Document:

EX-10.1

 Exhibit 10.1 

AMENDMENT NO. 1 TO CREDIT AGREEMENT AND LIMITED WAIVER 

AMENDMENT NO. 1 TO CREDIT AGREEMENT AND LIMITED WAIVER (this “Amendment and Waiver”), dated as of October 11, 2013,
among ALLIANCE HEALTHCARE SERVICES, INC., a Delaware corporation (“Company”), the Lenders party hereto, and CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH, as administrative agent for Lenders (in such capacity, the “Administrative
Agent”). Capitalized terms used and not otherwise defined herein shall have the meanings assigned to such terms in the Credit Agreement referred to below. 

W I T N E S S E T H: 

WHEREAS, Company, the Lenders and the Administrative Agent are parties to a Credit Agreement, dated as of June 3, 2013 (as amended,
restated, amended and restated, supplemented or modified to but not including the date hereof, the “Credit Agreement”); 

WHEREAS, Company wishes to redeem in full the outstanding amount of the 2009 Senior Notes in accordance with the terms of the 2009 Senior
Notes Indenture (the “2009 Note Redemption”); 
 WHEREAS, in order to fund the 2009 Note Redemption and to pay certain
fees, premiums, expenses and other transaction costs associated with the 2009 Note Redemption and the borrowing of Incremental Term Loans as contemplated hereunder, in addition to the borrowing of Revolving Loans and the use of cash on hand, Company
will borrow an aggregate principal amount equal to $70,000,000 of Incremental Term Loans (the “2013 Incremental Term Loans”) made pursuant to Section 2.11 of the Credit Agreement, which shall be added to and constitute a part
of the Initial Term Loans (other than for purposes of Sections 2.1A(i), Section 2.5A, Section 4.4 and Sections 5.9A and C of the Credit Agreement); 

WHEREAS, Company has requested that each 2013 Incremental Term Loan Lender make commitments (each a “2013 Incremental Term
Commitment”) to provide the 2013 Incremental Term Loans, on the terms and conditions set forth herein, in the 2013 Incremental Term Loan Commitment Agreement and in Section 2.11 of the Credit Agreement; 

WHEREAS, in order to solely permit the incurrence of the 2013 Incremental Term Loans, Company is seeking a limited waiver as more fully set
forth in Section 2 below; 
 WHEREAS, the parties hereto desire to make certain amendments to the Credit Agreement and grant a limited
waiver and consent thereunder as more fully set forth herein; 
 NOW, THEREFORE, for good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties hereto agree as follows: 
 SECTION 1. Amendments to Credit
Agreement. 
 Effective on (and subject to the occurrence of) the First Amendment Effective Date (as defined below), the Credit
Agreement is hereby amended in accordance with this Section 1. 

 A. Section 1 of the Credit Agreement is hereby amended by adding in the appropriate
alphabetical order the following new definitions: 
 “2013 Incremental Term Loan Commitment Agreement” means the Incremental
Term Loan Commitment Agreement, dated as of October 11, 2013, among Company, each 2013 Incremental Term Loan Lender and the Administrative Agent and acknowledged by each Subsidiary Guarantor. 

“2013 Incremental Term Loan Lenders” means the persons identified as “Lenders” and listed on the signature pages to
the 2013 Incremental Term Loan Commitment Agreement, together with their successors and permitted assigns pursuant to Section 10.1. 

“2013 Incremental Term Loans” means the Loans made by the 2013 Incremental Term Loan Lenders pursuant to the 2013 Incremental
Term Loan Commitment Agreement. 
 “First Amendment” means Amendment No. 1 to Credit Agreement, dated as of
October 11, 2013, among Company, the Lenders party thereto and the Administrative Agent. 
 “First Amendment Effective
Date” has the meaning assigned thereto in the First Amendment. 
 B. The definition of “Initial Term Loans” is
hereby replaced in its entirety with the following provision: 
 ““Initial Term Loans” means the Loans made by the
Lenders to Company pursuant to Section 2.1A(i); provided that after the conversion of Delayed Draw Term Loans into Initial Term Loans pursuant to a DDTL Conversion as contemplated by Section 2.1F, such converted Delayed Draw Term
Loans shall be deemed to be Initial Term Loans for all purposes of this Agreement and the other Loan Documents (other than for purposes of Sections 2.1A(i) and (iii), Section 2.4B(iii)(h), Section 2.5A, Section 4.4 and Sections 5.9A
and C); provided, further, that after the incurrence of the 2013 Incremental Term Loans on the First Amendment Effective Date, the 2013 Incremental Term Loans shall be deemed to be Initial Term Loans for all purposes of this Agreement
and the other Loans documents (other than for purposes of Section 2.1A(i), Section 2.5A and Sections 5.9A and C).” 
 C. The
definition of “Loan Documents” is hereby replaced in its entirety with the following provision: 
 ““Loan
Documents” means this Agreement, the Notes, the Letters of Credit (and any applications for Letters of Credit), the Guaranties, the 

  
 2 

 
Collateral Documents, the First Amendment, any Incremental Loan Commitment Agreement (including, without limitation, the 2013 Incremental Term Loan Commitment Agreement), any Refinancing
Amendment or any Extension Amendment.” 
 D. Section 2.2C of the Credit Agreement is hereby replaced in its entirety with the
following provision: 
 “Interest Payments. Subject to the provisions of Section 2.2E, interest on each Loan shall be
payable in arrears on and to each Interest Payment Date applicable to that Loan, upon any prepayment of that Loan (to the extent accrued on the amount being prepaid), on the First Amendment Effective Date (in the case of the Initial Term Loans
outstanding immediately prior to the First Amendment Effective Date) and at maturity (including final maturity); provided that in the event any Revolving Loans that are Base Rate Loans are prepaid pursuant to Section 2.4B, interest
accrued on such Revolving Loans through the date of such prepayment shall be payable on the next succeeding Interest Payment Date applicable to Base Rate Loans (or, if earlier, at final maturity).” 

E. Section 2.4A(i) of the Credit Agreement is hereby replaced in its entirety with the following provision: 

“A. Scheduled Payments of Term Loans. 

(i) Scheduled Payments of Initial Term Loans. In addition to any other mandatory repayments pursuant to this Section 2.4, on each
date set forth below (each, a “Scheduled Initial Term Loan Repayment Date”), Company shall be required to repay the principal amount of Initial Term Loans, to the extent then outstanding, until the Initial Term Loans are paid in
full, as set forth opposite each such date below (each such repayment, a “Scheduled Initial Term Loan Repayment”): 
  

					
	 Scheduled Initial Term Loan Repayment Date
	  	Scheduled Initial Term Loan
Repayment	 
	 December, 15, 2013
	  	$	1,225,000	  
	 March 15, 2014
	  	$	1,225,000	  
	 June 15, 2014
	  	$	1,225,000	  
	 September, 15 2014
	  	$	1,225,000	  
	 December, 15, 2014
	  	$	1,225,000	  
	 March 15, 2015
	  	$	1,225,000	  
	 June 15, 2015
	  	$	1,225,000	  
	 September, 15 2015
	  	$	1,225,000	  
	 December, 15, 2015
	  	$	1,225,000	  
	 March 15, 2016
	  	$	1,225,000	  
	 June 15, 2016
	  	$	1,225,000	  

  
 3 

					
	 Scheduled Initial Term Loan Repayment Date
	  	Scheduled Initial Term Loan
Repayment	 
	 September, 15 2016
	  	$	1,225,000	  
	 December, 15, 2016
	  	$	1,225,000	  
	 March 15, 2017
	  	$	1,225,000	  
	 June 15, 2017
	  	$	1,225,000	  
	 September, 15 2017
	  	$	1,225,000	  
	 December, 15, 2017
	  	$	1,225,000	  
	 March 15, 2018
	  	$	1,225,000	  
	 June 15, 2018
	  	$	1,225,000	  
	 September, 15 2018
	  	$	1,225,000	  
	 December, 15, 2018
	  	$	1,225,000	  
	 March 15, 2019
	  	$	1,225,000	  
	 Initial Term Loan Maturity Date
	  	$	462,000,000	  

 ; provided that the Scheduled Initial Term Loan Repayments set forth above shall be reduced in
connection with any voluntary or mandatory prepayments of the Initial Term Loans in accordance with Section 2.4B(iv) and provided, further, that the Initial Term Loans and all other amounts owed hereunder with respect to the
Initial Term Loans shall be paid in full on the Initial Term Loan Maturity Date, and the final installment payable by Company in respect of the Initial Term Loans on such date shall be in an amount, if such amount is different from that specified
above, sufficient to repay all amounts owing by Company under this Agreement with respect to the Initial Term Loans; provided that the amount of any such payment set forth above shall be adjusted to account for the addition of any Extended
Term Loans to contemplate the reduction in the aggregate principal amount of any Initial Term Loans that were converted in connection with the incurrence of such Extended Term Loans.” 

SECTION 2. Limited Waiver and Consent. 

(a) Subject to the satisfaction (or due waiver) of the conditions set forth in Section 3 hereof, and in reliance upon the representations
and warranties of Company set forth in Section 4 hereof, the Requisite Lenders hereby waive compliance with Section 7.1(vi)(5)(i) of the Credit Agreement solely to permit the incurrence of the 2013 Incremental Term Loans in an aggregate
amount of $70,000,000 in connection with the 2009 Note Redemption (the “Limited Waiver”). 
 (b) The Limited Waiver shall
be limited precisely as written, and nothing in this Limited Waiver shall be deemed to constitute a waiver of any other term, provision or condition of the Credit Agreement. 

SECTION 3. 
 A.
Conditions Precedent to Effectiveness. This Amendment and Waiver shall become effective on the date (the “First Amendment Effective Date”) when each of the following conditions shall have been satisfied: 

  
 4 

 (i) (a) Company, the Administrative Agent, the 2013 Incremental Term Lenders and
the Requisite Lenders shall have signed a counterpart hereof (whether the same or different counterparts) and shall have delivered (including by way of facsimile or other electronic transmission) the same to the Administrative Agent,
(b) Company, the Administrative Agent and each 2013 Incremental Term Loan Lender shall have signed a counterpart (whether the same or different counterparts) of that certain 2013 Incremental Term Loan Commitment Agreement, dated as of the date
hereof (the “2013 Incremental Term Loan Commitment Agreement”) and shall have delivered (including by way of facsimile or other electronic transmission) the same to the Administrative Agent and (c) each Subsidiary Guarantor
shall have signed a counterpart (whether the same or different counterparts) of an acknowledgement in connection with the 2013 Incremental Term Loan Commitment Agreement and shall have delivered (including by way of facsimile or other electronic
transmission) the same to the Administrative Agent; 
 (ii) the Administrative Agent shall have received from Company and
each other Loan Party the following: 
 (a) an officer’s certificate certifying that no amendments, modifications or
changes have been made to (i) the Certificate or Articles of Incorporation or other appropriate organizational documents of such Loan Party and (ii) the Bylaws or similar organizational documents of such Loan Party, since such documents
were delivered to the Administrative Agent on the Closing Date, together with a good standing certificate from the Secretary of State of such Loan Party’s jurisdiction of incorporation or formation each dated a recent date prior to the First
Amendment Effective Date; 
 (b) Resolutions of the Board of Directors or similar governing body of such Loan Party (or other
evidence reasonably satisfactory to the Administrative Agent) approving and authorizing the execution, delivery and performance of this Amendment and Waiver and the Amended Credit Agreement, certified as of the First Amendment Effective Date by the
corporate secretary, an assistant secretary or a Responsible Officer of such Loan Party as being in full force and effect without modification or amendment; and 

(c) Signature and incumbency certificates of the officers of such Loan Party executing this Amendment and Waiver; 

(iii) the representations and warranties contained in Section 5 of the Credit Agreement and in the other Loan Documents
shall be true and correct in all material respects on and as of that First Amendment Effective Date to the same extent as though made on and as of that date, except to the extent such representations and warranties specifically relate to an earlier
date, in which case such representations and warranties shall have been true and correct in all material respects on and as of such earlier date; and 

  
 5 

 (iv) Company shall have paid (x) for distribution to each Lender which
executes and delivers a counterpart of this Amendment and Waiver by 5:00 p.m. (EDT) on October 10, 2013, an amendment fee equal to 0.10% of the sum of such Lender’s Revolving Loan Exposure plus such Lender’s Term Loan Exposure, in
each case, as of the First Amendment Effective Date (prior to giving effect to any Lender’s 2013 Incremental Term Commitment), (y) to Credit Suisse Securities (USA) LLC all fees set forth in the Engagement Letter dated as of
October 3, 2013 between the Borrower and Credit Suisse Securities (USA) LLC within the time periods specified therein and (z) to the Administrative Agent for the account of the Administrative Agent all reasonable fees, expenses and other
amounts payable to the Administrative Agent in connection with this Amendment and Waiver (including, without limitation, all reasonable legal fees and expenses of White & Case LLP, counsel to the Administrative Agent to the extent an
invoice has been provided to Company prior to the First Amendment Effective Date). 
 B. Conditions Precedent to Funding. Each 2013
Incremental Term Loan Lender’s obligation to make 2013 Incremental Term Loans is subject to satisfaction or due waiver of the conditions set forth in Annex I to the 2013 Incremental Term Loan Commitment Agreement. 

SECTION 4. Representations and Warranties. In order to induce the Lenders to enter into this Amendment and Waiver, Company
hereby represents and warrants that: (a) all of the representations and warranties set forth in Section 5 of the Credit Agreement and in each of the other Loan Documents are true and correct in all material respects both immediately before
and immediately after the First Amendment Effective Date, with the same effect as though such representations and warranties had been made on and as of the First Amendment Effective Date (it being understood that any representation or warranty made
as of a specific date shall be true and correct in all material respects as of such specific date) and as if each reference in any such representation or warranty to “this Agreement” or “the Credit Agreement” included reference
to this Amendment and Waiver and to the Credit Agreement, as amended by this Amendment and Waiver (the “Amended Credit Agreement”), (b) after giving effect to this Amendment and Waiver, no Potential Event of Default or Event of
Default shall have occurred and be continuing and (c) the execution, delivery and performance by Company of this Amendment and Waiver and the Amended Credit Agreement have been duly authorized by all necessary corporate action required on its
part and each of this Amendment and Waiver and the Amended Credit Agreement is a legal, valid and binding obligation of Company enforceable against Company in accordance with its terms except as the enforcement thereof may be subject to (i) the
effect of any applicable bankruptcy, insolvency, reorganization, moratorium or similar laws affecting creditors’ rights generally and (ii) general principles of equity (regardless of whether enforcement is sought in a proceeding in equity
or at law). 
 SECTION 5. Waiver of Defenses; and Release. 

This Amendment and Waiver shall be limited precisely as written and, except as expressly provided herein, shall not be deemed or construed
(i) to be a consent granted pursuant to, or a waiver, amendment, modification or forbearance of, any term or condition of the Credit Agreement, any other Loan Document or any of the instruments or agreements referred to therein or a waiver of
any Potential Event of Default or Event of Default under the Credit 

  
 6 

 
Agreement, whether or not known to the Administrative Agent or any of the Lenders, (ii) to prejudice any right or remedy which the Administrative Agent or any of the Lenders may now have or
have in the future under or in connection with the Credit Agreement, any other Loan Document or any of the instruments or agreements referred to therein, or (iii) as an agreement by the Lenders to make any Loans or otherwise to extend
additional credit at any time other than as expressly provided in and in accordance with the terms of the Credit Agreement, as amended by this Amendment and Waiver. Except as specifically set forth herein, the Credit Agreement and the other Loan
Documents shall remain in full force and effect and are hereby ratified and confirmed. 
 SECTION 6. References. From and
after the First Amendment Effective Date, all references to the “Credit Agreement”, “thereunder”, “thereof” or words of like import in the Credit Agreement or any other Loan Document and the other documents and
instruments delivered pursuant to or in connection therewith (as they relate to the Credit Agreement) shall mean and be a reference to the Credit Agreement as modified hereby and as may in the future be amended, restated, supplemented or modified
from time to time. 
 SECTION 7. Integration. This Amendment and Waiver represents the entire agreement of the parties hereto
with respect to the subject matter hereof. There are no representations, agreements, arrangements or understandings, oral or written, between the parties hereto, relating to the subject matter of this Amendment and Waiver, which are not fully
expressed herein. 
 SECTION 8. Successors and Assigns. The provisions of this Amendment and Waiver shall be binding upon the
parties hereto and their respective successors and assigns and shall inure to the benefit of the parties hereto and the successors and assigns of the Lenders (subject to Section 10.1 of the Credit Agreement). 

SECTION 9. Severability. In case any provision in or obligation under this Amendment and Waiver shall be held 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. 

SECTION10. Governing Law. THIS AMENDMENT AND WAIVER AND THE RIGHTS AND OBLIGATIONS OF THE PARTIES HEREUNDER SHALL BE
CONSTRUED IN ACCORDANCE WITH AND BE GOVERNED BY THE LAW OF THE STATE OF NEW YORK (WITHOUT REGARD TO CONFLICTS OF LAW PRINCIPLES THAT WOULD CAUSE THE LAW OF ANY OTHER JURISDICTION TO APPLY). 

SECTION 11. Counterparts. This Amendment and Waiver may be executed in any number of counterparts and by different parties
hereto in separate counterparts, each of which when so executed and delivered shall be deemed an original, but all such counterparts together shall constitute but one and the same instrument. Delivery of an executed counterpart of a signature page
by telecopier or electronic transmission shall be effective as delivery of a manually executed counterpart. 

  
 7 

 SECTION 12. Headings. Section headings in this Amendment and Waiver are included
for convenience of reference only and shall not constitute a part of this Amendment and Waiver for any other purposes or be given any substantive effect. 

[Signature pages follow] 

  
 8 

 IN WITNESS WHEREOF, Company, the Administrative Agent and the Lenders party hereto have caused
this Amendment and Waiver to be duly executed by their respective authorized officers as of the day and year first above written. 
  

			
	ALLIANCE HEALTHCARE SERVICES, INC.
		
	By:	 	   /s/ Richard W. Johns

		 	Name: Richard W. Johns
		 	Title: Secretary
	
	CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH,
	as Lender and as Administrative Agent
		
	By:	 	   /s/ Robert Hetu

		 	Name: Robert Hetu
		 	Title: Authorized Signatory
		
	By:	 	   /s/ Alex Verdone

		 	Name: Alex Verdone
		 	Title: Authorized Signatory

 
			
	SIGNATURE PAGE TO AMENDMENT NO.1 TO CREDIT AGREEMENT AND LIMITED WAIVER, DATED AS OF THE DATE FIRST REFERENCED ABOVE, AMONG ALLIANCE HEALTHCARE SERVICES, INC., VARIOUS LENDERS AND CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH,
AS ADMINISTRATIVE AGENT
	
	NAME OF INSTITUTION:
	
	  

		
	By:	 	  

		 	Name:
		 	Title:EX-10.2

 Exhibit 10.2 

INCREMENTAL TERM LOAN COMMITMENT AGREEMENT 

CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH 

Eleven Madison Avenue 
 New York,
New York 10010 
 Alliance HealthCare Services, Inc. 
 100
Bayview Circle 
 Suite 400 
 Newport Beach, CA 92660 

Re: Incremental Term Loan Commitments 
 Ladies and
Gentlemen: 
 Reference is hereby made to the Credit Agreement, dated as of June 3, 2013, among Alliance HealthCare Services, Inc.
(“Company”), the lenders from time to time party thereto (the “Lenders”) and Credit Suisse AG, Cayman Islands Branch, as Administrative Agent (“Administrative Agent”) (as amended, supplemented,
restated, amended and restated or otherwise modified from time to time, including pursuant to the Credit Agreement Amendment described herein, the “Credit Agreement”). Unless otherwise defined herein, capitalized terms used herein
shall have the respective meanings set forth in the Credit Agreement. 
 Each Lender (each, an “Incremental Term Loan
Lender”) party to this letter agreement (this “Agreement”) hereby severally agrees to provide the Incremental Term Loan Commitment set forth opposite its name on Annex I attached hereto (for each such Incremental
Term Loan Lender, its “Incremental Term Loan Commitment”; the Loans borrowed thereunder the “Incremental Term Loans”) subject to the terms and conditions set forth herein. 

Each Incremental Term Loan Lender, Company and Administrative Agent acknowledge and agree that the Incremental Term Loan Commitments provided
pursuant to this Agreement shall constitute Incremental Term Loan Commitments of the respective Tranche specified in Annex I attached hereto (i.e., the Initial Term Loans) and, upon the incurrence of Incremental Term Loans pursuant to such
Incremental Term Loan Commitments, such Incremental Term Loans shall be deemed Initial Term Loans for all purposes of the Credit Agreement (other than for purposes of Section 2.1(a)(i), Section 2.5A, Section 4.4 and Sections 5.9A and
C of the Credit Agreement) and the other applicable Loan Documents. 
 Furthermore, each of the parties to this Agreement hereby agrees to
the terms and conditions set forth on Annex I hereto (including all of the conditions contained therein) in respect of each Incremental Term Loan Commitment provided pursuant to this Agreement. 

Upon the date of (i) the execution of a counterpart of this Agreement by each Incremental Term Loan Lender, Administrative Agent, Company
and its acknowledgement by each Subsidiary Guarantor, (ii) the delivery to Administrative Agent of such fully executed counterparts (including by way of facsimile or other electronic transmission), (iii) the delivery to the Administrative
Agent of the items described in Annexes II, III, IV and V hereto, (iv) receipt 

 
by the Administrative Agent and the Incremental Term Loan Lenders of a financial condition certificate dated the Agreement Effective Date, substantially in the form of Exhibit A hereto and with
appropriate attachments and in any event in form and substance reasonably satisfactory to the Administrative Agent demonstrating that, assuming the incurrence of the Incremental Term Loans and the consummation of the 2009 Note Redemption, Company
will be Solvent and (v) the occurrence of the First Amendment Effective Date (as defined in Amendment No. 1 to Credit Agreement and Limited Waiver, dated as of the date hereof among Company, the Lenders party thereto and the Administrative
Agent (the “Credit Agreement Amendment”)), this Agreement shall be deemed to be effective (such date, the “Agreement Effective Date”). Upon satisfaction of the conditions precedent set forth in Section 11 of
Annex I hereto (such date, the “Incremental Term Loan Closing Date”), each Incremental Term Loan Lender party hereto (i) shall be obligated to make the Incremental Term Loans on the date set forth in the Notice of
Borrowing required to be delivered pursuant to Section 11(iii) of Annex I hereto and (ii) to the extent provided in this Agreement, shall have the rights and obligations of a Lender thereunder and under the other applicable Loan
Documents. 
 Company acknowledges and agrees that (i) it shall be liable for all Obligations with respect to the Incremental Term Loan
Commitments provided hereby including, without limitation, all Incremental Term Loans made pursuant thereto, and (ii) all such Obligations (including all such Incremental Term Loans) shall be entitled to the benefits of the Collateral Documents
and the Subsidiary Guaranty to the extent set forth therein. 
 Each Subsidiary Guarantor acknowledges and agrees that all Obligations with
respect to the Incremental Term Loan Commitments provided hereby and all Incremental Term Loans made pursuant thereto shall (i) be fully guaranteed pursuant to the Subsidiary Guaranty to the extent set forth therein and constitute
“Guarantied Obligations” thereunder and (ii) be entitled to the benefits of the Loan Documents to the extent set forth therein. 

Attached hereto as Annex II is the officers’ certificate required to be delivered pursuant to clause (iii) of the definition
of “Incremental Loan Commitment Requirements” appearing in Section 1 of the Credit Agreement certifying that the conditions set forth in clauses (i) and (ii) of the definition of “Incremental Loan Commitment
Requirements” appearing in Section 1 of the Credit Agreement have been satisfied (together with calculations demonstrating same (where applicable) in reasonable detail). 

Attached hereto as Annex III are opinions of Richard Johns, General Counsel for Company and Latham & Watkins LLP, special
counsel to the Loan Parties, delivered as required pursuant to clause (vi) of the definition of “Incremental Loan Commitment Requirements” appearing in Section 1 of the Credit Agreement. 

Attached hereto as Annex IV are officers’ certificates, board of director resolutions and evidence of good standing of Company and
each other Loan Party required to be delivered pursuant to clause (vii) of the definition of “Incremental Loan Commitment Requirements” appearing in Section 1 of the Credit Agreement. 

Attached hereto as Annex V is evidence demonstrating that the full amount of the Loans to be made under the Incremental Term Loan
Commitments (assuming the full utilization thereof) may be incurred without violating the terms of material Indebtedness of Company (after giving effect to the Credit Agreement Amendment) and its Subsidiaries (including, without

  
 2 

 
limitation, the 2009 Senior Notes) as required to be delivered pursuant to clause (viii) of the definition of “Incremental Loan Commitment Requirements” appearing in Section 1
of the Credit Agreement. 
 Company shall pay to Administrative Agent, for distribution to each Incremental Term Loan Lender, a ticking fee
equal to 1.625% per annum of each Incremental Term Loan Lender’s Incremental Term Loan Commitment (calculated on the basis of the actual number of days elapsed in a 360-day year), beginning to accrue on November 1, 2013 and payable to
each Incremental Term Loan Lender on the earlier of (1) the date of termination of the Incremental Term Loan Commitments and (2) the Incremental Term Loan Closing Date (the “Incremental Ticking Fee”). 

You may accept this Agreement by signing the enclosed copies in the space provided below, and returning one copy of same to us before the
close of business on October 11, 2013. If you do not so accept this Agreement by such time, our Incremental Term Loan Commitments set forth in this Agreement shall be deemed canceled. 

After the execution and delivery to Administrative Agent of a fully executed copy of this Agreement (including by way of counterparts and by
facsimile or other electronic transmission) by the parties hereto, this Agreement may only be changed, modified or varied by written instrument in accordance with the requirements for the modification of Loan Documents pursuant to Section 10.6
of the Credit Agreement. 
 The Incremental Term Loan Commitments shall terminate on the earliest of (i) the borrowing of the
Incremental Term Loans by Company, (ii) December 6, 2013 and (iii) the irrevocable termination of the Incremental Term Loan Commitments by notice in writing by Company to Administrative Agent and the Incremental Term Loan Lenders.

 In the event of any conflict between the terms of this Agreement and those of the Credit Agreement, the terms of the Credit Agreement
shall control. 
 ***** 

  
 3 

 THIS AGREEMENT SHALL BE CONSTRUED IN ACCORDANCE WITH AND GOVERNED BY THE LAW OF THE STATE OF
NEW YORK WITHOUT REGARD TO CONFLICTS OF LAWS PRINCIPLES THAT WOULD CAUSE THE LAW OF ANY OTHER JURISDICTION TO APPLY. ANY LEGAL ACTION OR PROCEEDING WITH RESPECT TO THIS AGREEMENT MAY BE BROUGHT IN THE COURTS OF THE STATE OF NEW YORK OR OF THE UNITED
STATES FOR THE SOUTHERN DISTRICT OF NEW YORK, IN EACH CASE WHICH ARE LOCATED IN THE COUNTY OF NEW YORK, AND, BY EXECUTION AND DELIVERY OF THIS AGREEMENT, COMPANY, EACH SUBSIDIARY GUARANTOR, ADMINISTRATIVE AGENT AND EACH INCREMENTAL TERM LOAN LENDER
CONSENTS, FOR ITSELF AND IN RESPECT OF ITS PROPERTY, TO THE EXCLUSIVE JURISDICTION OF THE AFORESAID COURTS. COMPANY, EACH SUBSIDIARY GUARANTOR, ADMINISTRATIVE AGENT AND EACH INCREMENTAL TERM LOAN LENDER IRREVOCABLY WAIVES ANY OBJECTION, INCLUDING
ANY OBJECTION TO THE LAYING OF VENUE OR BASED ON THE GROUNDS OF FORUM NON CONVENIENS, WHICH IT MAY NOW OR HEREAFTER HAVE TO THE BRINGING OF ANY ACTION OR PROCEEDING IN SUCH JURISDICTION IN RESPECT OF THIS AGREEMENT OR OTHER
DOCUMENT RELATED THERETO. COMPANY, EACH SUBSIDIARY GUARANTOR, ADMINISTRATIVE AGENT AND EACH INCREMENTAL TERM LOAN LENDER WAIVES PERSONAL SERVICE OF ANY SUMMONS, COMPLAINT OR OTHER PROCESS, WHICH MAY BE MADE BY ANY OTHER MEANS PERMITTED BY THE LAW OF
SUCH STATE. 
  

			
	Very truly yours,
	
	CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH, as Incremental Term Loan Lender
		
	By	 	   /s/ Robert Hetu

		 	Name: Robert Hetu
		 	Title: Authorized Signatory
		
	By	 	   /s/ Alex Verdone

		 	Name: Alex Verdone
		 	Title: Authorized Signatory

 Agreed and Accepted 
 this
11th day of October, 2013: 
  

			
	ALLIANCE HEALTHCARE SERVICES, INC.
		
	By:	 	   /s/ Richard W. Johns

		 	Name: Richard W. Johns
		 	Title: Secretary

			
	 CREDIT SUISSE AG, CAYMAN ISLANDS BRANCH, as Administrative Agent

		
	By:	 	   /s/ Robert Hetu

		 	Name: Robert Hetu
		 	Title: Authorized Signatory
		
	By:	 	   /s/ Alex Verdone

		 	Name: Alex Verdone
		 	Title: Authorized Signatory

 Each Subsidiary Guarantor acknowledges and agrees to each the foregoing provisions of this Incremental Term Loan
Commitment Agreement and to the incurrence of the Incremental Term Loans to be made pursuant thereto. 
  

			
	 ADVANCED IMAGING SERVICES, LLC

	 AROOSTOOK MRI LLC

	 DIAGNOSTIC HEALTH CENTER OF ANCHORAGE, LLC

	 MSA MANAGEMENT, LLC

	 NEOSPINE RADIOSURGERY, LLC

	 NEW ENGLAND MOLECULAR IMAGING LLC

	 RADIOLOGY 24 | 7, LLC

	 REA MANAGEMENT, LLC

	 U.S. RADIOSURGERY, LLC

	 U.S. RADIOSURGERY OF AUSTIN, LLC

	 U.S. RADIOSURGERY OF CHICAGO, LLC

	 U.S. RADIOSURGERY OF COLUMBUS, LLC

	 U.S. RADIOSURGERY OF ILLINOIS, LLC

	 U.S. RADIOSURGERY OF PHILADELPHIA, LLC

	 U.S. RADIOSURGERY OF RENO, LLC

	 U.S. RADIOSURGERY OF RUSH-CHICAGO, LLC

	 U.S. RADIOSURGERY OF SAN DIEGO, LLC

	 U.S. RADIOSURGERY OF TULSA, LLC

	 USR HOLDINGS, LLC

		
	By:	 	   /s/ Richard W. Johns

		 	Name: Richard W. Johns
		 	Title:   Secretary
		
	By:	 	   /s/ Nicholas Poan

		 	Name: Nicholas Poan
		 	Title:   Assistant Secretary

 
							
	 ALLIANCE MEDICAL IMAGING SOLUTIONS, LLC

		
	By:	 	ALLIANCE HEALTHCARE SERVICES, INC.,
		 	its sole member
			
		 	By:	 	   /s/ Howard K. Aihara

		 		 	Name:	 	Howard K. Aihara
		 		 	Title:	 	 Executive Vice President and
 Chief Financial
Officer

 
			
	ILLINOIS CYBERKNIFE, LLC
	
	By: US RADIOSURGERY OF ILLINOIS, LLC,
		 	its managing member
		
	By:	 	   Richard W. Johns

		 	Name: Richard W. Johns
		 	Title:   Secretary

 
			
	ALLIANCE IMAGING NC, INC.
	ALLIANCE ONCOLOGY, LLC
	ALLIANCE RADIOSURGERY, LLC
	MEDICAL DIAGNOSTICS, INC.
	MEDICAL OUTSOURCING SERVICES, LLC
	MID-AMERICAN IMAGING INC.
	NEOSPINE BLOCKER CORP.
	NEHE/WSIC II, LLC
	NEW ENGLAND HEALTH ENTERPRISES, INC.
	PET SCANS OF AMERICA CORP.
	THREE RIVERS HOLDING CORP.
	SHARED P.E.T. IMAGING, LLC
	SMT HEALTH SERVICES INC.
	RAMIC DES MOINES, LLC
	WEST COAST PETCT, LLC
		
	By:	 	   /s/ Richard W. Johns

		 	Name: Richard W. Johns
		 	Title:   Secretary

 
					
	 WESTERN MASSACHUSETTS MAGNETIC RESONANCE SERVICES, INC.

		
	By:	 	   /s/ Howard K. Aihara

		 	Name: Howard K. Aihara
		 	Title: Treasurer
	
	NEHE - MRI, LLC
		
	By:	 	NEW ENGLAND HEALTH ENTERPRISES, INC.,
		 	its sole member and manager
			
		 	By:	 	   /s/ Richard W. Johns

		 		 	Name: Richard W. Johns
		 		 	Title:   Secretary

 
			
	 NEW ENGLAND HEALTH ENTERPRISES BUSINESS TRUST

		
	By:	 	   /s/ Percy C. Tomlinson, Jr.

		 	Name: Percy C. Tomlinson, Jr.
		 	Title:   Trustee
		
	By:	 	   /s/ Richard W. Johns

		 	Name: Richard W. Johns
		 	Title:   Trustee

 
							
	NEW ENGLAND HEALTH IMAGING-HOULTON, LLC
		
	By:	 	NEHE - MRI, LLC,
		 	its sole member
			
		 	By:	 	NEW ENGLAND HEALTH ENTERPRISES, INC.,
		 		 	its sole member and manager
				
		 		 	By:	 	   /s/ Richard W. Johns

		 		 		 	Name: Richard W. Johns
		 		 		 	Title: Secretary

 ANNEX I 

TERMS AND CONDITIONS FOR 

INCREMENTAL TERM LOAN COMMITMENT AGREEMENT 

Dated as of October 11, 2013 
  

	1.	Name of Borrower: Alliance HealthCare Services, Inc. 

  

	2.	Incremental Term Loan Commitment Amounts: 

  

					
	 Names of Incremental Term Loan Lenders
	  	Amount of Incremental Term Loan
Commitment	 
	 Credit Suisse AG, Cayman Islands Branch
	  	$	70,000,000	  
	 Total Incremental Term Loan Commitment: $70,000,000
	  			

  

	3.	Designation of Tranche of Incremental Term Loan Commitments (and Incremental Term Loans to be funded thereunder): To constitute part of, and be added to, the outstanding Initial Term Loans in accordance with
Section 2.11C of the Credit Agreement. 

  

	4.	Indicate the Incremental Term Loan Funding Date: As of the date set forth in the Notice of Borrowing required to be delivered in accordance with Section 11(iii) of this Annex I. 

 

	5.	Incremental Term Loan Maturity Date: The Initial Term Loan Maturity Date (June 3, 2019) 

  

	7.	Dates for, and amounts of, Scheduled Incremental Term Loan Repayments: Each Scheduled Initial Term Loan Repayment Date and at the amounts set forth in the Credit Agreement Amendment. 

 

	8.	Applicable Margins: The same as those that are applicable to the Initial Term Loans. 

  

	9.	The proceeds of the Incremental Term Loans along with cash on hand of Company and borrowings of Revolving Loans shall be used (a) to redeem the outstanding amount of the 2009 Senior Notes in accordance with the
terms of the 2009 Senior Notes Indenture (the “2009 Note Redemption”) and (b) to pay fees and expenses in connection with the 2009 Note Redemption and the Credit Agreement Amendment. 

 

	10.	 To the extent that the 2009 Note Redemption will be consummated on a date that is more than two Business Days after the Incremental Term Loan Closing
Date, the proceeds of such Incremental Term Loans shall be held in an account with the Collateral Agent until such time as it receives a written notice from Company no earlier than two Business Days

 ANNEX I 
  

	 	
prior to the date the 2009 Note Redemption is consummated, upon which time the proceeds of such Incremental Term Loans shall be credited to the account of Company at the Funding and Payment
Office. 

  

	11.	Conditions to Funding: 

 (i) the Agreement Effective Date shall have occurred;

 (ii) upon the funding of the Incremental Term Loans on the Incremental Term Loan Closing Date, (x) payment by Company
to each Incremental Term Loan Lender a fee equal to 1.00% of such Incremental Term Loan Lender’s Incremental Term Loan Commitment (the “Upfront Fee”), which Upfront Fee shall be earned, due and payable in full on the
Incremental Term Loan Closing Date, (y) payment by Company of the Incremental Ticking Fee and (z) payment by Company to Credit Suisse Securities (USA) LLC all fees set forth in the Engagement Letter dated as of October 3, 2013 between
Company and Credit Suisse Securities (USA) LLC; 
 (iii) Administrative Agent shall have received at the Notice Office on or
before the Incremental Term Loan Closing Date, in accordance with the provisions of Section 2.1B of the Credit Agreement, an executed Notice of Borrowing, in each case signed by the chief executive officer, the chief financial officer or the
treasurer of Company or by any officer of Company designated by any of the above-described officers on behalf of Company in a writing delivered to Administrative Agent; 

(iv) Company shall have sent a notice of redemption in accordance with Section 1105 of the 2009 Senior Notes Indenture
within eight Business Days of the Agreement Effective Date in connection with the 2009 Note Redemption; 
 (v) as of the date
that the notice of redemption was sent as described in clause (iv) above, the representations and warranties contained in the Credit Agreement and in the other Loan Documents shall be true and correct in all material respects on and as of that
date to the same extent as though made on and as of that date, except to the extent such representations and warranties specifically relate to an earlier date, in which case such representations and warranties shall have been true and correct in all
material respects on and as of such earlier date; and 
 (vi) no event shall have occurred and be continuing or would result
from the consummation of the borrowing of the Incremental Term Loans that would constitute a Potential Event of Default or an Event of Default under Sections 8.1 or 8.6 of the Credit Agreement. 

 ANNEX II 
  

[Officers’ certificate required to be delivered pursuant to clause (iii) of the definition of “Incremental Loan Commitment Requirements”
appearing in Section 1 of the Credit Agreement certifying that the conditions set forth in clauses (i) and (ii) of the definition of “Incremental Loan Commitment Requirements” appearing in Section 1 of the Credit
Agreement have been satisfied] 

 ANNEX III 
  

 [Opinions of counsel to the Loan Parties, delivered as required pursuant to clause (vi) of the
definition of “Incremental Loan Commitment Requirements” appearing in Section 1 of the Credit Agreement] 
  

 ANNEX IV 
  

[Officers’ certificates, board of director resolutions and evidence of good standing of Company and the other Loan Parties required to be delivered
pursuant to clause (vii) of the definition of “Incremental Loan Commitment Requirements” appearing in Section 1 of the Credit Agreement] 

 ANNEX V 
  

[Evidence demonstrating that the full amount of the Loans to be under the Incremental Term Loan Commitments (assuming the full utilization thereof) may be
incurred without violating the terms of material Indebtedness of Company (after giving effect to the Credit Agreement Amendment) and its Subsidiaries (including, without limitation, the 2009 Senior Notes) as required to be delivered pursuant to
clause (viii) of the definition of “Incremental Loan Commitment Requirements” appearing in Section 1 of the Credit Agreement] 

 EXHIBIT A 

[FORM OF] FINANCIAL CONDITION CERTIFICATE 
 To
the Administrative Agent and each of the Incremental 
 Term Loan Lenders party to the Incremental Term Loan 

Commitment Agreement referred to below: 
 I, the
undersigned, the Chief Financial Officer of Alliance HealthCare Services, Inc. (“Company”), a Delaware corporation, in that capacity only and not in my individual capacity, do hereby certify as of the date hereof that: 

1. This Certificate is furnished to the Administrative Agent and the Incremental Term Loan Lenders pursuant to the Incremental Term Loan
Commitment Agreement, dated as of October 11, 2013 among Company, the lenders party thereto (each, an “Incremental Term Loan Lender” and, collectively, the “Incremental Term Loan Lenders”), and Credit Suisse
AG, Cayman Islands Branch, as Administrative Agent (the “Administrative Agent”) (including the Annexes thereto and as amended, updated, modified and supplemented from time to time, the “Incremental Term Loan Commitment
Agreement”), which Incremental Term Loan Commitment Agreement is being entered into in accordance with Section 2.11 of that certain Credit Agreement, dated as of June 3, 2013 among Company, the lenders from time to time party
thereto, and the Administrative Agent (as amended, updated, modified and supplemented from time to time, the “Credit Agreement”) . Unless otherwise defined herein, capitalized terms used in this Certificate shall have the meanings
set forth in the Credit Agreement. 
 2. Assuming the incurrence of the Incremental Term Loans (as defined in the Incremental Term Loan
Commitment Agreement) and the consummation of the 2009 Note Redemption (as defined in the Incremental Term Loan Commitment Agreement): 

(a) the fair value of the assets of the Company and its Subsidiaries, on a consolidated basis, is greater than the total amount of
liabilities, including, without limitation, contingent liabilities, of the Company and its Subsidiaries, on a consolidated basis; 
 (b) the
present fair saleable value of the assets of the Company and its Subsidiaries, on a consolidated basis, is not less than the amount that will be required to pay the probable liability of the Company on its debts and liabilities as they become
absolute and matured; 
 (c) the Company and its Subsidiaries do not intend to, and do not believe that they will, on a consolidated basis,
incur debts or liabilities beyond their ability to pay such debts and liabilities as they mature; and 
 (D) the Company and its
Subsidiaries, on a consolidated basis, are not engaged in business or a transaction, and are not about to engage in business or a transaction, for which the Company’s assets would constitute unreasonably small capital. 

For purposes of this Financial Condition Certificate, the amount of contingent liabilities at any time shall be computed as the amount of
liabilities that, in the light of all the facts and 

 
circumstances existing at such time, can reasonably be expected to become an actual or matured liability (irrespective of whether such contingent liabilities meet the criteria for accrual under
Statement of Financial Accounting Standard No. 5). 
 3. For purposes of this Financial Condition Certificate, I, or officers of
Company and/or its Subsidiaries under my direction and supervision, have performed the following procedures as of and for the periods set forth below. 
  

	 	(a)	Reviewed (i) the financial statements referred to in Section 5.3A of the Credit Agreement and (ii) the financial statements for the Fiscal Quarter ended June 30, 2013 delivered pursuant to
Section 6.1(i)(b) of the Credit Agreement. 

  

	 	(b)	Made inquiries of certain officers of Company and its Subsidiaries that I have deemed necessary as a foundation for this Financial Condition Certificate. 

 

	 	(c)	Reviewed to my satisfaction the Incremental Term Loan Commitment Agreement, the Credit Agreement Amendment (as defined in the Incremental Term Loan Commitment Agreement) and the other Loan Documents. 

IN WITNESS WHEREOF, the undersigned has set his hand this 11th day of October, 2013. 

 

					
	ALLIANCE HEALTHCARE SERVICES, INC.
		
	By:	 	  

		 	Name:	 	Howard K. Aihara
		 	Title:	 	Executive Vice President and Chief Financial Officer

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00222-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00222-of-00352.parquet"}]]