Document:

EXHIBIT 10.7

AMENDMENT TO
 BUSINESS OPERATIONS AND SUPPORT SERVICES AGREEMENT

          THIS AMENDMENT TO BUSINESS OPERATIONS AND SUPPORT SERVICES AGREEMENT (“Amendment”) dated as of November 15, 2006 by and between Phoenix Management Company, LLC, a Michigan limited liability company (“Practice Manager”) and American Oncologic Associates of Michigan, P.C. a Michigan professional services corporation (“Medical Practice”).  

RECITALS

          WHEREAS, Pontiac Investment Associates, a Michigan co-partnership (“PIA”), and Medical Group are parties to that certain Business Operations and Support Services Agreement dated August 19, 2000 (the “Agreement”).

          WHEREAS, pursuant to that certain Bill of Sale, dated as of November 13, 2006, between PIA and Practice Manager, PIA sold and transferred all rights, title and interest to the Agreement and Practice Manager purchased and assumed all rights, title, interest and obligations under the Agreement.

          WHEREAS, pursuant to the Agreement, the Practice Manager is responsible for general management and administration operations of the medical practices (the “Practices”) operated by Medical Group located at 70 Fulton, Pontiac, Michigan and 30365 Dequindre, Madison Heights, Michigan (the “Offices”).

          WHEREAS, Practice Manager’s obligations include owning, maintaining and/or providing Medical Group with equipment, fixtures and furnishings (collectively, the “Equipment”) at the Offices necessary for the operation of the Practices.

          WHEREAS, the Michigan Department of Community Health (“MDCH”) issued three Certificates of Need (“CONs”) to Medical Group in connection with owning and operating the Equipment at the Offices.

          WHEREAS, Medical Group desires to transfer to Practice Manager, and Practice Manager desires to accept from Medical Group, all of Practice Manager’s right, title and interest in and to the CONs.

          WHEREAS, the parties desire to amend the Agreement in accordance with the terms and conditions set forth below. 

          NOW THEREFORE, intending to be legally bound and for good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties hereto agree as follows: 

          1.          Defined Terms.  Capitalized terms used herein but not otherwise defined shall have the meanings ascribed to them in the Agreement.

          2.          Section 5.1 of the Agreement is hereby amended to add the following at the end of Section 5.1:

	
  
 
  	
  
Medical   Group hereby agrees to transfer to Practice Manager all of its right, title   and interest in and to the Certificate of Need (“CON”) associated with the   Madison Heights location issued by the Michigan Department of Community   Health (the “MDCH”) originally issued to Medical Group relating to the   Equipment at no additional cost (the “Transfer”).  The parties acknowledge and agree that the Transfer of the CON   is intended to assist Practice Manager in performing its obligations set   forth in this Agreement and that the absence of consideration therefore has   been determined by the parties through good faith to be fair and   reasonable.  Medical Group shall fully   cooperate with Practice Manager in all respects to effectuate the Transfer,   including but not limited to execution of any documents deemed necessary by   Practice Manager or MDCH.
  
	
   
  	
  
 
  
	
  
 
  	
  
In addition,   Medical Group, at such later date as determined by Practice Manager in its   sole discretion, hereby agrees to transfer to Practice Manager all of its   right, title and interest in and to the CONs associated with the Pontiac   location issued by the Michigan Department of Community Health (the “MDCH”)   originally issued to Medical Group relating to the Equipment at no additional   cost (the “Transfer”).  The parties   acknowledge and agree that the Transfer of the CON is intended to assist   Practice Manager in performing its obligations set forth in this Agreement   and that the absence of consideration therefore has been determined by the   parties through good faith to be fair and reasonable.  Medical Group shall fully cooperate with   Practice Manager in all respects to effectuate the Transfer, including but   not limited to execution of any documents deemed necessary by Practice   Manager or MDCH.

          3.          Section 5.14 of the Agreement is hereby deleted in its entirety and replaced with the following:

	
  
 
  	
  
5.14      Recruitment   of Physicians.  Practice Manager   shall coordinate recruiting of physicians including advertising for   recruitment of Physicians to become shareholders, employees or independent   contractors of the Medical Practice.    It shall be a joint responsibility of Medical Practice and Practice   Manager to interview, select, contract with, supervise, control, and   terminate all Physicians performing Medical Services.  Costs of recruiting not identified in the   yearly budget on a continual basis shall be borne as an additional expense to   the Medical Practice.
  

          4.          Section 8.3 of the Agreement is amended to delete the second paragraph in its  entirety.

          5.          Section 9.4 of the Agreement is hereby deleted in its entirety and replaced with the following:

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9.4       Notices.  Any notice, demand, or communication   required, permitted, or desired to be given under this Agreement shall be in   writing and shall be deemed given if delivered in person or deposited in   United States Mail, postage prepaid, registered or certified mail, return   receipt requested, addressed to the parties as set forth opposite their   respective names below:
  

	
  
 
  	
  
Medical   Practice:
  	
  
American   Oncologic Associates
  
	
   
  	
  
 
  	
  
of Michigan,   P.C. 
  
	
  
 
  	
  
 
  	
  
Attention:   Michael J. Katin, M.D.
  
	
  
 
  	
  
 
  	
  
28595   Orchard Lake Road, Suite 110
  
	
  
 
  	
  
 
  	
  
Farmington   Hills, MI 48334
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
Practice   Manager:
  	
  
Phoenix   Management Company, LLC 
  
	
  
 
  	
  
 
  	
  
Attention:   Daniel E. Dosoretz, M.D. 
  
	
  
 
  	
  
 
  	
  
2234   Colonial Boulevard 
  
	
   
  	
  
 
  	
  
Fort Myers,   FL 33907
  

          6.          Ratification.  Except as expressly modified by this Amendment, all of the terms and conditions of the Agreement shall remain in full force and effect.

          7.          Counterparts.  This Amendment may be executed by the parties hereto in separate counterparts and both counterparts taken together shall constitute one and the same instrument.

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IN WITNESS WHEREOF, the undersigned have executed this Amendment as of November 15, 2006.

	
  
 
  	
  
PHOENIX   MANAGEMENT COMPANY, LLC
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
   
  	
  
By:  
  	
  
/s/ David M.   Koeninger
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name: 
  	
  
David M.   Koeninger
  
	
  
 
  	
  
Title:
  	
  
Vice   President
  
	
  
 
  	
  
 
  
	
  
 
  	
  
 
  
	
  
 
  	
  
AMERICAN ONCOLOGIC ASSOCIATES OF MICHIGAN, P.C.
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
   
  	
  By: 
  	
   /s/ Daniel E. Dosoretz
  
	
   
  	
   
  	
  

  
	
   
  	
  Name: 
  	
  Daniel E. Dosoretz, M.D.
  
	
   
  	
  Title:
  	
  Vice   President
  

4EXHIBIT 10.8

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED CREDIT
AGREEMENT, LIMITED WAIVER AND CONSENT

          THIS AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT (the “Amendment Agreement”) is made and entered into this 14th day of November, 2006, among RADIATION THERAPY SERVICES, INC., a Florida corporation (the “Borrower”), each Subsidiary Guarantor party to a Subsidiary Guaranty pursuant to the terms of the Credit Agreement (as defined below), BANK OF AMERICA, N.A., as Administrative Agent (the “Administrative Agent”), and the Lenders party hereto.  Unless the context otherwise requires, capitalized terms used but not defined herein have the meanings ascribed thereto in the Credit Agreement.

W I T N E S S E T H:

          WHEREAS, the Borrower, the Administrative Agent and the Lenders have entered into that certain Fourth Amended and Restated Credit Agreement dated as of December 16, 2005 (as hereby amended and as may be modified, supplemented, amended or amended and restated from time to time, the “Credit Agreement”), whereby the Lenders have made available to the Borrower a term loan B facility and a revolving credit facility with a letter of credit subfacility and a swing line subfacility; and

          WHEREAS, the Borrower has notified the Administrative Agent that it proposes to acquire (through a newly created wholly-owned Subsidiary, Michigan Radiation Therapy Management Services, Inc.) Michigan Institute for Radiation Oncology, Inc.’s (“MIRO”) equity in Phoenix Management Company, LLC and American Consolidated Technologies, LLC and the option to acquire certain assets of and/or MIRO’s equity in Pontiac Investment Associates, LLC for an aggregate Acquisition Amount of not to exceed $48,800,000 (collectively, the “MIRO Acquisition”) (which notification is set forth as Exhibit A hereto), which Acquisition Amount will cause the aggregate Acquisition Amounts for 2006 to exceed the limitation set forth in Section 9.9 of the Credit Agreement, and the Borrower has requested that Section 9.9 of the Credit Agreement be amended to exclude the MIRO Acquisition from the
limitation set forth therein for fiscal year 2006; and 

          WHEREAS, as set forth in Exhibit A, the Borrower has requested that Section 11.10 of the Credit Agreement be amended to increase the Capital Expenditures limitation set forth therein to $50,000,000 for fiscal year 2006; 

          WHEREAS, as further set forth in Exhibit A, the Borrower has requested that the Credit Agreement be amended to increase the allowance for purchase money indebtedness to $70,000,000; and 

          WHEREAS, the Lenders have previously indicated to the Administrative Agent that the real property subject to the Mortgages has been taken as Collateral out of an “abundance of caution”, within the meaning of Financial Institutions Reform Recovery and Enforcement Act (FIRREA), to secure the Obligations under the Credit Agreement; and

          WHEREAS, the Borrower has requested that the deadline for receipt of certain of the Mortgages and Mortgage Property Support Documents with respect to the properties listed in Part 2 of Schedule 9.15 be extended until November 30, 2006 and any default under the Credit Agreement with respect to such Part 3 be waived so long as such requirements are satisfied by November 30, 2006 (the “Mortgage Document Delay”);

          WHEREAS, the Administrative Agent and the Lenders signatory hereto are willing so to effect such waivers of certain covenants, amendments to certain provisions and certain consents under the Credit Agreement, in each case as set forth below pursuant to the terms and conditions contained in this Agreement;

          NOW, THEREFORE, the Borrower, the Administrative Agent and the Lenders do hereby agree as follows:

          1.        Credit Agreement.  The term “Credit Agreement” as used herein and in the Credit Documents (as defined in the Credit Agreement) shall mean the Credit Agreement as hereby amended and modified.  

          2.        Amendment.  Subject to the conditions set forth herein, the Credit Agreement is hereby amended as follows:

	
  
 
  	
  
          (a)          Section   1.2 of the Credit Agreement is hereby amended to add a new definition of   “MIRO Acquisition” and to amend and restate in its entirety the definition of   “Mortgaged Property Support Documents”, to read as follows:
  
	
  
 
  	
  
 
  
	
  
 
  	
  
          “MIRO   Acquisition” means the acquisition by the Borrower (through its wholly-owned   Subsidiary, Michigan Radiation Therapy Management Services, Inc.) of Michigan   Institute for Radiation Oncology, Inc.’s (“MIRO”) equity in Phoenix   Management Company, LLC and American Consolidated Technologies, LLC and the   option to acquire certain assets of and/or MIRO’s equity in Pontiac   Investment Associates, LLC for an aggregate Acquisition Amount not to exceed   $48,800,000.
  
	
  
 
  	
  
 
  
	
  
 
  	
  
          “Mortgaged   Property Support Documents” shall mean, for each Mortgaged Property, (i) the   Title Policy pertaining thereto, (ii) such surveys, flood hazard   certifications and environmental assessments thereof as the Administrative   Agent may require prepared by recognized experts in their respective fields   selected by the Borrower and reasonably satisfactory to the Administrative   Agent, (iii) as to the Mortgaged Properties located in a flood hazard area,   such flood hazard insurance as the Administrative Agent may require, (iv) if   required by the Administrative Agent, appraisals conducted by nationally   recognized appraisal experts selected by the Administrative Agent in its   reasonable discretion and reasonably acceptable to the Borrower, (v) with   respect to facilities leased or 
  

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subleased   from third parties, such lessor’s estoppel, waiver and consent certificates   as the Administrative Agent may reasonably require and the Borrower can   deliver using its best efforts and subordination, nondisturbance and   attornment agreements as the Administrative Agent may reasonably require,   (vi) such owner’s or lessee’s affidavits as the Administrative Agent may   reasonably require, (vii) such opinions of local counsel with respect to the   Mortgages, as applicable, as the Administrative Agent may reasonably require,   and (viii) such other documentation as the Administrative Agent may   reasonably require, in each case as shall be in form and substance reasonably   acceptable to the Administrative Agent.
  
	
  
 
  	
  
 
  
	
  
 
  	
  
          (b)       Section   1.7(a) of the Credit Agreement is hereby amended and restated in its entirety   to read as follows:
  

	
   
  	
  
 
  	
  
 
  	
  
(a)          Covenant   Acquisition Adjustments.  Except   as otherwise expressly provided herein, for purposes of calculating the   Leverage Ratio and the Fixed Charge Coverage Ratio and, for purposes of   Section 9.9(a)(ii), the prior fiscal year’s Consolidated EBITDA for any   period (or a portion of a period) that includes the date of the consummation   of any Permitted Acquisition, references to “the Borrower and its   Subsidiaries” shall include each acquired Person, or lines of business, as   applicable, the EBITDA of such acquired Person or line of business (such   EBITDA to be formulated on the basis of the definition of Consolidated EBITDA   set forth herein, subject to such customary adjustments by the Borrower as to   which the Required Lenders do not object) and the interest expense of such   acquired Person or line of business, as if the Acquisition had been   consummated on

the first day of any such period of measurement.
  
	
  
 
  	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
          (c)       Section   9.9(a)(ii) of the Credit Agreement is hereby amended and restated in its   entirety to read as follows:
  
	
  
 
  	
  
 
  
	
   
  	
  
 
  	
  
 
  	
  
(ii)          the   Required Lenders shall have given their consent to such Acquisition which   consent shall (A) not be unreasonably withheld and (B) be given within ten   (10) Business Days from the Administrative Agent’s receipt of the   information, in form and substance satisfactory to the Administrative Agent   in its reasonable discretion, referred to in clauses (b) and (c) of this Section 9.9; provided that no such   consent will be required if the Acquisition Amount with respect to such   Acquisition, (y) shall not exceed $12,000,000, and (z) together with the   aggregate of the Acquisition Amounts for all other Permitted Acquisitions   consummated during the same fiscal year and the aggregate amount of any   “earnout” payments made in such fiscal year with respect to any Permitted   Acquisition, irrespective of when such Permitted Acquisition was   consummated), shall not
exceed (1) in the case of fiscal year 2005,   $50,000,000, or (2) in the case of fiscal year 2006 and each fiscal year   thereafter, 100% of Consolidated EBITDA for the preceding fiscal year   (excluding, for fiscal year 2006 only, the Acquisition Amount attributable to   the MIRO Acquisition in an amount not to exceed $48,800,000).
  

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          (d)       Section   11.2(v) of the Credit Agreement is hereby amended and restated in its   entirety to read as follows:
  
	
   
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  	
  
(v)          purchase   money Indebtedness of the Borrower and its Subsidiaries (including any   Excluded Subsidiary) incurred solely to finance the payment of all or part of   the purchase price of any equipment, real property or other fixed assets   and  Indebtedness in respect of   capital lease obligations, and any renewals, refinancings or replacements   thereof, in an aggregate principal amount (including any such purchase money   Indebtedness and capital leases existing on the Effective Date) outstanding   at any time not exceeding $70,000,000;
  
	
  
 
  	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
          (e)       Section   11.10 of the Credit Agreement is hereby amended and restated in its entirety   to read as follows:
  
	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  	
  
11.10      Capital   Expenditures.  The Borrower will   not permit the aggregate Capital Expenditures of the Borrower and its   Subsidiaries in any fiscal year to be greater than (i) in the case of fiscal   year 2005, $35,000,000, (ii) in the case of fiscal year 2006, $50,000,000 and   (iii) in the case of each other fiscal year, the percentage of the net book   value of the Borrower’s Capital Assets determined as of the end of the   immediately preceding fiscal year as set forth below, in each case excluding   any Capital Expenditures for any Permitted Acquisition during such fiscal   year:
  

	
  
Fiscal Year of
Capital Expenditure
  	
   
 	
  
Percentage
   of Prior Fiscal Year’s
   Capital Assets
  
	
  

  	
  
 
  	
  

  
	
  
  2007
  	
  
 
  	
  
30%
  
	
  
2008 and   thereafter
  	
  
 
  	
  
25%
  

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          3.        Consent to MIRO Acquisition.  Subject to the delivery of final audited financial statements for Michigan Institute for Radiation Oncology, Inc. and its subsidiaries, the Administrative Agent and the Lenders signatory hereto hereby consent to the MIRO Acquisition.   The Lenders hereby waive the requirement that the Borrower delivery the information required by Section 9.9(b) not less than ten (10) Business Days prior to the consummation of the MIRO Acquisition.  Notwithstanding the foregoing, the requirements set forth in Section 9.10 with respect to Michigan Radiation Therapy Management Services, Inc. must be timely satisfied, provided that, the Administrative Agent and the Lenders signatory hereto hereby agree that the Borrower and the applicable Subsidiaries shall have until February 28, 2007 to deliver the Mortgages and
Mortgage Property Support Documents required pursuant to such section.

          4.        Limited Waiver to Mortgage Document Delay.  Subject to the terms and conditions set forth herein, the Administrative Agent and the Lenders signatory hereto hereby waive any Default or Event of Default arising from the Mortgage Document Delay, provided that the remaining Mortgages and Mortgage Property Support Documents delivery requirements are satisfied by November 30, 2006.  The waivers set forth in this Section 4 are limited to the extent specifically set forth above and no other terms, covenants or provisions of the Credit Agreement or any other Credit Document are intended to be effected hereby.

          5.        Representations, Warranties and Covenants.  The Borrower hereby represents, warrants and covenants that:

	
  
 
  	
  
          (a)          The   representations and warranties made by the Borrower in Article VIII of the   Credit Agreement are true on and as of the date hereof, except to the extent   that such representations and warran-ties expressly relate to an earlier   date;
  
	
  
 
  	
  
 
  
	
  
 
  	
  
          (b)          There   has been no Material Adverse Change in the condition, financial or otherwise,   of the Borrower since the date of the most recent financial reports of the   Borrower delivered pursuant to Section 9.1   of the Credit Agreement;
  
	
   
  	
  
 
  
	
  
 
  	
  
          (c)          The   business and properties of the Borrower are not and have not been adversely   affected in any substantial way as the result of any fire, explosion,   earthquake, accident, strike, lockout, combination of workers, flood,   embargo, riot, activities of armed forces, war or acts of God or the public   enemy, or cancellation or loss of any major contracts; and
  
	
  
 
  	
  
 
  
	
  
 
  	
  
          (d)          No   Default or Event of Default, other than those addressed herein, has occurred   and is continuing immediately prior to the effectiveness of this Amendment   Agreement and no Default or Event of Default is continuing immediately after   the effectiveness of this Amendment Agreement.
  

          6.        Conditions.  This Amendment Agreement shall become effective upon the Borrower delivering to the Administrative Agent the following:

	
  
 
  	
  
          (a)          a   counterpart of this Amendment Agreement duly executed by the Administrative   Agent, such Lenders as are necessary to constitute the Required Lenders, the   Borrower and the Subsidiary Guarantors;
  

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          (b)          all   fees and expenses payable by the Borrower by reason of this Amendment Agreement;   and
  
	
  
 
  	
  
 
  
	
  
 
  	
  
          (c)          such   other documentation, instruments, consents and agreements as the   Administrative Agent shall reasonably request.
  

          7.        Full Force and Effect of Agreement.  Except as hereby specifically amended, modified or supplemented, the Credit Agreement and all of the other Credit Documents are hereby confirmed and ratified in all respects and shall remain in full force and effect according to their respective terms.

          8.        Counterparts.  This Amendment Agreement may be executed in any number of counterparts and all the counterparts taken together shall be deemed to constitute one and the same instrument.

          9.        Documentation.  All instruments and documents incident to the consummation of the transactions contemplated hereby shall be satisfactory in form and substance to the Administrative Agent and its counsel; the Administrative Agent shall have received copies of all additional agreements, instruments and documents which it may reasonably request in connection therewith, such documents, when appropriate, to be certified by appropriate corporate or governmental authorities; and all proceedings of the Borrower relating to the matters provided for herein shall be satisfactory to the Administrative Agent and its counsel.

          10.      Entire Agreement.  This Amendment Agreement sets forth the entire understanding and agreement of the parties hereto in relation to the subject matter hereof and supersedes any prior negotiations and agreements among the parties relative to such subject matter.  None of the terms or conditions of this Amendment Agreement may be changed, modified, waived or canceled orally or otherwise, except as provided in the Credit Agreement.

          11.      Ratification.  Except as hereby specifically amended, modified or supplemented, the Agreement and all of the other Loan Documents are hereby confirmed and ratified in all respects and shall remain in full force and effect according to their respective terms.

          12.      Consent of the Subsidiary Guarantors.  Each Subsidiary Guarantor hereby consents, acknowledges and agrees to the amendments set forth herein and hereby confirms, reaffirms and ratifies in all respects the Subsidiary Guaranty to which such Subsidiary Guarantor is a party (including without limitation the continuation of such Subsidiary Guarantor’s payment and performance obligations thereunder upon and after the effectiveness of this Agreement and the amendments contemplated hereby) and the enforceability of the Subsidiary Guaranty against such Subsidiary Guarantor in accordance with its terms.

[Remainder of page intentionally left blank.]

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

	
   
  	
  
BORROWER:
  
	
  
 
  	
  

  
	
  
 
  	
  
 
  
	
  
 
  	
  
RADIATION THERAPY SERVICES, INC.
  
	  
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ David M.   Koeninger
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
David M.   Koeninger
  
	
  
 
  	
  
Title:
  	
  
Executive   Vice President – Chief Financial Officer
  

	
  
 
  	
  
GUARANTORS:
  
	
  
 
  	
  

  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
21ST  CENTURY   ONCOLOGY, INC.
  
	
  
 
  	
  
21ST  CENTURY   ONCOLOGY OF NEW JERSEY, INC.
  
	
  
 
  	
  
21ST  CENTURY   ONCOLOGY OF KENTUCKY, LLC
  
	
  
 
  	
  
21ST  CENTURY   ONCOLOGY OF ALABAMA, INC.
  
	
   
  	
  
NEW YORK RADIATION THERAPY
  
	
  
 
  	
  
  MANAGEMENT SERVICES, INCORPORATED
  
	
  
 
  	
  
NEVADA RADIATION THERAPY
  
	
  
 
  	
  
  MANAGEMENT SERVICES, INC.
  
	
  
 
  	
  
FINANCIAL SERVICES OF SOUTHWEST
  
	
  
 
  	
  
  FLORIDA, LLC.
  
	
  
 
  	
  
RADIATION THERAPY SCHOOL FOR
  
	
  
 
  	
  
  RADIATION THERAPY TECHNOLOGY, INC.
  
	
  
 
  	
  
MARYLAND RADIATION THERAPY
  
	
  
 
  	
  
  MANAGEMENT SERVICES, INC.
  
	
   
  	
  
NORTH CAROLINA RADIATION THERAPY
  
	
  
 
  	
  
  MANAGEMENT SERVICES, INC.
  
	
  
 
  	
  
CALIFORNIA RADIATION THERAPY
  
	
  
 
  	
  
  MANAGEMENT SERVICES, INC.
  
	
  
 
  	
  
21ST CENTURY ONCOLOGY OF HARFORD
  
	
  
 
  	
  
  COUNTY, MARYLAND LLC
  
	
  
 
  	
  
21ST CENTURY ONCOLOGY OF PENNSYLVANIA, INC.
  
	
  
 
  	
  
NEW ENGLAND RADIATION THERAPY
  
	
  
 
  	
  
  MANAGEMENT SERVICES, INC.
  
	
  
 
  	
  
ARIZONA RADIATION THERAPY MANAGEMENT
  
	
   
  	
  
  SERVICES, INC.
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ David M.   Koeninger
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
David M.   Koeninger
  
	
  
 
  	
  
Title:
  	
  
See   ATTACHMENT A for title for each Guarantor.
  

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

7

ATTACHMENT A TO SIGNATURE PAGE

David M. Koeninger is the Vice President of each of the following Guarantors:

	
  
 
  	
  
•
  	
  
21st  Century Oncology, Inc.
  
	
  
 
  	
  
•
  	
  
21st  Century Oncology of New Jersey, Inc.
  
	
  
 
  	
  
•
  	
  
21st  Century Oncology of Alabama, Inc.
  
	
  
 
  	
  
•
  	
  
New York   Radiation Therapy Management Services, Incorporated
  
	
  
 
  	
  
•
  	
  
Nevada   Radiation Therapy Management Services, Inc.
  
	
   
  	
  
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Financial   Services of Southwest Florida, LLC
  
	
  
 
  	
  
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Radiation   Therapy School For Radiation Therapy Technology, Inc.
  
	
  
 
  	
  
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Maryland   Radiation Therapy Management Services, Inc.
  
	
  
 
  	
  
•
  	
  
North   Carolina Radiation Therapy Management Services, Inc.
  
	
  
 
  	
  
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21st   Century Oncology of Harford County, Maryland LLC
  
	
  
 
  	
  
•
  	
  
21st   Century Oncology of Pennsylvania, Inc.
  
	
  
 
  	
  
•
  	
  
New England   Radiation Therapy Management Services, Inc.
  
	
   
  	
  
•
  	
  
Arizona   Radiation Therapy Management Services, Inc.
  

David M. Koeninger is the Chief Financial Officer of each of the following Guarantors:

	
  
 
  	
  
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21st  Century Oncology of Kentucky, LLC
  
	
  
 
  	
  
•
  	
  
California   Radiation Therapy Management Services, Inc.
  

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

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BANK OF AMERICA, N.A., as Administrative   Agent
  
	 
	  
	  

	
   
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Kristine   Thennes
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Kristine   Thennes
  
	
  
 
  	
  
Title:
  	
  
Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
BANK OF AMERICA, N.A., as a Lender, as   Swingline Lender and as Issuing Bank
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
   
  	
  
By:
  	
  
/s/   Alexander L. Rody
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Alexander L.   Rody
  
	
  
 
  	
  
Title:
  	
  
Senior Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
FIFTH THIRD BANK
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
 
  
	
   
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
 
  
	
  
 
  	
  
Title
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
SUNTRUST BANK
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Pamela   W. Peters
  
	
  
 
  	
  
 
  	
  

  
	
   
  	
  
Name:
  	
  
Pamela W.   Peters
  
	
  
 
  	
  
Title:
  	
  
Senior Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
WACHOVIA BANK, NATIONAL ASSOCIATION
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Kirk   Tesch
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Kirk Tesch
  
	
   
  	
  
Title:
  	
  
Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
REGIONS BANK
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
 
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
 
  
	
  
 
  	
  
Title:
  	
  
 
  

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

9

	
  
 
  	
  
NATIONAL CITY BANK OF KENTUCKY
  
	  
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Deroy   Scott
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Deroy Scott
  
	
  
 
  	
  
Title:
  	
  
Senior Vice   President
  
	
   
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
CAROLINA FIRST BANK
  
	  
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Kevin M.   Short
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Kevin M.   Short
  
	
  
 
  	
  
Title:
  	
  
Senior Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
   
  	
  
THE INTERNATIONAL BANK OF MIAMI, N.A.
  
	  
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/   Panayiotis Ch. Zotos
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Panayiotis   Ch. Zotos
  
	
  
 
  	
  
Title:
  	
  
Senior Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
LASALLE BANK, NATIONAL ASSOCIATION
  
	  
	  
	  

	
   
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Whitney   M. Black
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Whitney M.   Black
  
	
  
 
  	
  
Title:
  	
  
Assistant   Vice President
  

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

10

	
  
 
  	
  
U.S. BANK, NATIONAL ASSOCIATION
  
	 
	  
	  

	
   
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Thomas   A. Heckman
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Thomas A.   Heckman
  
	
  
 
  	
  
Title:
  	
  
Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
DENALI CAPITAL LLC, managing member of DC Funding Partners LLC,   portfolio manager for DENALI CAPITAL CLO V, LTD., or an affiliate
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
   
  	
  
By:
  	
  
/s/ Nicole   D. Kouba
  
	
  
 
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Nicole D.   Kouba
  
	
  
 
  	
  
Title:
  	
  
Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
DENALI CAPITAL LLC, managing member of DC Funding Partners LLC,   portfolio manager for DENALI CAPITAL CLO VI, LTD., or an affiliate
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Nicole   D. Kouba
  
	
   
  	
  
 
  	
  

  
	
  
 
  	
  
Name:
  	
  
Nicole D.   Kouba
  
	
  
 
  	
  
Title:
  	
  
Vice   President
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
DENALI CAPITAL LLC, managing member of DC Funding Partners, portfolio   manager for DENALI CAPITAL CREDIT OPPORTUNITY FUND FINANCING, LTD., or an   affiliate
  
	 
	  
	  

	
  
 
  	
  
 
  	
  
 
  
	
  
 
  	
  
By:
  	
  
/s/ Nicole   D. Kouba
  
	
  
 
  	
  
 
  	
  

  
	
   
  	
  Name:
  	
  Nicole D.   Kouba
  
	
   
  	
  Title:
  	
  Vice   President
  

AMENDMENT NO. 1 TO FOURTH AMENDED AND RESTATED
CREDIT AGREEMENT, LIMITED WAIVER AND CONSENT

11

EXHIBIT A

See attached.

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00113-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00113-of-00352.parquet"}]]