De Kreeke
	Name: Ernest A. Bates, MD	Name: Jeffrey Van De Kreeke
	Title: Policy Committee Member	Title: VP – Finance

 

    	 

    	 

    

  

Exhibit 1

 

PER PROCEDURE PAYMENTS

 

	Annual Paid Procedures 	 	Non-Medicare	 	Medicare 
	Performed	 	Fee Per Procedure	 	Fee Per Procedure
	*	 	*	 	*
	*	 	*	 	*
	*	 	*	 	*

 

Notwithstanding anything to the contrary set forth herein, (a)
for purposes of determining the per procedure payment, the number of annual procedures performed shall be reset to zero (0) on
each anniversary of the first day of the first full month after the Effective Date of this Agreement; (b) for purposes of determining
the applicable per procedure payment tier, non-Medicare and Medicare procedures will be grouped chronologically as they are performed;
and (c) there shall be no retroactive adjustment of the per procedure payment irrespective of whether the number of procedures
performed during any fiscal year reaches a lower per procedure payment level. For example, if during an annual measuring period,
* procedures are performed (of which * are non-Medicare procedures and * are Medicare procedures), then, (i) for each of the first
* procedures performed (irrespective of the number of non-Medicare and Medicare procedures comprising the first * procedures),
Medical Center would pay * for each non-Medicare procedure and * for each Medicare procedure; and (ii) for each of the next * procedures
performed (irrespective of the number of non-Medicare and Medicare procedures comprising the next * procedures), Medical Center
would pay * for each non-Medicare procedure and * for each Medicare procedure.

 

If no Procedures are performed utilizing the Equipment, no charges
shall be incurred by Medical Center.

 

As used in the Agreement, a “Procedure” shall mean
any treatment, whether performed on an inpatient or outpatient basis, 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, that is performed by Medical Center or its representatives or affiliates, irrespective
of whether the Procedure is performed on the Model C or using any other equipment or devices.

 

Within then (10) days after Medical Center’s receipt of
written request by GKF, GKF shall have the right to audit Medical Center’s books and records (including, without limitation,
the books and records pertaining to any other radiosurgery equipment or devices) to verify the number of Procedures that have been
performed by Medical Center, and Medical Center shall provide GKF with access to such books and records; provided that any patient
names or identifiers shall not be disclosed.Exhibit 10.35b

 

Confidential material appearing in this document
has been omitted and filed separately with the Securities and Exchange Commission in accordance with Rule 24b-2, promulgated under
the Securities and Exchange Act of 1934, as amended. Omitted information has been replaced with asterisks.

 

ADDENDUM TWO

TO LEASE AGREEMENT FOR A GAMMA KNIFE
UNIT

 

This ADDENDUM TWO TO
LEASE AGREEMENT FOR A GAMMA KNIFE UNIT (this “Addendum Two”) is dated effective as of October 31, 2012, and is entered
into between GK Financing, LLC, a California limited liability company (“GKF”) or its wholly owned subsidiary whose
obligation under this Agreement shall be guaranteed by GKF, and OSF Healthcare System, an Illinois not for profit corporation,
owner and operator of St. Francis Medical Center (“Medical Center”), with reference to the following recitals:

 

Recitals:

 

WHEREAS, on February
18, 2000, GKF and Medical Center executed a Lease Agreement for a Gamma Knife Unit, as amended by a certain Addendum to Lease Agreement
for a Gamma Knife Unit dated as of April 13, 2007 (as amended, the “Lease”); and

 

WHEREAS, the parties
desire to 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.	Extend System.

 

		a.	It is acknowledged that the Medical Center wishes to add the Extend system to the Perfexion Model.

 

		b.	Subject to the terms and conditions set forth in Section 3 (Per Procedure Payment) below, (i) GKF
at GKF’s cost and expense shall add the Extend system to the Perfexion Model; and (ii) GKF shall use its commercially reasonable
efforts to perform the Extend system addition in fourth quarter 2013.

 

    	 

    	 

    

 

Exhibit 10.35b

 

		3.	Per Procedure Payment. 

 

		a.	Without modifying, amending or otherwise affecting the per procedure payments payable by Medical
Center for the Perfexion Model under the Lease, commencing from and after the first clinical use of the Extend system, Medical
Center shall pay to GKF a per treatment payment for using the Extend system, which payment shall be in the amount of * per treatment,
irrespective of the number of treatments performed using the Extend system. As used in this Addendum Two, the term “treatment”
shall mean each course of treatment (two to five fractions), whether performed on an inpatient or outpatient basis, during which
a patient receives treatment using the Extend and/or any other equipment or devices that are used in lieu of, or as an alternative
to, the Extend system. Medical Center shall be billed on the fifteenth (15th) and the last day of each month for the actual number
of treatments performed using the Extend system during the first and second half of the month, respectively. Medical Center shall
pay the treatments invoiced within thirty (30) days after being invoiced. Interest shall begin to accrue at the rate of 1-112%
per month on all invoices remaining unpaid after 45 days.

 

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

 

		5.	Full Force and Effect. Except as amended by this Addendum Two, all of the terms and
provisions of the Lease shall remain in full force and effect and shall be applicable to the Extend system, where appropriate;
provided that, nothing set forth in this Addendum Two shall modify, amend or otherwise affect any of the parties respective obligations
under the Lease with respect to the Perfexion Model.

 

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

 

	GK FINANCING, LLC	 	
        OSF HEALTHCARE SYSTEM,

        owner and operator of Saint Francis

        Medical Center

	 	 	 	 	 
	By:	/s/ Ernest A. Bates, M.D.	 	By:	/s/ Kevin D. Schocplein
	 	 	 	 	 
	Name: 	Ernest A. Bates, M.D.	 	Name: 	Kevin D. Schocplein
	 	 	 	 	 
	Title:	GKF Policy Committee Member	 	Title:	CEOConfidential material appearing in this document
has been omitted and filed separately with the Securities and Exchange Commission in accordance with Rule 24b-2, promulgated under
the Securities and Exchange Act of 1934, as amended. Omitted information has been replaced with asterisks.

 

AMENDMENT TO EQUIPMENT LEASE AGREEMENT

(PERFEXION UPGRADE)

 

This AMENDMENT
TO EQUIPMENT LEASE AGREEMENT (PERFEXION UPGRADE) (this “Amendment”) is dated effective as of June 8, 2012 (the “Effective
Date”), and is entered into by and among (i) GK FINANCING, LLC, a California limited liability company (“GKF”),
whose address is Four Embarcadero Center, Suite 3700, San Francisco, CA 94111, and (ii) NORTHERN WESTCHESTER HOSPITAL CENTER, a
not for profit corporation (“Hospital”), whose address is 400 East Main Street, Mount Kisco, NY 10549.

 

Recitals:

 

A.           GKF
and Hospital entered into a certain Equipment Lease Agreement dated March 21, 2003 (the “Lease”), pursuant to which
GKF agreed to lease to Hospital a Leksell Stereotactic Gamma Knife unit, Model C with Automatic Positioning System (the “Model
C”).

 

B.           Hospital
and GKF desire to amend the Lease to provide for the replacement and upgrade of the Model C that is currently being leased by GKF
to Hospital pursuant to the Lease, with a Leksell Gamma Knife Perfexion unit (such Perfexion unit leased hereunder is referred
to as the “Perfexion”), which will be installed at the existing Site at which the Model C is currently installed, and
contemporaneously with the de-installation of the Model C (the “Perfexion Upgrade”).

 

Agreement:

 

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:

 

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

 

2.           Upgrade
of the Model C to the Perfexion.

 

a.           Subject
to the terms and conditions set forth herein, GKF shall acquire and hold title to the Perfexion, and install the Perfexion with
new cobalt-60 sources at the Site. GKF shall use its commercially reasonable efforts to complete the Perfexion Upgrade on or around
_____________ or such other time as mutually agreed to in writing by Hospital and GKF, subject to availability of the Perfexion
from the equipment manufacturer, issuance of all regulatory approvals, permits and/or waivers in a timely manner, and completion
of construction of the Site. The parties acknowledge that Hospital may not be able to perform Procedures for approximately one
(1) month during the Perfexion Upgrade and the deinstallation of the Model C. Concurrently with the execution of this Amendment,
Hospital shall enter into a new LGK Agreement with Elekta, Inc., a Georgia corporation (“Elekta”), which shall supersede
and replace the previous LGK Agreement attached as Exhibit 1 to the Lease (such new LGK Agreement shall hereinafter be referred
to as the "LGK Agreement," and shall be deemed attached as Exhibit 1 to the Lease). Hospital shall operate and maintain
a fully functional radiation therapy department at the Site which shall include the Perfexion. Use of the Perfexion shall be made
available to all neurosurgeons and radiation oncologists with Hospital privileges.

 

    	- 1 -

    	 

    

 

Exhibit 10.46a

 

b.           Subject
to Section 3.a below, Hospital shall be solely responsible for the construction and preparation of the Site and the rigging and
installation of the Perfexion.

 

c.           GKF
shall be solely responsible for maintenance and service, personal property taxes, and the cost of insurance coverage for the Perfexion
to the same extent and at the same levels as required under the Lease.

 

d.           In
connection with the Perfexion Upgrade, Hospital shall, at Hospital’s sole cost and expense, provide GKF with Hospital personnel
(including Hospital physicists) and cooperation upon request and as reasonably required by GKF, among other things, to assist with
compliance with local, state and federal regulatory requirements and with nuclear regulatory compliance issues and the calibration
of the Perfexion.

 

e.           Notwithstanding
the foregoing, the Perfexion Upgrade shall be performed by GKF only after all necessary and appropriate licenses, permits, approvals,
waivers, consents and authorizations, and the proper handling of the Cobalt-60 (collectively, the “Permits”), have
been obtained by Hospital at Hospital’s sole cost and expense.

 

f.            Upon
request by GKF and at GKF’s reasonable expense, Hospital shall execute and deliver a commercially reasonable form of consent
to sublease, subordination or other documentation if such a document is reasonably requested by the third party financing company
which holds a security interest in the Perfexion.

 

g.           It
is acknowledged that the Perfexion will come with two (2) new headframes. GKF agrees that Hospital shall, at no additional cost,
retain its existing headframes from the Model C for use on the Perfexion, and that GKF shall, at GKF's sole cost and expense, refurbish
such existing headframes for use on the Perfexion.

 

h.           GKF,
at its cost and expense, shall cover the Perfexion training tuition costs for those physicians and physicists who will be using
the Perfexion. Any travel and entertainment associated with training shall not be the responsibility of GKF.

 

i.            GKF
hereby grants to Hospital a non-exclusive right and sublicense to use the "LGP Software" as defined in and contemplated
under, and subject to the terms and conditions of, the LGK Agreement.

 

    	- 2 -

    	 

    

 

Exhibit 10.46a

 

j.            Upon
receipt of Elekta’s report on the results of the Acceptance Tests (as defined in the LGK Agreement), Hospital shall have
three (3) business days to review and validate the results of the Acceptance Tests to confirm that the Perfexion meets the manufacturer’s
specifications and documentation. If Hospital fails to respond within such three (3) business day period, Hospital shall be deemed
to have validated and confirmed the results of the Acceptance Tests.

 

3.           Model
C; No Ownership Interests; Allocation of Shared Costs. Subject to Section 3.a below, GKF shall de-install, remove and retain
all ownership rights and title to the existing Model C. Notwithstanding anything to the contrary set forth in the Lease or this
Amendment, Hospital shall have no ownership interest (or option to purchase any ownership interest) in the Model C and/or the Perfexion.

 

a.           Allocation
of Shared Costs. Notwithstanding anything set forth herein to the contrary, Hospital shall contribute the aggregate sum of
* (the "Hospital Contribution") towards the costs payable to third parties pertaining to the construction and preparation
of the Site, the rigging and installation of the Perfexion, and the de-installation and removal of the existing Model C (collectively,
the "Shared Costs"), which Hospital Contribution shall be paid as set forth herein irrespective of the final aggregate
amount of the Shared Costs. In furtherance of the foregoing, * of the Hospital Contribution (i.e., *) shall be paid to GKF upon
the commencement of the deinstallation of the Model C, and the remaining * of the Hospital Contribution (i.e., *) shall be paid
to GKF upon the successful completion of the Acceptance Tests as set forth in Section 2.j above. For the avoidance of doubt, Shared
Costs shall only include direct costs actually paid to unaffiliated third parties, without administrative overhead or markup.

 

4.           Extension
of Lease Term. In consideration of GKF’s agreement to perform the Perfexion Upgrade, the Term is hereby extended
to the date that is ten (10) years following the “First Perfexion Procedure Date” (as hereinafter defined).

 

5.           Lease
Payments.

 

a.           It
is understood and agreed that Section 8.1 of the Lease (Per Procedure Payments) shall remain in full force and effect with respect
to all Procedures performed prior to the de-installation of the Model C, and that all rent or lease payments pertaining to Procedures
performed prior to the de-installation of the Model C shall continue to be calculated in accordance Section 8.1 of the Lease and
shall be paid by Hospital to, and retained solely by, GKF. However, effective from and after the date the first Procedure is performed
at the Site using the Perfexion (the “First Perfexion Procedure Date”), (i) the first paragraph only of Section 8.1
of the Lease shall be substituted and replaced with the following; and (ii) the remainder of Section 8.1 of the Lease (Per Procedure
Payments) shall remain in full force and effect and shall apply to the Perfexion:

 

    	- 3 -

    	 

    

 

Exhibit 10.46a

 

"8.1 Per Procedure Payments.
As rent for the lease of the Perfexion to Hospital pursuant to this Agreement, commencing from and after the First Perfexion Procedure
Date, Hospital shall pay to GKF the sum as stipulated in Exhibit “A” attached hereto (under the caption, "Per
Procedure Payments") for each “Procedure” that is performed by Hospital or its representatives or affiliates at
the Site or within the State of New York at the direction of Hospital or any of its affiliates, whether on an inpatient or outpatient
basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure
is performed on the Perfexion or using any other equipment or devices. As used herein, a “Procedure” means any treatment
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. Hospital’s
obligation to make Lease Payments pursuant to this Section 8.1 shall be expressly limited by Section 8.2, 8.3, and 8.4 hereof.

 

"Subject to the satisfaction
in full of all of the "Payment Reduction Option Conditions," Hospital shall have the one-time option (the "Payment
Reduction Option") in its sole discretion to effect a reduction to the Lease Payment, which reduction shall be in the amount
of * per Procedure (i.e., if exercised, the Lease Payment would be as stipulated in Exhibit “A” attached hereto under
the caption, "Per Procedure Payments With Payment Reduction Option"). As used herein, the "Payment Reduction Option
Conditions" shall include all of the following: (a) Hospital shall have given prior written notice to GKF of Hospital's intent
to exercise the Payment Reduction Option, which notice shall be given to GKF not less than sixty (60) days prior to the date of
shipment of the Perfexion from Sweden (the "Perfexion Shipment Date"); (b) on or prior to the Perfexion Shipment Date,
Hospital shall have paid to GKF by wire transfer a capital cost reduction payment in the amount of *; (c) no Hospital Event of
Default (as defined in Section 20) has occurred and is then continuing, and no act or omission has occurred and is then continuing
which, with the giving of notice and/or the passage of time, would constitute a Hospital Event of Default; and (d) Hospital is
then in compliance and continues to be in compliance with all of the requirements set forth in this Agreement, including, without
limitation, this Section."

 

b.           The
parties acknowledge that the compensation payable by Hospital for the Perfexion as set forth in this Amendment has been negotiated
by the parties at arm’s length based upon reasonable and jointly derived assumptions regarding the capacity for clinical
services available from the Perfexion, Hospital’s capabilities in providing high quality radiation oncology services, market
dynamics, GKF’s risk in providing the Perfexion, and the provision to GKF of a reasonable rate of return on its investment
in support of the Perfexion. Based thereon, the Parties believe that the rent payments (including the reduced rent payments, if
exercised) represent fair market value for the use of the Perfexion, the de-installation and removal of the Model C, the Perfexion
Upgrade, maintenance and service, personal property taxes, cost of insurance coverage for the Perfexion, educational support, the
capital cost reduction payment (if applicable), and any other additional services and costs to be provided or paid for by GKF pursuant
to this Amendment. Hospital undertakes no obligation to perform any minimum number of procedures on the Perfexion, and the use
of the Perfexion for the performance of procedures is wholly based upon the independent judgment of physicians who order such procedures
to meet the medical needs of their patients.

 

    	- 4 -

    	 

    

 

Exhibit 10.46a

 

6.           Cobalt
Reloading of the Perfexion. Subject to scheduling availability, around the end of the sixth (6th) year following the First
Perfexion Procedure Date, the Perfexion shall be reloaded with new cobalt-60 that meets the manufacturer’s radioactivity
level specifications (the “Reload”), subject to the following terms and conditions:

 

a.           Hospital
shall be solely responsible for the rigging and installation of the Perfexion in connection with the Reload. The Reload shall be
performed only after all necessary and appropriate licenses, permits, approvals, consents and authorizations, including, without
limitation, the proper handling of the cobalt-60 (collectively, the “Reload Permits”), have been obtained by Hospital
at Hospital’s sole cost and expense. The timing and procedure for such Reload shall be as mutually agreed upon between the
parties.

 

b.           GKF
makes no representation or warranty to Hospital concerning the Reload, and GKF shall have no obligation or liability to pay any
damages to Hospital resulting therefrom, including, without limitation, any lost revenues or profits during the period of time
that the Perfexion is unavailable to perform procedures due to the Reload process.

 

c.           Upon
request and as required by GKF, Hospital, at Hospital’s cost and expense, shall provide GKF with Hospital personnel (including
Hospital’s physicists) and services in connection with the Reload, 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
and the calibration of the Perfexion.

 

d.           Subject
to Section 6.a above, GKF shall be solely responsible for the actual costs of the Reload paid or payable to third parties; provided
that Hospital shall not be entitled to reimbursement for its own respective personnel costs, internal costs or overhead.

 

e.           Upon
completion of the Reload, the Term (as extended pursuant to Section 4 above) shall be automatically further extended by an additional
two (2) years (i.e., to the date that is twelve (12) years following the First Perfexion Procedure Date), plus the period
of time that the Perfexion is unavailable to perform procedures due to the Reload (which is estimated to take approximately three
(3) weeks for the Reload).

 

7.           Educational
Support. Hospital’s obligations with respect to community and physician education regarding the Perfexion shall continue
in the same manner and with the same amounts as set forth in Section 7 of the Lease; provided that community education activities
may be expanded to the general public (in addition to physicians).

 

    	- 5 -

    	 

    

 

Exhibit 10.46a

 

8.           Charity/Excluded
Procedures.

 

a.           As
a means to permit Hospital to perform care for persons who are not covered by insurance programs and who do not have the
means to pay for such procedures based upon Hospital’s adopted standards of indigency, GKF shall waive the per
procedure Lease Payment for not more than   * Perfexion procedure to be performed for an indigent person meeting the
foregoing qualifications (a “Charity Procedure”) for each * paid Perfexion procedures (without counting
any Charity Procedures) for which a per procedure Lease Payment is made to GKF. For purposes of counting the number of
Perfexion procedures to determine the number of Charity Procedures allowed, there shall be no retroactive counting of
procedures performed prior to the date of the First Perfexion Treatment Date. Hospital shall be solely responsible (and GKF
shall not in any manner be or become responsible) for determining (i) whether any person described herein requires a
Perfexion procedure, (ii) who shall receive a Perfexion procedure hereunder if more than * person described herein
requires a Perfexion procedure, and (iii) whether any person meets the standards of indigency. Hospital shall provide
reasonable written documentation evidencing satisfaction of the conditions set forth herein to GKF at or prior to the
expected time of treatment.

 

b.           As
a means of accommodating differing medical judgment and medical preference for alternative treatment modalities, for each annual
period commencing from and after the First Perfexion Procedure Date, GKF shall waive the per procedure Lease Payment for not more
than * procedures that are performed using equipment or devices other than the Perfexion (each, an “Excluded Procedure”).

  

 9.         Supplier
and Owner of Perfexion. The parties hereto agree that, notwithstanding anything to the contrary set forth herein, the
Lease is and shall be treated and interpreted as a "finance lease," as such term is defined in Article 2A of the Uniform
Commercial Code, that GKF shall be treated as a finance lessor who is entitled to the benefits and releases from liability accorded
to a finance lessor under Article 2A of the Uniform Commercial Code. In furtherance of the foregoing, Hospital acknowledges that,
before signing this Amendment, GKF has informed Hospital in writing (a) that Elekta is the entity supplying the Perfexion, (b)
that Hospital is entitled (under Section 2A of the Uniform Commercial Code) to the promises and warranties, including those of
any third party, provided to GKF by Elekta which is the entity supplying the goods in connection with or as part of the contract
by which GKF acquired the Perfexion or the right to possession and use of the Perfexion, and (c) that Hospital may communicate
with Elekta and receive an accurate and complete statement of those promises and warranties, including any disclaimers and limitations
of them or of remedies. Hospital also acknowledges that Hospital has selected Elekta to supply the Perfexion and has directed
GKF to acquire the Perfexion or the right to possession and use of the Perfexion from Elekta.

 

10.         Miscellaneous.
This Amendment (a) shall be governed by and construed under the laws of the State of New York, without reference to its principles
of conflicts of law; and (b) may be executed in separate counterparts, each of which when so executed and delivered shall be an
original, but all of which counterparts shall together constitute the same instrument. The captions and paragraph headings used
herein are for convenience only and shall not be used in construing or interpreting this Amendment. This Amendment constitutes
the full and complete agreement and understanding between the parties hereto concerning the subject matter hereof and shall supersede
any and all prior written and oral agreements with regard to such subject matter.

 

    	- 6 -

    	 

    

 

Exhibit 10.46a

  

11.         Full
Force and Effect; Except as amended by this Amendment, all of the terms and provisions of the Lease shall
remain unchanged and in full force and effect and, together with this Amendment, represent the entire agreement of the parties
with respect to the Perfexion and its use by Hospital. Unless the context requires otherwise, with respect to the Perfexion, all
references in the Lease to (i) the “Agreement” shall be deemed to mean the Lease as amended by this Amendment; (ii)
the “Equipment” shall be deemed to mean the Perfexion; (iii) the “LGK Agreement” shall be deemed to refer
to the new LGK Agreement to be executed by Hospital relating to the Perfexion; and (iv) the “Term” shall be deemed
to refer to the Term, as extended pursuant to this Amendment. To the extent any of the terms of the Lease conflict with the terms
of this Amendment as it pertains to the Perfexion and the Perfexion Upgrade, the terms and provisions of this Amendment shall prevail
and control. Where not different or in conflict with the terms and provisions of this Amendment, all applicable terms and provisions
set forth in the Lease are incorporated within this Amendment as is if set forth herein and shall apply with equal force and effect
to the Perfexion. Notwithstanding anything to the contrary set forth herein, no term or condition of this Agreement shall be effective
to the extent it causes Hospital to breach the LGK Agreement or otherwise violate or infringe upon the rights of Elekta. Nothing
set forth in this Amendment shall relieve either party from any or all of its obligations under the Lease with respect to the Model
C, including, without limitation, the obligation to pay rent or lease payments and the service, insurance and property tax expenses
associated with the Model C until de-installation.

 

IN WITNESS WHEREOF,
the parties have executed this Amendment effective as of the Effective Date.

 

	GKF:	 	Hospital:
	 	 	 
	GK FINANCING, LLC	 	NORTHERN WESTCHESTER HOSPITAL 

CENTER
	 	 	 	 
	By:	/s/ Ernest A. Bates, MD	 	By: /s/ Joel Seligman
	 	Ernest A. Bates, M.D.	 	Joel Seligman
	 	Policy Committee Member	 	President and CEO
	 	Date: June 15, 2012	 	Date: 6/13/12

 

    	- 7 -

    	 

    

 

Exhibit 10.46a

 

Exhibit “A”

 

PER PROCEDURE PAYMENTS

 

	Annual Paid Procedures Performed	 	Per Procedure Payment
	*	 	* per Procedure
	*	 	* per Procedure
	*	 	* per Procedure

 

PER PROCEDURE PAYMENTS

WITH PAYMENT REDUCTION
OPTION

 

	Annual Paid Procedures Performed	 	Per Procedure Payment
	*	 	* per Procedure
	*	 	* per Procedure
	*	 	* per Procedure

 

Notwithstanding anything
to the contrary set forth herein, for purposes of determining the Per Procedure Payments, (a) only those Procedures performed on
or after the First Perfexion Procedure Date shall be counted; (b) the number of annual Procedures performed on the Perfexion or
using any other equipment or devices shall be reset to zero (0) at the commencement of each anniversary of the First Perfexion
Procedure Date; (c) Charity Procedures and Excluded Procedures shall not be counted towards the annual Procedures performed; and
(d) there shall be no retroactive adjustment of the Per Procedure Payments irrespective of whether the number of Procedures performed
reaches a lower Per Procedure Payment level. For example, if during an annual measuring period, the number of annual counted Procedures
totals *, then, the Per Procedure Payments for the first * Procedures would remain at * per Procedure while the Per Procedure Payments
for the next * procedures (i.e., for Procedures * through *) would be * per Procedure (assuming the Payment Production Option has
not been exercised). There are no minimum volume requirements.

 

    	- 8 -

    	 

    

 

Exhibit 10.46a

 

 

 

Prepared for

 

Northern
Westchester Hospital

400 East Main Street

Mount Kisco, NY 10549-3477

 

April 16, 2012

 

    	- 1 -

    	 

    

 

LEKSELL GAMMA KNIFE® END USER AGREEMENT

 

THIS AGREEMENT is entered into as of the
8 day of June                  2012 by and
between ELEKTA, INC., a corporation organized and existing under the laws of Georgia (hereinafter referred to as “Elekta”),
and Northern Westchester Hospital,. (hereinafter referred to as “End User”).

 

WITNESSETH:

 

WHEREAS, Elekta has agreed to sell the “Leksell
Gamma Knife®” system (hereinafter defined and referred to as the “LGK®”) to GK Financing, LLC., hereinafter
referred to as “Buyer”), and

 

WHEREAS, Buyer has agreed to lease the LGK®
to End User under separate agreement.

 

WHEREAS, Elekta and End User wish to enter
this Agreement for their mutual benefit;

 

NOW THEREFORE, in consideration of the mutual covenants and
obligations, warranties and indemnities herein contained and other good and valuable consideration, the receipt and sufficiency
of which are hereby acknowledged, the parties hereto agree as follows:

 

ARTICLE I. DEFINED TERMS. 

 

The following words and terms shall have the meanings
set forth opposite them in this Article I:

 

Acceptance Tests are those
tests which demonstrate that the LGK® meets the manufacturer’s specification and which are defined in the Purchase Agreement
between Buyer and Elekta.

 

Charging means all handling of the Cobalt Supply
at the Site and the installation of such Cobalt Supply in the LGK®.

 

Cobalt Supply means the supply of the Cobalt-60
sources to be installed in the LGK®.

 

Effective Date is the date of execution of
this Agreement by the End User, as indicated in this Agreement.

 

Hardware shall mean that computer hardware
and related equipment described in the Specification.

 

Lease Agreement shall mean the Agreement between
Buyer and End User pursuant to which Buyer shall lease the LGK® to End User.

 

LGK®  is the device, which is technically
specified in Exhibit A hereto, to be sold, delivered, and installed by Elekta at the Site.

 

LGP Software means the dose planning software
for the LGK®, which is described in the Specification.

 

Site shall mean that location described on
the Exhibit B hereto.

 

Site Planning Criteria
are the requirements which the Site must meet to properly accommodate the LGK® and are defined in the Purchase Agreement between
Elekta and Buyer.

 

Specification refers to the technical standards
with which the LGK® shall comply, as described in Exhibit A hereto.

 

ARTICLE II. PERMITS 

 

2.1Permits. End User shall obtain
any license (the “User License”) from the Nuclear Regulatory Commission (or relevant state agency if the Site is located
in an “Agreement State”) authorizing it to take possession of the Cobalt Supply and shall obtain such other licenses,
permits, approvals, consents and authorizations which may be required by local governmental or other regulatory agencies for the
Site, its preparation, the Charging of the LGK® with its Cobalt Supply, the conduct of Acceptance Tests, and the use of the
LGK®. End User shall not run, operate, or otherwise use the LGK®, except for the purpose of conducting the Acceptance Tests,
until the Acceptance Tests have been successfully completed.

 

ARTICLE III. OPERATION AND TRAINING.

 

3.1          Operation.
End User warrants and covenants that the LGK® shall not be run, operated or otherwise used, except by and to qualified
employees or physicians, who are suitably skilled and experienced to use the LGK®.

 

3.2          Technical
Training. Elekta shall provide to four (4) persons on the Buyer’s staff instruction relating to the technical operation
and maintenance of the LGK. Such instruction shall not exceed two consecutive days and will be provided on site by installation
personnel at the time of install.

 

3.3          Introductory
Clinical Training. Introductory Clinical Training Program. Indications, Technique, Literature, etc. Length of training is 5
consecutive days. Up to four (4) training spaces included (Tuition only). May be substituted for Technical/Applications training
course at Elekta Sweden as noted on Exhibit A.

 

3.4          Post
Clinical Start Up Site Visit. Elekta shall provide a one-day site visit from one Clinical Applications representative. The
visit must be arranged within 3-6 months post clinical start up. The commitment will expire thereafter unless documented alternate
arrangements are made. The purpose is to ensure the customer is comfortable using all features in the Leksell GammaPlan® PFXTM
software.

 

3.5          LGK®
Software. Elekta hereby consents to Buyer’s sublicense to End User of the LGK® Software, to be utilized only for
the purpose of planning dosages of treatments to be performed with the LGK®. A copy of the LGK® Software License from Elekta
to Buyer is attached hereto as Exhibit D End User agrees that its sublicense to the LGK® Software shall be subject to the terms
and conditions of Exhibit D hereto. End User grees, in favor of Elekta, to perform the obligations assigned to Buyer in Exhibit
D hereto. In the event the sublicense of the LGK® Software from Buyer to End User is terminated due to an act or omission of
Buyer and without fault of the End User, then End User shall have the right to obtain from Elekta a direct royalty-free license
to utilize the LGK® Software on the terms and conditions described in Exhibit D hereto.

 

    	- 2 -

    	 

    

 

3.6          Intellectual
Property.

 

(a)          End
User hereby acknowledges that the trademarks Gamma Knife® and Leksell Gamma Knife® (collectively, the “Mark”)
are protected by United States federal registrations and the Mark constitutes valuable intellectual property of an affiliate of
Elekta in which it has established substantial goodwill. End User hereby acknowledges that proper use of the Mark in any advertising
of End User’s own surgical services performed with the LGK® surgical instrument is highly important to maintaining such
value and goodwill.

 

(b)          Subject
to the terms and conditions of this section, Elekta, as agent for Elekta Instrument, S.A. of Geneva, Switzerland, the owner of
the Mark, hereby grants End-User a non-exclusive, royalty-free license without right to sublicense solely for the purpose of using
the Mark in connection with the promotion and advertising of any of End User’s own services to be performed by use of the
LGK® surgical instrument.

 

(c)          End
User, in the conduct of End User’s business, is strictly prohibited from using the Mark in or as its official legal name.
However, End User may use the trademark as part of the following fictitious trade name:

 

“Gamma Knife® ® Center of
Northern Westchester Hospital”

 

As long
as End User utilizes a fictitious trade name which includes the Mark, End User shall not perform radiosurgical services with any
equipment other than the LGK®. If End User performs any radiosurgical service with any equipment other than the LGK® or
if End User ceases to perform radiosurgical services with the LGK®, End User shall immediately cease utilizing the Mark as
part of its fictitious trade name.

 

(d)          In
advertising, references to the Mark must include the registration symbol ® and such symbol must be used at least once per piece
of advertising material along with the words “Gamma Knife® and Leksell Gamma Knife® are U.S. federally registered
trademarks of Elekta Instrument S.A.., Geneva, Switzerland” somewhere in the advertisement. Elekta reserves the right to
require End User to discontinue the use of advertising that does not conform to such requirements.

 

(e)          End
User may use the words “Gamma Knife® Center of [add distinctive name]” as part of any internet domain name,
or URL, telephone number or other communications address or symbol provided that the full name, “Gamma Knife® Center
of [add distinctive name]” is used. User may use a variation or abbreviation of such term only after obtaining Elekta’s
prior written consent to the proposed use in question. User may not under any circumstances, use the words “gamma
Knife® ” alone, for any internet domain name, or URL, telephone number or other communications address or symbol.

 

(f)          All
advertising or promotional materials in which the mark is utilized shall comply with all applicable laws and regulations as well
as the standards of proper advertising.

 

(g)         Elekta
shall have the right to terminate the license granted in this section with immediate effect if End User violates any provision
of this section or utilizes the Mark in any manner which, in the sole opinion of Elekta, presents a reasonable possibility of damage
to the Mark.

 

(h)         Upon
termination of the license granted by this section, End User shall immediately cease all use of the mark, including, but not limited
to, the use permitted under subsection (e) of this section.

 

(i)          Buyer
acknowledges that a breach of any of its covenants or agreements hereunder will cause immediate and irreparable harm to Elekta
and Elekta Instrument S.A. End User acknowledges and agrees that no adequate remedy at law exists for any such breach, and End
User agrees that in the event of such a breach Elekta shall be entitled to injunctive relief and such other relief as any court
with jurisdiction may deem just and proper.

 

ARTICLE IV. CONFIDENTIALITY

 

4.1          End
User shall treat and maintain as confidential all technical information and know-how to it pursuant to this Agreement (including
LGK® Software), except for know-how specifically designated as non-confidential pursuant to this Agreement or otherwise so
designated by the Elekta. End User shall not disclose any aspect of such know-how (including the LGK® Software) to any other
Person, including any corporation or governmental or quasi-governmental agency; provided that, End User shall have the right to
disclose such know-how to its employees and resident physicians to the extent necessary for use of the LGK®, but End User shall
be responsible to ensure that such know-how is not disclosed by such persons.

 

4.2          The
provisions of this Article IV shall survive the termination of this Agreement and shall apply with equal force to any technical
information or know-how concerning the LGK® acquired by End User other than pursuant to this Agreement.

 

4.4          The
obligations of confidentiality and restriction of access pursuant to this Article IV shall not apply to any trade secret or confidential
information that was (a) in the public domain at the time of such access or subsequently came in to the public domain through no
fault of the Person subject to the provisions of Article IV; (b) rightfully known to the Person given such access prior to such
access or developed independently by the Person given such access; (c) received by the Person given such access as a matter of
right from a source other than a Person subject to the provisions of this Article IV; or (d) required to be disclosed by subpoena
or court order, but Buyer shall give immediate notice of such subpoena or court order to Elekta and shall request the court to
grant confidential treatment to the confidential information disclosed pursuant to such subpoena or court order.

 

ARTICLE V. WARRANTY AND REPAIR SERVICE AGREEMENT

 

5.1          Elekta
provides the warranty for the LGK® set forth in Exhibit C hereto.

 

5.2          On
the date on which the Installation Test Protocol is completed, a Repair Service Agreement shall be in effect for five (5) years
with the purpose of providing repair parts and services for the LGK® as per the Purchase Agreement between Buyer and Elekta.

 

ARTICLE VI. EXCUSABLE DELAYS

 

If the performance of this Agreement by
Elekta or Buyer or any obligation of Elekta or Buyer hereunder is prevented, restricted or interfered with by reason of fire, explosion,
acts of God, labor disputes or accidents affecting performance under this Agreement, or war, mobilization, civil commotions, blockade
or embargo, or any law, regulation, ordinance or requirement of any government or regulatory agency, or any other act whatsoever
similar to those above enumerated, or any other circumstance being beyond the reasonable control of Elekta or Buyer, then and in
that event Elekta or Buyer, as the case may be, shall promptly notify the other parties hereto of the resulting difficulties therefrom,
and any of the foregoing events shall excuse any performance required under this Agreement.

 

    	- 3 -

    	 

    

 

ARTICLE VII. LIMITATION OF LIABILITY; INDEMNIFICATION.

 

7.1          The
exclusive remedies of End User and Elekta’s sole liabilities for breaches of this Agreement shall be limited to those specifically
provided for in Section 5.1 (and Exhibit E hereto) and in this Article VII. In no event shall Elekta be liable to End User for
loss of use, revenue or profit, or for any other direct, indirect, incidental or consequential damage, whether arising in contract
or tort.

 

7.2          Elekta
shall defend and indemnify End User and its Affiliates, agents, servants and employees, and hold them harmless from and against
all damages, claims, judgments and liabilities by or to third parties (plus litigation costs incurred) resulting from injury to
or death of any person or physical loss or damage to property arising out of defective materials, workmanship, or manufacture of
the LGK® or the defective maintenance of the LGK® (but, with respect to maintenance, only to the extent performed by or
on behalf of Elekta).

 

7.3          End
User shall defend and indemnify Elekta and its Affiliates, agents, servants, and employees and hold them harmless from and against
all damages, claims, judgments and liabilities by or to third parties (plus litigation costs incurred) resulting from injury to
or death of any person or physical loss or damage to property arising out of the operation or medical use or misuse of the LGK®
by or for End User (but which is not attributable to defective materials, workmanship or manufacture of the LGK®), the defective
maintenance of the LGK® by or for End User (but only to the extent not performed by or on behalf of the Elekta), the failure
of the Site to comply with the Site Planning Criteria, or the training provided by Elekta.

 

ARTICLE VIII. MISCELLANEOUS PROVISIONS. 

 

8.1          Assignment.
No party hereto shall assign its respective rights or obligations under this Agreement (including the LGP Software License)
in whole or in part to any person without the prior written consent of the other party, except as provided in this Section 8.2
hereinafter. In the event of any assignment or transfer by End User of its rights or duties under this Agreement or the Lease or
of any sale, transfer, lease or sublease of the LGK® or any component thereof to a third party, End User shall obtain the prior
approval of Elekta of the proposed transferee (such approval not to be unreasonably withheld) and cause such transferee, prior
to such transfer, to sign (1) an agreement that any acquired interest in the LGK® System is subject to the terms and conditions
of this Agreement and evidencing such transferee’s agreement to be bound, to the same extent as End User, by the then-surviving
provisions of this Agreement, including but not limited to the technical and scientific information provisions (Section 3.3), the
confidentiality provisions (Article IV), the provisions of Articles V and VII hereof, and the provisions of the LGK® Software
License or (2) a similar agreement otherwise approved by the Elekta, which approval shall not be unreasonably withheld.

 

8.2          Subcontractors.
Elekta shall be entitled to appoint subcontractors or any other third parties for the performance or fulfillment in whole or in
part of Elekta’s obligations under this Agreement without the consent of End User, and Elekta shall be fully responsible
and liable for the performance of other entities. Elekta shall be entitled to assign any of its rights or obligations hereunder
to any of its Affiliates without the consent of End User, but Elekta agrees that it will be fully responsible for any obligations
assigned to Elekta’s Affiliates hereunder.

 

8.3          Arbitration.
All disputes arising in connection with this Agreement shall be finally resolved by arbitration in Atlanta, Georgia under the
Commercial Arbitration Rules of the American Arbitration Association. Judgment upon the award rendered may be entered in any court
having jurisdiction or application may be made to such court for judicial acceptance of such award and an order of enforcement
as the case may be. The parties hereby agree the rendering of an award by the arbitrator or arbitrators shall be a condition precedent
to the initiation of any legal proceeding with respect to any dispute arising in connection with this Agreement. This Agreement
shall be governed by and construed in accordance with the laws of the State of Georgia and the United States.

 

8.4          Entire
Agreement. This Agreement constitutes the entire agreement between the parties hereto and supersedes any prior or contemporaneous
agreements, negotiations or discussions between the parties with respect to the subject matter hereof. No amendment of the provisions
of this Agreement will be valid unless made in writing and signed by both parties hereto..

 

IN WITNESS WHEREOF, the parties
hereto have signed this Agreement in duplicate as of the date first written above.

 

ELEKTA INC.

 

	By:	/s/ Timothy R. Chandler	 
	Title:	Secretary and Legal Counsel	 
	Date:	8/13/2012	 
	 	 	 
	END USER	 
	 	 	 
	By:	/s/ Joel Seligman	 
	 	 	 
	Title:	President	 
	 	 	 
	Date: 	6/15/12	 

 

    	- 4 -

    	 

    

 

EXHIBIT A

SPECIFICATION

 

Leksell Gamma Knife® PERFEXIONTM

 

PRODUCT SPECIFICATION

Standard turn-key system

  

	Qty	 	Description	 	Article no.
	1	 	Leksell Gamma Knife® PERFEXIONTM	 	715000
	2	 	Leksell® Coordinate FrameTM Kit for PERFEXIONTM	 	1002407
	1	 	Leksell GammaPlan®	 	in BOM
	1	 	PERFEXIONTM system tool kit	 	 
	1	 	LSS Spare Part Kit for Leksell® Coordinate FrameTM	 	1002406
	1	 	Skull scaling instrument	 	A0202-01
	1	 	CT planning kit	 	 
	1	 	MRI planning kit	 	 
	1	 	X-ray planning kit	 	 
	1	 	Set of Co60 sources	 	2000000
	 	 	Cobalt loading	 	 
	 	 	Site planning	 	 
	 	 	Installation and commissioning	 	 
	 	 	 	 	 
	1	 	Support and Education & Training for PERFEXIONTM	 	SER PERFEXION 0001

 

    	- 5 -

    	 

    

 

Leksell Gamma Knife® PERFEXIONTM

 

Radiation unit

- With radiation shielding doors and collimator system.

 

Patient Positioning SystemTM

- Patient couch and automatic Patient Positioning
System.

 

Covers for radiation unit and Patient Positioning
System

 

Electric cabinet

- Electric cabinet with cabling

- ECU - central unit and safety system electronic
board, circuit breakers and cabling.

- SDU - sector drive electronic board, circuit breakers
and cabling

- PPC1- software

- PPC2- software

- Medical UPS

 

Operator area

- Office cabinet

- Keyboard and mouse

- Operator console with patient and operator audio/video,
power supply, opto insulators, cabling and connectors Flat screen monitors

Office UPS

 

MCU kit

MCU PC with USB CAN

MCU software

 

Treatment couch

Height adjustable mattress

Manual controls for treatment setup

 

Frame adapter

Model “Standard G”. For interfacing between
Leksell Coordinate Frame model G and

Leksell Gamma Knife PERFEXIONTM.

 

Clearance check tool

 

Document set

Installation and supplementary documents

2
instructions for use

2 emergency routines

Signs and labels

 

    	- 6 -

    	 

    

 

Leksell® Coordinate Frame® Kit for PERFEXIONTM

 

	Includes:	 	 	 	 
	Qty	 	Consists Of:	 	Article No.
	1	 	Frame with Feet and Straight Front Piece	 	50487-01
	1	 	Front Piece, Curved	 	60638-01
	2	 	Insulated Fixation Post, Anterior	 	912462
	2	 	Insulated Fixation Post, Short Posterior	 	912463
	2	 	Insulated Fixation Post, Long Posterior	 	912862
	6	 	Locking Screw, 5 x 19 mm, Titanium	 	60490-03
	6	 	Locking Piece for Fixation Post	 	60497-01
	1	 	Ear Plug Holder, Right	 	50498-01
	1	 	Ear Plug Holder, Left	 	50498-02
	2	 	Ear Plug	 	60136-01
	1	 	Fixation Screws, Titanium, kit of 20 pairs	 	907999
	2	 	Instrument Screw Driver, Double	 	50146-02
	1	 	Sterilizing Tray for Frame	 	50151-03
	4	 	Disposable Inserts, 25x4 pieces	 	912464
	1	 	Instruction for Use, Leksell® Coordinate Frame kit	 	003818
	1	 	Instructions for Use, Insulated Fixation Posts	 	012594
	1	 	Quick Reference Guide	 	014611

 

PERFEXIONTM system tool kit

Includes:

	QA tool	1001182
	- For radiation focus precision check.	 
	Frame Cap	717960

 - The frame cap is used during patient preparation
for a treatment with Leksell Gamma Knife® PERFEXIONTM.

 

LSS Spare Part Kit for Leksell®
Coordinate FrameTM

 Consists of 4 pieces of each of the following;

- Locking Screw, 5 x 19 mm, Titanium

- Locking Piece for Fixation Post

- Screw, 4 x 10 mm, Titanium

 

Skull scaling instrument

For measurement of skull shape for Leksell GammaPlan®
modeling

 

CT planning kit

Includes:

	CT indicator	A0800-11
	- Fiducial box for CT imaging procedure	 
	CT adapter	A0400-04
	- Fixating the stereotactic frame to the CT table fixation	 
	CT table fixation	A0401-XX
	- Fixating the CT adapter to specified CT table.	 

 

    	- 7 -

    	 

    

 

	MRI planning kit	 
	Includes:	 
	MR adapter	A0420-XX
	- Fixating the stereotactic frame to specified MR table.	 
	MR indicator	A0820-07
	- Fiducial box for MR imaging procedure	 
	 	 
	X-ray planning kit	 
	Includes:	 
	X-ray indicator	A0860-04
	- Fiducial box for angiography imaging procedure	 
	X-ray adapter and support	A0440-XX
	- Fixating the stereotactic frame to specified angiography table.	 

 

Standard LGP for LGK PERFEXION

 

Includes one (1) Leksell GammaPlan® (LGP)
license for creating new treatment plans for Leksell Gamma Knife® PERFEXIONTM .This main license allows the addition, management
and storage of an unlimited number patient records and treatment plans. LGP also allows the visualization of treatment plans created
at other LGK units.

 

Leksell GammaPlan® for
Leksell Gamma Knife® PERFEXIONTM includes: 

 

1         STANDARD
LGP FOR PERFEXION LICENSE

 

Includes one (1) Leksell GammaPlan® (LGP) license
for creating new treatment plans for Leksell Gamma Knife® PERFEXIONTM .This main license allows the addition, management and
storage of an unlimited number patient records and treatment plans. LGP also allows the visualization of treatment plans created
at other LGK units.

 

1         RETREATMENTTM
LICENSE

 

This software add-on facilitates planning of treatments
days before surgery, the assessment of treatments and re-treatments. Users are free to plan days ahead of treatment, to prepare
tomorrow’s follow-ups and plan additional treatment. ReTreatmentTM also lets any user to integrate images and
vital treatment information from previous plans. It is a powerful tool to import and display previous key treatment data in the
new treatment images. Imported data are user defined regions (targets, risk structures) and prescription isodose. It increases
the customer confidence when treating new lesions after an initial treatment.

 

1         WARPSPEEDTM,
REAL-TIME DOSE UPDATE LICENSE

 

This add-on speeds up planning by allowing the update
of isodoses instantly during planning. Isodoses displayed in any workspace are instantly updated whenever one or several isocenters
are added, modified, or removed. It is possible to fully apprehend the potential of composite shots, while also simplifying the
elaboration of new dose plans. WarpSpeedTM provides a shorter learning curve, more intuitive and faster planning.

 

1         FUNCTIONAL
PLANNINGTM LICENSE

 

This software add-on allows users to perform some
functional procedures based on the definition on the AC-PC line the visualization of functional targets based on functional target
formulas.

 

1         IMAGEMERGETM
LICENSE

 

This software add-on allows an automatic or manual
co-registration of any frameless image studies with a frame based reference study. Once co-registered, the frameless image can
be used in LGP like any other study. Supports MR, CT and PET images (requires the optional module ColorPETTM).

 

1         COLOR
PETTM LICENSE

 

The ColorPETTM software add-on help users
to can combine the physiological data of PET images with the anatomical data of CT and MR images using predefined color lookup
tables. Requires the ImageMerge software add-on.

 

    	- 8 -

    	 

    

 

Color Printer 110V

Network color laser printer with

-         Ethernet
connector, minimum speed 10/100

-         Support
for Postscript Level 3 printing

-         Power
supply 110 V

-         English
menus and labels

-         Support
for printing A4, US letter, US executive and US legal

Delivered model: HP Color Laser Jet or similar

 

		1	LGP – DICOM RT License

DICOM RT provides an exclusive possibility to share
treatment information with any DICOM RT compatible system. It includes:

IMPORT of DICOM RT STRUCT allows displaying any user-defined
region/volume created on a DICOM RT system. Volumes can be target volumes, organ at risks, isodoses or any other region of interest
defined by the user.

EXPORT of treatment data via DICOM RT STRUCT and DICOM
RT DOSE allows sharing information with any compatible systems to perform dose comparison or dose addition.

 

Additional Training for Leksell Gamma Knife®
PERFEXIONTM

 

		6	Clinical Training

Principle and practice of Gamma Knife Surgery, clinical
lectures, treatment planning, patient treatment - 5 days. Arranged by Elekta in collaboration with participating hospital.

 

    	- 9 -

    	 

    

 

Technical Specifications

	Workflow	 	 
	Automatic positioning system	 	Couch integrated
	Typical repositioning time	 	< 3 s
	Typical collimator size setup time	 	< 3 s
	Blocked collimation setup time	 	< 3 s
	Mixed collimation setup time (Composite shot)	 	< 3 s
	Check and verify	 	100%
	QA procedure	 	Automatic
	Accuracy	 	 
	Radiological accuracy	 	< 0.5 mm
	Positioning repeatability	 	< 0.05 mm
	Maximum patient weight	 	210 kg (460 pounds)
	Treatment planning	 	 
	Treatment planning system	 	PC/Linux based
	Dynamic shaping	 	Yes
	Remote planning	 	Yes
	Image co-registration	 	Yes
	PET supported	 	Yes
	Mechanical treatment range X/Y/Z	 	160/180/220 mm
	Shape of accessible volume	 	Cylindrical
	Real collimator sizes	 	4,8,16 mm diameter
	Radiation data	 	 
	Total cobalt-60 activity at loading (approx.)	 	< 6,600 Curie (2.44 x 1014 Bq)
	Number of radiation sources	 	192
	Radiation dose rate at focal point at loading	 	> 3 Gy/min
	Physical data	 	 
	Overall length, including cover	 	4.46 m
	Overall width, including cover	 	2.12 m
	Overall height, including cover	 	1.91 m
	Total weight (approximate)	 	20,000 kg

 

Radiation unit

The radiation unit is the radiation delivery system. It houses
192 Cobalt-60 sources and the collimator system that directs the radiation to the focus point. The radiation unit incorporates
the management of the shielding doors and electro-mechanics of the source sectors.

 

The following section describes selected components within the
radiation unit.

 

All components are chosen from well-recognized suppliers to
secure reliability and to optimize performance of the system.

		Collimator	body with radiation shielding

	Collimator body	 	Tungsten body with 576 collimator channels.
	Collimators	 	Tungsten collimator inserts.
	Pre-collimator	 	576 lead pre-collimator channels.
	Outer shielding	 	Cast iron.
	Inner shielding	 	Tungsten and lead.
	Bearing for collimator body	 	Crossed roller bearing. Static axial load 680000 N
	Shielding doors	 	Steel.
	Shielding strips	 	Stainless Steel.
	Servo Controller	 	High precision, fully digital servo drive with embedded intelligence.
	Motor	 	DC motor with 2000 line encoder
	Linear guide	 	 
	Linear guide blocks	 	Caged ball technology.
	Gear	 	Planetary gear
	Clutch	 	Ratchetting clutch
	8 source carrying sector units	 	 
	Sector	 	Aluminum. 24 source housing
	Shafts	 	Induction hardened stainless steel.
	Bearings	 	Graphite bushings
	Motor	 	24V DC motor
	Encoder	 	500 impulses/turn
	Linear guide unit	 	Repeatability: ±0.003mm.
	Linear encoder	 	Absolute Linear encoder.
	Solenoid	 	Photo-micro sensor.
	Servo controllers	 	Intelligent servo card

 

    	- 10 -

    	 

    

 

Patient Positioning System

The Patient Positioning System is the component of the PERFEXIONTM
system that the patient reclines on for treatment and is positioned relative the point of focus in the radiation unit.

 

The following section describes selected components within the
Patient Positioning System.

 

All components are chosen from well-recognized suppliers to
secure reliability and to optimize the performance of Leksell Gamma Knife PERFEXION.

Couch framework with X/Y/Z drive

	Framework	 	20 mm zinc chromated steel
	Motors	 	DC motors with 2000 line encoders.
	Gear	 	X/Y-axis Planetary gear 30:1 Z-axis Planetary gear 4:1
	Ball screws Bearing houses Support bearings	 	X/Z -axis.
	Screw jack	 	Y-axis: Integrated safety nut.
	Linear guides	 	 
	Linear guide blocks	 	Caged ball technology.
	Solenoid	 	Y-axis: Photo-micro sensor.
	Linear encoders	 	Absolute Linear encoders. Accuracy grade +/- 0.005mm.
	Servo Controllers	 	High precision, fully digital servo drive, with embedded intelligence.
	Frame fixation	 	Hardened stainless steel
	Comfort system	 	 
	Mattress support	 	Sandwich structure with aluminum honeycomb core and steel sheets
	Actuator	 	DC actuator
	Ball bearing	 	Stainless steel.
	Covers	 	 
	Radiation unit and couch covers	 	3 layers glass reinforced polyester. Meets ASTM E84 with flame spread index less than 75. Flammability rating V-0 according to UL 94.

 

Control System 

 

Office Cabinet

 

Includes:

MCU - Main Computer Unit

Office UPS - Uninterrupted Power Supply Ethernet Switch

 

Operators Console

Includes:

CIU - Connection and Isolation Unit

The CIU is powered by the office UPS and the internal power
supply converting 100-250VAC to 24VDC.

 

PSS - Patient Surveillance system

The PSS is included in the operator console as a separate unit
and handles the video/audio signals of the PERFEXIONTM system. It is possible to connect a video recorder on the ‘auxiliary’
outputs.

External audio system, e.g., patients MP3 player, can be connected
and played over the sound system integrated in the radiation unit covers.

 

MCU Monitor

19” Flat screen, UL-approved.

The MCU Monitor shows the Graphical User Interface of the MCU.

 

PSS Monitor

19” Flat screen, UL-approved.

The PSS monitor shows the video
from the patient camera and provides the sound from the patient microphone.

 

    	- 11 -

    	 

    

 

Treatment room Monitor

19” Flat screen, UL-approved.

The treatment room monitor displays the same information as
the MCU monitor on the operators console.

 

Treatment room Camera

The treatment room camera provides video to the PSS Monitor
in the Operators Area.

 

Medical Cabinet

Includes:

 

SDU - Sector Drive Unit

The SDU contains 8 servo controllers (one for each sector).

 

ECU- Electronic Control Unit

The Control Unit consists of two complete Power PCs (PPC) with
peripherals (RAM, ROM, inputs, outputs, CAN interfaces).

 

Medical UPS - Uninterrupted Power Supply

The medical UPS delivers 24VDC and 48VDC needed for the PERFEXIONTM
system. It is approved for medical use.

 

Radiation phantom

 

The Radiation Phantom with Cassettes is used for calibrating
the absorbed dose rate of Leksell Gamma Knife®.

 

INFORMATION TO BE FURNISHED BY BUYER

 

Not later than six months prior to the Contractual Delivery
Date or two weeks after the Effective Date, whichever occurs later, Buyer shall inform Seller in writing of:

 

(i)the orientation of the LGK

 

(ii)the minimum lengths of cables required to connect the
LGK at the Site; and

 

(iii)the manufacturer and model numbers of the CT, MRI and
angiographic equipment which Buyer intends to use in connection with the LGK.

 

    	- 12 -

    	 

    

 

Support
and Education & Training for PERFEXIONTM

 

Education & Training Services

 

On-site Clinical Start-Up

One week on-site application training with Gamma Knife
experienced neurosurgeon and/or radiation physicist certified by Elekta.

 

4 spaces in total selecting between the following
two courses:

 

1)Leksell Gamma Knife® PERFEXIONTM
Clinical Introductory Course

Principle and practice of Gamma Knife Surgery, clinical
lectures, treatment planning, patient treatment 4-5 days. Arranged by Elekta in collaboration with participating hospital. We pay
for the tuition at an approved Elekta training site.

 

2)Leksell GammaKnife® PERFEXIONTM
Technical / Application training

For use, care and maintenance of the equipment.

Stereotactic imaging, physics, dosimetry, treatment
planning, technical training on unloaded machine, QA procedures - 4 day arranged in Elekta Sweden. We pay for the tuition at an
approved Elekta training site.

 

Support Services

The following support services are delivered in addition
to parts warranty during the first year.

 

Maintenance System Management

Customization of the maintenance schedule for maximum
equipment availability, performance and safety with minimum disruption to clinical patient flow.

 

Planned Maintenance

Scheduled preventive
maintenance inspections in accordance with Elekta recommended maintenance intervals and procedures performed by Elekta
certified engineers. The service includes installation of software maintenance releases and software upgrades. Also included
is a service report detailing outstanding service needs and/or recommended parts replacement to sustain equipment performance
at original design specifications. Parts, software and further service activities are not included. The customer is
responsible for equipment availability for inspections at a mutually agreed time during regular Elekta office hours.

 

Remote Technical Support

Unlimited remote technical support, via phone, e-mail,
fax or suitable equivalent, during regular Elekta office hours.

 

On-site Technical Support

Preplanned corrective maintenance by Elekta certified
engineers to resolve technical issues on-site during regular Elekta office hours. This service includes a service report detailing
the maintenance actions completed and recommending further service actions to eliminate the root cause of the problem(s). It is
at the discretion of Elekta to determine whether an on-site visit is required to solve the technical issue. Parts and further service
activities not included.

 

Remote Application Support

Unlimited remote application support, via phone, e-mail,
fax or a suitable equivalent, during regular Elekta office hours.

 

Leksell GammaPlan®, remote application
support

Unlimited remote application support, via phone, e-mail,
fax or a suitable equivalent, during regular Elekta office hours.

 

    	- 13 -

    	 

    

 

EXHIBIT B

DESCRIPTION OF SITE

 

Northern
Westchester

400 East Main Street

Mount Kisco, NY 10549-3477

 

    	- 14 -

    	 

    

 

EXHIBIT C

ELEKTA'S WARRANTY

 

		1.	Subject to the exceptions set forth below, Elekta warrants to Buyer that for one year from the
date of completed Installation Test Protocol, the LGK will perform consistently with the Specification and the LGK will be free
from defects in design, materials, and workmanship which result in non-compliance with the Specification, except as otherwise provided
herein below. Notwithstanding the foregoing, Elekta’s warranty set forth in this Section 1 does not cover:

 

		(i)	defects arising out of materials or parts provided, modified or designed by Buyer;

		(ii)	defects emanating from Buyer’s improper use or maintenance;

		(iii)	normal deterioration or normal wear and tear, including radioactive decay of the Cobalt Supply;

		(iv)	defects resulting from repairs or service of the LGK supplied other than by Elekta or its authorized
representative;

		(v)	defects in the Hardware (and its operating software) (the warranty for which is regulated in Section
7 below) or the LGP Software (the warranty for which is regulated in Section 2 below).

		(vi)	the training referred to in Subsection 3.2 of the Terms and Conditions; or

		(vii)	defects in positioning or in the Site.

 

		2.	Elekta warrants that the LGP Software will, for a period of one year from the date of the completed
Installation Test Protocol, perform substantially in accordance with the documentation delivered with such LGP Software. The warranty
set forth in this Section 2 shall not apply if the LGP Software is subject to unauthorized repair or modification, improper application,
improper installation, accidental damage, negligence in use, improper storage, acts of God, electrical power damage, equipment
malfunction, or abnormal operating conditions, and in the event of any of the foregoing, Buyer shall be responsible to pay Elekta’s
then standard charges for any repairs, replacements or services performed by Elekta.

 

		3.	In the event that the LGK or any part or component thereof shall fail to conform with the relevant
warranty described herein, Elekta shall (or cause one of its Affiliates to) promptly repair or replace, at its option and at its
expense, the defect in the LGK or component thereof. Repair or replacement parts furnished or work performed under this warranty
shall be warranted for a period of one year from and after the date of such repair of replacement, but in no event shall any such
warranty with respect to repair or replacement work or parts extend past that date which is two (2) years from and after the date
of completion of the Installation Test Protocol. The defective LGK or part thereof which is replaced in accordance with this warranty
shall be the property of Elekta, and Elekta will notify Buyer in writing immediately after repair or replacement as to what disposition
Elekta desires of such LGK or part thereof, all at Elekta’s cost.

 

		4.	  In order to avail itself of its rights under this warranty, Buyer shall immediately notify Elekta
in writing of any defects that appear under the warranty and shall give Elekta every opportunity of inspecting and remedying such
defects.

 

		5.	  Year 2000 Compliance Warranty. Elekta further warrants that the equipment, software and use of
data will be year 2000 compliant and accommodate a full year calculation in its software. Licensor will guarantee that the equipment
and software will accept all data and perform to comply with the year 2000 warranties, assuring that the full four (4) positions
(e.g. 1997) year is utilized.

 

		6.	THE FOREGOING WARRANTIES ARE EXCLUSIVE AND GIVEN AND ACCEPTED IN LIEU OF ALL OTHER WARRANTIES
OF ELEKTA OR ITS REPRESENTATIVES WITH RESPECT TO QUALITY, PERFORMANCE AND OPERATION OF THE LGK, WRITTEN OR ORAL, EXPRESSED OR IMPLIED.
ALL OTHER WARRANTIES OF ELEKTA OR ITS REPRESENTATIVES, INCLUDING, WITHOUT LIMITATION, ANY WARRANTY OF MERCHANTABILITY OR FITNESS
FOR A PARTICULAR PURPOSE ARE HEREBY EXPRESSLY DISCLAIMED. CORRECTION OF NON-CONFORMITIES OR DEFECTS AS PROVIDED ABOVE SHALL BE
BUYER’S EXCLUSIVE REMEDY AND SHALL CONSTITUTE FULL AND FINAL FULFILLMENT OF ALL LIABILITIES OF ELEKTA, WHETHER IN WARRANTY,
CONTRACT, NEGLIGENCE, STRICT LIABILITY, TORT OR OTHERWISE WITH RESPECT TO THE LGK. IN NO EVENT SHALL ELEKTA BE LIABLE FOR LOSS
OF USE, REVENUE OR PROFIT, OR FOR ANY OTHER DIRECT, INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGE ARISING IN ANY RESPECT FROM THE
LGK OR ITS USE, OPERATION OR PERFORMANCE. THE PROVISIONS OF THIS PARAGRAPH SHALL SURVIVE THE TERMINATION OF THIS AGREEMENT.

 

		7.	Elekta shall assign to Buyer all of Elekta’s rights under the warranty or warranties provided by the manufacturer (the
“Computer Manufacturer”) for the Hardware and operating software included in the LGK. In the event the Hardware or
operating software exhibit defects which are covered by the warranty of the Computer Manufacturer, Buyer may notify Elekta of the
nature of such defects. In such case, Elekta shall promptly inform the Computer Manufacturer thereof and use its best efforts to
arrange prompt repair service by the Computer Manufacturer pursuant to the terms of the Computer Manufacturer’s warranty
or warranties Elekta shall furnish Buyer with such reasonable cooperation as Buyer may request with respect to the purchase by
Buyer of any extended warranty or maintenance contract offered by the Computer Manufacturer.

 

    	- 15 -

    	 

    

 

EXHIBIT E

LEKSELL GAMMAPLAN® PFXTM
SOFTWARE LICENSE

 

		1.	LGP Software

 

		1.1	   Elekta hereby licenses to Buyer at no additional cost beyond the Purchase Price, the LGP Software,
to be utilized only for the purpose of planning dosages of treatments to be performed with the LGK. In case Buyer already has an
existing Leksell Gamma Knife® Buyer may also retain one license to the old Leksell Gamma Plan® software
for archival purposes. Such license is also subject to the license terms and conditions set out in this Exhibit E. Such license
is for the use by Buyer of the software at one (1) workstation.

 

		1.2	  Buyer shall not: (a) use LGP except in connection with the radiosurgical operations performed with
the LGK at the Site; (b) make any modification to, adapt, translate, decompile, disassemble or create derivative works based on
LGP or merge LGP into any other software; (c) reproduce LGP (or any portion thereof) or any materials related thereto except for
one back-up copy made as part of Buyer’s regular computer software maintenance routines; (d) transfer, assign or sublicense
LGP to any person except to an assignee of all of Buyer’s rights in this Agreement in a manner permitted by Section 8.1 of
the Terms and Conditions; or (e) use LGP in connection with any access terminal other than the Hardware which has been specifically
approved by Elekta in writing.

 

		1.3	All right, title, interest and ownership of, in and to LGP, including but not limited to all trademarks,
service marks, registrations, copyrights, and all other proprietary rights not expressly granted in this License, shall at all
times remain the exclusive property of Elekta. Elekta shall retain all rights to LGP recorded on the original disk(s) and all subsequent
copies of LGP, in whatever form recorded.

 

		1.4	  The term of Buyer’s license to LGP shall continue until the earlier of: (a) any sublicense,
assignment or transfer or attempted sublicense, assignment or transfer by Buyer of LGP without the consent of Elekta; (b) the transport,
movement or attempted transport or movement by the Buyer of LGP, or the Hardware on which LGP is installed, from the Site without
prior written consent of Elekta; (c) any modification or adaptation of LGP for use with any equipment other than the LGK; (d) the
use of LGP in connection with more than one access terminal unless Buyer has obtained the written consent of Elekta to the use
of more than one access terminal at the same time or in connection with any access terminal other than the Hardware which has not
been specifically approved by Elekta in writing; or (E) the mutual written consent of Buyer and Elekta.

 

		2.	Buyer’s Responsibilities Concerning Hardware and LGP

 

		2.1	To facilitate E-Mail/Internet support, Buyer shall provide for E-Mail/Internet connectivity.

 

		2.2	Buyer shall assign a system manager who will undergo the appropriate training on the operating
system HP-UX and /or already have sufficient UNIX system administrator experience. Such training will be provided by the Hardware
manufacturer and Elekta shall pay the fee therefore. Buyer shall pay all travel and other expenses associated with such training.

 

		2.3	If Buyer elects to transfer images by a data network, then:

 

		(a)	Buyer shall provide the format to and right to read the diagnostic images generated by the user’s
diagnostic equipment and planned to be used as input for LGP. The Buyer shall provide a sample image in digital and hard copy form
in the orientation intended for clinical use.

 

		(b)	Buyer is responsible for obtaining up-to-date and accurate scanner image formats and any other
scanner or PACS information from vendors necessary to integrate images into LGP and providing this to Elekta.

 

		(c)	The Hardware used to run LGP must be used solely for this purpose. All changes and additions to
LGP and/or Hardware running LGP must receive prior written approval of Elekta.

 

		(d)	Buyer shall provide the images via an Ethernet connection using TCP/IP protocol and will provide
all physical cabling to the LGP Hardware compatible with 100-Base-T or 1000-Base-T at the Installation location of the LGK.

 

		(e)	Buyer shall provide all TCP/IP networking parameters such as IP address, netmask, gateway address,
etc. for the HP workstation included as a part of the Hardware.

 

    	- 16 -

    	 

    

 

EXHIBIT E

END USER
AGREEMENT AMENDMENTS

 

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