Document:

Mutual General Release and Waiver

 Exhibit 10.44 

MUTUAL GENERAL RELEASE AND WAIVER 

THIS MUTUAL GENERAL RELEASE AND WAIVER (the “Release”) is dated effective as of June 30, 2010 and is between
NightHawk Radiology Holdings, Inc., a Delaware corporation (“NightHawk”); NightHawk Radiology Services, LLC, an Idaho limited Liability company (“NRS” and together with NightHawk, the “NightHawk
Companies”) on the one hand and St. Paul Radiology, P.A., a Minnesota corporation (“SPRPA”); Cornerstone Radiology, PLC, a Minnesota limited liability company (“CR”); Midwest Radiology, LLC, a
Minnesota limited liability company (“MWR”); SPR Holdings, LLC, a Minnesota limited liability company (“Holdings”); SPR Holdings II, LLC, a Minnesota limited liability company (“Holdings II”);
Physicians Services Building, LLC, a Minnesota limited liability company (“PSB”); Physicians Imaging Building, LLC, a Minnesota limited liability company (“PIB” and collectively, with SPRPA, CR, MWR, Holdings,
Holdings II, PSB and PIB, the “SPR Companies”) on the other hand with respect to the following: 

WHEREAS, NightHawk purchased Midwest Physicians Services, LLC, a Minnesota limited liability company (“Support Services
Company”), and Emergency Radiology Services, LLC, a Minnesota limited liability company (“ERS” and together with Support Services Company, the “Acquired Companies”), from Holdings II pursuant to that
certain Membership Interest Purchase Agreement by and among NightHawk, the Acquired Companies and Holdings II dated July 16, 2007 (the “2007 Purchase Agreement”); 

WHEREAS, in connection with the 2007 Purchase Agreement and thereafter, the NightHawk Companies and the Acquired Companies entered into
certain agreements with the SPR Companies for, among other things, professional services and administrative services, including but not limited to: (a) that certain Administrative Support Services Agreement between Support Services Company and
SPRPA dated July 16, 2007, as amended October 3, 2007 and April 18, 2008 along with the Acknowledgment and Addendum dated June 30, 2010; (b) that certain Administrative Support Services Agreement between Support Services
Company and MWR dated July 16, 2007, as amended October 3, 2007 and as further amended on September 1, 2009 along with the Acknowledgment and Addendum dated June 30, 2010; (c) that certain Professional Services Agreement
between NRS and SPRPA dated July 16, 2007, along with the addendum dated April 17, 2009 and along with the Acknowledgment and Addendum dated June 30, 2010; and (d) that certain Data License Agreement between MWR, SPRPA and
Support Services Company dated July 16, 2007 (all of the foregoing agreements contemplated or specifically referenced in this recital, other than the 2007 Purchase Agreement, are collectively referred to in this Release as the “Services
Agreements”); 
 WHEREAS, contemporaneously herewith the NightHawk Companies, on the one hand, and the Acquired
Companies, on the other hand, have executed a Mutual General Release and Waiver; and 
 WHEREAS, to resolve disputes among the
NightHawk Companies on the one hand and the SPR Companies on the other hand with respect to their liabilities and obligations to one another under the 2007 Purchase Agreement and the Services Agreements, the SPR Companies and the NightHawk Companies
have agreed that certain of the Services Agreements will be terminated as set forth in that certain Termination Agreement of even date herewith 

 
(“Termination Agreement”), that the parties hereto will release one another from claims arising prior to the date of this Release as provided herein, and that certain of the
parties hereto will enter into that certain Confidentiality Agreement by and between SPRPA and Nighthawk dated April 16, 2010 (the “NDA”), that certain Transition Period Professional Services Agreement dated July 1, 2010
by and between NRS and SPRPA (the “Transition Services Agreement”) and that certain Promissory Note of even date herewith in the original amount of $14,000,000 made by SPR in favor of NightHawk (the “Note” and
together with the NDA, the Termination Agreement and the Transition Services Agreement, the “2010 Agreements”). 

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

	1.	Incorporation of Recitals. The parties agree that the foregoing recitals are true and accurate and are hereby incorporated herein by reference.

  

	2.	Release of NightHawk by SPR. Each of the SPR Companies, on behalf of itself and for each of its respective affiliates, subsidiaries, parents, successors and
assigns, hereby releases, dismisses and forever discharges each of the NightHawk Companies and their respective affiliates, subsidiaries and parents and their respective stockholders, directors, officers, employees, successors and assigns
(collectively, “NightHawk Parties”) from any and all claims, demands, rights, actions or causes of action, liabilities, damages, losses, obligations, judgments, suits, matters, costs, attorneys’ fees, and issues of any kind or
nature whatsoever, including without limitation those arising under or in connection with the 2007 Purchase Agreement as well as the Services Agreements, whether known or unknown, contingent or absolute, suspected or unsuspected, disclosed or
undisclosed, and whether sounding in fraud, tort, misrepresentation or breach of contract, that have been or could have been, could now be, or could in the future be, asserted, based in whole or in part on events, facts or agreements existing as of
the date of this Release, by any of the SPR Companies against any or all of the NightHawk Parties by reason of, arising out of, relating to or in connection with any matter, fact or thing whatsoever from the beginning of time through the date
hereof, including, without limitation, claims arising from, related to or arising under the 2007 Purchase Agreement, the Services Agreements as well as the transactions related thereto; provided, however, the foregoing release does not extend
to: (i) obligations of the NightHawk Companies specifically set forth in the 2010 Agreements, including indemnification or contribution obligations owed to the SPR Companies thereunder; or (ii) any NightHawk Retained Liabilities (as
defined below). 

  

	3.	 Release of SPR by NightHawk. Each of the NightHawk Companies, on behalf of itself and for each of its respective affiliates, subsidiaries,
parents, successors and assigns, hereby releases, dismisses and forever discharges each of the SPR Companies and their respective affiliates, subsidiaries, parents and their respective stockholders, directors, officers, employees, successors and
assigns (collectively, “SPR Parties”), from any and all claims, demands, rights, actions or causes of action, liabilities, damages, losses, obligations, judgments, suits, matters, costs, attorneys’ fees, and issues of any kind
or nature whatsoever, including without limitation those arising under or in connection with the 2007 Purchase Agreement as well as the Services Agreements, whether known or 

	 	 
unknown, contingent or absolute, suspected or unsuspected, disclosed or undisclosed, and whether sounding in fraud, tort, misrepresentation or breach of contract, that have been or could have
been, could now be, or could in the future be, asserted, based in whole or in part on events, facts, or agreements existing as of the date of this Release, by any of the NightHawk Companies against any or all of the SPR Parties by reason of, arising
out of, relating to or in connection with any matter, fact, or thing whatsoever from the beginning of time through the date hereof, including without limitation, claims arising from, related to or arising under the 2007 Purchase Agreement, the
Services Agreements as well as the transactions related thereto; provided, however, the foregoing release does not extend to: (i) obligations of the SPR Companies specifically set forth in the 2010 Agreements, including indemnification
or contribution obligations owed to the NightHawk Companies thereunder; or (ii) liabilities for taxes related or attributable to the SPR Companies for all taxable periods or portion thereof. 

 

	4.	NightHawk Retained Liabilities. Notwithstanding anything to the contrary set forth in Sections 2 and 3, NightHawk shall retain limited liability for all damages,
losses, and judgments (including reasonable attorneys’ fees) related to Third Party Claims (the “NightHawk Retained Liabilities”), provided, however, that (i) NightHawk’s liability for Third Party Claims
hereunder shall be capped at One Million Dollars ($1,000,000) (such amount to be inclusive of attorneys’ fees and costs) in the aggregate; and (ii) the SPR Companies agree not to seek indemnification or contribution from the NightHawk
Parties as contemplated in the provisios of Section 2 or as contemplated in this Section 4 unless and until they and the Acquired Companies have Exhausted all available insurance coverage maintained by it or its affiliates for such Third
Party Claims. “Third Party Claims” shall mean causes of action (other than Medical Liability Claims (as defined in the Transition Services Agreement)) brought against any of the SPR Parties by any person other than any of the SPR
Parties or any of the NightHawk Companies (each such person, a “Third Party”) that are premised upon any omission of or action taken by the Nighthawk Parties prior to the date of this Release. As used in this Section 4,
the term “Exhausted” means that the SPR Companies, the Acquired Companies and their respective affiliates have filed claims seeking coverage from the applicable insurance carriers and have made commercially reasonable efforts to
cause such carriers to pay such claims (which efforts shall include, but not be limited to, filing and prosecuting any and all administrative appeals and pursuing any and all administrative procedures pursuant to the terms of the applicable
insurance policies and the policies and procedures of the applicable carriers). For the avoidance of doubt, the term Exhausted does not mean that the SPR Companies, the Acquired Companies or their affiliates are required to file suit against such
insurance carriers if the claims are denied. 

  

	5.	Terminate Proceedings. The SPR Companies and the NightHawk Companies shall promptly take all steps necessary to terminate and dismiss with prejudice (with each
of the parties bearing their own costs and fees) any and all pending actions or proceedings arising from or relating in any way to the 2007 Purchase Agreement and the Service Agreements, including any action or proceeding pending in Minnesota in the
Hennepin County District or in the Ramsey County District Court or any arbitration. 

	6.	Waiver of Unknown Claims. Each of the SPR Companies and the NightHawk Companies shall be deemed to have waived, and shall waive and relinquish to the fullest
extent permitted by law any and all provisions, rights and benefits conferred by any law of the United States or any state or territory of the United States, or principle of common law, which governs or limits a person’s release of unknown
claims, including any law of any state or territory of the United States, or principle of common law, which is similar, comparable or equivalent to California Civil Code § 1542, which provides as follows: A GENERAL RELEASE DOES NOT EXTEND TO
CLAIMS WHICH THE CREDITOR DOES NOT KNOW OR SUSPECT TO EXIST IN HIS OR HER FAVOR AT THE TIME OF EXECUTING THE RELEASE, WHICH IF KNOWN BY HIM OR HER MUST HAVE MATERIALLY AFFECTED HIS OR HER SETTLEMENT WITH THE DEBTOR 

 

	7.	Unknown Claims Released, New Claims Preserved. The parties hereto acknowledge that they may discover facts in addition to or different from those that they now
know or believe to be true with respect to the subject matter of this Release, but affirm that it is their intention to fully, finally and forever settle and release any and all Claims released hereby known or unknown, suspected or unsuspected,
which now exist in whole or in part, or heretofore existed, or may hereafter exist, and without regard to the subsequent discovery or existence of such additional or different facts; provided, however, the parties hereto do not intend to
grant, nor do they grant hereby, any releases or waivers with respect to any obligations identified in the provisos contained in Sections 2 and 3 hereof. 

  

	8.	No Admission of Liability. It is expressly understood and agreed that this Release constitutes a compromise and settlement of disputed claims and that this
Release is not intended, nor shall it be construed by the parties to be, an admission of liability by or on behalf of any party hereto, by whom all such liability is expressly denied, said parties intending merely to avoid the cost and inconvenience
of prolonging their disputes. 

  

	9.	Jointly Drafted. This Release was jointly drafted by the parties hereto and such parties hereby agree that none should be favored in the construction,
interpretation or application of any provision or any ambiguity. 

  

	10.	No Duress or Coercion. The parties hereto acknowledge and agree that they have entered into this Release of their own free will and volition and were not coerced
to do so nor under duress at the time of executing this Release, and that each of the parties hereto has chosen to enter into this Release voluntarily and knowingly. 

 

	11.	Professional Advice. Each of the undersigned parties acknowledges and represents that it has had the opportunity to consult with legal, financial, tax, and other
professional advisors as it deems appropriate in connection with its consideration and execution of this Release. Each such party further represents and declares that in executing this Release, it has relied solely upon its own judgment, belief, and
knowledge, and the advice and recommendation of its own professional advisors, concerning the nature, extent and duration of its rights, obligations and claims, and that it has not been influenced to any extent whatsoever in executing this Release
by any representations or statements made by the other parties or their representatives, except those expressly contained or referred to herein. 

	12.	Governing Law; Venue. This Release shall be governed by and construed in accordance with the laws of the State of Minnesota, regardless of the laws that might
otherwise govern under any applicable conflicts of law analysis. Each of the parties hereto irrevocably consents to the exclusive jurisdiction and venue of any court within Hennepin County, Minnesota, in connection with any matter based upon or
arising out of this Release, and agrees that process may be served upon them in any manner authorized by the laws of the State of Minnesota. The parties agree not to dispute jurisdiction, forum, or venue if proper under this section.

  

	13.	Attorney Fees. If any action or other proceeding (“Proceeding”) is brought to enforce or interpret the provisions of this Release, the
prevailing party shall be entitled to recover all costs and expenses incurred in such Proceeding or on appeal, including reasonable attorneys’ fees as fixed by the court, and including a reasonable amount for costs and attorneys’ fees to
be incurred in collecting any money judgment or award or otherwise enforcing each order, judgment, or decree entered in the Proceeding. 

  

	14.	Entire Release. This Release constitutes the entire agreement of the undersigned parties concerning the subject matter hereof and supersedes and replaces any and
all prior agreements and understandings among the parties concerning such subject matter. 

  

	15.	Release Stands. A breach of any other agreement between the parties hereto shall not affect the validity of this Release. Without limiting the foregoing, in the
event of any claim, judgment, award, or order in favor of any party hereto, now or at any time in the future, regardless of the basis therefor, this Release shall not be affected in any manner by such claim, judgment, award, or order, and each party
hereto hereby irrevocably renounces, relinquishes, waives, abandons, and otherwise agrees that no such claim, judgment, award, or order shall in any way affect this Release, and each party agrees to refrain from advancing any claim in violation of
this paragraph. 

  

	16.	Waiver, Modification or Amendment. No waiver, modification, or amendment of any term, condition or provision of this Release shall be valid or of any effect
unless made in writing, signed by the party to be bound or its duly authorized representative, and specifying with particularity the nature and extent of such waiver, modification or amendment. 

 

	17.	Binding Effect. The provisions of this Release shall be binding upon and inure to the benefit of the parties hereto and their respective successors and assigns.

  

	18.	Headings. The headings in this Release are for convenience of reference only, will not be deemed to be a part of this Release and will not be referred to in
connection with the construction or interpretation of this Release. 

	19.	Execution in Counterparts. This Release may be executed in any number of counterparts, including facsimile counterparts, each of which shall be deemed an
original and together which shall constitute one and the same document. 

 (Signature page follows) 

 In Witness Whereof, the Parties have caused this Mutual General Release and Waiver to be
signed and delivered by its duly authorized representative as of the effective date set forth above. 
  

			
	NIGHTHAWK COMPANIES:
	
	NightHawk Radiology Holdings, Inc.
		
	 By:
	 	 /s/ Paul E. Cartee

		
	 Its:
	 	Senior Vice President and General Counsel
	
	NightHawk Radiology Services, LLC
		
	 By:
	 	 /s/ Paul E. Cartee

		
	 Its:
	 	Senior Vice President and General Counsel
	
	SPR COMPANIES:
	
	St. Paul Radiology, P.A.
		
	 By:
	 	 /s/ Michael T. Madison

		
	 Its:
	 	 Chief Executive Officer

	
	Cornerstone Radiology, PLC
		
	 By:
	 	 /s/ Michael T. Madison

		
	 Its:
	 	 Chief Manager

	
	Midwest Radiology, LLC
		
	 By:
	 	 /s/ Michael T. Madison

		
	 Its:
	 	 Chief Manager

(Signature Page to Mutual General Release and Waiver) 

			
	SPR Holdings, LLC
		
	 By:
	 	 /s/ Michael T. Madison

		 	Michael T. Madison
		 	Chief Manager
	
	SPR Holdings II, LLC
		
	 By:
	 	 /s/ Michael T. Madison

		 	Michael T. Madison
		 	Chief Manager
	
	Physicians Services Building, LLC
		
	 By:
	 	 /s/ Michael T. Madison

		 	Michael T. Madison
		 	Chief Manager
	
	Physicians Imaging Building, LLC
		
	 By:
	 	 /s/ Michael T. Madison

		 	Michael T. Madison
		 	Chief Manager

 (Signature Page to
Mutual General Release and Waiver)Consent to Amended and Restated Credit Agreement

 Exhibit 10.45 

CONSENT TO AMENDED AND RESTATED CREDIT AGREEMENT 

CONSENT TO AMENDED AND RESTATED CREDIT AGREEMENT (this “Consent”) dated as of April 30, 2010, among NightHawk
Radiology Holdings, Inc., a Delaware corporation (the “Borrower”), the Lenders party hereto and Morgan Stanley Senior Funding, Inc., as Administrative Agent. Unless otherwise indicated, all capitalized terms used herein and not
otherwise defined herein shall have the respective meanings provided to such terms in the Credit Agreement referred to below. 

W I T N E S S E T H:

 WHEREAS, the Borrower, the Lenders and Morgan Stanley Senior Funding, Inc., as Administrative Agent are parties to that
certain Amended and Restated Credit Agreement, dated as of July 10, 2007 (as amended, modified or supplemented to the date hereof, the “Credit Agreement”); and 

WHEREAS, subject to the terms and conditions of this Consent, the parties hereto wish to amend the Credit Agreement as herein provided;

 NOW, THEREFORE, it is agreed: 
  

	I.	Defined Terms. 

 As used
in this Consent, the following terms shall have the following meanings: 
 “Divested Entities” shall mean,
collectively, (i) Midwest Physicians Services, LLC and (ii) Emergency Radiology Services, LLC. 
 “Section
III.1(i) Prepayment” shall have the meaning provided in Section III.1(i) hereof. 
 “Section III.1(ii)
Prepayment” shall have the meaning provided in Section III.1(ii) hereof. 
 “St. Paul Note” shall mean
that certain Promissory Note issued in favor of the Borrower pursuant to the Termination Agreement evidencing the termination fee payable under such agreement, as amended, modified or supplemented from time to time. 

“St. Paul Sale” shall mean the sale by the Borrower of all of its Equity Interests in each of the Divested Entities, in
each case to the Buyer (as defined in the St. Paul Sale Agreement). 
 “St. Paul Sale Agreement” shall mean
that certain Membership Interest Purchase Agreement delivered to the Administrative Agent pursuant to Section IV(2) hereof and by and between the Borrower and the Buyer (as defined in the St. Paul Sale Agreement). 

“St. Paul Sale Documents” shall mean the St. Paul Sale Agreement and all other material agreements and documents
relating to the St. Paul Sale (including that certain Termination Agreement entered into in connection with the St. Paul Sale Agreement (the “Termination Agreement”) and that certain Mutual General Release and Waiver by and
among Borrower, St. Paul Radiology, P.A. and the other parties thereto). 

	II.	Consent and Other Modifications. 

1. Subject to the satisfaction of the conditions set forth in Section IV hereof and anything in the Credit Agreement and the Credit
Documents to the contrary notwithstanding, including the limitations set forth in Sections 8.13, 9.02 and 9.05 of the Credit Agreement, the Lenders hereby agree that the Borrower may consummate the St. Paul Sale in accordance with the terms of the
St. Paul Sale Documents and may receive the St. Paul Note as partial consideration for such sale. 
 2. Upon the consummation of
the St. Paul Sale in accordance with the terms of the St. Paul Sale Documents and this Consent, the Divested Entities shall no longer be Credit Parties under the Credit Documents and the provisions contained in Section 7.13 of the Guaranty and
Collateral Agreement shall apply with respect to the Divested Entities and all Collateral sold pursuant to the St. Paul Sale. 

3. The Lenders hereby agree that notwithstanding anything to the contrary contained in Section 4.02(d) of the Credit Agreement, to
the extent (and only to the extent) that the Borrower has made the Section III.1(i) Prepayment, the Borrower shall not be required to apply Net Sale Proceeds from the St. Paul Sale thereafter received by the Borrower or any of its Subsidiaries as a
mandatory prepayment of Loans as otherwise required by such Section (it being understood and agreed that the Section III.1(i) Prepayment shall satisfy the Borrower’s obligations with respect to Section 4.02(d) of the Credit Agreement with
respect to the Net Sale Proceeds from the St. Paul Sale); provided that if the aggregate amount of Net Sale Proceeds received by the Borrower or any of its Subsidiaries from the St. Paul Sale at any time exceeds $26,000,000 (any such amount,
“Excess St. Paul Sale Proceeds”), the Borrower shall be required to apply 100% of such Excess St. Paul Sale Proceeds as a mandatory prepayment of Loans as otherwise required pursuant to Section 4.02(d) of the Credit Agreement.

 4. Notwithstanding anything to the contrary contained in Section 4.02(f) of the Credit Agreement, (i) the amount of
the mandatory prepayment otherwise required pursuant to Section 4.02(f) of the Credit Agreement on the Excess Cash Payment Date relating to the Excess Cash Payment Period ending on December 31, 2010 shall be reduced by an amount equal to
the amount of the Section III.1(i) Prepayment actually made by the Borrower pursuant to this Consent (it being understood that if after giving effect to such reduction the required payment would be less than zero, the Borrower shall not be required
to make a mandatory prepayment pursuant to Section 4.02(f) of the Credit Agreement on such Excess Cash Payment Date) and (ii) the amount of the mandatory prepayment otherwise required pursuant to Section 4.02(f) of the Credit
Agreement on the Excess Cash Payment Date relating to the Excess Cash Payment Period ending on December 31, 2011 shall be reduced by an amount equal to the amount of the Section III.1(ii) Prepayment actually made by the Borrower pursuant to
this Consent (it being understood that if after giving effect to such reduction the required payment would be less than zero, the Borrower shall not be required to make a mandatory prepayment pursuant to Section 4.02(f) of the Credit Agreement
on such Excess Cash Payment Date). 
  

 -2- 

	III.	Additional Payments. 

 1.
The Borrower hereby agrees that, in addition to any mandatory prepayments that are otherwise required pursuant to Section 4.02 of the Credit Agreement, (i) within five (5) Business Days following the consummation of the St. Paul Sale,
it shall apply an amount equal to at least $26,000,000 as a mandatory prepayment of the Loans, which shall be applied in accordance with Sections 4.02(g) and (h) of the Credit Agreement (such prepayment, the “Section III.1(i)
Prepayment”) (ii) in addition to the required payments pursuant to preceding clause (i), on or prior June 30, 2011, it shall apply an amount equal to at least $10,000,000 as a mandatory repayment of the Loans, which shall be
applied in accordance with Sections 4.02(g) and (h) of the Credit Agreement (such prepayment, the “Section III.1(ii) Prepayment”). 

2. Without limiting the effect of the provisions of Section II.4 hereof, neither the Section III.1(i) Prepayment nor the Section
III.1(ii) Prepayment shall impact the calculation of Excess Cash Flow for any Excess Cash Payment Period. 
 3. Any failure by
the Borrower to make the Section III.1(i) Prepayment or the Section III.1(ii) Prepayment shall constitute an immediate Event of Default for all purposes of the Credit Agreement and all other Credit Documents. 

 

	IV.	Conditions Precedent to the Effectiveness of this Consent. 

This Consent shall become effective on the date each of the following conditions shall have been satisfied (the “Effective
Date”): 
 1. the St. Paul Sale shall have been (or contemporaneously with the occurrence of the Effective Date shall
be) consummated in accordance with the St. Paul Sale Agreement and all applicable laws (and no provision of the St. Paul Sale Agreement or the schedules and exhibits thereto shall have been waived, amended, supplemented or otherwise modified in a
manner adverse to the Lenders in any material respect unless such waiver, amendment, supplement or modification has been agreed to by the Administrative Agent or the Required Lenders); 

2. all of the St. Paul Sale Documents and all legal proceedings in connection with the transactions contemplated by this Consent shall be
reasonably satisfactory in form and substance to the Administrative Agent, and the Administrative Agent shall have received certified copies of all St. Paul Sale Documents; 

3. the Borrower shall have delivered to the Collateral Agent the original St. Paul Note, duly endorsed or accompanied by such undated
instruments of transfer or assignment duly executed in blank in a manner satisfactory to the Collateral Agent; 
 4. all
invoiced fees, costs, expenses and disbursements owing to the Administrative Agent and the Lenders, including without limitation, the reasonable and documented fees and disbursements of White & Case LLP shall have been paid; and 

5. the Borrower and the Required Lenders shall have signed a counterpart hereof and shall have delivered (including by way of facsimile
or other electronic transmission) the same to White & Case LLP, 701 Thirteenth Street, NW, Washington DC 20005 Attention: Aristides Diaz Pedrosa (facsimile number: 202.639.9355/e-mail address: adiazpedrosa@whitecase.com). 

 

 -3- 

	V.	Miscellaneous Provisions. 

1. In order to induce the Lenders to enter into this Consent, the Borrower hereby represents and warrants that: 

(a) no Default or Event of Default exists as of the Effective Date, both before (except with respect to aspects of the St.
Paul Sale that may occur immediately prior to the Effective Date, which aspects the Lenders are consenting to pursuant to this Consent) and immediately after giving effect to this Consent; and 

(b) all of the representations and warranties contained in the Credit Agreement and the other Credit Documents are true
and correct in all material respects on the Effective Date, both before and after giving effect to this Consent, with the same effect as though such representations and warranties had been made on and as of the Effective Date (it being understood
that any representation or warranty made as of a specific date or for a given period shall be true and correct in all material respects as of such specified date or such given period, as the case may be). 

2. This Consent is limited as specified and shall not constitute a modification, acceptance or waiver of any other provision of the
Credit Agreement or any other Credit Document. From and after the Effective Date, all references in the Credit Agreement and each of the other Credit Documents to the Credit Agreement shall be deemed to be references to the Credit Agreement as
modified hereby. 
 3. This Consent may be executed in any number of counterparts and by the different parties hereto on
separate counterparts, each of which counterparts when executed and delivered shall be an original, but all of which shall together constitute one and the same instrument. A complete set of counterparts shall be lodged with the Borrower and the
Administrative Agent. 
 4. THIS CONSENT AND THE RIGHTS AND OBLIGATIONS OF THE PARTIES HEREUNDER SHALL BE CONSTRUED IN
ACCORDANCE WITH AND GOVERNED BY THE LAW OF THE STATE OF NEW YORK. 
 *    *    *

  

 -4- 

 IN WITNESS WHEREOF, each of the parties hereto has caused a counterpart of this Consent to
be duly executed and delivered as of the date first above written. 
  

					
	NIGHTHAWK RADIOLOGY HOLDINGS, INC.
		
	By:	 	David M. Engert
		 	Name: 	 	David M. Engert
		 	Title:	 	President & CEO
	
	MORGAN STANLEY SENIOR FUNDING, INC,
	as Administrative Agent
		
	By:	 	Stephen King
		 	Name: 	 	Stephen King
		 	Title:	 	
	
	SIGNATURE PAGE TO THE CONSENT TO AMENDED AND RESTATED CREDIT AGREEMENT, DATED AS OF April 30, 2010, AMONG NIGHTHAWK RADIOLOGY HOLDINGS, INC., THE LENDERS PARTY
THERETO AND MORGAN STANLEY SENIOR FUNDING, INC., AS ADMINISTRATIVE AGENT
		
		 	[LENDERS]

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