Document:

exv10w1

Exhibit 10.1

THIRD AMENDMENT TO REVOLVING CREDIT AGREEMENT

          THIS THIRD AMENDMENT TO REVOLVING CREDIT AGREEMENT is dated as of August 30, 2011 (this
“Amendment”) by and among AMSURG CORP., a Tennessee corporation (the “Borrower”),
the Lenders which have delivered signature pages to this Amendment in accordance herewith (the
“Consenting Lenders”) and SUNTRUST BANK, in its capacity as administrative agent for the
Lenders (the “Administrative Agent”).

          WHEREAS, the Borrower, the Lenders and the Administrative Agent are parties to that certain
Revolving Credit Agreement dated as of May 28, 2010, as amended by that certain First Amendment to
Revolving Credit Agreement dated as of April 6, 2011 (the “First Amendment”), and as
further amended by that certain Second Amendment to Revolving Credit Agreement dated as of April 6,
2011 (as so amended, the “Credit Agreement”);

          WHEREAS, in connection with the First Amendment, the Borrower entered into that certain Merger
Agreement, dated as of April 7, 2011, by and among the Borrower, AmSurg Merger Corporation,
National Surgical Care, Inc. and the other parties thereto (the “Merger Agreement”);

          WHEREAS, the Borrower intends to modify the structure and terms of the Merger Agreement
pursuant to the terms of that certain Asset Purchase Agreement, dated as of August 23, 2011, by and
among the Borrower, AmSurg Holdings, Inc., National Surgical Care, Inc., AmSurg Merger Corporation
and Brazos GP Partners, LLC; and

          WHEREAS, the Borrower, the Consenting Lenders and the Administrative Agent desire to amend
certain provisions of the Credit Agreement on the terms and conditions contained herein.

          NOW, THEREFORE, for good and valuable consideration, the receipt and sufficiency of which are
hereby acknowledged by the parties hereto, the parties hereto hereby agree as follows:

     Section 1. Specific Amendments.

          (a) Section 1.1 of the Credit Agreement is hereby amended by deleting the defined term
“NSC Acquisition Agreement” in its entirety and substituting in lieu thereof the following:

“NSC Acquisition Agreement” means that certain Asset Purchase Agreement,
dated as of August 23, 2011, by and among the Borrower, AmSurg Holdings, Inc.,
National Surgical Care, Inc., AmSurg Merger Corporation and Brazos GP Partners, LLC.

          (b) Section 1.1 of the Credit Agreement is hereby further amended by deleting the defined term
“EBITDA” in its entirety and substituting in lieu thereof the following:

“EBITDA” means, for the Borrower and its Subsidiaries on a consolidated
basis for any period, an amount equal to the sum of Consolidated Net Income for such

 

 

period plus, without duplication, and to the extent deducted in computing
Consolidated Net Income for such period, the sum of (a) income taxes, (b)
Consolidated Interest Expense, (c) depreciation and amortization expense, in each
case determined on a consolidated basis in accordance with GAAP; (d) to the extent
applicable, stock option compensation costs applicable under (and calculated in
accordance with) FASB ASC 718; (e) all non-cash charges for such period taken for
the impairment of goodwill in accordance with FASB ASC 350, but excluding any
non-cash charge that will result in a cash charge in a future period; and (f) all
documented fees and expenses actually paid in connection with the First Amendment
and the NSC Acquisition in an aggregate amount not to exceed $10,000,000;
provided, however, that, with respect to any Person that became a
Subsidiary of, or was merged with or consolidated into, the Borrower or any Wholly
Owned Subsidiary during such period, “EBITDA” shall also include the EBITDA of such
Person during such period and prior to the date of such acquisition, merger or
consolidation; and provided, further, with respect to any Person
that ceased to be a Subsidiary, or was the subject of a Disposition during any
measurement period, “EBITDA” shall not include the EBITDA of such Person for such
measurement period, such calculations under this proviso to be detailed with
supporting documentation and measured to the Administrative Agent’s reasonable
satisfaction.

          (c) Section 6.1 of the Credit Agreement is hereby amended by deleting such section in its
entirety and substituting in lieu thereof the following:

“Section 6.1. Leverage Ratio. The Borrower shall maintain, on a
consolidated basis and as calculated at the end of each Fiscal Quarter, a Leverage
Ratio of not greater than 3.25 to 1.00.”

     Section 3. Approval of NSC Acquisition.

          (a) In connection with the NSC Acquisition, the Administrative Agent and the Consenting
Lenders acknowledge that the conditions and information required to be delivered pursuant to
Section 7.13 of the Credit Agreement with respect to the NSC Acquisition have been satisfied by the
Borrower.

          (b) Subject to satisfaction of the conditions precedent in Section 6 hereof, the
Administrative Agent and the Consenting Lenders hereby provide their approval of the NSC
Acquisition.

     Section 4. Other Documents. All other Loan Documents executed and delivered
in connection with the Credit Agreement are hereby amended to the extent necessary to
conform to this Amendment.

     Section 5. Payment of Fees and Expenses. The Borrower agrees to pay or
reimburse the Administrative Agent for its reasonable out-of-pocket fees, costs and
expenses incurred in connection with the preparation, negotiation, execution and delivery
of this

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Amendment and the other documents and agreements executed and delivered in
connection herewith.

     Section 6. Conditions Precedent. The effectiveness of this Amendment is subject to
the satisfaction of the following conditions precedent:

(i) The Administrative Agent shall have received a counterpart of this Amendment (and any
other documents necessary to evidence the transactions relating thereto) duly executed by
the Borrower, each of the Consenting Lenders (so long as the Consenting Lenders shall
constitute Required Lenders) and the Administrative Agent;

(ii) No Default or Event of Default shall exist;

(iii) A certificate of the chief financial officer of the Borrower demonstrating compliance
on a Pro Forma Basis with the financial covenants contained in Article VI of the Credit
Agreement after the NSC Acquisition is completed, in form and substance satisfactory to the
Administrative Agent;

(iv) A Reaffirmation of Obligations Under Loan Documents (the “Reaffirmation”) duly
executed by the Borrower and each other Loan Party, in the form of Exhibit A
attached hereto;

(v) The Administrative Agent shall have received a duly executed copy of an amendment to the
Note Purchase Agreement, in form and substance satisfactory to the Administrative Agent and
its counsel; and

(vi) Such other documents, instruments, agreements, certifications and opinions as the
Administrative Agent, on behalf of the Lenders, may reasonably request.

     Section 7. Representations. The Borrower represents and warrants to the
Administrative Agent and the Lenders that:

(a) Authorization. Each of the Borrower and the other Loan Parties have the right
and power, and have taken all necessary action to authorize them, to execute and deliver
this Amendment and the Reaffirmation and to perform their respective obligations hereunder
and under the Credit Agreement, as amended by this Amendment, and the other Loan Documents
to which they are a party in accordance with their respective terms. This Amendment has
been duly executed and delivered by a duly authorized officer of the Borrower and the Loan
Parties and each of this Amendment and the Credit Agreement, as amended by this Amendment,
is a legal, valid and binding obligation of the Borrower enforceable against the Borrower in
accordance with its respective terms.

(b) Compliance with Laws. The execution and delivery by the Borrower and the other
Loan Parties of this Amendment and the Reaffirmation and the performance by the Borrower of
this Amendment and the Credit Agreement, as amended by this Amendment, in accordance with
their respective terms, do not and will not, by the passage of time, the

- 3 -

 

giving of notice or otherwise: (i) require any consent or approval of, registration or filing with, or any
action by, any Governmental Authority or any other Person or violate any Requirements of Law
applicable to the Loan Parties or any judgment, order or ruling of any Governmental
Authority; (ii) violate or result in a default under any indenture, material agreement
(including the Private Placement Documents) or other material instrument binding on the Loan
Parties or any of their assets or give rise to a right thereunder to require any payment to
be made by the Loan Parties; or (iii) result in the creation or imposition of any Lien on
any asset of the Loan Parties.

(c) Reaffirmation. As of the date of this Amendment and immediately after giving
effect to this Amendment, all representations and warranties of each Loan Party set forth in
the Loan Documents is true and correct in all material respects (except to the extent that
any such representation or warranty expressly relates to a specified earlier date, in which
case such representation or warranty shall be true and correct as of such earlier date).

(d) No Default. As of the date hereof and immediately after giving effect to this
Amendment, no Default or Event of Default shall exist.

(e) No Impairment of Liens. The execution, delivery, performance and effectiveness
of this Amendment will not: (a) impair the validity, effectiveness or priority of the Liens
granted pursuant to any Loan Document, and such Liens continue unimpaired with the same
priority to secure repayment of all of the applicable Obligations, whether heretofore or
hereafter incurred, and (b) require that any new filings be made or other action taken to
perfect or to maintain the perfection of such Liens.

(f) No Material Adverse Effect. Since the date of the most recent financial
statements of the Borrower described in Section 5.1(a) of the Credit Agreement,
there has been no change which has had or could reasonably be expected to have a Material
Adverse Effect.

(g) Loan Parties. As of the date hereof, the parties listed as signatories to the
Reaffirmation represent a true, correct and complete list of the all the Loan Parties.

     Section 8. Release. In consideration of the amendments contained herein, the
Borrower hereby waives and releases each of the Lenders, the Administrative Agent and the Issuing
Bank from any and all claims and defenses, known or unknown as of the date hereof, with respect to
the Credit Agreement and the other Loan Documents and the transactions contemplated thereby.

     Section 9. Effect; Ratification.

          (a) Except as expressly herein amended, the terms and conditions of the Credit Agreement and
the other Loan Documents remain unchanged and continue to be in full force and
effect. The amendments contained herein shall be deemed to have prospective application only,
unless otherwise specifically stated herein. The Credit Agreement is hereby ratified and confirmed
in all respects. Each reference to the Credit Agreement in any of the Loan Documents

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(including
the Credit Agreement) shall be deemed to be a reference to the Credit Agreement, as amended by this
Amendment.

          (b) Nothing contained herein shall be deemed to constitute a waiver of compliance with any
term or condition contained in the Credit Agreement or any of the other Loan Documents, or
constitute a course of conduct or dealing among the parties. The Administrative Agent and the
Lenders reserve all rights, privileges and remedies under the Loan Documents.

          (c) Nothing in this Amendment is intended, or shall be construed, to constitute a novation or
an accord and satisfaction of any of the Obligations or to modify, affect or impair the perfection,
priority or continuation of the security interests in, security titles to or other Liens on any
collateral (including the Collateral) securing the Obligations.

          (d) This Amendment constitutes the entire agreement and understanding among the parties hereto
with respect to the subject matter hereof and supersedes any and all prior agreements and
understandings, oral or written, relating to the subject matter hereof.

          (e) This Amendment may be executed in any number of counterparts and by different parties
hereto on separate counterparts, each of which when so executed and delivered shall be deemed to be
an original, but all of which when taken together shall constitute a single instrument. Delivery
of an executed counterpart of a signature page of this Amendment by facsimile transmission or by
email in Adobe “.pdf” format shall be effective as delivery of a manually executed counterpart
hereof.

     Section 10. Further Assurances. The Borrower agrees to, and to cause any Loan Party
to, take all further actions and execute such other documents and instruments as the Administrative
Agent may from time to time reasonably request to carry out the transactions contemplated by this
Amendment, the Loan Documents and all other agreements executed and delivered in connection
herewith.

     Section 11. Miscellaneous. THIS AMENDMENT SHALL BE GOVERNED BY, AND CONSTRUED IN
ACCORDANCE WITH, THE INTERNAL LAWS OF THE STATE OF TENNESSEE WITHOUT REGARD TO CONFLICT OF LAWS
PRINCIPLES THEREOF. This Amendment shall be binding upon and shall inure to the benefit of the
parties hereto and their respective permitted successors and assigns.

     Section 12. Severability. In case any provision of or obligation under this
Amendment shall be invalid, illegal or unenforceable in any jurisdiction, the validity, legality
and enforceability of the remaining provisions or obligations, or of such provision or obligation
in any other jurisdiction, shall not in any way be affected or impaired thereby.

     Section 13. Definitions. All capitalized terms not otherwise defined herein are used
herein with the respective definitions given them in the Credit Agreement.

[Signature Pages Follow]

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          IN WITNESS WHEREOF, the parties hereto have caused this Third Amendment to Revolving Credit
Agreement to be duly executed by their respective authorized officers as of the day and year first
above written.

	 	 	 	 	 	 	 

	 	 	BORROWER:	 	 
	 
	 	 	 	 	 	 
	 	 	AMSURG CORP.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ Claire M. Gulmi	 	 
	 

	 	 	 	 

	 	 
	 

	 	Name:	 	Claire M. Gulmi	 	 
	 

	 	Title:	 	Executive Vice President, Chief
Financial Officer, and Secretary	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	SUNTRUST BANK
as Administrative Agent, as Issuing Bank,
and as a Lender	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	REGIONS BANK	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	BANK OF AMERICA, N.A.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	JPMORGAN CHASE BANK, N.A.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	US BANK NATIONAL ASSOCIATION	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	RAYMOND JAMES BANK, FSB	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	BRANCH BANKING AND TRUST COMPANY	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	FIFTH THIRD BANK, N.A.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	WELLS FARGO BANK, N.A.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	COMPASS BANK	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	FIRST TENNESSEE BANK NATIONAL

ASSOCIATION	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	KEYBANK NATIONAL ASSOCIATION	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	UNION BANK, N.A.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	THE BANK OF NASHVILLE	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	GOLDMAN SACHS BANK USA	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

	 	 	 	 	 	 	 

	 	 	LENDER:	 	 
	 
	 	 	 	 	 	 
	 	 	AVENUE BANK	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	/s/ 	 	 
	 

	 	Title:
	 	 

	 	 
	 

	 	 	 	 

	 	 

 

 

EXHIBIT A

REAFFIRMATION OF OBLIGATIONS UNDER LOAN DOCUMENTS

          Reference is hereby made to that certain Revolving Credit Agreement dated as of May 28, 2010,
as amended, among AmSurg Corp. (the “Borrower”), the Lenders party thereto and SunTrust Bank, as
Administrative Agent (as amended and in effect on the date hereof, the “Credit Agreement”;
capitalized terms used herein and not defined herein have the meanings ascribed to such terms in
the Credit Agreement).

          Each of the undersigned Loan Parties hereby: (i) agrees that (A) the amendments contained in
the Third Amendment to Revolving Credit Agreement dated as of the date hereof (the “Third
Amendment”) shall not in any way affect the validity and/or enforceability of any Loan
Document, or reduce, impair or discharge the obligations of such Person thereunder and (B) nothing
in the Third Amendment is intended, or shall be construed, to constitute a novation or an accord
and satisfaction of any of the Obligations or to modify, affect or impair the perfection, priority
or continuation of the security interests in, security titles to or other Liens on any collateral
(including the Collateral) securing the Obligations; (ii) reaffirms its continuing obligations
owing to the Administrative Agent and the Lenders under each of the other Loan Documents to which
such Person is a party; and (iii) confirms that the liens and security interests created by the
Loan Documents continue to secure the Obligations.

          Each of the undersigned Loan Parties (other than the Borrower) hereby represents and warrants
to the Administrative Agent and the Lenders that each of the representations and warranties
applicable to such Loan Party made by the Borrower in Section 7 of the Third Amendment are true and
correct.

          This Reaffirmation shall be construed in accordance with and be governed by the law of the
State of Tennessee.

[Signature page follows]

 

 

          IN WITNESS WHEREOF, each of the undersigned has duly executed and delivered this Reaffirmation
of Obligations under Loan Documents as of August __, 2011.

	 	 	 	 	 	 	 

	 	 	AMSURG CORP.	 	 
	 
	 	 	 	 	 	 
	 

	 	By:	 	 	 	 
	 

	 	 	 	 

Name:
	 	 
	 

	 	 	 	Title:	 	 

AmSurg Holdings, Inc.

AmSurg Anesthesia Management Services, LLC

AmSurg EC Topeka, Inc.

AmSurg EC St. Thomas, Inc.

AmSurg EC Beaumont, Inc.

AmSurg KEC, Inc.

AmSurg EC Santa Fe, Inc.

AmSurg EC Washington, Inc.

AmSurg Torrance, Inc.

AmSurg Abilene, Inc.

AmSurg Suncoast, Inc.

AmSurg Lorain, Inc.

AmSurg La Jolla, Inc.

AmSurg Hillmont, Inc.

AmSurg Palmetto, Inc.

AmSurg Northwest Florida, Inc.

AmSurg Ocala, Inc.

AmSurg Maryville, Inc.

AmSurg Miami, Inc.

AmSurg Burbank, Inc.

AmSurg Melbourne, Inc.

AmSurg El Paso, Inc.

AmSurg Crystal River, Inc.

AmSurg Abilene Eye, Inc.

AmSurg Inglewood, Inc.

AmSurg Glendale, Inc.

AmSurg San Antonio TX, Inc.

AmSurg San Luis Obispo CA, Inc.

AmSurg Temecula CA, Inc.

AmSurg Escondido CA, Inc.

AmSurg Scranton PA, Inc.

AmSurg Arcadia CA Inc.

AmSurg Main Line PA, Inc.

AmSurg Oakland CA, Inc.

AmSurg Lancaster PA, Inc.

 

 

AmSurg Pottsville PA, Inc.

AmSurg Glendora CA, Inc.

AmSurg Kissimmee FL, Inc.

AmSurg Altamonte Springs FL., Inc.

AmSurg New Port Richey FL, Inc.

AmSurg EC Centennial, Inc.

AmSurg Naples, Inc.

	 	 	 	 	 	 	 

	 

	 	By:	 	 	 	 
	 

	 	 	 	 

Name:
	 	 
	 

	 	 	 	Title:exv10w2

Exhibit 10.2

Execution Version

SECOND AMENDMENT TO NOTE PURCHASE AGREEMENT

     THIS SECOND AMENDMENT TO NOTE PURCHASE AGREEMENT (this “Amendment”), is made and entered into
as of August 30, 2011, by and among AMSURG CORP., a Tennessee corporation (the “Company”), the
other Credit Parties signatory hereto, THE PRUDENTIAL INSURANCE COMPANY OF AMERICA and the other
holders of Notes (as defined in the Note Agreement defined below) that are signatories hereto
(together with their successors and assigns, the “Noteholders”).

W I T N E S S E T H:

     WHEREAS, the Company and the Noteholders are parties to a certain Note Purchase Agreement,
dated as of May 28, 2010 (as amended by that certain First Amendment to Note Purchase Agreement
dated as of April 6, 2011 (the “First Amendment”), and as further amended, restated, supplemented
or otherwise modified from time to time, the “Note Agreement”; capitalized terms used herein and
not otherwise defined shall have the meanings assigned to such terms in the Note Agreement),
pursuant to which the Noteholders have purchased Notes from the Company;

     WHEREAS, in connection with the First Amendment, the Company entered into that certain Merger
Agreement, dated as of April 7, 2011, by and among the Company, AmSurg Merger Corporation, National
Surgical Care, Inc. and the other parties thereto (the “Merger Agreement”);

     WHEREAS, the Company intends to modify the structure and terms of the Merger Agreement
pursuant to the terms of that certain Asset Purchase Agreement, dated as of August 23, 2011, by and
among the Company, AmSurg Holdings, Inc., National Surgical Care, Inc., AmSurg Merger Corporation
and Brazos GP Partners, LLC; and

     WHEREAS, the Company has requested that the Noteholders amend certain provisions of the Note
Agreement, and subject to the terms and conditions hereof, the Noteholders are willing to do so;

     NOW, THEREFORE, for good and valuable consideration, the sufficiency and receipt of all of
which are acknowledged, the Company and the Noteholders agree as follows:

     1. Amendments.

     (a) Paragraph 2B of the Note Agreement is hereby amended by replacing such Paragraph in its
entirety with the following:

     Increase in Interest Rate after a Major Acquisition. If, immediately
following any Major Acquisition (and the incurrence of Indebtedness in connection
therewith), the Leverage Ratio exceeds 3.25:1.00, then, commencing with the first
day of the first fiscal quarter immediately following such Major Acquisition, the
per annum stated interest rate on the outstanding Notes shall
automatically be increased by 0.75% per annum until the later of (i) the first day

 

of the fifth fiscal quarter immediately following such Major Acquisition and (ii)
the date on which Company has delivered to the holders of the Notes an Officer’s
Certificate (x) demonstrating that the Leverage Ratio on the last day of any Fiscal
Quarter ending after such Major Acquisition does not exceed 3.25:1.0 and (y)
certifying that no Default or Event of Default has occurred, at which time the per
annum stated interest rate on the outstanding Notes shall automatically decrease to
the original stated interest rate.

     (b) Paragraph 6A(1) of the Note Agreement is hereby amended by replacing such Paragraph in its
entirety with the following:

     6A(1) Leverage Ratio. The Company shall maintain, on a consolidated basis and
as calculated at the end of each Fiscal Quarter, a Leverage Ratio of not greater
than 3.25 to 1.00; provided however, that if, immediately following a Major
Acquisition (and the incurrence of Indebtedness in connection therewith), the
Leverage Ratio exceeds 3.25:1.00, then with respect to the calendar quarter in which
such Major Acquisition is closed and each of the three immediately following
calendar quarters, the Company shall maintain a Leverage Ratio of not greater than
3.75 to 1.00 instead of 3.25 to 1.00.

     (c) Paragraph 10B of the Note Agreement is hereby amended by replacing the definitions of
“EBITDA” and “NSC Acquisition Agreement” in their entirety with the following definitions:

     “EBITDA” shall mean, for the Company and its Subsidiaries on a consolidated
basis for any period, an amount equal to the sum of Consolidated Net Income for such
period plus, without duplication, and to the extent deducted in computing
Consolidated Net Income for such period, the sum of (a) income taxes, (b)
Consolidated Interest Expense, (c) depreciation and amortization expense, in each
case determined on a consolidated basis in accordance with GAAP; (d) to the extent
applicable, stock option compensation costs applicable under (and calculated in
accordance with) FASB ASC 718; (e) all non-cash charges for such period taken for
the impairment of goodwill in accordance with FASB ASC 350, but excluding any
non-cash charge that will result in a cash charge in a future period; and (f) all
documented fees and expenses actually paid in connection with the First Amendment
and the NSC Acquisition in an aggregate amount not to exceed $10,000,000;
provided, however, that, with respect to any Person that became a
Subsidiary of, or was merged with or consolidated into, the Company or any Wholly
Owned Subsidiary during such period, “EBITDA” shall also include the EBITDA of such
Person during such period and prior to the date of such acquisition, merger or
consolidation; and provided, further, with respect to any Person
that ceased to be a Subsidiary, or was the subject of a Disposition during any
measurement period, “EBITDA” shall not include the EBITDA of such Person for such
measurement period, such calculations under this proviso to
be detailed with supporting documentation and measured to the Required Holders’
reasonable satisfaction.

2

 

     “NSC Acquisition Agreement” means that certain Asset Purchase Agreement, dated
as of August 23, 2011, by and among the Company, AmSurg Holdings, Inc., National
Surgical Care, Inc., AmSurg Merger Corporation and Brazos GP Partners, LLC.

     2. Conditions to Effectiveness of this Amendment. Notwithstanding any other provision
of this Amendment and without affecting in any manner the rights of the holders of the Notes
hereunder, it is understood and agreed that this Amendment shall not become effective, and the
Company shall have no rights under this Amendment, until the Noteholders shall have received (i)
reimbursement or payment of its costs and expenses incurred in connection with this Amendment or
the Note Agreement (including reasonable fees, charges and disbursements of King & Spalding LLP,
counsel to the Noteholders), and (ii) each of the following documents:

     (a) Executed counterparts to this Amendment from the Company, each of the Guarantors and the
Noteholders;

     (b) A duly executed copy of an amendment to the Credit Agreement, in form and substance
satisfactory to the Noteholders and their counsel;

     (c) A certificate of the chief financial officer of the Company demonstrating compliance on a
Pro Forma Basis with the financial covenants contained in Paragraph 6A of the Note Agreement after
the NSC Acquisition is completed, in form and substance satisfactory to the Required Holders; and

     (d) Such other documents, instruments, agreements, certifications and opinions as any
Noteholder may reasonably request.

     3. NSC Acquisition. In connection with the NSC Acquisition, the Noteholders
acknowledge that the conditions and information required to be delivered pursuant to Paragraph
6N(iv) of the Note Agreement with respect to the NSC Acquisition have been satisfied by the
Company.

     4. Representations and Warranties. To induce the Noteholders to enter into this
Amendment, each Credit Party hereby represents and warrants to the Noteholders that:

     (a) The execution, delivery and performance by such Credit Party of this Amendment (i) are
within such Credit Party’s power and authority; (ii) have been duly authorized by all necessary
corporate and shareholder action; (iii) are not in contravention of any provision of such Credit
Party’s certificate of incorporation or bylaws or other organizational documents; (iv) do not
violate any law or regulation, or any order or decree of any Governmental Authority; (v) do not
conflict with or result in the breach or termination of, constitute a default under or accelerate
any performance required by, any indenture, mortgage, deed of trust, lease, agreement or other
instrument to which such Credit Party or any of its Subsidiaries is a party or by which such Credit
Party or any such Subsidiary or any of their respective property is bound; (vi) do not
result in the creation or imposition of any Lien upon any of the property of such Credit Party
or any of its Subsidiaries; and (vii) do not require the consent or approval of any Governmental
Authority or any other person;

3

 

     (b) This Amendment has been duly executed and delivered for the benefit of or on behalf of
each Credit Party and constitutes a legal, valid and binding obligation of each Credit Party,
enforceable against such Credit Party in accordance with its terms;

     (c) After giving effect to this Amendment, the representations and warranties contained in the
Note Agreement and the other Note Documents are true and correct in all material respects, and no
Default or Event of Default has occurred and is continuing as of the date hereof;

     (d) The execution, delivery, performance and effectiveness of this Amendment will not: (a)
impair the validity, effectiveness or priority of the Liens granted pursuant to any Note Document,
and such Liens continue unimpaired with the same priority to secure repayment of all of the
applicable Obligations, whether heretofore or hereafter incurred, and (b) require that any new
filings be made or other action taken to perfect or to maintain the perfection of such Liens;

     (e) Since the date of the most recent financial statements of the Company described in
paragraph 5A(i) of the Note Agreement, there has been no change which has had or could reasonably
be expected to have a Material Adverse Effect; and

     (f) As of the date hereof, the parties listed as signatories to this Amendment represent a
true, correct and complete list of the all the Credit Parties.

     5. Reaffirmations and Acknowledgments.

     (a) Reaffirmation of Guaranty. Each Guarantor consents to the execution and delivery
by the Company of this Amendment and jointly and severally ratifies and confirms the terms of the
Guaranty Agreement with respect to the indebtedness now or hereafter outstanding under the Note
Agreement as amended hereby and all promissory notes issued thereunder. Each Guarantor acknowledges
that, notwithstanding anything to the contrary contained herein or in any other document evidencing
any indebtedness of the Company to the Noteholders or any other obligation of the Company, or any
actions now or hereafter taken by the Noteholders with respect to any obligation of the Company,
the Guaranty Agreement (i) is and shall continue to be a primary obligation of the Guarantors, (ii)
is and shall continue to be an absolute, unconditional, joint and several, continuing and
irrevocable guaranty of payment, and (iii) is and shall continue to be in full force and effect in
accordance with its terms. Nothing contained herein to the contrary shall release, discharge,
modify, change or affect the original liability of the Guarantors under the Guaranty Agreement.

     (b) Acknowledgment of Perfection of Security Interest. Each Credit Party hereby
acknowledges that, as of the date hereof, the security interests and liens granted to the
Collateral Agent under the Security Documents for the benefit of the Noteholders and other secured
parties are in full force and effect, are properly perfected and are enforceable in accordance with
the terms of the Note Agreement, the Security Documents and the other Note Documents.

     6. Release. In consideration of the amendments contained herein, each Credit Party
hereby waives and releases each of the Noteholders from any and all claims and defenses, known or
unknown as of the date hereof, with respect to the Note Agreement and the other Note Documents and
the transactions contemplated thereby.

4

 

     7. Effect of Amendment. Except as set forth expressly herein, all terms of the Note
Agreement, as amended hereby, and the other Note Documents shall be and remain in full force and
effect and shall constitute the legal, valid, binding and enforceable obligations of the Company
and the other Credit Parties party thereto to all holders of the Notes. The execution, delivery
and effectiveness of this Amendment shall not, except as expressly provided herein, operate as a
waiver of any right, power or remedy of the holders of the Notes under the Note Agreement, nor
constitute a waiver of any provision of the Note Agreement. From and after the date hereof, all
references to the Note Agreement shall mean the Note Agreement as modified by this Amendment. This
Amendment shall constitute a Note Document for all purposes of the Note Agreement.

     8. Governing Law. This Amendment shall be governed by, and construed in accordance
with, the internal laws of the State of New York and all applicable federal laws of the United
States of America.

     9. No Novation. This Amendment is not intended by the parties to be, and shall not be
construed to be, a novation of the Note Agreement or an accord and satisfaction in regard thereto.

     10. Costs and Expenses. The Company agrees to pay on demand all costs and expenses of
the Noteholders in connection with the preparation, execution and delivery of this Amendment,
including, without limitation, the reasonable fees and out-of-pocket expenses of outside counsel
for the Noteholders with respect thereto.

     11. Counterparts. This Amendment may be executed by one or more of the parties hereto
in any number of separate counterparts, each of which shall be deemed an original and all of which,
taken together, shall be deemed to constitute one and the same instrument. Delivery of an executed
counterpart of this Amendment by facsimile transmission or by electronic mail in pdf form shall be
as effective as delivery of a manually executed counterpart hereof.

     12. Binding Nature. This Amendment shall be binding upon and inure to the benefit of
the parties hereto, any other holders of Notes from time to time and their respective successors,
successors-in-titles, and assigns.

     13. Entire Understanding. This Amendment sets forth the entire understanding of the
parties with respect to the matters set forth herein, and shall supersede any prior negotiations or
agreements, whether written or oral, with respect thereto.

[remainder of page intentionally left blank]

5

 

     IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be duly executed, under
seal in the case of the Company and the Guarantors, by their respective authorized officers as of
the day and year first above written.

	 	 	 	 	 
	 	COMPANY:

AMSURG CORP.

 	 
	 	By:  	/s/ Claire M. Gulmi
	 
	 	 	Name:  	Claire M. Gulmi 	 
	 	 	Title:  	Executive Vice President, Chief

 Financial Officer, and Secretary 	 
	 

[SIGNATURE PAGE TO SECOND AMENDMENT TO NOTE PURCHASE AGREEMENT]

 

	 	 	 	 	 
	 	GUARANTORS:

AmSurg Holdings, Inc.

AmSurg Anesthesia Management Services, LLC

AmSurg EC Topeka, Inc.

AmSurg EC St. Thomas, Inc.

AmSurg EC Beaumont, Inc.

AmSurg KEC, Inc.

AmSurg EC Santa Fe, Inc.

AmSurg EC Washington, Inc.

AmSurg Torrance, Inc.

AmSurg Abilene, Inc.

AmSurg Suncoast, Inc.

AmSurg Lorain, Inc.

AmSurg La Jolla, Inc.

AmSurg Hillmont, Inc.

AmSurg Palmetto, Inc.

AmSurg Northwest Florida, Inc.

AmSurg Ocala, Inc.

AmSurg Maryville, Inc.

AmSurg Miami, Inc.

AmSurg Burbank, Inc.

AmSurg Melbourne, Inc.

AmSurg El Paso, Inc.

AmSurg Crystal River, Inc.

AmSurg Abilene Eye, Inc.

AmSurg Inglewood, Inc.

AmSurg Glendale, Inc.

AmSurg San Antonio TX, Inc.

AmSurg San Luis Obispo CA, Inc.

AmSurg Temecula CA, Inc.

AmSurg Escondido CA, Inc.

AmSurg Scranton PA, Inc.

AmSurg Arcadia CA Inc.

AmSurg Main Line PA, Inc.

AmSurg Oakland CA, Inc.

AmSurg Lancaster PA, Inc.

AmSurg Pottsville PA, Inc.

AmSurg Glendora CA, Inc.

AmSurg Kissimmee FL, Inc.

AmSurg Altamonte Springs FL., Inc.

AmSurg New Port Richey FL, Inc.

AmSurg EC Centennial, Inc.

AmSurg Naples, Inc.

 	 
	 	By:  	/s/ Claire M. Gulmi 	 
	 	 	Name:  	Claire M. Gulmi 	 
	 	 	Title:  	Vice President, Secretary and Treasurer 	 
	 

[SIGNATURE PAGE TO SECOND AMENDMENT TO NOTE PURCHASE AGREEMENT]

 

	 	 	 	 	 
	 	NOTEHOLDERS:

THE PRUDENTIAL INSURANCE COMPANY

OF AMERICA

 	 
	 	By:  	/s/
 	 
	 	 	Senior Vice President 	 
	 	 	 	 
	 
	 	PRUCO LIFE INSURANCE COMPANY

 	 
	 	By:  	/s/
 	 
	 	 	Assistant Vice President 	 
	 	 	 	 
	 
	 	PRUDENTIAL RETIREMENT INSURANCE

AND ANNUITY COMPANY

By: Prudential Investment Management, Inc.,

as investment manager

 	 
	 	By:  	/s/
 	 
	 	 	Senior Vice President 	 
	 	 	 	 
	 
	 	FORETHOUGHT LIFE INSURANCE COMPANY

By: Prudential Private Placement Investors,

L.P. (as Investment Advisor)

By: Prudential Private Placement Investors, Inc.

(as its General Partner)

 	 
	 	 	 
	 	By:  	/s/
 	 
	 	 	Senior Vice President 	 
	 	 	 	 
	 

[SIGNATURE PAGE TO SECOND AMENDMENT TO NOTE PURCHASE AGREEMENT]

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