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.

[Section 8.1] “Administration” is hereby amended to read in full as follows:

[Section 8.01] (any such failure to observe any term, covenant or agreement contained in [Section 8.01] and any failure to observe other Financial Covenants contained from time to time in a Loan Document, a “Financial Covenant Event of Default”); provided that a Financial Covenant Event of Default shall not constitute an Event of Default with respect to any Term Loans or any other Facility (other than the Revolving Facility incurred on the Closing Date unless such Financial Covenant is, by its terms, applicable to such other Facility) unless and until the date on which the Revolving Lenders have terminated all Revolving Commitments and declared all Revolving Loans to be immediately due and payable in accordance with [Section 9.02(b)], and such termination and declaration has not been rescinded (a “Financial Covenant Cross Default”); or

[Section 8.2(a)] of the Purchase Agreement is hereby amended to insert the following additional defined terms into such Section in alphabetical order:

[Section 8.13(b)] of the Credit Agreement is hereby amended and restated in its entirety as follows:

[Section 8.02(g)] is amended in its entirety to read as follows:

[[Sections 8.02(m), (n) and (o)])])]])])] 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 ​ at the time outstanding upon the same terms and conditions only with the written consent of the ​ and the Super-Majority Holders.

Savings Clause. If this [Article VI] or any portion hereof shall be invalidated or held to be unenforceable on any ground by any court of competent jurisdiction, the decision of which shall not have been reversed on appeal, the Company shall nevertheless # indemnify each Indemnified Person as to costs, charges and expenses (including attorneys' fees), judgments, fines and amounts paid in settlement and # advance expenses in accordance with [Section 2] of this [Article VI], in each case with respect to any Proceeding in connection with which he or she is an Indemnified Person, including an action by or in the right of the Company, to the fullest extent permitted by any applicable portion of this [Article VI] that shall not have been invalidated or held to be unenforceable and as permitted by applicable law.

SAVINGS CLAUSE. Save and except as hereinabove expressly amended, the Plan Statement shall continue in full force and effect.