Document:

Amendment to the Note Purchase Agreement

 Exhibit 10.22 
  
 AMENDMENT TO THE NOTE PURCHASE AGREEMENT 
  
 This AMENDMENT TO THE NOTE PURCHASE AGREEMENT, is made and entered into as of June 17, 2004 (this “Amendment”) to amend the Note Purchase
Agreement by and among HealthEssentials Solutions, Inc. (the “Company”), Bruckmann, Rosser, Sherrill & Co. II, L.P. (“BRS”), Marilena Tibrea, Julie Frist and the other parties that from time to time become party
thereto, dated as of June 10, 2004 (the “Note Purchase Agreement”), as set forth herein. 
  
 All capitalized terms used and not otherwise defined herein shall have the respective meanings ascribed to such terms in the Note Purchase Agreement.

  
 NOW, THEREFORE, in consideration of the mutual covenants and
premises contained herein and for other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, the parties hereto hereby agree as follows: 
  
 Section 1. Amendments. The Note Purchase Agreement is hereby amended as follows: 
  
 (a) Section 1.3 is hereby deleted in its entirety and
replaced with the following amended Section 1.3: 
  
 The Closing. The closing of the purchase and sale of the BRS Notes contemplated by Section 1.2.(a) above (the “Initial Closing”) shall take place at the offices of Dechert LLP, 4000 Bell Atlantic Tower, 1717 Arch
Street, Philadelphia, PA 19103 at 10:00 a.m. on June 15, 2004, or at such other place or on such other date as may be mutually agreeable to the Company and BRS. The closing of the purchases and sales of the Notes contemplated by Sections 1.2.(b)
above (the “Second Closing”) shall take place at the offices of Dechert LLP, 4000 Bell Atlantic Tower, 1717 Arch Street, Philadelphia, PA 19103 at such time and on such date as may be mutually agreeable to the Company and BRS. The
closing of the purchases and sales of the Notes contemplated by Sections 1.2.(c) above (the “Third Closing”) shall take place at the offices of Dechert LLP, 4000 Bell Atlantic Tower, 1717 Arch Street, Philadelphia, PA 19103 at such
time and on such date as may be mutually agreeable to the Company and BRS. Within 30 days following each Closing, the Company shall deliver to each Purchaser instruments evidencing the Note to be purchased by such Purchaser at such Closing, payable
to the order of such Purchaser or its nominee or registered in such Purchaser’s or its nominee’s name, respectively, upon payment of the purchase price thereof by a cashier’s or certified check, or by wire transfer of immediately
available funds to an account designated by the Company, in the aggregate amount set forth opposite such Purchaser’s name on the applicable schedule attached hereto. 
  
 Section 2. Effect of Amendment. Except as specifically set forth herein, this Amendment shall not by implication or
otherwise limit, impair, constitute a waiver of, or 

  

 
otherwise affect, the rights and remedies of the parties under the Note Purchase Agreement, and shall not alter, modify, amend or in any way affect any of
the terms, conditions, obligations, covenants or agreements contained in the Note Purchase Agreement, all of which are ratified and affirmed in all respects and shall remain in full force and effect. This Amendment shall apply and be effective only
with respect to the provisions of the Note Purchase Agreement specifically referred to herein. 
  
 Section 3. Severability. Whenever possible, each provision of this Amendment shall be interpreted in such manner as to be effective and valid under applicable law, but if any provision of this Amendment is held
to be prohibited by or invalid under applicable law, such provision shall be ineffective only to the extent of such prohibition or invalidity, without invalidating the remainder of this Amendment. 
  
 Section 4. Counterparts. This Amendment may be executed simultaneously
in two or more counterparts, any one of which need not contain the signatures of more than one party, but all such counterparts taken together shall constitute one and the same Amendment. 
  
 Section 5. Descriptive Headings; Interpretation. The descriptive headings of this Amendment are inserted for
convenience only and do not constitute a substantive part of this Amendment. The use of the word “including” in this Amendment shall be by way of example rather than by limitation. 
  
 Section 6. Governing Law. This Amendment shall be governed by and
construed and enforced in accordance with the internal laws of the State of Delaware, without giving effect to any choice of law or conflict of law rules or provisions (whether of the State of Delaware or any other jurisdiction) that would cause the
application of the laws of any jurisdiction other than those of the State of Delaware. 
  
 [Remainder of page left intentionally blank.] 
  

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

			
	 HEALTHESSENTIALS SOLUTIONS, INC.

		
	 By:
	 	  

	 	 	 Name:

	 	 	 Title:

	
	 BRUCKMANN, ROSSER, SHERRILL & CO.
 II, L.P.

		
	 By:
	 	 BRSE, L.L.C.

	 Its:
	 	 General Partner

		
	 By:
	 	  

	 	 	 Name:

	 	 	 Title:

	
	
	 
	 Marilena Tibrea

	
	 
	 Julie FristWarrant Agreement

 Exhibit 10.23 
  
 WARRANT AGREEMENT 
  
 WARRANT AGREEMENT (the “Agreement”) dated as of September     , 2001, by and among the Persons listed on the
Schedule of Purchasers attached hereto, (collectively, the “Purchasers”, and each a “Purchaser”), and HealthEssentials Solutions, Inc., a Delaware corporation (the “Company”). Capitalized terms used
herein shall have the meanings given to such terms in Section VI hereof. 
  
 WHEREAS, on the date hereof, pursuant to that certain note purchase agreement (the “Note Purchase Agreement”), by and among the Purchasers and the Company, the Purchasers are buying from the Company a
subordinated promissory note in the aggregate amount of $2,500,000 (the “Note”). 
  
 WHEREAS, the Purchasers are acquiring from the Company warrants in the form attached as Exhibit 1 hereto (the “Warrants”),
representing the right to purchase from the Company a total of 4,038,000,000 Warrant Shares (in each case as adjusted from time to time pursuant to the provisions of the Warrants) on the terms and conditions set forth in the Warrants. 
  
 WHEREAS, the Warrants are being issued as an inducement and partial
consideration for the Purchasers to enter into the Note Purchase Agreement and to purchase the Note, and without such issuance, the Purchasers will not enter into the Note Purchase Agreement. 
  
 NOW, THEREFORE, for good and valuable consideration, the receipt and
sufficiency of which are hereby acknowledged, the parties hereto hereby agree as follows: 
  
 I. Purchase Price and Closing. 
  
 A. Closing. The closing of the issuance of the Warrants to the Purchasers (the “Closing”) shall take place simultaneously with the closing pursuant to the Note Purchase Agreement. The date of
such Closing is hereinafter referred to as the “Closing Date.” 
  
 B. Transactions on Closing Date. At the Closing, the Company shall deliver to each Purchaser a duly issued Warrant for such number
of Warrant Shares as set forth next to each Purchaser’s name on the Schedule of Purchasers attached hereto. 
  
 II. Representations and Warranties of the Company. The Company represents and warrants to each Purchaser as follows: 
  
 A. Good Standing. The Company is a corporation duly
organized, validly existing and in good standing under the laws of the State of Delaware. 
  
 B. Authority Relative to this Agreement. The Company has all requisite corporate power and authority to enter into and perform this
Agreement and to issue and deliver the 

  

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Warrants to the Purchasers. The execution, delivery and performance by the Company of this Agreement, including the issuance and delivery of the Warrants to
the Purchasers, have been duly authorized by all necessary corporate action on the part of the Company. This Agreement has been duly executed and delivered by the Company and (assuming due execution and delivery by the Purchasers) is a legal, valid
and binding obligation of the Company and is enforceable against the Company in accordance with its terms. 
  
 C. No Conflict or Violation. The execution and delivery of this Agreement by the Company, the performance by the Company of its
terms and the issuance and delivery of the Warrant to the Purchaser will not on the Closing Date conflict with or result in a violation of (i) the Certificate of Incorporation or By-Laws of the Company as in effect on the Closing Date, or (ii) any
agreement, instrument, law, rule, regulation, order, writ, judgment or decree to which the Company is a party or is subject. 
  
 D. Validity of Issuance. The Warrants to be issued to the Purchasers pursuant to this Agreement and the Warrant Shares issued upon
exercise of the Warrants will, when issued, be duly and validly issued, fully paid and nonassessable (assuming in the case of the Warrant Shares, payment of the exercise price is made in accordance with the terms of the Warrants). 
  
 III. Representations and Warranties of the Purchaser. Each Purchaser
hereby severally, and not jointly, represents and warrants to the Company, on behalf of itself and not the other Purchaser, as follows: 
  
 A. Investment Intention. Each Purchaser is acquiring its Warrant, and if any portion of such Warrant is exercised, the Warrant
Shares, for its own account and for investment purposes and not with a view to, or for offer or sale in connection with, any distribution or other disposition thereof in violation of the Securities Act of 1933, as amended, and the rules and
regulations thereunder (the “Securities Act”). Each Purchaser agrees and acknowledges that it will not, directly or indirectly, offer, transfer or sell its Warrant or any Warrant Shares, or solicit any offers to purchase or acquire
its Warrant or any Warrant Shares, unless the transfer or sale is (i) pursuant to an effective registration statement under the Securities Act and has been registered under any applicable state securities or “blue sky” laws or (ii)
pursuant to an exemption from registration under the Securities Act and applicable state securities or “blue sky” laws. 
  
 B. Legend. Each Purchaser has been advised by the Company that the certificates representing its Warrant and the Warrant Shares
will bear the following legend: 
  
 THE SECURITIES REPRESENTED BY
THIS CERTIFICATE HAVE NOT BEEN REGISTERED UNDER THE SECURITIES ACT OF 1933 OR ANY STATE SECURITIES LAWS, AND MAY BE OFFERED AND SOLD ONLY IF SO REGISTERED OR IF AN EXEMPTION FROM SUCH REGISTRATION IS AVAILABLE. 
  
 C. Additional Investment Representations. Each
Purchaser is an “accredited investor” as such term is defined in Rule 501 promulgated under the Securities Act. 
  

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 IV. Inspection Rights. The Company shall permit one representative of any holder of the Warrant or
the Warrant Shares selected by the holders of the majority of the Warrant Shares (assuming for purposes of this section that the Warrants have been fully exercised), upon reasonable notice and during normal business hours and such other times as any
such holder may reasonably request, to (i) visit and inspect any of the properties of the Company and its subsidiaries (ii) examine the corporate and financial records of the Company and its subsidiaries and make copies thereof or extracts therefrom
and (iii) discuss the affairs, finances and accounts of any such corporations with the directors, officers, key employees and independent accountants of the Company and its subsidiaries. 
  
 V. Information Rights. For so long as each Purchaser shall hold any Warrant Shares or any Warrant, such Purchaser
shall have the right to receive with reasonable promptness, such other information and data with respect to the Company and its subsidiaries as from time to such Purchaser may reasonably request. 
  
 VI. Miscellaneous 
  
 A. Definitions. For the purposes of this Agreement,
the following terms shall have the following meanings: 
  
 “Common Stock” means the Company’ Common Stock, par value $.001 per share or any securities into which such Common Stock is hereafter converted or exchanged. 
  
 “Warrant Shares” means shares of the Common
Stock obtained or obtainable upon exercise of the Warrant; provided, that if there is a change such that the securities issuable upon exercise of the Warrants are issued by an entity other than the Company or there is a change in the class of
securities so issuable, then the term “Warrant Shares” shall mean shares of the security issuable upon exercise of the Warrants if such security is issuable in shares, or shall mean the equivalent units in which such security is issuable
if such security is not issuable in shares. 
  
 B. Notices. All notices and other communications provided for herein shall be dated and in writing and shall be deemed to have been duly given (i) when delivered, if delivered personally, sent by registered or certified mail, return
receipt requested and postage prepaid, or sent via nationally recognized overnight courier (charges prepaid) or via facsimile and (ii) when received if delivered otherwise, to the party to whom it is directed: 
  
 To the Company: 
  
 HealthEssentials Solutions, Inc. 
 9721 Ormsby Station Road 
 Louisville, Kentucky 40223 
 Attention: Chief Executive Officer 
 Facsimile No.: (502) 429-4557 
  

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 with a copy (which shall not constitute notice to the Company) to: 
  
 Brown, Todd & Heyburn PLLC 
 400 West Market Street, 32nd Floor 
 Louisville, Kentucky 40202-3363 
 Attention: William G. Strench, Esq. 
 Facsimile No.: (502) 581-1087 
  
 To the Purchasers: 
  
 to the addresses set forth next to each 
 Purchaser’s name on the Schedule 
 of Purchasers attached hereto. 
  
 or to such other address as either party hereto shall have specified by notice in writing to
the others. 
  
 C. Assignment. This
Agreement and all the provisions hereof shall be binding upon and shall inure to the benefit of the parties hereto and their respective successors and permitted assigns; provided, that neither this Agreement nor any rights or obligations
hereunder shall be assigned by any of the Purchasers without the prior written consent of the Company. 
  
 D. Amendment. This Agreement may be amended only by a written instrument signed by the Company and Bruckmann, Rosser, Sherrill
& Co. II, L.P. 
  
 E. Severability. In
the event that any one or more of the provisions hereof, or the application thereof in any circumstances, is held invalid, illegal or unenforceable in any respect for any reason, the validity, legality and enforceability of any such provision in
every other respect and of the remaining provisions hereof shall not be in any way impaired, it being intended that all rights, powers and privileges of the parties hereto shall be enforceable to the fullest extent permitted by law. 
  
 F. Governing Law. This Agreement and the exhibits
and schedules hereto shall be governed by and construed and enforced in accordance with the internal laws of the State of Delaware, without giving effect to any choice of law or conflicts of law rules or provisions (whether of the State of Delaware
or any other jurisdiction) that would cause the application of the laws of any jurisdiction other than those of the State of Delaware. 
  
 G. Expenses. All reasonable fees and expenses incurred by the Purchasers in connection with the preparation of this Agreement and
the transactions referred to herein, including the reasonable fees of the Purchasers’ counsel, shall be paid by the Company, whether or not the issuance of the Warrant, or any other transaction contemplated hereby is consummated. 
  
 H. Counterparts. This Agreement may be executed in
two or more counterparts, each of which when so executed and delivered shall be deemed to be an original and all of which together shall be deemed to be one and the same agreement. 
  

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 I. Descriptive Headings: Interpretation. The descriptive headings of this
Agreement are inserted for convenience only and do not constitute a substantive part of this Agreement. The use of the word “including” in this Agreement shall be by way of example rather than by limitation. 
  
 * * * 
  
 [signature page follows] 
  

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 IN WITNESS WHEREOF, the parties hereto have caused this Warrant Agreement to be signed and attested by
its duly authorized officers under its corporate seal and to be dated as of the date hereof. 
  

					
	HEALTHESSENTIALS SOLUTIONS, INC.
			
	 By:
	 	 	 	 /s/ Michael R. Barr

	 	 	 Name:
	 	 Michael R. Barr

	 	 	 Title:
	 	 CEO

	
	BRUCKMANN, ROSSER, SHERRILL & CO. II, L.P.
		
	 By:
	 	BRSE, L.L.C.
	 Its:
	 	 General Partner

			
	 By:
	 	 	 	 
	 	 	 Name:
	 	 
	 	 	 Title:
	 	 

  

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