Document:

Amendment to the Stock Purchase Agreement, dated September 8, 2006

         THIS AMENDMENT ("Amendment"), dated as of November 30, 2006 is by and
among (i) Rand Medical Billing, Inc., a California corporation ("Rand"), (ii)
Marvin I. Retsky, M.D., the sole stockholder of Rand ("Retsky") and (iii) Orion
HealthCorp Inc., a Delaware corporation ("Purchaser"), Purchaser, Retsky and
Rand are each a "Party" and are collectively the "Parties"). Capitalized terms
used herein and not defined herein shall have the meanings ascribed to them in
the Purchase Agreement.

                                    RECITALS
                                    --------

         WHEREAS, Rand, Retsky and Purchaser are parties to that certain Stock
Purchase Agreement dated September 8, 2006, ("Purchase Agreement") and
Purchaser, Rand and Retsky desire to amend the Purchase Agreement as set forth
below.

         NOW, THEREFORE, for good and valuable consideration, the receipt and
sufficiency of which is hereby acknowledged, the Parties hereby agree to amend
the Purchase Agreement pursuant to Section 13.2 thereof as follows:

         SECTION 1. Section 2.1 (a) of the Purchase Agreement is hereby amended
and restated in its entirety to read as follows:

         "(a) Cash Down. At the Closing Purchaser will pay Retsky, by wire
transfer of immediately available funds to an account specified by Retsky, an
amount equal to Seven Million Two Hundred Thousand Dollars($7,200,000) (the
"Cash Down Payment");"

         SECTION 2. Section 2.1 (c) of the Purchase Agreement is hereby amended
and restated in its entirety to read as follows:

         "(c) Cash Escrow. At the Closing, Purchaser will deliver to Purchaser's
counsel, Benesch Friedlander Coplan & Aronoff LLP ("BFCA"), for deposit into the
IOLTA account of BFCA, by wire transfer of immediately available funds, an
amount equal to Two Hundred Thousand Dollars ($200,000) (the "Escrow Amount"),
to be held in trust on behalf of Purchaser and Retsky. Purchaser and Retsky
hereby authorize and instruct BFCA to disburse the Escrow Amount (without
further instructions from Retsky or Purchaser) as promptly as possible following
receipt by BFCA of wire instructions for an interest-bearing escrow account in
the joint name of Orion HealthCorp and Retsky (the "Cash Escrow Account") set up
by City National Bank (the "Escrow Agent") to Escrow Agent for deposit into the
Cash Escrow Account, by wire transfer of immediately available funds, to be held
pursuant to the terms of an Escrow Agreement between Retsky, Purchaser and
Escrow Agent (the "Escrow Agreement"). Purchaser and Retsky hereby release BFCA
from all liability associated with holding of the Escrow Amount other than
claims arising as a result of BFCA's willful misconduct and will jointly and
severally indemnify BFCA from any and all liability associated with holding of
the Escrow Amount. Purchaser and Retsky acknowledge that BFCA is an intended
third party beneficiary of this Agreement for the purpose of enforcing the
release and indemnity provisions of this section."

<PAGE>

         SECTION 3. Notwithstanding anything to the contrary contained in
Sections 2.3 or 2.4 of the Purchase Agreement to the contrary, in the event that
the earn-out formula set forth therein does not result in a payment being due
from Purchaser to Retsky, or results in a payment being due that is less than
Four Hundred Thousand Dollars ($400,000), then Retsky shall within five (5) days
of final determination of such earn-out calculation transfer to Purchaser, via
wire transfer of immediately available U.S. funds to an account specified by
Purchaser for such purpose, an amount equal to the difference between Four
Hundred Thousand Dollars ($400,000) and the amount of the earn-out actually due
Retsky. Retsky acknowledges that his obligation to refund all or a portion of
the Four Hundred Thousand Dollars ($400,000) specified in this Section 3 of this
Amendment falls outside of the remedy limitations otherwise set forth in the
Purchase Agreement and that Purchaser may, in its sole discretion, seek to
pursue a cause of action for breach of contract against Purchaser for recovery
of such amounts. Any amount repaid by Retsky to Purchaser pursuant to this
Section 3 of this Amendment shall be treated, to the extent permitted by law, as
an adjustment to the Purchase Price.

         SECTION 4. Notwithstanding anything to the contrary contained in the
Purchase Agreement, neither Rand nor Retsky shall be required to pay-off or
terminate the capital lease obligation of Rand to Bank of the West (Churchill)
in the amount of approximately $5,600 and Purchaser hereby waives any closing
condition to the contrary.

         SECTION 5. Section 2.6 of the Purchase Agreement is hereby deleted in
its entirety. Schedule 2.6 of the Purchase Agreement is hereby deleted in its
entirety.

         SECTION 6. Section 4.33 of the Purchase Agreement is hereby amended and
restated in its entirety to read as follows:

         "4.33 Cash. At the close of business on the first business day
following the Closing, the cash of Rand net of outstanding checks and deposits
will be no less than One Hundred Fifty Three Thousand Four Hundred Dollars
($153,400) ("Closing Date Cash Amount"). To the best knowledge of Retsky, the
Closing Date Cash Amount is adequate to cover the accrued payroll of Rand and
the accounts payable of Rand."

         SECTION 7. Section 6.10 of the Purchase Agreement is hereby amended and
restated in its entirety to read as follows:

         "6.10 Cash At the close of business on the first business day following
the Closing, the cash of Rand net of outstanding checks and deposits will be no
less than One Hundred Fifty Three Thousand Four Hundred Dollars ($153,400)."

         SECTION 8. Effect of Amendment. Purchaser, Rand and Retsky agree that
except as specifically amended herein, the Purchase Agreement shall continue in
full force and effect in accordance with its original terms, and reference to
this specific Amendment need not be made in the Purchase Agreement or any other
document executed pursuant to or with respect to the Purchase Agreement, any
reference to the Purchase Agreement in any such document being sufficient to
refer to the Purchase Agreement as amended hereby.

<PAGE>

         SECTION 9. Counterparts. Purchaser, Rand and Retsky agree that this
Amendment may be executed in counterparts, each of which shall be deemed an
original but all of which together shall constitute one and the same instrument.

         SECTION 10. Governing Law. This Amendment shall be governed by and
construed in accordance with the laws of the State of California as though made
and to be fully performed in that State without regard to conflicts of laws
principles. This Amendment shall be construed and enforced in accordance with
the terms and provisions of the Purchase Agreement.

[Signature pages follow]

<PAGE>

         IN WITNESS WHEREOF, the undersigned have caused this Amendment to be
duly executed as of the day and year first above written.

                                            Orion HealthCorp, Inc.

                                         By: /s/ Terrence L. Bauer
                                            -------------------------------
                                            Terrence L. Bauer, CEO

                                          /s/ Marvin I. Retsky
                                         ------------------------------------
                                         Marvin I. Retsky, M.D.

                                         Rand Medical Billing, Inc.

                                         By:   /s/ Marvin I. Retsky
                                            --------------------------------
                                            Marvin I. Retsky, M.D.
                                            President and CEO

<PAGE>12

 THIS NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED,
AND MAY NOT BE SOLD OR OTHERWISE TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION
OR AN EXEMPTION THEREFROM UNDER SUCH ACT. FURTHERMORE, THIS NOTE MAY BE SOLD OR
OTHERWISE TRANSFERRED ONLY IN COMPLIANCE WITH THE CONDITIONS SPECIFIED HEREIN.

THIS INSTRUMENT AND THE RIGHTS AND OBLIGATIONS EVIDENCED HEREBY ARE SUBORDINATE
AND JUNIOR, IN THE MANNER AND TO THE EXTENT SET FORTH IN THE SUBORDINATION
AGREEMENTS REFERRED TO HEREIN, TO ALL SENIOR INDEBTEDNESS REFERRED TO THEREIN,
AND EACH HOLDER OF THIS INSTRUMENT, BY ITS ACCEPTANCE HEREOF, SHALL BE BOUND BY
THE PROVISIONS OF THE SUBORDINATION AGREEMENTS.

                             ORION HEALTHCORP, INC.

          Amended and Restated Subordinated Note Due December 15, 2008

$________                                                     December 1, 2006

         FOR VALUE RECEIVED, the undersigned, Orion HealthCorp, Inc., a Delaware
corporation formerly known as SurgiCare, Inc. (the "Company"), hereby promises
to pay to the order of _____________ ("MBS Seller") or registered permitted
assigns (such original payee or any such assignee from time to time, the
"Noteholder"), at the address set forth in Section 9.02 of the Agreement and
Plan of Merger referred to in Section 1 hereof, or at such other place as the
Noteholder shall from time to time have designated to the Company in writing, on
December 15, 2008 (the "Maturity Date") the principal amount of ________________
($_______) and to pay interest thereon as provided in Section 2 hereof.

1. THE NOTE. This Note (the "Note") is issued pursuant to Section 2.07(c) of the
Amended and Restated Agreement and Plan of Merger dated as of July 16,2004, as
amended by First Amendment to Agreement and Plan of Merger, dated as of
September 9, 2004, and Second Amendment to Agreement and Plan of Merger dated as
of December 15,2004, among the Company, DCPS/MBS Acquisition, Inc., Dennis Cain
Physician Solutions, Ltd., Medical Billing Services, Inc. and the sellers party
thereto (as amended to date, the "Agreement and Plan of Merger"). This Note,
together with any notes issued in exchange for it, are collectively referred to
herein as the "Notes". Certain terms are used in this Note as specifically
defined herein. This Note amends and restates the terms of that certain
Subordinated Note Due December 15, 2007, dated December 15, 2004, issued by the
Company in favor of MBS Seller (the "Original Note") and the Original Note is
hereby deemed cancelled and of no further force and effect.

2. INTEREST PROVISIONS. This Note shall bear interest (computed on the basis of
a 360-day year of twelve 30-day months) from the date hereof, on the principal
amount hereof from time to time unpaid, to and including the maturity hereof and
repayment of all sums due hereunder, at a rate per annum equal to 9%. Interest
shall be payable monthly on the last day of each month (each an "Interest
Payment Date"), commencing on December 31, 2006. Payments of principal and
interest hereunder shall be made by mailing a check in the amount thereof to the
Noteholder at its address appearing in the register maintained by the Company
pursuant to Section 5 hereof.

                                       2
<PAGE>

         Notwithstanding any provisions of this Note, in no event shall the
amount of interest paid or agreed to be paid by the Company exceed an amount
computed at the highest rate of interest permissible under applicable law.

3. PAYMENT PROVISIONS. The Company covenants that so long as any of the Notes
are outstanding:

         3.1 Principal Payments. Subject at all times to the subordination
Agreement, on the dates specified below, or on any accelerated maturity of the
Notes permitted hereby and thereby, the Company will pay to the Noteholder the
amount of principal of this Note specified below:

   Principal Payment Date    Principal Amount Due
   ----------------------    --------------------
   December 15, 2007         $_________

   March 15, 2008            $_________

   June 15, 2008             $_________

   September 15, 2008        $_________

   December 15, 2008         Outstanding principal balance, together with all
                             accrued and unpaid interest thereon

         3.2 Voluntary Prepayments. Subject at all times to the Subordination
Agreement, the Company may at any time and from time to time prepay all or part
of the principal amount of the Note then outstanding without penalty or premium.

         3.3 Notice of Prepayments. Notice of each voluntary prepayment of the
Note pursuant to Section 3.2 hereof shall be given in accordance with Section
9.02 of the Agreement and Plan of Merger not fewer than three days before the
prepayment date, in each case by mailing to the Noteholder a notice of intention
to prepay specifying the date of prepayment, the aggregate amount of the Note to
be prepaid on such date, the principal amount of the Note to be prepaid on such
date held by the Noteholder, and the accrued interest applicable to such
prepayment.

         3.4 Payment and Interest Cut-Of. Upon each prepayment of the Note, in
whole or in part, the Company will pay to the Noteholder the amount of the Note
to be prepaid, as set forth in the notice delivered pursuant to Section 3.3
hereof, together with unpaid interest in respect thereof accrued to and
including the prepayment date.

         3.5 Payment Certificate. Each principal payment by the Company (whether
on a specified payment date or as a prepayment) shall be accompanied by a
certificate from the Chief Financial Officer of the Company stating that as of
the date of such payment (i) no event of default has occurred and is continuing
with respect to the Senior Debt (as such term is defined in the Subordination
Agreements), (ii) the payment made hereunder would not result in an event of
default with respect to the Senior Debt and (iii) the Company has the required
availability under the documents governing the Senior Debt to make such payment.

                                       3
<PAGE>

4.       DEFAULTS.

         4.1 If any one or more of the following events (each such event being
an "Event of Default") shall happen, that is to say:

                  4.1.1 The Company shall fail to make any payment in respect of
principal of or interest on the Note (other than interest not so paid as a
result of the applicability of restrictions contained in the Subordination
Agreement) as the same shall become due whether at maturity acceleration or
otherwise, and such failure shall continue uncured and unremedied for 15
business days after the Noteholder has provided notice thereof to the Company;
or

                  4.1.2    The Company shall:

                           (a) commence a voluntary case concerning itself under
         Title 11 of the United States Code entitled `Bankruptcy" as now or
         hereafter in effect, or any successor thereto (the "Bankruptcy Code");

                           (b) have commenced against it an involuntary case
         under said Bankruptcy Code and the petition is dismissed within 60 days
         of the commencement of the case; or

                           (c) have appointed for it a custodian (as defined in
         the Bankruptcy Code) to take charge of all or substantially all of its
         property; or

                           (d) have filed against it any proceeding under any
         reorganization, arrangement, adjustment of debt, relief of debtors,
         dissolution, insolvency or liquidation or similar law of any
         jurisdiction whether now or hereafter in effect, which such proceeding
         remains undismissed for a period of 60 days or shall suffer the
         appointment of any receiver or custodian or the like for it or all or
         substantially all of its property which continues undischarged or
         unstayed for a period of 60 days; or

                           (e) make a general assignment for the benefit of its
         creditors;

         then and in each and every such case, subject to the provisions of the
         Subordination Agreement, the Noteholder may proceed to protect and
         enforce its rights by suit in equity, action at law and/or other
         appropriate proceeding, and may by notice to the Company declare (each,
         an "Acceleration") all or any part of the unpaid principal amount of
         the Note then outstanding to be forthwith due and payable, and
         thereupon such unpaid principal amount or part thereof, together with
         interest accrued thereon and all other sums, if any, payable under the
         Note, shall become so due and payable without presentation,
         presentment, protest or further demand or notice of any kind, all of
         which are hereby expressly waived, and such holder or holders may
         proceed to enforce payment of such amount or part thereof in such
         manner as it or they may elect; provided, however, notwithstanding the
         foregoing, in the case of an Event of Default under Section 4.1.2,
         Acceleration shall be deemed automatic without notice to the Company.

         4.2 Annulment of Defaults. An Event of Default shall not be deemed to
be in existence for any purpose of this Note if the Noteholder shall have waived
such event in writing or stated in writing that the same has been cured to its
reasonable satisfaction. No waiver or statement of satisfactory cure pursuant to
this Section 4.2 shell extend to or affect any subsequent or other Event of
Default not specifically identified in: such waiver or statement of satisfactory
cure or impair any of the rights of any holder of the Notes upon the occurrence
thereof.

                                       4
<PAGE>

5. RESTRICTIONS ON TRANSFER OF NOTE; REGISTER. The Noteholder may not transfer
or assign this Note in full or in part, without obtaining the Company's prior
written consent. The Company shall keep at its principal office a register in
which shall be entered the names and addresses of the registered holders of the
Notes and particulars of the respective Notes held by them and of all transfers
of the Notes.

6. SUBORDINATION OF NOTE. This Note and the rights and obligations evidenced
hereby are subordinate and junior, in the manner and to the extent set forth in
(i) the Subordination Agreement, dated as of December 1, 2006, among the
original Noteholder, the Company, Wells Fargo Foothill, Inc., and other parties
named therein (as from time to time in effect, the "Senior Subordination
Agreement"), (ii) the Subordination Agreement, dated as of December 1, 2006,
among the original Noteholder, the Company, Phoenix Life Insurance Company (as
from time to time in effect, the "Subdebt Subordination Agreement") and (iii)
any other subordination agreement in favor of any senior lender of the Company,
the terms of which subordination agreement are not more restrictive with respect
to payment of amounts due under this Note than the terms set forth in the Senior
Subordination Agreement or the Subdebt Subordination Agreement, (collectively
with the Specified Subordination Agreement and the Senior Subordination
Agreement, the "Subordination Agreements"), in each case to all Senior Debt as
defined therein. Notwithstanding anything elsewhere herein or in the
Subordination Agreement, the Company agrees that any additional debt incurred by
the Company in subsequent acquisition transactions in which the Sellers accept
notes payable from the Company, any such note or instrument shall in all
circumstances be expressly subordinated to the Senior Debt (as such term is
defined in the Subordination Agreement) and to this Note.

7. MISCELLANEOUS.

         7.1 Notices. Any notice or other communication to the Company or the
Noteholder in connection with this Note shall be deemed to be delivered and
received by such addressee if delivered or made in the manner stipulated in the
notice provisions of Section 9.02 of the Agreement and Plan of Merger (a) in the
case of the Company, to the addresses specified therein or to such other address
as the Company shall have specified to the Noteholder in writing, and (b) in the
case of the Noteholder to the address of the Noteholder contained in the
register referred to in Section 5 hereof.

         7.2 Waiver of Jury Trial. TO THE EXTENT NOT PROHIBITED BY APPLICABLE
LAW WHICH CANNOT BE WAIVED, EACH OF THE COMPANY (BY ITS EXECUTION HEREOF) AND
THE NOTEHOLDER (BY ITS ACCEPTANCE OF THIS NOTE) WAIVES AND COVENANTS THAT IT
WILL NOT ASSERT (WHETHER AS PLAINTIFF, DEFENDANT OR OTHERWISE) ANY RIGHT TO
TRIAL BY JURY IN ANY FORUM IN RESPECT OF ANY ISSUE OR ACTION ARISING OUT OF OR
BASED UPON OR RELATING TO THIS NOTE OR IN ANY WAY CONNECTED WITH OR RELATED OR
INCIDENTAL TO THE TRANSACTIONS CONTEMPLATED HEREBY, IN EACH CASE WHETHER NOW
EXISTING OR HEREAFTER ARISING.

         7.3 Governing Law. This Note shall be governed by and construed in
accordance with the domestic substantive laws of the State of New York without
giving effect to any choice or conflict of law provision or rule that would
cause the application of the domestic substantive laws of any other
jurisdiction.

                  [Remainder of page intentionally left blank]

                                       5
<PAGE>

         IN WITNESS WHEREOF, the undersigned has caused this Note to be executed
by a duly authorized officer as of the date first written above.

                                           ORION HEALTHCORP, INC.

                                           By: /s/Terrence L. Bauer
                                           ------------------------
                                           Name:  Terrence L. Bauer
                                           Title:  Chief Executive Officer

                                       6
<PAGE>

 THIS NOTE HAS NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933, AS AMENDED,
AND MAY NOT BE SOLD OR OTHERWISE TRANSFERRED IN THE ABSENCE OF SUCH REGISTRATION
OR AN EXEMPTION THEREFROM UNDER SUCH ACT. FURTHERMORE, THIS NOTE MAY BE SOLD OR
OTHERWISE TRANSFERRED ONLY IN COMPLIANCE WITH THE CONDITIONS SPECIFIED HEREIN.

THIS INSTRUMENT AND THE RIGHTS AND OBLIGATIONS EVIDENCED HEREBY ARE SUBORDINATE
AND JUNIOR, IN THE MANNER AND TO THE EXTENT SET FORTH IN THE SUBORDINATION
AGREEMENTS REFERRED TO HEREIN, TO ALL SENIOR INDEBTEDNESS REFERRED TO THEREIN,
AND EACH HOLDER OF THIS INSTRUMENT, BY ITS ACCEPTANCE HEREOF, SHALL BE BOUND BY
THE PROVISIONS OF THE SUBORDINATION AGREEMENTS.

                             ORION HEALTHCORP, INC.

          Amended and Restated Subordinated Note Due December 15, 2008

$____________                                                  December 1, 2006

         FOR VALUE RECEIVED, the undersigned, Orion HealthCorp, Inc., a Delaware
corporation formerly known as SurgiCare, Inc. (the "Company"), hereby promises
to pay to the order of _________ ("MBS Seller") or registered permitted assigns
(such original payee or any such assignee from time to time, the "Noteholder"),
at the address set forth in Section 9.02 of the Agreement and Plan of Merger
referred to in Section 1 hereof, or at such other place as the Noteholder shall
from time to time have designated to the Company in writing, on December 15,
2008 (the "Maturity Date") the principal amount of ____________________
($__________) and to pay interest thereon as provided in Section 2 hereof.

1. THE NOTE. This Note (the "Note") is issued pursuant to Section 2.07(c) of the
Amended and Restated Agreement and Plan of Merger dated as of July 16, 2004, as
amended by First Amendment to Agreement and Plan of Merger, dated as of
September 9, 2004, and Second Amendment to Agreement and Plan of Merger dated as
of December 15,2004, among the Company, DCPS/MBS Acquisition, Inc., Dennis Cain
Physician Solutions, Ltd., Medical Billing Services, Inc. and the sellers party
thereto (as amended to date, the "Agreement and Plan of Merger"). This Note,
together with any notes issued in exchange for it, are collectively referred to
herein as the "Notes". Certain terms are used in this Note as specifically
defined herein. This Note amends and restates the terms of that certain
Subordinated Note Due December 15, 2007, dated April 19, 2006, issued by the
Company in favor of MBS Seller (the "Original Note") and the Original Note is
hereby deemed cancelled and of no further force and effect.

2. INTEREST PROVISIONS. This Note shall bear interest (computed on the basis of
a 360-day year of twelve 30-day months) from the date hereof, on the principal
amount hereof from time to time unpaid, to and including the maturity hereof and
repayment of all sums due hereunder, at a rate per annum equal to 9%. Interest
shall be payable monthly on the last day of each month (each an "Interest
Payment Date"), commencing on December 31, 2006. Payments of principal and
interest hereunder shall be made by mailing a check in the amount thereof to the
Noteholder at its address appearing in the register maintained by the Company
pursuant to Section 5 hereof.

                                       7
<PAGE>

         Notwithstanding any provisions of this Note, in no event shall the
amount of interest paid or agreed to be paid by the Company exceed an amount
computed at the highest rate of interest permissible under applicable law.

3. PAYMENT PROVISIONS. The Company covenants that so long as any of the Notes
are outstanding:

         3.1 Principal Payments. Subject at all times to the subordination
Agreement, on the dates specified below, or on any accelerated maturity of the
Notes permitted hereby and thereby, the Company will pay to the Noteholder the
amount of principal of this Note specified below:

   Principal Payment Date   Principal Amount Due
   ----------------------   --------------------
   December 15, 2007        $_______
   March 15, 2008           $_______
   June 15, 2008            $_______
   September 15, 2008       $_______
   December 15, 2008        Outstanding principal balance, together with all
                            accrued and unpaid interest thereon

         3.2 Voluntary Prepayments. Subject at all times to the Subordination
Agreement, the Company may at any time and from time to time prepay all or part
of the principal amount of the Note then outstanding without penalty or premium.

         3.3 Notice of Prepayments. Notice of each voluntary prepayment of the
Note pursuant to Section 3.2 hereof shall be given in accordance with Section
9.02 of the Agreement and Plan of Merger not fewer than three days before the
prepayment date, in each case by mailing to the Noteholder a notice of intention
to prepay specifying the date of prepayment, the aggregate amount of the Note to
be prepaid on such date, the principal amount of the Note to be prepaid on such
date held by the Noteholder, and the accrued interest applicable to such
prepayment.

         3.4 Payment and Interest Cut-Of. Upon each prepayment of the Note, in
whole or in part, the Company will pay to the Noteholder the amount of the Note
to be prepaid, as set forth in the notice delivered pursuant to Section 3.3
hereof, together with unpaid interest in respect thereof accrued to and
including the prepayment date.

         3.5 Payment Certificate. Each principal payment by the Company (whether
on a specified payment date or as a prepayment) shall be accompanied by a
certificate from the Chief Financial Officer of the Company stating that as of
the date of such payment (i) no event of default has occurred and is continuing
with respect to the Senior Debt (as such term is defined in the Subordination
Agreements), (ii) the payment made hereunder would not result in an event of
default with respect to the Senior Debt and (iii) the Company has the required
availability under the documents governing the Senior Debt to make such payment.

4.       DEFAULTS.

         4.1 If any one or more of the following events (each such event being
an "Event of Default") shall happen, that is to say:

                  4.1.1 The Company shall fail to make any payment in respect of
principal of or interest on the Note (other than interest not so paid as a
result of the applicability of restrictions contained in the Subordination
Agreement) as the same shall become due whether at maturity acceleration or
otherwise, and such failure shall continue uncured and unremedied for 15
business days after the Noteholder has provided notice thereof to the Company;
or

                                       8
<PAGE>

                  4.1.2    The Company shall:

                           (a) commence a voluntary case concerning itself under
         Title 11 of the United States Code entitled `Bankruptcy" as now or
         hereafter in effect, or any successor thereto (the "Bankruptcy Code");

                           (b) have commenced against it an involuntary case
         under said Bankruptcy Code and the petition is dismissed within 60 days
         of the commencement of the case; or

                           (c) have appointed for it a custodian (as defined in
         the Bankruptcy Code) to take charge of all or substantially all of its
         property; or

                           (d) have filed against it any proceeding under any
         reorganization, arrangement, adjustment of debt, relief of debtors,
         dissolution, insolvency or liquidation or similar law of any
         jurisdiction whether now or hereafter in effect, which such proceeding
         remains undismissed for a period of 60 days or shall suffer the
         appointment of any receiver or custodian or the like for it or all or
         substantially all of its property which continues undischarged or
         unstayed for a period of 60 days; or

                           (e) make a general assignment for the benefit of its
         creditors;

         then and in each and every such case, subject to the provisions of the
         Subordination Agreement, the Noteholder may proceed to protect and
         enforce its rights by suit in equity, action at law and/or other
         appropriate proceeding, and may by notice to the Company declare (each,
         an "Acceleration") all or any part of the unpaid principal amount of
         the Note then outstanding to be forthwith due and payable, and
         thereupon such unpaid principal amount or part thereof, together with
         interest accrued thereon and all other sums, if any, payable under the
         Note, shall become so due and payable without presentation,
         presentment, protest or further demand or notice of any kind, all of
         which are hereby expressly waived, and such holder or holders may
         proceed to enforce payment of such amount or part thereof in such
         manner as it or they may elect; provided, however, notwithstanding the
         foregoing, in the case of an Event of Default under Section 4.1.2,
         Acceleration shall be deemed automatic without notice to the Company.

         4.2 Annulment of Defaults. An Event of Default shall not be deemed to
be in existence for any purpose of this Note if the Noteholder shall have waived
such event in writing or stated in writing that the same has been cured to its
reasonable satisfaction. No waiver or statement of satisfactory cure pursuant to
this Section 4.2 shell extend to or affect any subsequent or other Event of
Default not specifically identified in: such waiver or statement of satisfactory
cure or impair any of the rights of any holder of the Notes upon the occurrence
thereof.

                                       9
<PAGE>

5. RESTRICTIONS ON TRANSFER OF NOTE; REGISTER. The Noteholder may not transfer
or assign this Note in full or in part, without obtaining the Company's prior
written consent. The Company shall keep at its principal office a register in
which shall be entered the names and addresses of the registered holders of the
Notes and particulars of the respective Notes held by them and of all transfers
of the Notes.

6. SUBORDINATION OF NOTE. This Note and the rights and obligations evidenced
hereby are subordinate and junior, in the manner and to the extent set forth in
(i) the Subordination Agreement, dated as of December 1, 2006, among the
original Noteholder, the Company, Wells Fargo Foothill, Inc., and other parties
named therein (as from time to time in effect, the "Senior Subordination
Agreement"), (ii) the Subordination Agreement, dated as of December 1, 2006,
among the original Noteholder, the Company, Phoenix Life Insurance Company (as
from time to time in effect, the "Subdebt Subordination Agreement") and (iii)
any other subordination agreement in favor of any senior lender of the Company,
the terms of which subordination agreement are not more restrictive with respect
to payment of amounts due under this Note than the terms set forth in the Senior
Subordination Agreement or the Subdebt Subordination Agreement, (collectively
with the Specified Subordination Agreement and the Senior Subordination
Agreement, the "Subordination Agreements"), in each case to all Senior Debt as
defined therein. Notwithstanding anything elsewhere herein or in the
Subordination Agreement, the Company agrees that any additional debt incurred by
the Company in subsequent acquisition transactions in which the Sellers accept
notes payable from the Company, any such note or instrument shall in all
circumstances be expressly subordinated to the Senior Debt (as such term is
defined in the Subordination Agreement) and to this Note.

7. MISCELLANEOUS.

         7.1 Notices. Any notice or other communication to the Company or the
Noteholder in connection with this Note shall be deemed to be delivered and
received by such addressee if delivered or made in the manner stipulated in the
notice provisions of Section 9.02 of the Agreement and Plan of Merger (a) in the
case of the Company, to the addresses specified therein or to such other address
as the Company shall have specified to the Noteholder in writing, and (b) in the
case of the Noteholder to the address of the Noteholder contained in the
register referred to in Section 5 hereof.

         7.2 Waiver of Jury Trial. TO THE EXTENT NOT PROHIBITED BY APPLICABLE
LAW WHICH CANNOT BE WAIVED, EACH OF THE COMPANY (BY ITS EXECUTION HEREOF) AND
THE NOTEHOLDER (BY ITS ACCEPTANCE OF THIS NOTE) WAIVES AND COVENANTS THAT IT
WILL NOT ASSERT (WHETHER AS PLAINTIFF, DEFENDANT OR OTHERWISE) ANY RIGHT TO
TRIAL BY JURY IN ANY FORUM IN RESPECT OF ANY ISSUE OR ACTION ARISING OUT OF OR
BASED UPON OR RELATING TO THIS NOTE OR IN ANY WAY CONNECTED WITH OR RELATED OR
INCIDENTAL TO THE TRANSACTIONS CONTEMPLATED HEREBY, IN EACH CASE WHETHER NOW
EXISTING OR HEREAFTER ARISING.

         7.3 Governing Law. This Note shall be governed by and construed in
accordance with the domestic substantive laws of the State of New York without
giving effect to any choice or conflict of law provision or rule that would
cause the application of the domestic substantive laws of any other
jurisdiction.

                                   [Remainder of page intentionally left blank]

                                       10
<PAGE>

         IN WITNESS WHEREOF, the undersigned has caused this Note to be executed
by a duly authorized officer as of the date first written above.

                                       ORION HEALTHCORP, INC.

                                       By: /s/Terrence L. Bauer
                                           ---------------------
                                       Name:  Terrence L. Bauer
                                       Title:  Chief Executive Officer

                                       11

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