Clause 8.5.1 of the Agreement shall be deleted in its entirety and replaced with the following:

Clause 8.1 (Mandatory prepayment – illegality), Clause 8.2 (Mandatory prepayment – change of control), sub-clause 8.3.3 of Clause 8.3 (Voluntary prepayment) or Clause 32 (Pro rata sharing);

[Section 8.16] of the Existing Credit Agreement is hereby amended and restated in its entirety to read as follows:

[Section 8.4] of the Existing Credit Agreement is hereby amended by # deleting “and” at the end of subclause (e), (ii) re-lettering subclause # as subclause (g) and (iii))] adding new subclause # as follows:

[Schedule 8.17] hereto sets forth a complete list of all “business associate agreements” (as such term is defined in HIPAA) that any Borrower or Guarantor has entered into with any person as of the date of Amendment No. 4.

[Schedule 8.18] hereto sets forth an accurate, complete and current list of all participation agreements of any Borrower or Guarantor with health maintenance organizations, insurance programs, preferred provider organizations and other Third Party Payors and all such agreements are in full force and effect and no material default exists thereunder.

[Sections 8.11(a) and (b)])] are amended in their entirety to read as follows:

[Section 8.1] (Payment Default). [Section 8.1] of the Loan Agreement hereby is amended and restated in its entirety and replaced with the following:

[Section 8.5] may be amended or waived to permit offers to purchase made by the ​ or an Affiliate pro rata to the holders of all [[holders of the Notes:Organization]] at the time outstanding upon the same terms and conditions only with the written consent of the ​ and the Super-Majority Holders.

[Section 8.1(a)] of the Credit Agreement is hereby amended by inserting the text “(in each case, other than with respect to or resulting from the upcoming maturity of any Loans under this Agreement or the Senior Notes)” immediately after the text ““going concern” or like qualification or exception” appearing in such Section.