10-Q

Ardent Health, Inc. (ARDT)

10-Q 2024-11-07 For: 2024-09-30
View Original
Added on April 12, 2026

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

_______________________________________________________

FORM 10-Q

_______________________________________________________

(Mark One)

QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the quarterly period ended September 30, 2024
or
TRANSITION REPORT PURSUANT TO SECTION 13 OR 15(d) OF THE SECURITIES EXCHANGE ACT OF 1934
For the transition period from                   to
Commission File Number: 001-42180
Ardent Health Partners, Inc.
(Exact name of registrant as specified in its charter) Delaware 61-1764793
--- --- ---
(State or other jurisdiction of<br><br>incorporation or organization) (I.R.S. Employer<br><br>Identification No.)
340 Seven Springs Way, Suite 100<br><br>Brentwood, Tennessee 37027
(Address of principal executive offices) (Zip Code)
(615) 296-3000
(Registrant’s telephone number, including area code)

Securities registered pursuant to Section 12(b) of the Act:

Title of each class Trading Symbol(s) Name of each exchange on which registered
Common Stock, $0.01 par value per share ARDT New York Stock Exchange

Indicate by check mark whether the registrant (1) has filed all reports required to be filed by Section 13 or 15(d) of the Securities Exchange Act of 1934 during the

preceding 12 months (or for such shorter period that the registrant was required to file such reports), and (2) has been subject to such filing requirements for the past 90

days. Yes ☒ No ☐

Indicate by check mark whether the registrant has submitted electronically every Interactive Data File required to be submitted pursuant to Rule 405 of Regulation S-T

(§232.405 of this chapter) during the preceding 12 months (or for such shorter period that the registrant was required to submit such files). Yes ☒ No ☐

Indicate by check mark whether the registrant is a large accelerated filer, an accelerated filer, a non-accelerated filer, a smaller reporting company, or an emerging

growth company. See the definitions of “large accelerated filer,” “accelerated filer,” “smaller reporting company,” and “emerging growth company” in Rule 12b-2 of the

Exchange Act.

Large accelerated filer Accelerated filer Smaller reporting company
Non-accelerated filer Emerging growth company

If an emerging growth company, indicate by check mark if the registrant has elected not to use the extended transition period for complying with any new or

revised financial accounting standards provided pursuant to Section 13(a) of the Exchange Act. ☐

Indicate by check mark whether the registrant is a shell company (as defined in Rule 12b-2 of the Exchange Act). Yes ☐ No ☒

As of November 7, 2024, the registrant had 142,732,815 shares of common stock outstanding.

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Page
PART I. FINANCIAL INFORMATION
Item 1. Financial Statements 1
Condensed Consolidated Income Statements for thethree and nine months endedSeptember 30, 2024and2023<br><br>(Unaudited) 1
Condensed ConsolidatedComprehensive IncomeStatements for thethree and nine months endedSeptember 30,<br><br>2024and2023 (Unaudited) 2
Condensed Consolidated Balance Sheets as ofSeptember 30, 2024and December 31,2023 (Unaudited) 3
Condensed Consolidated Statements of Cash Flows for thenine months endedSeptember 30, 2024and<br><br>2023 (Unaudited) 4
Condensed Consolidated Statements of Changes in Equity for thethree and nine months endedSeptember<br><br>30, 2024and2023 (Unaudited) 5
Notes to Condensed Consolidated Financial Statements (Unaudited) 7
Item 2. Management's Discussion and Analysis of Financial Condition and Results of Operations 22
Item 3. Quantitative and Qualitative Disclosures About Market Risk 45
Item 4. Controls and Procedures 45
PART II. OTHER INFORMATION
Item 1. Legal Proceedings 46
Item 1A. Risk Factors 46
Item 2. Unregistered Sales of Equity Securities and Use of Proceeds 46
Item 3. Defaults Upon Senior Securities 46
Item 4. Mine Safety Disclosures 46
Item 5. Other Information 47
Item 6. Exhibits 47
Signatures 49

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PART I – FINANCIAL INFORMATION

ITEM 1. FINANCIAL STATEMENTS

ARDENT HEALTH PARTNERS, INC.

CONDENSED CONSOLIDATED INCOME STATEMENTS

Unaudited

(Dollars in thousands, except per share amounts)

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
2024 2023 2024 2023
Total revenue $1,449,817 $1,377,727 $4,359,783 $4,063,449
Expenses:
Salaries and benefits 635,223 595,580 1,880,790 1,785,939
Professional fees 274,223 246,540 810,820 715,111
Supplies 251,862 249,548 769,034 743,713
Rents and leases 26,410 24,506 76,251 73,230
Rents and leases, related party 37,249 36,413 111,413 108,914
Other operating expenses 117,700 124,642 354,851 342,026
Government stimulus income (8,463)
Interest expense 14,629 19,041 52,050 55,854
Depreciation and amortization 36,771 35,488 108,434 104,860
Loss on extinguishment and modification of debt 1,490 3,388
Other non-operating gains (2,807) (3,062) (522)
Total operating expenses 1,392,750 1,331,758 4,163,969 3,920,662
Income before income taxes 57,067 45,969 195,814 142,787
Income tax expense 11,062 7,261 36,997 24,591
Net income 46,005 38,708 158,817 118,196
Net income attributable to noncontrolling interests 19,683 17,870 62,678 60,139
Net income attributable to Ardent Health Partners, Inc. $26,322 $20,838 $96,139 $58,057
Net income per share:
Basic $0.19 $0.17 $0.74 $0.46
Diluted $0.19 $0.17 $0.74 $0.46
Weighted-average common shares outstanding:
Basic 137,107,595 126,115,301 129,877,510 126,115,301
Diluted 137,542,995 126,115,301 130,022,643 126,115,301

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ARDENT HEALTH PARTNERS, INC.

CONDENSED CONSOLIDATED COMPREHENSIVE INCOME STATEMENTS

Unaudited

(Dollars in thousands)

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
2024 2023 2024 2023
Net income $46,005 $38,708 $158,817 $118,196
Other comprehensive (loss) income
Change in fair value of interest rate swap (10,180) 43 (12,280) 76
Other comprehensive (loss) income before income taxes (10,180) 43 (12,280) 76
Income tax (benefit) expense related to other comprehensive (loss) income items (2,657) 12 (3,205) 20
Other comprehensive (loss) income, net of income taxes (7,523) 31 (9,075) 56
Comprehensive income 38,482 38,739 149,742 118,252
Comprehensive income attributable to noncontrolling interests 19,683 17,870 62,678 60,139
Comprehensive income attributable to Ardent Health Partners, Inc. $18,799 $20,869 $87,064 $58,113

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ARDENT HEALTH PARTNERS, INC.

CONDENSED CONSOLIDATED BALANCE SHEETS

Unaudited

(Dollars in thousands)

September 30,<br><br>2024 (1) December 31,<br><br>2023 (1)
Assets
Current assets:
Cash and cash equivalents $563,142 $437,577
Accounts receivable 705,747 775,452
Inventories 108,231 105,485
Prepaid expenses 119,956 77,281
Other current assets 193,616 222,290
Total current assets 1,690,692 1,618,085
Property and equipment, net 814,860 811,089
Operating lease right of use assets 261,214 260,003
Operating lease right of use assets, related party 932,246 941,150
Goodwill 852,001 844,704
Other intangible assets, net 76,930 76,930
Deferred income taxes 34,764 32,491
Other assets 137,307 147,106
Total assets $4,800,014 $4,731,558
Liabilities and Equity
Current liabilities:
Current installments of long-term debt $12,167 $18,605
Accounts payable 368,850 474,543
Accrued salaries and benefits 255,370 267,685
Other accrued expenses and liabilities 250,945 233,271
Total current liabilities 887,332 994,104
Long-term debt, less current installments 1,083,725 1,168,253
Long-term operating lease liability 233,786 235,241
Long-term operating lease liability, related party 922,665 932,090
Self-insured liabilities 231,951 243,552
Other long-term liabilities 53,686 76,002
Total liabilities 3,413,145 3,649,242
Commitments and contingencies (see Note 9)
Redeemable noncontrolling interests 2,391 7,302
Equity:
Common units, no and unlimited units authorized as of September 30, 2024 and December 31, 2023,<br><br>respectively; no and 484,922,828 units issued and outstanding as of September 30, 2024 and December 31, 2023,<br><br>respectively 496,882
Preferred stock, par value $0.01 per share; 50,000,000 and no shares authorized as of September 30, 2024 and<br><br>December 31, 2023, respectively; no shares issued and outstanding as of September 30, 2024 and December 31,<br><br>2023
Common stock, par value $0.01 per share; 750,000,000 and no shares authorized as of September 30, 2024 and<br><br>December 31, 2023, respectively; 142,735,842 and no shares issued and outstanding as of September 30, 2024<br><br>and December 31, 2023, respectively 1,428
Additional paid-in capital 743,364
Accumulated other comprehensive income 9,486 18,561
Retained earnings 251,592 155,453
Equity attributable to Ardent Health Partners, Inc. 1,005,870 670,896
Noncontrolling interests 378,608 404,118
Total equity 1,384,478 1,075,014
Total liabilities and equity $4,800,014 $4,731,558

(1)  As of September 30, 2024 and December 31, 2023, the unaudited condensed consolidated balance sheets included total liabilities of consolidated variable interest entities of

$303.2 million and $337.8 million, respectively. Refer to Note 2, Summary of Significant Accounting Policies, for further discussion.

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ARDENT HEALTH PARTNERS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS

Unaudited

(Dollars in thousands)

Nine Months Ended<br><br>September 30,
2024 2023
Cash flows from operating activities:
Net income $158,817 $118,196
Adjustments to reconcile net income to net cash provided by operating activities:
Depreciation and amortization 108,434 104,860
Other non-operating gains (45)
Loss on extinguishment and modification of debt 2,158
Amortization of deferred financing costs and debt discounts 4,235 4,266
Deferred income taxes 1,690 5,346
Equity-based compensation 8,873 723
Loss from non-consolidated affiliates 2,160 3,622
Changes in operating assets and liabilities, net of effect of acquisitions and divestitures:
Accounts receivable 77,284 (54,896)
Inventories (2,545) (556)
Prepaid expenses and other current assets (21,189) (20,450)
Accounts payable and other accrued expenses and liabilities (132,031) 9,996
Accrued salaries and benefits (12,429) (16,863)
Net cash provided by operating activities 195,457 154,199
Cash flows from investing activities:
Investment in acquisitions, net of cash acquired (8,044)
Purchases of property and equipment (106,234) (79,959)
Other (738) (1,318)
Net cash used in investing activities (115,016) (81,277)
Cash flows from financing activities:
Proceeds from initial public offering, net of underwriting discounts and commissions 208,656
Proceeds from insurance financing arrangements 10,797 24,749
Proceeds from long-term debt 3,600 1,225
Payments of principal on insurance financing arrangements (7,370) (15,885)
Payments of principal on long-term debt (106,335) (10,549)
Debt issuance costs (2,450)
Payments of initial public offering costs (8,636)
Distributions to noncontrolling interests (53,138) (50,677)
Redemption of equity attributable to noncontrolling interests (26,024)
Other (7,209)
Net cash provided by (used in) financing activities 45,124 (84,370)
Net increase (decrease) in cash and cash equivalents 125,565 (11,448)
Cash and cash equivalents at beginning of year 437,577 456,124
Cash and cash equivalents at end of year $563,142 $444,676
Supplemental Cash Flow Information:
Non-cash purchases of property and equipment $5,546 $13,188
Offering costs not yet paid $898 $—

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ARDENT HEALTH PARTNERS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY

Unaudited

(Dollars in thousands, except for unit amounts)

Equity Attributable to<br><br>Ardent Health Partners, Inc. Noncontrolling<br><br>Interests Total Equity
Redeemable<br><br>Noncontrolling<br><br>Interests Common Units Accumulated<br><br>Other<br><br>Comprehensive<br><br>Income Retained<br><br>Earnings
Units(*) Amount
Balance at December 31, 2022 $10,796 482,726,544 $510,968 $26,533 $101,549 $400,460 $1,039,510
Net income attributable to<br><br>Ardent Health Partners, Inc. 4,143 4,143
Net income attributable to<br><br>noncontrolling interests 20,427 20,427
Net loss attributable to<br><br>redeemable noncontrolling<br><br>interests (788)
Other comprehensive loss (4,564) (4,564)
Distributions to<br><br>noncontrolling interests (12,555) (12,555)
Vesting of Class C Units 587,053 360 360
Balance at March 31, 2023 $10,008 483,313,597 $511,328 $21,969 $105,692 $408,332 $1,047,321
Net income attributable to<br><br>Ardent Health Partners, Inc. 33,076 33,076
Net income attributable to<br><br>noncontrolling interests 23,600 23,600
Net loss attributable to<br><br>redeemable noncontrolling<br><br>interests (970)
Other comprehensive income 4,589 4,589
Distributions to<br><br>noncontrolling interests (19,254) (19,254)
Redemption of equity<br><br>attributable to noncontrolling<br><br>interests (14,990) (11,034) (26,024)
Vesting of Class C Units 558,013 182 182
Balance at June 30, 2023 $9,038 483,871,610 $496,520 $26,558 $138,768 $401,644 $1,063,490
Net income attributable to<br><br>Ardent Health Partners, Inc. .. 20,838 20,838
Net income attributable to<br><br>noncontrolling interests ......... 17,837 17,837
Net income attributable to<br><br>redeemable noncontrolling<br><br>interests .................................. 33
Other comprehensive income 31 31
Distributions to<br><br>noncontrolling interests ......... (18,868) (18,868)
Vesting of Class C Units ....... 543,589 181 181
Balance at September 30, 2023 .. $9,071 484,415,199 $496,701 $26,589 $159,606 $400,613 $1,083,509

(*) See Note 1, Description of the Business and Basis of Presentation - Initial Public Offering and Corporate Conversion, for further discussion.

The accompanying notes are an integral part of these condensed consolidated financial statements.

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ARDENT HEALTH PARTNERS, INC.

CONDENSED CONSOLIDATED STATEMENTS OF CHANGES IN EQUITY

Unaudited

(Dollars in thousands, except for unit amounts)

Equity Attributable to<br><br>Ardent Health Partners, Inc. Non-<br><br>controlling<br><br>Interests Total<br><br>Equity
Redeemable<br><br>Noncontrolling<br><br>Interests Common Units Common Stock Additional<br><br>Paid-in<br><br>Capital Accumulated<br><br>Other<br><br>Comprehensive<br><br>Income Retained<br><br>Earnings
Units(*) Amount Shares Amount
Balance at December 31, 2023 $7,302 484,922,828 $496,882 $— $— $18,561 $155,453 $404,118 $1,075,014
Net income attributable to<br><br>Ardent Health Partners, Inc. 27,047 27,047
Net income attributable to<br><br>noncontrolling interests 21,089 21,089
Net loss attributable to<br><br>redeemable noncontrolling<br><br>interests (2,285)
Other comprehensive income 703 703
Distributions to<br><br>noncontrolling interests (14,256) (14,256)
Vesting of Class C Units 464,853 512 512
Balance at March 31, 2024 $5,017 485,387,681 $497,394 $— $— $19,264 $182,500 $410,951 $1,110,109
Net income attributable to<br><br>Ardent Health Partners, Inc. 42,770 42,770
Net income attributable to<br><br>noncontrolling interests 25,540 25,540
Net loss attributable to<br><br>redeemable noncontrolling<br><br>interests (1,349)
Other comprehensive loss (2,255) (2,255)
Distributions to<br><br>noncontrolling interests (17,401) (17,401)
Vesting of Class C Units 522,002 226 226
Balance at June 30, 2024 $3,668 485,909,683 $497,620 $— $— $17,009 $225,270 $419,090 $1,158,989
Net income attributable to<br><br>Ardent Health Partners, Inc. 26,322 26,322
Net income attributable to<br><br>noncontrolling interests 20,960 20,960
Net loss attributable to<br><br>redeemable noncontrolling<br><br>interests (1,277)
Other comprehensive loss (7,523) (7,523)
Issuance of common stock in<br><br>connection with initial public<br><br>offering, net of underwriting<br><br>discounts and commissions<br><br>and other offering costs 13,800,000 138 198,984 199,122
Conversion of member units<br><br>to common stock (485,909,683) (497,620) 128,963,328 1,290 536,291 (39,961)
Distributions to<br><br>noncontrolling interests (21,481) (21,481)
Vesting of restricted stock<br><br>unit awards 9,441
Tax withholding on vesting<br><br>of restricted stock unit<br><br>awards (2,396) (46) (46)
Forfeiture of restricted stock<br><br>awards (34,531)
Equity-based compensation 8,135 8,135
Balance at September 30, 2024 $2,391 $— 142,735,842 $1,428 $743,364 $9,486 $251,592 $378,608 $1,384,478

(*) See Note 1, Description of the Business and Basis of Presentation - Initial Public Offering and Corporate Conversion, for further discussion.

The accompanying notes are an integral part of the condensed consolidated financial statements.

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ARDENT HEALTH PARTNERS, INC.

NOTES TO CONDENSED CONSOLIDATED FINANCIAL STATEMENTS

September 30, 2024

(Unaudited)

1.  Description of the Business and Basis of Presentation

Reporting Entity

Ardent Health Partners, Inc. was initially formed in Delaware in 2015 as Ardent Health Partners, LLC. On July 17, 2024,

Ardent Health Partners, LLC converted from a Delaware limited liability company into a Delaware corporation in connection

with its initial public offering and changed its name to Ardent Health Partners, Inc. Ardent Health Partners, Inc. is a holding

company that has affiliates that operate acute care hospitals and other healthcare facilities and employ physicians. The terms

“Ardent,” the “Company,” “we,” “our” and “us,” as used in these notes to the unaudited condensed consolidated financial

statements, refer to Ardent Health Partners, LLC and its affiliates and, subsequent to July 16, 2024, Ardent Health Partners,

Inc. and its affiliates, unless stated otherwise or indicated by context. The term “affiliates” includes direct and indirect

subsidiaries of Ardent and partnerships and joint ventures in which such subsidiaries are equity owners. At September 30,

2024, the Company operated 30 acute care hospitals in six states, including two rehabilitation hospitals and two surgical

hospitals.

Basis of Presentation

The accompanying unaudited condensed consolidated financial statements have been prepared in accordance with U.S.

generally accepted accounting principles (“GAAP”) for interim financial information. Accordingly, they do not include all of

the information and notes required by GAAP for complete financial statements. In the opinion of management, all

adjustments, which consist of normal recurring adjustments, and disclosures considered necessary for a fair presentation have

been included. The preparation of financial statements in conformity with GAAP requires management to make estimates and

assumptions that affect the amounts reported in the unaudited condensed consolidated financial statements. Actual results

could differ from these estimates under different assumptions or conditions.

The financial statements include the unaudited condensed consolidated balance sheets, income statements, comprehensive

income statements, statements of cash flows and statements of changes in equity of the Company and its affiliates, which are

controlled by the Company through the Company’s direct or indirect ownership of a majority equity interest and rights

granted to the Company through certain variable interests.  All intercompany balances and transactions have been eliminated

in consolidation.

Certain information and disclosures normally included in annual financial statements presented in accordance with GAAP

have been omitted pursuant to rules and regulations of the Securities and Exchange Commission ("SEC").  Accordingly,

these unaudited condensed consolidated financial statements and related notes should be read in conjunction with the

Company's audited consolidated financial statements and notes thereto as of and for the year ended December 31, 2023

included in the Company's final prospectus, dated July 17, 2024, filed with the SEC pursuant to Rule 424(b) under the

Securities Act of 1933, as amended, on July 18, 2024 in connection with the Company's initial public offering.

Initial Public Offering and Corporate Conversion

On July 19, 2024, the Company completed an initial public offering of 12,000,000 shares of its common stock at a public

offering price of $16.00 per share (the "IPO") for aggregate gross proceeds of $192.0 million and net proceeds of

approximately $181.4 million, after deducting underwriting discounts and commissions of approximately $10.6 million. The

Company provided the underwriters with an option to purchase up to an additional 1,800,000 shares of common stock of the

Company, which was fully exercised by the underwriters, and, on July 30, 2024, the Company issued 1,800,000 additional

shares of common stock at $16.00 per share for additional net proceeds of approximately $27.2 million, after deducting

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underwriting discounts and commissions of approximately $1.6 million. The Company’s common stock is listed on the New

York Stock Exchange under the symbol “ARDT”.

On July 17, 2024, in connection with the IPO and immediately prior to the effectiveness of the Company's registration

statement on Form S-1, the Company converted from a Delaware limited liability company into a Delaware corporation by

means of a statutory conversion (the “Corporate Conversion”) and changed its name to Ardent Health Partners, Inc. As a

result of the Corporate Conversion, the outstanding limited liability company membership units and vested profits interest

units were converted into 120,937,099 shares of common stock and outstanding unvested profits interest units were converted

into 2,848,027 shares of restricted common stock. Immediately following the Corporate Conversion, ALH Holdings, LLC, a

subsidiary of Ventas, Inc. ("Ventas"), a common unit holder that beneficially owned a percentage of the Company’s

outstanding membership interests and maintained a seat on the Company’s board of managers, making Ventas a related party,

contributed all of its outstanding common stock in AHP Health Partners, Inc. ("AHP Health Partners"), a direct subsidiary of

the Company, to Ardent Health Partners, Inc. in exchange for 5,178,202 shares of common stock of Ardent Health Partners,

Inc. (the "ALH Contribution"). As a result of the ALH Contribution, AHP Health Partners is a wholly-owned subsidiary of

Ardent Health Partners, Inc. The Corporate Conversion and the ALH Contribution have been retrospectively applied to prior

periods herein for the purposes of calculating basic and diluted net income per share. The Company’s certificate of

incorporation authorizes 750,000,000 shares of common stock and 50,000,000 shares of preferred stock, each with a $0.01

par value per share.

Cybersecurity Incident

In November 2023, the Company determined that a ransomware cybersecurity incident had impacted and disrupted a number

of the Company’s operational and information technology systems (the “Cybersecurity Incident”). During this time, the

Company’s hospitals remained operational and continued to deliver patient care utilizing established downtime procedures.

The Company immediately suspended user access to impacted information technology applications, executed cybersecurity

protection protocols, and took steps to restrict further unauthorized activity. Additionally, because of the time taken to contain

and remediate the Cybersecurity Incident, online electronic billing systems were not functioning at their full capacities and

certain billing, reimbursement and payment functions were delayed, which had an adverse impact on the Company’s results

of operations and cash flows for 2023 and the first quarter of 2024.

While the Company’s hospitals continued to deliver patient care at varying levels during the disruption and remediation

periods and the Company’s business is no longer materially disrupted, the Company has incurred, and will continue to incur,

certain expenses related to the Cybersecurity Incident, including expenses related to the settlement of the consolidated class

action lawsuit related to the Cybersecurity Incident. The Company continues to work with its various insurance carriers to

obtain reimbursement for its costs and liabilities incurred due to the Cybersecurity Incident.

Pure Health Equity Investment

On May 1, 2023, an affiliate of Pure Health Holding PJSC (“Pure Health”) purchased a minority interest in the Company

from the unit holders at the time. In connection with Pure Health’s investment, unit holders were eligible to exercise tag-

along rights to sell a proportionate share of their individual equity ownership interest in Ardent Health Partners, LLC and

AHP Health Partners, the Company's direct subsidiary. Ventas exercised its tag-along right to sell its proportionate share of

ownership interest in both Ardent Health Partners, LLC and AHP Health Partners. To fulfill Ventas’ right to sell its

proportionate share of noncontrolling ownership interest in AHP Health Partners, the Company exercised its right to

repurchase those shares from Ventas for $26.0 million concurrent with Pure Health’s purchase of a minority interest in the

Company. The carrying value of the noncontrolling interest was adjusted proportionate to the shares repurchased to reflect

the change in ownership of AHP Health Partners, with the difference between the fair value of the consideration paid and the

amount by which the noncontrolling interest was adjusted recognized in equity attributable to Ardent Health Partners, LLC.

As of September 30, 2024, Pure Health and Ventas beneficially owned approximately 21.2% and 6.5%, respectively, of the

Company’s outstanding common stock.

General and Administrative Costs

The majority of the Company’s expenses are “cost of revenue” items. Costs that could be classified as general and

administrative by the Company would include its corporate office costs, which were $33.7 million and $29.0 million for the

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three months ended September 30, 2024 and 2023, respectively, and $95.7 million and $82.2 million for the nine months

ended September 30, 2024 and 2023, respectively.

2.  Summary of Significant Accounting Policies

COVID-19 Pandemic

In March 2020, the World Health Organization declared the outbreak of Coronavirus Disease 2019 (“COVID-19”), a disease

caused by a novel strain of coronavirus, a global pandemic. On March 27, 2020, the Coronavirus Aid, Relief and Economic

Security Act (“CARES Act”) was enacted by the federal government.  Among other provisions, the CARES Act authorized

relief funding to healthcare providers through the Public Health and Social Services Emergency Fund (“Provider Relief

Fund”).  The CARES Act also expanded the Medicare Accelerated and Advance Payment Program through which eligible

providers could request accelerated Medicare payments to be repaid through withholdings against future Medicare fee-for-

service payments.  Distributions from the Provider Relief Fund were intended to reimburse healthcare providers for lost

revenue and increased expenses related to the pandemic and were not subject to repayment, provided recipients attested to

and complied with applicable terms and conditions set forth by legislation.  Distributions provided by the Provider Relief

Fund were accounted for as government grants and were recognized in the unaudited condensed consolidated income

statements once the grant was received and there was reasonable assurance that the applicable terms and conditions required

to retain the distributions were met.

During the three and nine months ended September 30, 2024, the Company did not receive or recognize any cash

distributions from the Provider Relief Fund and other state and local programs. During the three and nine months ended

September 30, 2023, the Company received $0.0 million and $8.5 million, respectively, in cash distributions from the

Provider Relief Fund and other state and local programs and recognized the distributions as government stimulus income, a

reduction of operating expenses, on its unaudited condensed consolidated income statements. Government compliance audits

may result in derecognition of amounts previously recognized and repayment of such amounts. Since 2020, the Company has

received and recognized $366.4 million of government stimulus income. Pursuant to Accounting Standards Update (“ASU”)

2021-10, Disclosures by Business Entities about Government Assistance, as an accounting policy election, the Company has

utilized International Accounting Standards (“IAS”) 20, Accounting for Government Grants and Disclosure of Government

Assistance, by analogy to recognize funds received under the CARES Act from the Provider Relief Fund as revenue, given no

direct authoritative guidance is available to for-profit organizations to recognize revenue for government contributions and

grants. CARES Act revenue may be subject to future adjustments based on compliance audits.

Adoption of Recently Issued Accounting Standards

In March 2020, the Financial Accounting Standards Board (the “FASB”) issued ASU 2020-04, Reference Rate Reform (Topic

848): Facilitation of the Effects of Reference Rate Reform on Financial Reporting (“ASU 2020-04”).  ASU 2020-04 provides

optional guidance for a limited period of time to ease the potential burden in accounting for or recognizing the effects of

reference rate reform on financial reporting and applies only to contracts, hedging relationships, and other transactions that

reference the London interbank offered rate (“LIBOR”) or another reference rate expected to be discontinued because of

reference rate reform. ASU 2020-04 became effective as of March 12, 2020 and continues through December 31, 2024.

Entities may adopt ASU 2020-04 as of any date from the beginning of an interim period that includes or is subsequent to

March 12, 2020 or prospectively from a date within an interim period that includes or is subsequent to March 12, 2020, up to

the date that the financial statements are available to be issued. The Company adopted the standard as of January 1, 2023. The

adoption of this standard had no material impact on the Company’s unaudited condensed consolidated financial statements

and notes.

Recent Accounting Pronouncements Not Yet Adopted

In November 2023, the FASB issued ASU 2023-07, Segment Reporting (Topic 280): Improvements to Reportable Segment

Disclosures ("ASU 2023-07"), which expands disclosures about reportable segments and provides requirements for more

detailed reporting of a segment’s expenses that are regularly provided to the Chief Operating Decision Maker ("CODM") and

included within each reported measure of a segment’s profit or loss. Additionally, ASU 2023-07 requires all segment profit or

loss and assets disclosures to be provided on an annual and interim basis. ASU 2023-07 is effective for fiscal years beginning

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after December 15, 2023 and interim periods within fiscal years beginning one year later. Early adoption is permitted, and

amendments must be applied retrospectively to all prior periods presented. The adoption of this guidance will not impact the

Company’s consolidated results of operations, financial position or cash flows.  The Company is currently evaluating the

standard to determine its impact on the Company’s disclosures.

In December 2023, the FASB issued ASU 2023-09, Income Taxes (Topic 740): Improvements to Income Tax Disclosures

("ASU 2023-09"), which requires a public business entity to disclose specific categories in its annual effective tax rate

reconciliation and provide disaggregated information about significant reconciling items by jurisdiction and by nature. ASU

2023-09 also requires entities to disclose their income tax payments (net of refunds) to international, federal, and state and

local jurisdictions and includes several other changes to income tax disclosure requirements. This standard is effective for

annual periods beginning after December 15, 2024, and requires prospective application with the option to apply it

retrospectively. The adoption of this guidance will not affect the Company’s consolidated results of operations, financial

position or cash flows. The Company is currently evaluating the standard to determine its impact on the Company’s

disclosures.

Variable Interest Entities

GAAP requires variable interest entities (“VIEs”) to be consolidated if an entity’s interest in the VIE is a controlling financial

interest in accordance with ASC 810, Consolidation. Under the variable interest model, a controlling financial interest is

determined based on which entity, if any, has (i) the power to direct the activities of the VIE that most significantly impact

the VIE’s economic performance and (ii) the obligation to absorb the losses, or the right to receive benefits, from the VIE that

could potentially be significant to the VIE.

The Company performs ongoing reassessments of whether changes in the facts and circumstances regarding the Company’s

involvement with a VIE could cause the Company’s consolidation conclusion to change. The consolidation status of the VIEs

with which the Company is involved may change as a result of such reassessments. Changes in consolidation status are

applied prospectively.

The Company, through its wholly-owned subsidiaries, owns majority interests in certain limited liability companies

(“LLCs”), with each LLC owning and operating one or more hospitals. The noncontrolling interest is typically owned by a

not-for-profit medical system, university, academic medical center or foundation or combination thereof (individually or

collectively referred to as “minority member”). The employees that work for the LLC and the related hospital(s) are

employees of the Company, and the Company manages the day-to-day operations of the LLC and the hospital(s) pursuant to

a management services agreement (“MSA”).

The LLCs are VIEs due to their structure as LLCs and the control that resides with the Company through the MSA. The

Company consolidates each of these LLCs as it is considered the primary beneficiary due to the MSA providing the

Company the right to direct the day-to-day operating and capital activities of the LLC and the respective hospital(s) that most

significantly impact the LLC’s economic performance. Additionally, the Company would absorb a majority of the entity’s

expected losses, receive a majority of the entity’s expected residual returns, or both, as a result of its majority ownership,

contractual or other financial interests in the entity. The MSAs are subject to termination only by mutual agreement of the

Company and minority member, except in the case of gross negligence, fraud or bankruptcy of the Company, in which case

the minority member can force termination of the MSA.

The governance rights of the minority members are restricted to those that protect their financial interests and do not preclude

consolidation of the LLCs. The rights of minority members generally are limited to such items as the right to approve the

issuance of new ownership interests, calls for additional cash contributions, the acquisition or divestiture of significant assets

and the incurrence of debt in excess of levels not expected to be incurred in the normal course of business.

All of the Company’s VIEs meet the definition of a business, and the Company holds a majority of their issued voting equity

interest. Their assets are not required to be used only for the settlement of VIE obligations as the Company has the ability to

direct the use of the VIE assets through its joint venture and cash management agreements.

As of September 30, 2024 and December 31, 2023, nine of the Company’s hospitals were owned and operated through LLCs

that have been determined to be VIEs and were consolidated by the Company. Consolidated assets at September 30, 2024 and

December 31, 2023 included total assets of VIEs equal to $1.2 billion. The Company’s VIEs do not have creditors that have

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recourse to the Company. As the structure and nature of business are very similar for each of the LLCs, they are discussed

and presented herein on a combined basis.

The total liabilities of VIEs included in the Company’s unaudited condensed consolidated balance sheets are shown below (in

thousands):

September 30, 2024 December 31, 2023
Current liabilities
Current installments of long-term debt $2,222 $2,386
Accounts payable 86,521 103,274
Accrued salaries and benefits 32,480 34,730
Other accrued expenses and liabilities 48,116 53,684
Total current liabilities 169,339 194,074
Long-term debt, less current installments 7,679 8,044
Long-term operating lease liability 111,449 120,056
Long-term operating lease liability, related party 9,449 9,520
Self-insured liabilities 659 651
Other long-term liabilities 4,606 5,437
Total liabilities $303,181 $337,782

Income from operations before income taxes attributable to VIEs was $68.6 million and $60.3 million for the three months

ended September 30, 2024 and 2023, respectively. Income from operations before income taxes attributable to VIEs was

$207.0 million and $198.4 million for the nine months ended September 30, 2024 and 2023, respectively.

Accounting Estimates

The preparation of financial statements in conformity with GAAP requires management to make estimates and judgments

that affect the amounts reported in the unaudited condensed consolidated financial statements and accompanying notes. On

an ongoing basis, the Company evaluates its estimates. The Company bases its estimates on historical experience and on

various other assumptions that are believed to be reasonable under the circumstances, the results of which form the basis for

making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. Actual

results may differ from these estimates.

Deferred Offering Costs

Deferred offering costs consist primarily of legal and accounting fees, which are direct and incremental fees related to equity

financings. The Company capitalizes these costs until equity financings are consummated, at which time the costs are

recorded against the gross proceeds of the offering. Upon receipt of the IPO proceeds during the current period, deferred

offering costs were recorded against the IPO proceeds within additional paid-in capital on the Company's condensed

consolidated balance sheet as of September 30, 2024.

Revenue Recognition

The Company’s revenue generally relates to contracts with patients in which its performance obligations are to provide

healthcare services to the patients. Revenue is recorded during the period the Company’s obligations to provide healthcare

services are satisfied. Revenue for performance obligations satisfied over time is recognized based on charges incurred in

relation to total expected charges. The Company’s performance obligations for inpatient services are generally satisfied over

periods that average approximately five days. The Company’s performance obligations for outpatient services are generally

satisfied over a period of less than one day. As the Company’s performance obligations relate to contracts with a duration of

one year or less, the Company elected the optional exemption under ASC Topic 606, Revenue from Contracts with

Customers, and, therefore, is not required to disclose the transaction price for the remaining performance obligations at the

end of the reporting period or when the Company expects to recognize revenue. Additionally, the Company is not required to

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adjust the consideration for the existence of a significant financing component when the period between the transfer of the

services and the payment for such services is one year or less.

Contractual relationships with patients, in most cases, involve a third-party payor (Medicare, Medicaid and managed care

health plans) and the transaction prices for services provided are dependent upon the terms provided by (Medicare and

Medicaid) or negotiated with (managed care health plans) the third-party payors. The payment arrangements with third-party

payors for the services provided to the related patients typically specify payments at amounts less than the Company’s

standard charges.

The Company’s revenue is based upon the estimated amounts the Company expects to be entitled to receive from patients

and third-party payors. Estimates of contractual adjustments under managed care insurance plans are based upon the payment

terms specified in the related contractual agreements. Revenue related to uninsured patients and copayment and deductible

amounts for patients who have healthcare coverage may have discounts applied (uninsured discounts and other discounts).

The Company also records estimated implicit price concessions (based primarily on historical collection experience) related

to uninsured accounts to record self-pay revenue at the estimated amounts expected to be collected.

Medicare and Medicaid regulations and various managed care contracts, under which the discounts from the Company’s

standard charges must be calculated, are complex and are subject to interpretation and adjustment. The Company estimates

contractual adjustments on a payor-specific basis based on its interpretation of the applicable regulations or contract terms.

However, the necessity of the services authorized and provided, and resulting reimbursements, are often subject to

interpretation. These interpretations may result in payments that differ from the Company’s estimates. Additionally, updated

regulations and contract renegotiations occur frequently, necessitating continual review and assessment of the estimates by

management.

Laws and regulations governing Medicare and Medicaid programs are complex and subject to interpretation. Estimated

reimbursement amounts are adjusted in subsequent periods as cost reports are prepared and filed and as final settlements are

determined (in relation to certain government programs, primarily Medicare, this is generally referred to as the “cost report”

filing and settlement process). Settlements under reimbursement agreements with third-party payors are estimated and

recorded in the period in which the related services are rendered and are adjusted in future periods as final settlements are

determined. Final determination of amounts earned under the Medicare, Medicaid and other third-party payor programs often

occurs in subsequent years because of audits by the programs, rights of appeal, and the application of technical provisions.

Settlements are considered in the recognition of net patient service revenue on an estimated basis in the period the related

services are rendered, and such amounts are subsequently adjusted in future periods as adjustments become known or as

years are no longer subject to such audits and reviews. Differences between original estimates and subsequent revisions,

including final settlements, are included in the results of operations of the period in which the revisions are made. These

adjustments resulted in changes to net patient service revenue of an increase of $4.9 million and $1.1 million for the three

months ended September 30, 2024 and 2023, respectively, and an increase to net patient service revenue of $4.9 million and

$6.1 million for the nine months ended September 30, 2024 and 2023, respectively.

At September 30, 2024 and December 31, 2023, the Company’s settlements under reimbursement agreements with third-

party payors were a net payable of $2.9 million and $10.3 million, respectively, of which a receivable of $39.2 million and

$34.4 million, respectively, was included in other current assets and a payable of $42.1 million and $44.7 million,

respectively, was included in other accrued expenses and liabilities in the unaudited condensed consolidated balance sheets.

Final determination of amounts earned under prospective payment and other reimbursement activities is subject to review by

appropriate governmental authorities or their agents. In the opinion of the Company’s management, adequate provision has

been made for any adjustments that may result from such reviews.

Subsequent adjustments that are determined to be the result of an adverse change in the patient’s or the payor’s ability to pay

are recognized as bad debt expense. Bad debt expense for the three and nine months ended September 30, 2024 and 2023 was

not material to the Company.

Currently, several states utilize supplemental reimbursement programs for the purpose of providing reimbursement to

providers to offset a portion of the cost of providing care to Medicaid and indigent patients. These programs are designed

with input from the Center for Medicare & Medicaid Services (“CMS”) and are funded with a combination of state and

federal resources, including, in certain instances, fees or taxes levied on the providers. Under these supplemental programs,

the Company recognizes revenue and related expenses in the period in which amounts are estimable and collection is

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reasonably assured. Reimbursement under these programs is reflected in total revenue. Taxes or other program-related costs

are reflected in other operating expenses.

The Company’s total revenue is presented in the following table (dollars in thousands):

Three Months Ended September 30, Nine Months Ended September 30,
2024 2023 2024 2023
Amount % of<br><br>Revenue Amount % of<br><br>Revenue Amount % of<br><br>Revenue Amount % of<br><br>Revenue
Medicare $561,491 38.7% $537,884 39.0% $1,709,137 39.3% $1,608,041 39.6%
Medicaid 148,448 10.2% 151,401 11.0% 460,060 10.6% 459,244 11.3%
Other managed care 627,112 43.3% 587,802 42.7% 1,874,705 43.0% 1,713,964 42.2%
Self-pay and other 79,390 5.5% 75,761 5.5% 234,522 5.2% 210,338 5.1%
Net patient service revenue $1,416,441 97.7% $1,352,848 98.2% $4,278,424 98.1% $3,991,587 98.2%
Other revenue 33,376 2.3% 24,879 1.8% 81,359 1.9% 71,862 1.8%
Total revenue $1,449,817 100.0% $1,377,727 100.0% $4,359,783 100.0% $4,063,449 100.0%

The Company provides care without charge to certain patients who qualify under the local charity care policy of the hospital

where the patient receives services. The Company estimates that its costs of care provided under its charity care programs

approximated $8.2 million and $8.4 million for the three months ended September 30, 2024 and 2023, respectively. The

Company estimates that its costs of care provided under its charity care programs approximated $41.8 million and $34.0

million for the nine months ended September 30, 2024 and 2023, respectively. The Company does not report a charity care

patient’s charges in revenue as it is the Company’s policy not to pursue collection of amounts related to these patients, and

therefore contracts with these patients do not exist.

The Company’s management estimates its costs of care provided under its charity care programs utilizing a calculated ratio of

costs to gross charges multiplied by the Company’s gross charity care charges provided. The Company’s gross charity care

charges include only services provided to patients who are unable to pay and qualify under the Company’s local charity care

policies. To the extent the Company receives reimbursement through the various governmental assistance programs in which

it participates to subsidize its care of indigent patients, the Company does not include these patients’ charges in its cost of

care provided under its charity care program.

Market Risks

The Company’s revenue is subject to potential regulatory and economic changes in certain states where the Company

generates significant revenue. The following is an analysis by state of revenue as a percentage of the Company’s total

revenue for those states in which the Company generates significant revenue:

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
2024 2023 2024 2023
Oklahoma 24.7% 24.7% 24.8% 24.3%
New Mexico 13.7% 15.2% 14.6% 15.7%
Texas 37.4% 37.2% 36.4% 35.9%
New Jersey 10.1% 10.1% 10.2% 10.4%
Other 14.1% 12.8% 14.0% 13.7%
Total 100.0% 100.0% 100.0% 100.0%

Texas Waiver Program

Certain of the Company’s facilities receive supplemental Medicaid reimbursement, including reimbursement from programs

supported by broad-based provider taxes to fund the non-federal share of Medicaid programs or fund indigent care within a

state. The State of Texas operates the Texas Health Care Transformation and Quality Improvement Program pursuant to a

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Medicaid waiver, the Texas Waiver Program (the “Program”), granted by Section 1115 of the Social Security Act. The

Program expands managed care programs in the state, provides funding for uncompensated care and supports various

delivery system reform initiatives. On March 25, 2022, the Program was extended through September 2030; however, certain

delivery system reform initiatives within the Program operate under separate approval periods.

The timing, determination and basis of funding is specific to the Program’s various components. For example,

reimbursements associated with the Program’s uncompensated care component are determined based on a participating

provider’s costs incurred with providing unreimbursed care to Medicaid and uninsured patients. The Company accrues for

estimated payments associated with the Program’s uncompensated care component to be received in the period in which the

associated unreimbursed care is provided constrained to an amount such that a significant reversal of cumulative revenue is

not probable in the future. Payments associated with certain directed payment programs are contingent on a provider

reporting and meeting certain pre-determined metrics and clinical outcomes and contributing to the non-federal share of the

Program component via provider assessments. The Company accrues directed payment program funding in the period in

which metrics are expected to be achieved and collection is reasonably assured. Management routinely monitors

communications regarding the Program from the State of Texas and CMS to ensure there is no uncertainty about entitlement

or collectability, such as disruption in state and federal funding.

Payments from the Program are received at different points of time during a funding year. Differences between original

estimates and subsequent revisions to the payments, including final settlements, represent changes in the estimate and are

recognized in the period in which the revisions are made. Subsequent adjustments to the payments received and the

Company’s related estimates have historically been insignificant. The Company recognized revenue of $54.0 million and

$68.6 million for the three months ended September 30, 2024 and 2023, respectively, and $165.9 million and $147.3 million

for the nine months ended September 30, 2024 and 2023, respectively. Additionally, the Company incurred costs related to

provider assessments for the Program in the amounts of $15.1 million and $28.7 million for the three months ended

September 30, 2024 and 2023, respectively, and $56.8 million and $58.8 million for the nine months ended September 30,

2024 and 2023, respectively, which were included in other operating expenses on the unaudited condensed consolidated

income statements.

Fair Value of Financial Instruments

Cash and cash equivalents, accounts receivable, inventories, prepaid expenses, other current assets, accounts payable, accrued

salaries and benefits, accrued interest and other accrued expenses and current liabilities (other than those pertaining to lease

liabilities) are reflected in the accompanying unaudited condensed consolidated financial statements at amounts that

approximate fair value because of the short-term nature of these instruments. The fair value of the Company’s revolving

credit facility also approximates its carrying value as it bears interest at current market rates.  Refer to Note 5, Interest Rate

Swap Agreements, for discussion of the fair value measurement of the Company’s derivative instruments.

The carrying amounts and fair values of the Company’s senior secured term loan facility and its 5.75% Senior Notes due

2029 (the “5.75% Senior Notes”) were as follows (in thousands):

Carrying Amount Fair Value
September 30, 2024 December 31, 2023 September 30, 2024 December 31, 2023
Senior Secured Term Loan Facility $773,515 $874,262 $773,515 $876,448
5.75% Senior Notes $299,574 $299,506 $293,582 $259,822

The estimated fair values of the Company’s senior secured term loan facility and the 5.75% Senior Notes were based upon

quoted market prices at that date and are categorized as Level 2 within the fair value hierarchy.

Noncontrolling Interests

The financial statements include the financial position and results of operations of hospital and healthcare operations in which

the Company owned less than 100% of the equity interests, but maintained a controlling interest during the presented periods.

Earnings or losses attributable to the noncontrolling interests are presented separately in the consolidated income statements.

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In accordance with ASC 810, Consolidation, holders of noncontrolling interests are considered to be equity holders in the

consolidated company, pursuant to which noncontrolling interests are classified as part of equity, unless the noncontrolling

interests are redeemable. Certain redemptive features associated with the noncontrolling interests for The University of

Kansas Health System – St. Francis Campus (“St. Francis”) could require the Company to deliver cash if the redemptive

features are exercised. These redemptive features could be exercised upon, among other things, the Company’s exclusion or

suspension from participation in any federal or state government healthcare payor program. Therefore, the noncontrolling

interests balance for St. Francis is classified outside the permanent equity section of the Company’s unaudited condensed

consolidated balance sheets.

The redeemable noncontrolling interests related to St. Francis at September 30, 2024 and December 31, 2023 have not been

subsequently measured at fair value since the acquisition date in 2017. The noncontrolling interests are not currently

redeemable and it is not probable that the noncontrolling interests will become redeemable as the possibility of the Company

being excluded or suspended from participation in any federal or state government healthcare payor program is remote.

Earnings Per Share

Basic net income per share is computed by dividing net income available to common stockholders by the weighted-average

common shares outstanding during the period. Diluted net income per share takes into account the potential dilution that

could occur if securities or other contracts to issue shares, such as stock options and unvested restricted stock units, were

exercised and converted into shares. Diluted net income per share is computed by dividing net income available to common

stockholders by the weighted-average common shares outstanding during the period, increased by the number of additional

shares that would have been outstanding if the potential shares had been issued and were dilutive.

Segment Reporting

The Company has one reportable segment: healthcare services. The healthcare services segment provides healthcare services

primarily through its ownership and operation of hospitals, certain of which provide related healthcare services through

physician practices, outpatient centers, and post-acute facilities. The CODM is its President and Chief Executive Officer, who

regularly reviews financial operating results on a consolidated basis for purposes of allocating resources and evaluating

financial performance. The Company’s CODM manages the operations on a consolidated basis to make decisions about

overall company resource allocation and to assess overall company performance.

As of September 30, 2024 and December 31, 2023, all of the Company’s long-lived assets were located in the United States,

and for the three and nine months ended September 30, 2024 and 2023, all revenue was earned in the United States.

3.  Related Party Transactions

Effective August 4, 2015, Ventas acquired ownership of the Company’s real estate in exchange for a $1.4 billion payment

from Ventas and the Company’s agreement to lease the acquired real estate back from Ventas (the “Ventas Master Lease”).

The Ventas Master Lease is a 20-year master lease agreement (with a renewal option for an additional 10 years) with certain

subsidiaries of Ventas, pursuant to which the Company currently leases 10 of the Company’s hospitals. The Ventas Master

Lease includes an annual rent escalator equal to the lesser of four times the Consumer Price Index or 2.5%. In accordance

with ASC 842, Leases (“ASC 842”), variable lease payments are excluded from the Company’s minimum rental payments

used to determine the right-of-use assets and lease obligations and are recognized as expense when incurred. The Ventas

Master Lease includes a number of operating and financial restrictions on the Company. Management believes it was in

compliance with all financial covenants as of September 30, 2024 and December 31, 2023.

The Company recorded rent expense related to the Ventas Master Lease and other lease agreements with Ventas for certain

medical office buildings of $37.2 million and $36.4 million for the three months ended September 30, 2024 and 2023,

respectively, and $111.4 million and $108.9 million for the nine months ended September 30, 2024 and 2023, respectively.

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4.  Long-Term Debt and Financing Matters

Long-term debt consists of the following (in thousands):

September 30, 2024 December 31, 2023
Senior secured term loan facility $773,515 $874,262
5.75% Senior Notes 299,574 299,506
Finance leases 19,848 21,706
Other debt 18,796 12,322
Deferred financing costs (15,841) (20,938)
Total debt 1,095,892 1,186,858
Less current maturities (12,167) (18,605)
Long-term debt, less current maturities $1,083,725 $1,168,253

As of September 30, 2024 and December 31, 2023, the senior secured term loan facility reflected an original issue discount

(“OID”) of $4.0 million and $5.5 million, respectively. As of September 30, 2024 and December 31, 2023, the 5.75% Senior

Notes balance reflected an OID of $0.4 million and $0.5 million, respectively.

Senior Secured Credit Facilities

On August 24, 2021, the Company entered into a credit agreement for its senior secured term loan facility (the "Term Loan B

Facility"), which provides funding up to a principal amount of $900.0 million.  The Term Loan B Facility has a seven year

maturity with principal due in consecutive equal quarterly installments of 0.25% of the initial $900.0 million principal

amount (subject to certain reductions from time to time as a result of the application of prepayments), with the remaining

balance due upon maturity of the Term Loan B Facility.  The proceeds from the Term Loan B Facility were used to prepay in

full the Company's $825.0 million senior secured term loan facility (the "2018 Term Loan B Facility"), including any accrued

and unpaid interest, fees and other expenses related to the transaction. On June 8, 2023, the Company further amended and

restated the Term Loan B Facility credit agreement (the "Term Loan B Credit Agreement") to replace LIBOR with the Term

Secured Overnight Financing Rate ("SOFR") and Daily Simple SOFR (each as defined in the amended Term Loan B Credit

Agreement) as the reference interest rate effective June 30, 2023. On June 26, 2024, the Company used cash on hand to

prepay $100.0 million of the $877.5 million outstanding principal on the Term Loan B Facility; no modification was made to

the Term Loan B Credit Agreement as a result of this prepayment. On September 18, 2024, the Company executed an

amendment to reprice its Term Loan B Credit Agreement. The repricing reduced the applicable interest rate by 50 basis

points from Term SOFR plus 3.25% to Term SOFR plus 2.75% and eliminated the credit spread adjustment. No

modifications were made to the maturity of the loans as a result of the repricing and all other terms were substantially

unchanged.

Effective July 8, 2021, the Company entered into an amended and restated senior credit agreement for its $225.0 million

senior secured asset based revolving credit facility (the “ABL Credit Agreement”). The ABL Credit Agreement consisted of a

$225.0 million senior secured asset-based revolving credit facility with a five-year maturity. On April 21, 2023, the Company

further amended and restated the ABL Credit Agreement to replace LIBOR with the Term SOFR and Daily Simple SOFR

(each, as defined in the amended ABL Credit Agreement) as the reference interest rate. On June 26, 2024, the Company

further amended the ABL Credit Agreement to increase the revolving commitment to $325.0 million and extend its maturity

date to June 26, 2029.

The Term Loan B Credit Agreement and ABL Credit Agreement contain a number of customary affirmative and negative

covenants that limit or restrict the ability of the Company and its subsidiaries to (subject, in each case, to a number of

important exceptions, thresholds and qualifications as set forth in the Term Loan B Credit Agreement and ABL Credit

Agreement):

•incur additional indebtedness (including guarantee obligations);

•incur liens;

•make certain investments;

•make certain dispositions and engage in certain sale / leaseback transactions;

•make certain payments or other distributions; and

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•engage in certain transactions with affiliates.

In addition, the ABL Credit Agreement contains a springing financial covenant that requires the maintenance, after failure to

maintain a specified minimum amount of availability to borrow under the senior secured asset-based revolving credit facility,

of a minimum fixed charge coverage ratio of 1.00 to 1.00, as determined at the end of each fiscal quarter. Management

believes that, as of September 30, 2024 and December 31, 2023, the Company maintained more than the minimum amount of

availability under the senior secured asset-based revolving credit facility and, therefore, the minimum fixed charge ratio

described herein was not applicable.

5.  Interest Rate Swap Agreements

Market risks relating to the Company’s operations result primarily from changes in interest rates. The Company’s exposure to

interest rate risk results from the entry into financial debt instruments that arose from transactions entered into during the

normal course of business. As part of an overall risk management program, the Company evaluates and manages exposure to

changes in interest rates on an ongoing basis. The Company has no intention of entering into financial derivative contracts,

other than to hedge a specific financial risk. To mitigate the Company’s exposure to fluctuations in interest rates, the

Company uses pay-fixed interest rate swaps, generally designated as cash flow hedges of interest payments on floating rate

borrowings. Pay-fixed swaps effectively convert floating-rate borrowings to fixed-rate borrowings. Unrealized gains or losses

from the designated cash flow hedges are deferred in accumulated other comprehensive income (“AOCI”) and recognized as

interest expense as the interest payments occur. Hedges and derivative financial instruments may continue to be used in the

future in order to manage interest rate exposure.

The Company has entered into interest rate swap agreements to manage its exposure to fluctuations in interest rates. The

valuation of these instruments is determined using widely accepted valuation techniques, including discounted cash flow

analysis on the expected cash flows of each derivative. This analysis reflects the contractual terms of the derivatives,

including the period to maturity, and uses observable market-based inputs, including interest rate curves and implied

volatilities. The Company has determined the inputs used to value its derivatives fall within Level 2 of the fair value

hierarchy.

On August 26, 2021, the Company amended its existing interest rate swap agreements with Barclays Bank PLC and Bank of

America, N.A. as counterparties, with original notional amounts totaling $558.0 million and expiring August 31, 2023. Under

the amended agreements, the Company was required to make monthly fixed rate payments at annual rates ranging from

2.50% to 2.51%, and the counterparties were obligated to make monthly floating rate payments to the Company based on

one-month LIBOR, each subject to a floor of 0.50%.

On October 8, 2021, the Company executed new interest rate swap agreements (the “October 2021 Agreements”) with

Barclays Bank PLC and Bank of America, N.A. as counterparties, with notional amounts totaling $529.0 million and an

effective date of August 31, 2023 and expiring June 30, 2026. Under the October 2021 Agreements, the Company was

required to make monthly fixed rate payments at annual rates ranging from 1.53% to 1.55%, and the counterparties were

obligated to make monthly floating rate payments to the Company based on one-month LIBOR, each subject to a floor of

0.50%. Effective August 31, 2023, the Company amended the October 2021 Agreements to adjust the fixed rates and replace

the LIBOR floating interest rate options with Term SOFR floating rate options. Under the amended October 2021

Agreements, the Company is required to make monthly fixed rate payments at annual rates ranging from 1.47% to 1.48%,

and the counterparties are obligated to make monthly floating rate payments to the Company based on one-month Term

SOFR, each subject to a floor of 0.39%.

The Company accounts for its interest rate swap agreements in accordance with ASC 815, Derivatives and Hedging. Because

the interest rate swap agreements amended on August 26, 2021 did not meet the definition of derivatives in their entirety due

to the financing element of the agreements, the Company accounted for these as hybrid instruments that consisted of a debt

instrument (debt host) and an embedded at-market derivative. At August 26, 2021, the debt portion of the hybrid instruments

was equal to the fair value of the existing interest rate swap agreements, and the balance within AOCI associated with the

debt portion was amortized on a straight-line basis to interest expense over the remaining effective period of the amended

agreements, which expired August 31, 2023. The at-market derivative portion of each hybrid instrument was designated as a

cash flow hedge with changes in fair value included in AOCI as a component of equity. Amounts were subsequently

reclassified from AOCI into interest expense in the same periods during which the hedged transactions affected earnings.

Cash interest payments associated with the at-market derivative portion of the hybrid instruments were classified as operating

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activities in the Company’s unaudited condensed consolidated statements of cash flows; whereas cash interest payments for

the debt portion of the hybrid instruments were classified as financing activities.

The Company performs assessments of effectiveness for its cash flow hedges on a quarterly basis to confirm that the hedges

continue to meet the highly effective criteria required to continue applying cash flow hedge accounting. During the nine

months ended September 30, 2024 and the year ended December 31, 2023, these hedges were highly effective. Accordingly,

no unrealized gain or loss related to these hedges was reflected in the accompanying unaudited condensed consolidated

income statements, and the change in fair value was included in AOCI as a component of equity. Realized gains and losses

during the period have been reclassified from AOCI to interest expense.

The following table presents the effects of derivatives in cash flow hedging relationships on the Company’s AOCI and

earnings (in thousands):

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
Classification 2024 2023 2024 2023
Unrealized (loss) income recognized AOCI $(5,062) $4,490 $3,077 $11,082
Loss reclassified from AOCI into earnings Interest expense, net (5,118) (4,447) (15,357) (11,006)
Net change in AOCI $(10,180) $43 $(12,280) $76

In the 12 months following September 30, 2024, the Company estimates that an additional $9.5 million will be reclassified as

a reduction to interest expense.

As of September 30, 2024 and December 31, 2023, the fair value of the Company’s interest rate swap agreements reflected

an asset balance of $12.8 million and $25.1 million, respectively. The following table presents the fair value of the

Company’s interest rate swap agreements as recorded in the unaudited condensed consolidated balance sheets (in thousands):

Classification September 30, 2024 December 31, 2023
Other current assets $9,530 $15,966
Other assets 3,310 9,100
Fair value $12,840 $25,066

6. Income Taxes

The Company’s tax provisions for the three months ended September 30, 2024 and 2023 were income tax expense of $11.1

million, which equates to an effective tax rate of 19.4%, and $7.3 million, which equates to an effective tax rate of 15.8%,

respectively. The Company’s tax provisions for the nine months ended September 30, 2024 and 2023 were income tax

expense of $37.0 million, which equates to an effective tax rate of 18.9%, and $24.6 million, which equates to an effective

tax rate of 17.2%, respectively.

The Company follows the provisions of ASC 740, Income Taxes, regarding uncertain tax positions. At September 30, 2024

and December 31, 2023, the Company had a liability for uncertain tax positions of $12.1 million. The Company believes that

it is reasonably possible that the reserve for uncertain tax positions will change in the coming 12 months as a result of being

within the applicable statute of limitations with respect to uncertain tax positions.

As of September 30, 2024, the Company had no ongoing or pending federal examinations for prior years. The Company has

outstanding federal income tax refund claims for the 2016 and 2018 tax years. Since the total amount of refund claims is

equal to $10.0 million, which was classified within other current assets on the Company’s unaudited condensed consolidated

balance sheet at September 30, 2024, the refund claims are subject to ongoing Joint Committee on Taxation reviews. The

Company’s tax years from 2021 through 2023 remain open to examination by federal and state taxing authorities.

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7.  Self-Insured Liabilities

The liabilities for professional, general, workers’ compensation and occupational injury liability risks are based on actuarially

determined estimates. Such liabilities represent the estimated ultimate cost of all reported and unreported losses incurred

through the respective balance sheet dates. The Company provides an accrual for actuarially determined claims reported but

not paid and estimates of claims incurred but not reported.

Professional and General Liability

The total costs for professional and general liability losses are based on the Company’s premiums and retention costs, and

were $15.6 million and $13.7 million for the three months ended September 30, 2024 and 2023, respectively, and were $50.5

million and $40.9 million for the nine months ended September 30, 2024 and 2023, respectively.

Workers' Compensation and Occupational Injury Liability

The total costs for workers’ compensation liability insurance are based on the Company’s premiums and retention costs, and

were $2.4 million and $2.5 million for the three months ended September 30, 2024 and 2023, respectively, and were $5.7

million and $7.6 million for the nine months ended September 30, 2024 and 2023, respectively.

8.  Employee Benefit Plans

Defined Contribution Plan

The Company maintains defined contribution retirement plans that cover its eligible employees. The Company incurred total

costs related to the retirement plans of $11.2 million and $10.3 million for the three months ended September 30, 2024 and

2023, respectively, and $36.2 million and $33.5 million for the nine months ended September 30, 2024 and 2023,

respectively.

Employee Health Plan

The Company maintains a self-insured medical and dental plan for substantially all of its employees. Amounts are accrued

under the Company’s medical and dental plans as the claims that give rise to them occur and the Company includes a

provision for incurred but not reported claims. Incurred but not reported claims are estimated based on an average lag time

and experience. Accruals are based on the estimated ultimate cost of settlement, including claim settlement expenses.

The total costs of employee health coverage were $47.2 million and $40.7 million for the three months ended September 30,

2024 and 2023, respectively, and $133.9 million and $122.9 million for the nine months ended September 30, 2024 and 2023,

respectively.

9.  Commitments and Contingencies

Litigation and Regulatory Matters

From time to time, claims and suits arise in the ordinary course of the Company’s business. The Company has been, is

currently, and may in the future be subject to claims, lawsuits, qui tam actions, civil investigative demands, subpoenas,

investigations, audits and other inquiries related to its operations. In certain of these actions, plaintiffs request punitive or

other damages against the Company that may not be covered by insurance. These claims, lawsuits, and proceedings are in

various stages of adjudication or investigation and involve a wide variety of claims and potential outcomes. Depending on

whether the underlying conduct in these or future inquiries or investigations could be considered systemic, their resolution

could have a material adverse effect on the Company’s results of operations, financial position or liquidity.

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The Company records accruals for such contingencies to the extent that the Company concludes it is probable that a liability

has been incurred and the amount of the loss can be reasonably estimated. The Company does not believe that it is party to

any proceeding that, either individually or in the aggregate, in the opinion of management, could have a material adverse

effect on the business, financial condition, results of operations or liquidity.

As a result of the Cybersecurity Incident that occurred in November 2023, three putative class actions were filed against the

Company in the U.S. District Court for the Middle District of Tennessee: Burke v. AHS Medical Holdings LLC, No. 3:23-

cv-01308; Redd v. AHS Medical Holdings, LLC, No. 3:23-cv-01342; and Epperson v. AHS Management Company, Inc.,

No. 3:24-cv-00396. These cases were consolidated by the District Court on April 24, 2024, under the caption Hodge v. AHS

Management Company, Inc., No. 3:23-cv-01308 (M.D. Tenn.). The complaint for the consolidated class action, filed on

behalf of approximately 38,000 individuals who allege their personal information and protected health information were

affected by the Cybersecurity Incident, generally asserts state common law claims of negligence, breach of implied contract,

unjust enrichment, breach of fiduciary duty, and invasion of privacy with respect to how the Company managed sensitive

data. On October 4, 2024, the Company executed a settlement agreement to resolve the consolidated class action litigation.

On October 9, 2024, the District Court preliminarily approved the settlement and set the hearing for the District Court’s final

approval of the settlement for August 1, 2025. Settlement of the consolidated case on the agreed terms will require the

Company to make cash settlement payments that will not have a material impact on the Company’s results of operations,

financial position or liquidity.

Acquisitions

The Company has acquired, and plans to continue to acquire, businesses with prior operating histories. Acquired companies

may have unknown or contingent liabilities, including liabilities for failure to comply with healthcare laws and regulations,

such as billing and reimbursement, fraud and abuse and anti-kickback laws. The Company has from time to time identified

certain past practices of acquired companies that do not conform to its standards. Although the Company institutes policies

designed to conform such practices to its standards following completion of acquisitions, there can be no assurance that the

Company will not become liable for the past activities of these acquired facilities that may later be asserted to be improper by

private plaintiffs or government agencies. Although the Company generally seeks to obtain indemnification from prospective

sellers covering such matters, there can be no assurance that any such matter will be covered by indemnification or, if

covered, that such indemnification will be adequate to cover potential losses and fines.

10.  Earnings Per Share

Basic net income per share is computed by dividing net income attributable to common stockholders by the weighted-average

number of common shares outstanding. Diluted net income per share is computed by dividing net income attributable to

common stockholders by the weighted-average number of common shares outstanding plus the dilutive effect of outstanding

securities, and such dilutive effect is computed using the treasury stock method.

For the purposes of determining the basic and diluted weighted-average number of common shares outstanding during the

periods presented that are prior to the Corporate Conversion and ALH Contribution, the Company retrospectively reflected

the effects of the Corporate Conversion and the ALH Contribution. As such, the basic and diluted weighted-average number

of common shares outstanding for those periods reflect the conversion of the Company's membership units into common

stock on the date of the Corporate Conversion and ALH Contribution, assuming that all common stock issued in conjunction

with the Corporate Conversion and ALH Contribution was issued and outstanding as of the beginning of the earliest period

presented.

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The following table sets forth the computation of basic and diluted net income per share (in thousands, except share and per

share amounts):

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
2024 2023 2024 2023
Basic:
Net income attributable to common stockholders $26,322 $20,838 $96,139 $58,057
Weighted-average number of common shares 137,107,595 126,115,301 129,877,510 126,115,301
Net income per common share $0.19 $0.17 $0.74 $0.46
Diluted:
Net income attributable to common stockholders $26,322 $20,838 $96,139 $58,057
Weighted-average number of common shares 137,542,995 126,115,301 130,022,643 126,115,301
Net income per common share $0.19 $0.17 $0.74 $0.46

The following table sets forth the components of the denominator for the computation of basic and diluted net income per

share for net income attributable to Ardent Health Partners, Inc. stockholders:

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
2024 2023 2024 2023
Weighted-average number of common shares - basic 137,107,595 126,115,301 129,877,510 126,115,301
Effect of dilutive securities(1) 435,400 145,133
Weighted-average number of common shares - diluted 137,542,995 126,115,301 130,022,643 126,115,301

(1) The effect of dilutive securities does not reflect 370,579 and 123,526 weighted-average potential common shares from restricted stock awards and

restricted stock units for the three and nine months ended September 30, 2024, respectively, because their effect was antidilutive as calculated under

the treasury stock method.

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ITEM 2.  MANAGEMENT'S DISCUSSION AND ANALYSIS OF FINANCIAL CONDITION AND

RESULTS OF OPERATIONS

Management's discussion and analysis of our financial condition and results of operations should be read in conjunction with

our interim unaudited condensed consolidated financial statements and related notes contained elsewhere in this Quarterly

Report on Form 10-Q for the quarter ended September 30, 2024 (this "Quarterly Report") and our annual financial

statements for the year ended December 31, 2023 included in our final prospectus dated July 17, 2024, filed with the

Securities and Exchange Commission (the "SEC") on July 18, 2024 pursuant to Rule 424(b) (the "Final Prospectus") under

the Securities Act of 1933, as amended (the "Securities Act"). The following discussion includes forward-looking statements

that involve risks and uncertainties, as well as assumptions that, if they never materialize or prove incorrect, could cause our

results to differ materially from those expressed or implied by such forward-looking statements.  When reviewing the

discussion below, you should keep in mind the substantial risks and uncertainties that could impact our business. In

particular, we encourage you to review the risks and uncertainties described in the section titled “Risk Factors” included

elsewhere in this Quarterly Report and our Final Prospectus. These risks and uncertainties could cause actual results to

differ materially from those projected in forward-looking statements contained in this Quarterly Report or implied by past

results and trends. Our historical results are not necessarily indicative of the results that may be expected for any period in

the future, and our interim results are not necessarily indicative of the results we expect for the full fiscal year or any other

period.

Unless otherwise indicated, all relevant financial and statistical information included herein relates to our consolidated

operations. Additionally, unless the context indicates otherwise, Ardent Health Partners, Inc. and its affiliates are referred to

in this section as “we,” “our,” or “us.”

Forward-Looking Statements

This Quarterly Report may contain certain “forward-looking statements,” as that term is defined in the U.S. federal securities

laws. These forward-looking statements include, but are not limited to, statements other than statements of historical facts,

including, among others, statements relating to our future financial performance, our business prospects and strategy,

anticipated financial position, liquidity and capital needs, the industry in which we operate and other similar matters. Words

such as “anticipates,” “expects,” “intends,” “plans,” “predicts,” “believes,” “seeks,” “estimates,” “could,” “would,” “will,”

“may,” “can,” “continue,” “potential,” “should” and the negative of these terms or other comparable terminology often

identify forward-looking statements. These forward-looking statements are not guarantees of future performance and are

subject to risks and uncertainties that could cause actual results to differ materially from the results contemplated by the

forward-looking statements, including the risk factors and other cautionary statements described under the heading “Risk

Factors” included in this Quarterly Report and those included within our Final Prospectus. Factors, risks, and uncertainties

that could cause actual outcomes and results to be materially different from those contemplated include, among others: (1)

changes in government healthcare programs, including Medicare and Medicaid and supplemental payment programs and

state directed payment arrangements; (2) reduction in the reimbursement rates paid by commercial payors, our inability to

retain and negotiate favorable contracts with private third-party payors, or an increasing volume of uninsured or underinsured

patients; (3) the highly competitive nature of the healthcare industry; (4) inability to recruit and retain quality physicians, as

well as increasing cost to contract with hospital-based physicians; (5) increased labor costs resulting from increased

competition for staffing or a continued or increased shortage of experienced nurses; (6) changes to physician utilization

practices and treatment methodologies and third-party payor controls designed to reduce inpatient services or surgical

procedures that impact demand for medical services; (7) continued industry trends toward value-based purchasing, third party

payor consolidation and care coordination among healthcare providers; (8) loss of key personnel, including key members of

our senior management team; (9) our failure to comply with complex laws and regulations applicable to the healthcare

industry or to adjust our operations in response to changing laws and regulations; (10) inability to successfully complete

acquisitions or strategic joint ventures ("JVs") or inability to realize all of the anticipated benefits, including anticipated

synergies, of past acquisitions and the risk that transactions may not receive necessary government clearances; (11) failure to

maintain existing relationships with JV partners or enter into relationships with additional healthcare system partners; (12) the

impact of known and unknown claims brought against our hospitals, physician practices, outpatient facilities or other

business operations or against healthcare providers who provide services at our facilities; (13) the impact of government

investigations, claims, audits, whistleblower and other litigation; (14) the impact of any security incidents affecting us or any

third-party vendor upon which we rely; (15) inability or delay in our efforts to construct, acquire, sell, renovate or expand our

healthcare facilities; (16) our failure to comply with federal and state laws relating to Medicare and Medicaid enrollment,

permit, licensing and accreditation requirements, or the expansion of existing or the enactment of new laws or regulation

relating to permit, licensing and accreditation requirements; (17) failure to obtain drugs and medical supplies at favorable

prices or sufficient volumes; (18) operational, legal and financial risks associated with outsourcing functions to third parties;

(19) sensitivity to regulatory, economic and competitive conditions in the states in which our operations are heavily

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concentrated; (20) decreased demand for our services provided due to factors beyond our control, such as seasonal

fluctuations in the severity of critical illnesses, pandemic, epidemic or widespread health crisis; (21) inability to accurately

estimate market opportunity and forecasts of market growth; (22) general economic and business conditions, both nationally

and in the regions in which we operate; (23) the impact of seasonal or severe weather conditions and climate change; (24)

inability to demonstrate meaningful use of Electronic Health Record ("EHR") technology; (25) inability to continually

enhance our hospitals with the most recent technological advances in diagnostic and surgical equipment; (26) effects of

current and future health reform initiatives, including the Affordable Care Act, and the potential for changes to the Affordable

Care Act, its implementation or its interpretation (including through executive orders and court challenges); (27) legal and

regulatory restrictions on certain of our hospitals that have physician owners; (28) risks related to the Ventas Master Lease

and its restrictions and limitations on our business; (29) the impact of our significant indebtedness, including our ability to

comply with certain debt covenants and other significant operating and financial restrictions imposed on us by the agreements

governing our indebtedness, and the effects that variable interest rates, and general economic factors could have on our

operations, including our potential inability to service our indebtedness; (30) conflicts of interest with certain of our existing

large stockholders; (31) effects of changes in federal tax laws; (32) increased costs as a result of operating as a public

company; (33) risks related to maintaining an effective system of internal controls; (34) volatility of our share price and size

of the public market for our common stock; (35) our guidance differing from actual operating and financial performance; (36)

the results of our efforts to use technology, including artificial intelligence, to drive efficiencies and quality initiatives and

enhance patient experience; (37) the impact of recent decisions of the U.S. Supreme Court regarding the actions of federal

agencies; and (38) other risk factors described in our filings with the SEC.

We caution you that the foregoing list may not contain all of the forward-looking statements made in this Quarterly Report.

You should not rely upon forward-looking statements as predictions of future events.

The forward-looking statements in this Quarterly Report are based on management’s current beliefs, expectations, and

projections about future events and trends affecting our business, results of operations, financial condition, and prospects.

These statements are subject to risks, uncertainties, and other factors described in the “Risk Factors” section and elsewhere in

this Quarterly Report. We operate in a competitive and rapidly changing environment where new risks and uncertainties can

emerge, making it impossible to predict all potential impacts on our forward-looking statements. Consequently, actual results

may differ materially from those described. The forward-looking statements pertain only to the date they are made, and we do

not undertake any obligation to update them to reflect new information or events unless required by law. You are advised not

to place undue reliance on these statements and to consult any additional disclosures we may provide through our other

filings with the SEC, such as Annual Reports on Form 10-K, Quarterly Reports on Form 10-Q, and Current Reports on Form

8-K.

Overview

Ardent is a leading provider of healthcare services in the United States, operating in eight growing mid-sized urban markets

across six states: Texas, Oklahoma, New Mexico, New Jersey, Idaho and Kansas. We deliver care through a system of 30

acute care hospitals and more than 200 sites of care with 1,808 employed and affiliated providers as of September 30, 2024,

an increase of 3.3% compared to September 30, 2023. Affiliated providers are physicians and advanced practice providers

with whom we contract for services through a professional services agreement or other independent contractor agreement.

We hold a leading position in a majority of our markets, and we believe we are one of the leading healthcare systems based

on market share and our integrated network of hospitals, ambulatory facilities, and physician practices. We operate either

independently or in partnership with premier academic medical centers, large not-for-profit hospital systems, community

physicians, and a community foundation through our well-established and differentiated JV model. Collectively, we operate

as a unified organization with a consumer-centric approach to caring for our patients and our communities. Our strategic JV

partners offer us significant advantages, including expanded access points, clinical talent availability, local brand recognition,

and scale that enable us to accelerate market penetration. We believe that we help our partners enhance their network and

regional presence through our operational acumen. We strive to strengthen clinical services, drive operating improvements,

and centrally manage operations to optimize hospital performance and enhance patient care. In each of these partnerships, we

are the majority owner and serve as the day-to-day operator.

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Recent Developments

Term Loan B Facility Repricing

On September 18, 2024, we executed an amendment to reprice our Term Loan B Facility credit agreement (the "Term Loan

B Credit Agreement"). The repricing reduced the applicable interest rate by 50 basis points from Term SOFR plus 3.25% to

Term SOFR plus 2.75% and eliminated the credit spread adjustment. No modifications were made to the maturity of the

loans as a result of the repricing and all other terms were substantially unchanged.

Initial Public Offering and Corporate Conversion

On July 19, 2024, we completed an initial public offering of 12,000,000 shares of our common stock (the "IPO"), at a public

offering price of $16.00 per share for aggregate gross proceeds of $192.0 million and net proceeds of approximately

$181.4 million after deducting underwriting discounts and commissions of approximately $10.6 million. The IPO provided

the underwriters with an option to purchase up to an additional 1,800,000 shares of our common stock, which was fully

exercised by the underwriters, and, on July 30, 2024, we issued 1,800,000 additional shares of common stock at $16.00 per

share for additional net proceeds of approximately $27.2 million, after deducting underwriting discounts and commissions of

approximately $1.6 million. Our common stock is listed on the New York Stock Exchange under the symbol “ARDT”.

On July 17, 2024, in connection with the IPO and immediately prior to the effectiveness of our registration statement on

Form S-1, we converted from a Delaware limited liability company into a Delaware corporation by means of a statutory

conversion (the “Corporate Conversion”) and changed our name to Ardent Health Partners, Inc. As a result of the Corporate

Conversion, the outstanding limited liability company membership units and vested profits interest units were converted into

120,937,099 shares of common stock and outstanding unvested profits interest units were converted into 2,848,027 shares of

restricted common stock. Immediately following the Corporate Conversion, ALH Holdings, LLC, a subsidiary of Ventas, Inc.

("Ventas"), contributed all of its outstanding common stock in AHP Health Partners, Inc. ("AHP Health Partners"), our direct

subsidiary, to Ardent Health Partners, Inc. in exchange for 5,178,202 shares of common stock of Ardent Health Partners, Inc.

(the "ALH Contribution"). The Corporate Conversion and the ALH Contribution have been retrospectively applied to prior

periods herein for the purposes of calculating basic and diluted net income per share. Our certificate of incorporation

authorizes 750,000,000 shares of common stock and 50,000,000 shares of preferred stock, each with a $0.01 par value per

share.

ABL Credit Agreement Amendment and Term Loan B Facility Prepayment

On June 26, 2024, we executed an amendment to our ABL Credit Agreement to increase the revolving commitment by

$100.0 million to $325.0 million and extend the maturity date to June 26, 2029. Concurrent with the execution of this

amendment on June 26, 2024, we also prepaid $100.0 million of the outstanding principal on our Term Loan B Facility. The

$100.0 million prepayment was applied in direct order of maturities of future payments, and no modification was made to the

Term Loan B Facility as a result of this prepayment.

2024 Supplemental Payment Program Updates

A new Oklahoma directed payment program (the “Oklahoma DPP”) became effective on April 1, 2024. Under the Oklahoma

DPP, hospitals receive directed payments in accordance with Oklahoma’s new Medicaid managed care delivery system,

resulting in reimbursement near the average commercial rate. The existing upper payment limit component of Oklahoma’s

Supplemental Hospital Offset Payment Program will remain in place for certain categories of Medicaid patients that continue

to be enrolled in Oklahoma’s traditional Medicaid Fee for Service program. We have recognized total revenue of $48.6

million under the Oklahoma DPP from the April 1, 2024 effective date through September 30, 2024.

In March 2024, New Mexico’s Healthcare Delivery and Access Act (the “New Mexico HDA Act”) was signed into law.

Subject to approval by the Center for Medicare & Medicaid Services (“CMS”), the New Mexico HDA Act would provide

directed payments for hospitals that serve patients in New Mexico’s Medicaid managed care delivery system, resulting in

reimbursement near the average commercial rate, and once approved, is expected to represent a material rate uplift for us.

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The directed payment program under the New Mexico HDA Act was submitted to CMS for approval on August 5, 2024, with

a requested effective date of July 1, 2024. The program is still under CMS review.

We believe the preliminary estimate of our net benefit under the Oklahoma DPP and the New Mexico HDA Act to be in

excess of $150 million on an annualized basis, subject to change, non-recurrence, and adjustment for potential quality

performance requirements.

Cybersecurity Incident

In November 2023, we determined that a ransomware cybersecurity incident had impacted and disrupted a number of our

operational and information technology systems (the “Cybersecurity Incident”).  Upon detecting the ransomware, we quickly

activated our incident response protocols and implemented a series of containment and remediation measures, including

engaging the services of cybersecurity experts and incident response professionals. We also promptly launched an

investigation, engaged external counsel to support the investigation and involved federal and state law enforcement. During

this time, our hospitals remained operational and continued to deliver patient care utilizing established downtime procedures;

however, we advised local EMS systems and other providers to divert emergency ambulance transports to other facilities for

a few days until the Cybersecurity Incident had been contained. As a result of our investigation, we determined that the

unauthorized actor acquired a copy of certain personal information and protected health information of a limited number of

our patients and personal information of certain of our employees, but did not gain access to our EHR platform. We have

cooperated with law enforcement authorities that have made inquiries into the Cybersecurity Incident, and we have been in

contact with, and complied with, the requirements of various governmental authorities that require notification of such

incidents. Additionally, because of the time taken to contain and remediate the Cybersecurity Incident, our online electronic

billing systems were not functioning at their full capacities and certain billing, reimbursement and payment functions were

delayed.

We estimate the Cybersecurity Incident had an adverse pre-tax impact of approximately $74 million during the year ended

December 31, 2023. This estimate includes lost revenue from the associated business interruption and costs to remediate the

issue, net of insurance proceeds. For the three months ended December 31, 2023, we also experienced decreases in

admissions, surgeries (both inpatient and outpatient) and emergency room visits of 2.5%, 2.1% and 5.7%, respectively,

compared to the three months ended December 31, 2022, which, prior to the Cybersecurity Incident, were estimated to have

increased by 4.1%, 5.5% and 3.3%, respectively, compared to the same period in 2022. While our operations were no longer

materially disrupted as of September 30, 2024, we continued to experience delays in billing claims and obtaining

reimbursements and payments through the first quarter of 2024, and will incur certain expenses related to the Cybersecurity

Incident, including expenses to defend claims brought by individuals and other expenses related to the Cybersecurity

Incident. On October 4, 2024, we executed a settlement agreement to resolve the consolidated class action litigation. On

October 9, 2024, the Court preliminarily approved the settlement and set the hearing for the Court’s final approval of the

settlement for August 1, 2025. Settlement of the consolidated case on the agreed terms will require us to make cash

settlement payments that will not have a material impact on our results of operations, financial position or liquidity.

Pure Health Equity Investment

On May 1, 2023, an affiliate of Pure Health Holding PJSC (“Pure Health”) purchased an equity interest representing 25.0%

of the total combined voting power of Ardent Health Partners, LLC from the unit holders at the time for approximately $500

million. In connection with Pure Health’s investment, unit holders were eligible to exercise tag-along rights to sell a

proportionate share of their individual equity ownership interest in Ardent Health Partners, LLC and AHP Health Partners,

our direct subsidiary. Ventas, a common unit holder that beneficially owned a percentage of our outstanding membership

interests and maintained a seat on our board of managers, making Ventas a related party, exercised its tag-along right to sell

its proportionate share of interest in both Ardent Health Partners, LLC and AHP Health Partners. Ventas sold approximately

24% of its ownership interest in Ardent Health Partners, LLC for $24.2 million in total cash proceeds. Additionally, to fulfill

Ventas’ right to sell its proportionate share of noncontrolling ownership interest in AHP Health Partners, we exercised our

right to repurchase those shares from Ventas for $26.0 million concurrent with Pure Health’s purchase of a minority interest

in Ardent Health Partners, LLC. The carrying value of Ventas’ noncontrolling interest was adjusted proportionate to the

shares repurchased to reflect the change in ownership of AHP Health Partners, with the difference between the fair value of

the consideration paid and the amount by which noncontrolling interest was adjusted recognized in equity attributable to

Ardent Health Partners, LLC. As of September 30, 2024, following the consummation of the IPO and the underwriters'

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exercise of their option to purchase additional shares, Pure Health and Ventas beneficially owned approximately 21.2% and

6.5%, respectively, of our outstanding common stock.

Key Factors Impacting Our Results of Operations

Staffing and Labor Trends

Our operations are dependent on the efforts, abilities and experience of our management and medical support personnel, such

as nurses, pharmacists and lab technicians, as well as our physicians. We compete with other healthcare providers in

recruiting and retaining qualified management and support personnel responsible for the daily operations of each of our

hospitals and other facilities, including nurses and other non-physician healthcare professionals. At times, the availability of

nurses and other medical support personnel has been a significant operating issue for healthcare providers, including at

certain of our facilities. The impact of labor shortages across the healthcare industry may result in other healthcare facilities,

such as nursing homes, limiting admissions, which may constrain our ability to discharge patients to such facilities and

further exacerbate the demand on our resources, supplies and staffing.

We contract with various third parties who provide hospital-based physicians. Third-party providers of hospital-based

physicians, including those with whom we contract, have experienced significant disruption in the form of regulatory

changes, including those stemming from enactment of the No Surprises Act, challenging labor market conditions resulting

from a shortage of physicians and inflationary wage-related pressures, as well as increased competition through consolidation

of physician groups. In some instances, providers of outsourced medical specialists have become insolvent and unable to

fulfill their contracts with us for providing hospital-based physicians. The success of our hospitals depends in part on the

adequacy of staffing, including through contracts with third parties. If we are unable to adequately contract with providers, or

the providers with whom we contract become unable to fulfill their contracts, our admissions may decrease, and our operating

performance, capacity and growth prospects may be adversely affected. Further, our efforts to mitigate the potential impact

on our business from third-party providers who are unable to fulfill their contracts to provide hospital-based physicians,

including through acquisitions of outsourced medical specialist businesses, employment of physicians and re-negotiation or

assumption of existing contracts, may be unsuccessful. These developments with respect to providers of outsourced medical

specialists, and our inability to effectively respond to and mitigate the potential impact of such developments, may disrupt our

ability to provide healthcare services, which may adversely impact our business, financial condition and results of operations.

We also depend on the available labor pool of semi-skilled and unskilled employees in each of the markets in which we

operate. In some of our markets, employers across various industries have increased minimum wages, which has created

more competition and, in some cases, higher labor costs for this sector of employees.

Seasonality

We typically experience higher patient volumes and revenue in the fourth quarter of each year in our acute care facilities. We

typically experience such seasonal volume and revenue peaks because more people generally become ill during the winter

months, which in turn results in significant increases in the number of patients we treat during those months. In addition,

revenue in the fourth quarter is also impacted by increased utilization of services due to annual deductibles, which are not

usually met until later in the year, and patient utilization of their healthcare benefits before they expire at year-end.

Inflation

The healthcare industry is labor intensive. Wages and other expenses increase during periods of inflation and when labor

shortages occur in the marketplace. In addition, our suppliers pass along rising costs to us in the form of higher prices. We

have implemented cost control measures to curb increases in operating costs and expenses. We have generally offset

increases in operating costs by increasing reimbursement for services, expanding services and reducing costs in other areas.

However, we cannot predict our ability to cover or offset future cost increases, particularly any increases in our cost of

providing health insurance benefits to our employees.

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Geographic Data

The information below provides an overview of our operations in certain markets as of September 30, 2024.

Texas. We operated 13 acute care hospital facilities (including one managed hospital that is owned by The University of

Texas Health Science Center at Tyler, an affiliate of The University of Texas System) with 1,436 licensed beds that serve the

areas of Tyler, Amarillo and Killeen, Texas. For the nine months ended September 30, 2024, we generated 36.4% of our total

revenue in the Texas market.

Oklahoma. We operated eight acute care hospital facilities with 1,173 licensed beds that serve the area of Tulsa, Oklahoma.

For the nine months ended September 30, 2024, we generated 24.8% of our total revenue in the Oklahoma market.

New Mexico. We operated five acute care hospital facilities with 619 licensed beds that serve the areas of Albuquerque and

Roswell, New Mexico. For the nine months ended September 30, 2024, we generated 14.6% of our total revenue in the New

Mexico market.

New Jersey. We operated two acute care hospital facilities with 476 licensed beds that serve the areas of Montclair and

Westwood, New Jersey. For the nine months ended September 30, 2024, we generated 10.2% of our total revenue in the New

Jersey market.

Other Industry Trends

The demand for healthcare services continues to be impacted by the following trends:

•A growing focus on healthcare spending by consumers, employers and insurers, who are actively seeking lower-cost

care solutions;

•A shift in patient volumes from inpatient to outpatient settings due to technological advancements and demand for

care that is more convenient, affordable and accessible;

•The growing aged population, which requires greater chronic disease management and higher-acuity treatment; and

•Ongoing consolidation of providers and insurers across the healthcare industry.

Additionally, the healthcare industry, particularly acute care hospitals, continues to be subject to ongoing regulatory

uncertainty. Changes in federal or state healthcare laws, regulations, funding policies or reimbursement practices, especially

those involving reductions to government payment rates or limitations on what providers may charge, could significantly

impact future revenue and operations. For example, the No Surprises Act prohibits providers from charging patients an

amount beyond the in-network cost sharing amount for services rendered by out-of-network providers, subject to limited

exceptions. For services for which balance billing is prohibited, the No Surprises Act includes provisions that may limit the

amounts received by out-of-network providers from health plans. Any reduction in the rates that we can charge or amounts

we can receive for our services will reduce our total revenue and our operating margins.

Results of Operations

Revenue and Volume Trends

Our revenue depends upon inpatient occupancy levels, ancillary services and therapy programs ordered by physicians and

provided to patients, the volume of outpatient procedures and the charges and negotiated payment rates for such services.

Total revenue is comprised of net patient service revenue and other revenue. We recognize patient service revenue in the

period in which we provide services. Patient service revenue includes amounts we estimate to be reimbursable by Medicare,

Medicaid and other payors under provisions of cost or prospective reimbursement formulas in effect. The amounts we receive

from these payors are generally less than the established billing rates, and we report patient service revenue net of these

differences (contractual adjustments) at the time we render the services. We also report patient service revenue net of the

effects of other arrangements where we are reimbursed for services at less than established rates, including certain self-pay

adjustments provided to uninsured patients. We also record estimated implicit price concessions (based primarily on

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historical collection experience) related to uninsured accounts to record self-pay revenue at the estimated amount expected to

be collected.

Total revenue for the three months ended September 30, 2024 increased $72.1 million, or 5.2%, compared to the same prior

year period. The increase in total revenue for the three months ended September 30, 2024 consisted of an increase in adjusted

admissions of 3.8% and an increase in net patient service revenue per adjusted admission of 0.9%. The increase in adjusted

admissions was primarily driven by growth in admissions of 6.4% compared to the same prior year period.  Outpatient

surgeries increased 0.2% compared to the same prior year period. Outpatient surgery growth was limited, in part, by ongoing

service line optimization efforts that resulted in strategic reallocation of resources from high volume, low margin procedures,

such as certain dental, otolaryngology and ophthalmology procedures, to alternate higher margin service lines. The increase

in net patient service revenue per adjusted admission was attributable to a combination of a favorable payor mix and

improved service mix as a result of ongoing service line optimization efforts, partially offset by a decrease in supplemental

funding as compared to the same prior year period.

Total revenue for the nine months ended September 30, 2024 increased $296.3 million, or 7.3%, compared to the same prior

year period. The increase in total revenue for the nine months ended September 30, 2024 consisted of an increase in adjusted

admissions of 3.5% and an increase in net patient service revenue per adjusted admission of 3.6%.  The increase in adjusted

admissions reflected growth in admissions of 5.6%, partially offset by a decrease in outpatient surgeries of 1.7% compared to

the same prior year period, driven, in part, by ongoing service line optimization efforts that resulted in strategic reallocation

of resources from high volume, low margin procedures, such as certain dental, otolaryngology and ophthalmology

procedures, to alternate higher margin service lines. The increase in net patient service revenue per adjusted admission was

attributable to a combination of a favorable payor mix, improved service mix as a result of ongoing service line optimization

efforts, and an increase in supplemental funding as compared to the same prior year period.

A key competitive strength and a significant component of our growth strategy has been our well-established and

differentiated JV model, which has resulted in partnerships with premier academic medical centers, large not-for-profit

hospital systems, community physicians, and a community foundation. During the three months ended September 30, 2024

and 2023, total revenue related to these JVs was $429.9 million and $394.8 million, respectively, which represented 29.7%

and 28.7%, respectively, of our total revenue for such periods. During the nine months ended September 30, 2024 and 2023,

total revenue related to these entities was $1,281.0 million and $1,203.4 million, respectively, which represented 29.4% and

29.6%, respectively, of our total revenue for such periods.

The following table provides the sources of our total revenue by payor:

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
2024 2023 2024 2023
Medicare 38.7% 39.0% 39.3% 39.6%
Medicaid 10.2% 11.0% 10.6% 11.3%
Other managed care 43.3% 42.7% 43.0% 42.2%
Self-pay and other 5.5% 5.5% 5.2% 5.1%
Net patient service revenue 97.7% 98.2% 98.1% 98.2%
Other revenue 2.3% 1.8% 1.9% 1.8%
Total revenue 100.0% 100.0% 100.0% 100.0%

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Operating Results Summary for the Three Months Ended September 30, 2024

The following table sets forth the consolidated results of our operations expressed in dollars and as a percentage of total

revenue for the periods presented.

Three Months Ended September 30,
(Unaudited, dollars in thousands) 2024 2023
Amount % Amount %
Total revenue $1,449,817 100.0% $1,377,727 100.0%
Expenses:
Salaries and benefits 635,223 43.8% 595,580 43.2%
Professional fees 274,223 18.9% 246,540 17.9%
Supplies 251,862 17.4% 249,548 18.1%
Rents and leases 26,410 1.8% 24,506 1.8%
Rents and leases, related party 37,249 2.6% 36,413 2.6%
Other operating expenses 117,700 8.2% 124,642 9.1%
Interest expense 14,629 1.0% 19,041 1.4%
Depreciation and amortization 36,771 2.5% 35,488 2.6%
Loss on extinguishment and modification of debt 1,490 0.1% 0.0%
Other non-operating gains (2,807) (0.2)% 0.0%
Total operating expenses 1,392,750 96.1% 1,331,758 96.7%
Income before income taxes 57,067 3.9% 45,969 3.3%
Income tax expense 11,062 0.7% 7,261 0.5%
Net income 46,005 3.2% 38,708 2.8%
Net income attributable to noncontrolling interests 19,683 1.4% 17,870 1.3%
Net income attributable to Ardent Health Partners, Inc. $26,322 1.8% $20,838 1.5%

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Operating Results Summary for the Nine Months Ended September 30, 2024

The following table sets forth, for the periods indicated, the consolidated results of our operations expressed in dollars and as

a percentage of total revenue for the periods presented.

Nine Months Ended September 30,
(Unaudited, dollars in thousands) 2024 2023
Amount % Amount %
Total revenue $4,359,783 100.0% $4,063,449 100.0%
Expenses:
Salaries and benefits 1,880,790 43.1% 1,785,939 44.0%
Professional fees 810,820 18.6% 715,111 17.6%
Supplies 769,034 17.6% 743,713 18.3%
Rents and leases 76,251 1.7% 73,230 1.8%
Rents and leases, related party 111,413 2.6% 108,914 2.7%
Other operating expenses 354,851 8.2% 342,026 8.3%
Government stimulus income 0.0% (8,463) (0.2)%
Interest expense 52,050 1.2% 55,854 1.4%
Depreciation and amortization 108,434 2.5% 104,860 2.6%
Loss on extinguishment and modification of debt 3,388 0.1% 0.0%
Other non-operating gains (3,062) (0.1)% (522) 0.0%
Total operating expenses 4,163,969 95.5% 3,920,662 96.5%
Income before income taxes 195,814 4.5% 142,787 3.5%
Income tax expense 36,997 0.9% 24,591 0.6%
Net income 158,817 3.6% 118,196 2.9%
Net income attributable to noncontrolling interests 62,678 1.4% 60,139 1.5%
Net income attributable to Ardent Health Partners, Inc. $96,139 2.2% $58,057 1.4%

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The following table provides information on certain drivers of our total revenue:

Three Months Ended September 30, Nine Months Ended September 30,
2024 % Change 2023 2024 % Change 2023
Operating Statistics
Total revenue (in thousands) $1,449,817 5.2% $1,377,727 $4,359,783 7.3% $4,063,449
Hospitals operated (at period end) (1) 30 (3.2)% 31 30 (3.2)% 31
Licensed beds (at period end) (2) 4,287 (0.8)% 4,323 4,287 (0.8)% 4,323
Utilization of licensed beds (3) 46% 4.5% 44% 46% 2.2% 45%
Admissions (4) 39,568 6.4% 37,191 116,995 5.6% 110,754
Adjusted admissions (5) 86,833 3.8% 83,643 254,909 3.5% 246,298
Inpatient surgeries (6) 8,871 0.5% 8,826 26,829 0.3% 26,751
Outpatient surgeries (7) 23,220 0.2% 23,164 69,201 (1.7)% 70,417
Emergency room visits (8) 161,343 2.6% 157,182 475,212 3.7% 458,160
Patient days (9) 182,023 4.8% 173,687 540,196 2.6% 526,634
Total encounters (10) 1,482,655 7.5% 1,378,599 4,304,097 4.7% 4,109,144
Average length of stay (11) 4.60 (1.5)% 4.67 4.62 (2.7)% 4.75
Net patient service revenue per adjusted admission (12) $16,312 0.9% $16,174 $16,784 3.6% $16,206

(1)“Hospitals operated (at period end).” This metric represents the total number of hospitals operated by us at the end of the applicable period, irrespective of

whether the hospital real estate is (i) owned by us, (ii) leased by us or (iii) held through a controlling interest in a JV. This metric includes the managed clinical

operations of the hospital at UT Health North Campus in Tyler, Texas (“UT Health North Campus Tyler”), a hospital owned by The University of Texas Health

Science Center at Tyler (“UTHSCT”), an affiliate of The University of Texas System. Since we only manage the clinical operations of UT Health North

Campus Tyler, the financial results of such entity are not consolidated under Ardent Health Partners, Inc.

On April 30, 2024, we closed UT Health East Texas Specialty Hospital, a long-term acute care hospital (the “LTAC Hospital”) in Tyler, Texas. The LTAC

Hospital's inventory and fixed assets were transferred or repurposed to be used by our other hospitals. The LTAC Hospital had 36 licensed patient beds and

accounted for approximately $0.0 million and $2.2 million of total revenue and a pre-tax loss of $0.2 million and $0.5 million for the three months ended

September 30, 2024 and 2023, respectively, and approximately $2.4 million and $8.0 million of total revenue and a pre-tax loss of $0.8 million and $0.5 million

for the nine months ended September 30, 2024 and 2023, respectively.

(2)“Licensed beds (at period end).” This metric represents the total number of beds for which the appropriate state agency licenses a facility, regardless of whether

the beds are actually available for patient use.

(3)“Utilization of licensed beds.” This metric represents a measure of the actual utilization of our inpatient facilities, computed by (i) dividing patient days by the

number of days in each period, and (ii) further dividing that number by average licensed beds, which is calculated by dividing total licensed beds (at period end)

by the number of days in the period, multiplied by the number of days in the period the licensed beds were in existence.

(4)“Admissions.” This metric represents the number of patients admitted for inpatient treatment during the applicable period.

(5)“Adjusted admissions.” This metric is used by management as a general measure of combined inpatient and outpatient volume. Adjusted admissions provides

management with a key performance indicator that considers both inpatient and outpatient volumes by applying an inpatient volume measure (admissions) to a

ratio of gross inpatient and outpatient revenue to gross inpatient revenue. Gross inpatient and outpatient revenue reflect gross inpatient and outpatient charges

prior to estimated contractual adjustments, uninsured discounts, implicit price concessions, and other discounts. The calculation of adjusted admissions is

summarized as follows:

Adjusted Admissions  =  Admissions  x  (Gross Inpatient Revenue + Gross Outpatient Revenue)

Gross Inpatient Revenue

(6)“Inpatient surgeries.” This metric represents the number of surgeries performed on patients who have been admitted to our hospitals. Pain management, c-

sections, and certain diagnostic procedures are excluded from inpatient surgeries.

(7)“Outpatient surgeries.” This metric represents the number of surgeries performed on patients who have not been admitted to our hospitals. Pain management, c-

sections, and certain diagnostic procedures are excluded from outpatient surgeries.

(8)“Emergency room visits.” This metric represents the total number of patients provided with emergency room treatment during the applicable period.

(9)“Patient days.” This metric represents the total number of days of care provided to patients admitted to our hospitals during the applicable period.

(10)“Total encounters.” This metric represents the total number of events where healthcare services are rendered resulting in a billable event during the applicable

period. This includes both hospital and ambulatory patient interactions.

(11)“Average length of stay.” This metric represents the average number of days admitted patients stay in our hospitals.

(12)“Net patient service revenue per adjusted admission.” This metric represents net patient service revenue divided by adjusted admissions for the applicable

period. Net patient service revenue reflects gross inpatient and outpatient charges less estimated contractual adjustments, uninsured discounts, implicit price

concessions, and other discounts.

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Overview of the Three Months Ended September 30, 2024

Total revenue for the three months ended September 30, 2024 increased $72.1 million, or 5.2%, compared to the same prior

year period. The increase in total revenue for the three months ended September 30, 2024 consisted of an increase in adjusted

admissions of 3.8% and an increase in net patient service revenue per adjusted admission of 0.9%. The increase in adjusted

admissions was primarily driven by growth in admissions of 6.4% compared to the same prior year period.  Outpatient

surgeries increased 0.2% compared to the same prior year period.  Outpatient surgery growth was limited, in part, by ongoing

service line optimization efforts that resulted in strategic reallocation of resources from high volume, low margin procedures,

such as certain dental, otolaryngology and ophthalmology procedures, to alternate higher margin service lines. The increase

in net patient service revenue per adjusted admission was attributable to a combination of a favorable payor mix and

improved service mix as a result of ongoing service line optimization efforts, partially offset by a decrease in supplemental

funding as compared to the same prior year period.

Total operating expenses increased $61.0 million for the three months ended September 30, 2024 compared to the same prior

year period due to higher patient volumes but decreased 0.6% as a percentage of total revenue. The decrease in total operating

expenses, as a percentage of total revenue, was driven by decreases in other operating expenses and supplies, as percentages

of total revenue, compared to the same prior year period. The decrease in other operating expenses, as a percentage of total

revenue, was primarily attributable to reduced provider assessments associated with various governmental supplemental

revenue programs during the three months ended September 30, 2024 compared to the same prior year period. The decrease

in supplies expense, as a percentage of net revenue, was driven by ongoing service line optimization efforts. The decrease in

total operating expense, as a percentage of total revenue, was partially offset by an increase in professional fees, as a

percentage of total revenue, due to higher costs for hospital-based providers as well as increased costs for revenue cycle

management services due to increased cash collections during the three months ended September 30, 2024, compared to the

same prior year period.

Overview of the Nine Months Ended September 30, 2024

Total revenue for the nine months ended September 30, 2024 increased $296.3 million, or 7.3%, compared to the same prior

year period. The increase in total revenue for the nine months ended September 30, 2024 consisted of an increase in adjusted

admissions of 3.5% and an increase in net patient service revenue per adjusted admission of 3.6%.  The increase in adjusted

admissions reflected growth in admissions of 5.6% compared to the same prior year period, partially offset by a decrease in

outpatient surgeries of 1.7% compared to the same prior year period, driven, in part, by ongoing service line optimization

efforts that resulted in strategic reallocation of resources from high volume, low margin procedures, such as certain dental,

otolaryngology and ophthalmology procedures, to alternate higher margin service lines. The increase in net patient service

revenue per adjusted admission was attributable to a combination of a favorable payor mix, improved service mix as a result

of ongoing service line optimization efforts, and an increase in supplemental funding as compared to the same prior year

period.

Total operating expenses increased $243.3 million for the nine months ended September 30, 2024 compared to the same prior

year period due to higher patient volumes but decreased 1.0% as a percentage of total revenue. The decrease in total operating

expenses, as a percentage of total revenue, was driven by decreases in salaries and benefits and supplies, as percentages of

total revenue, compared to the same prior year period. The decrease in salaries and benefits, as a percentage of total revenue,

was primarily due to a decrease in contract labor expense of $26.0 million during the nine months ended September 30, 2024

compared to the same prior year period.  The decrease in supplies expense, as a percentage of total revenue, was driven by

ongoing service line optimization efforts during the nine months ended September 30, 2024 compared to the same prior year

period. The decrease in total operating expense, as a percentage of total revenue, was partially offset by an increase in

professional fees, as a percentage of total revenue, driven by higher costs for hospital-based providers and an increase in costs

for revenue cycle management services due to increased cash collections during the nine months ended September 30, 2024,

compared to the same prior year period.

Comparison of the Three Months Ended September 30, 2024 and 2023

Total revenue — Total revenue for the three months ended September 30, 2024 increased $72.1 million, or 5.2%, compared

to the same prior year period. The increase in total revenue for the three months ended September 30, 2024 consisted of an

increase in adjusted admissions of 3.8% and an increase in net patient service revenue per adjusted admission of 0.9%. The

increase in adjusted admissions was primarily driven by growth in admissions of 6.4% compared to the same prior year

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period.  Outpatient surgeries increased 0.2% compared to the same prior year period.  Outpatient surgery growth was limited,

in part, by ongoing service line optimization efforts that resulted in strategic reallocation of resources from high volume, low

margin procedures, such as certain dental, otolaryngology and ophthalmology procedures, to alternate higher margin service

lines. The increase in net patient service revenue per adjusted admission was attributable to a combination of a favorable

payor mix and improved service mix as a result of ongoing service line optimization efforts, partially offset by a decrease in

supplemental funding as compared to the same prior year period.

Salaries and benefits — Salaries and benefits, as a percentage of total revenue, were 43.8% for the three months ended

September 30, 2024 compared to 43.2% for the same prior year period. The increase in salaries and benefits, as a percentage

of total revenue, was driven by an increase in equity-based compensation of $8.0 million.

Professional fees — Professional fees, as a percentage of total revenue, were 18.9% for the three months ended September

30, 2024 compared to 17.9% for the same prior year period.  The increase in professional fees, as a percentage of total

revenue, reflected higher costs for hospital-based providers as well as increased expenses for revenue cycle management

services due to increased cash collections during the three months ended September 30, 2024.

Supplies — Supplies, as a percentage of total revenue, were 17.4% for the three months ended September 30, 2024 compared

to 18.1% for the same prior year period.  The decrease in supplies, as a percentage of total revenue, was attributable to

ongoing service line optimization efforts and execution on various supply chain cost reduction initiatives, including improved

inventory management, standardized surgical supply procurement and strategic sourcing.

Rents and leases — Rents and leases were $26.4 million and $24.5 million for the three months ended September 30, 2024

and 2023, respectively.

Rents and leases, related party — Rents and leases, related party, consists of lease expense related to the Master Lease with

Ventas ("Ventas Master Lease"), under which we lease 10 of our facilities, and other lease agreements with Ventas for certain

medical office buildings. Rents and leases, related party were $37.2 million and $36.4 million for the three months ended

September 30, 2024 and 2023, respectively.

Other operating expenses — Other operating expenses, as a percentage of total revenue, were 8.2% for the three months

ended September 30, 2024 compared to 9.1% for the same prior year period.  Other operating expenses are comprised

primarily of repairs and maintenance, utility, insurance (including professional liability insurance) and provider assessments.

The change in other operating expenses, as a percentage of total revenue, was primarily driven by a decrease in provider

assessments associated with various governmental supplemental revenue programs during the three months ended September

30, 2024, compared to the same prior year period.

Interest expense — Interest expense was $14.6 million and $19.0 million for the three months ended September 30, 2024 and

2023, respectively.

Loss on extinguishment and modification of debt — On September 18, 2024, we executed an amendment to our Term Loan B

Credit Agreement. In connection with this transaction, we incurred a loss on the debt extinguishment of $0.3 million related

to the write-off of existing deferred financing costs and original issue discounts and transaction costs of $1.2 million related

to the modification of debt during the three months ended September 30, 2024.

Other non-operating gains — Other non-operating gains were $2.8 million and $0.0 million for the three months ended

September 30, 2024 and 2023, respectively. The increase in other non-operating gains was primarily due to the recognition of

insurance recovery proceeds of $2.9 million during the three months ended September 30, 2024 related to the Cybersecurity

Incident.

Income tax expense — We recorded income tax expense of $11.1 million, which equates to an effective tax rate of 19.4%, for

the three months ended September 30, 2024 compared to income tax expense of $7.3 million, which equates to an effective

tax rate of 15.8%, for the same prior year period. The increase in income tax expense was primarily driven by an increase in

income before income taxes attributable to Ardent Health Partners, Inc., which resulted in an increase in taxes at the federal

statutory rate during the three months ended September 30, 2024 compared to the same prior year period.  Additionally, the

effective tax rate was further impacted by permanent differences resulting from the disallowance of certain equity-based

compensation incurred during the during the three months ended September 30, 2024.

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Net income attributable to noncontrolling interests — Net income attributable to noncontrolling interests of $19.7 million for

the three months ended September 30, 2024 compared to $17.9 million for the same prior year period consisted primarily of

$19.7 million and $17.0 million of net income attributable to minority partners’ interests in hospitals and ambulatory services

that are owned and operated though limited liability companies and consolidated by us for the three months ended September

30, 2024 and 2023, respectively. Income from operations before income taxes related to these limited liability companies was

$68.6 million and $60.3 million for the three months ended September 30, 2024 and 2023, respectively. The remaining

portion of net income attributable to noncontrolling interests for the three months ended September 30, 2023 consisted of net

income attributable to ALH Holdings, LLC’s (a subsidiary of Ventas, a related party) minority interest in AHP Health

Partners, our direct subsidiary.

Comparison of the Nine Months Ended September 30, 2024 and 2023

Total revenue — Total revenue for the nine months ended September 30, 2024 increased $296.3 million, or 7.3%, compared

to the same prior year period. The increase in total revenue for the nine months ended September 30, 2024 consisted of an

increase in adjusted admissions of 3.5% and an increase in net patient service revenue per adjusted admission of 3.6%. The

increase in adjusted admissions reflected growth in admissions of 5.6% compared to the same prior year period. The growth

in admissions was partially offset by a decrease in outpatient surgeries of 1.7% compared to the same prior year period

driven, in part, by ongoing service line optimization efforts that resulted in strategic reallocation of resources from high

volume, low margin procedures, such as certain dental, otolaryngology and ophthalmology procedures, to alternate higher

margin service lines. The increase in net patient service revenue per adjusted admission was attributable to a combination of a

favorable payor mix, improved service mix as a result of ongoing service line optimization efforts, and an increase in

supplemental funding as compared to the same prior year period.

Salaries and benefits — Salaries and benefits, as a percentage of total revenue, were 43.1% for the nine months ended

September 30, 2024 compared to 44.0% for the same prior year period.  The decrease in salaries and benefits, as a percentage

of total revenue, was primarily attributable to a decrease in contract labor expense of $26.0 million due to a combination of

reduced contract labor rates and lower utilization, driven by ongoing recruiting and retention initiatives. Total contract labor

expenses, as a percentage of total salaries and benefits, were 4.2% and 5.9% for the nine months ended September 30, 2024

and 2023, respectively.

Professional fees — Professional fees, as a percentage of total revenue, were 18.6% for the nine months ended September 30,

2024 compared to 17.6% for the same prior year period. The increase in professional fees, as a percentage of total revenue,

reflected higher costs for hospital-based providers as well as increased expenses for revenue cycle management services due

to increased cash collections during the nine months ended September 30, 2024.

Supplies — Supplies, as a percentage of total revenue, were 17.6% for the nine months ended September 30, 2024 compared

to 18.3% for the same prior year period. The decrease in supplies expense, as a percentage of total revenue, was attributable

to ongoing service line optimization efforts and execution on various supply chain cost reduction initiatives, including

improved inventory management, standardized surgical supply procurement and strategic sourcing.

Rents and leases — Rents and leases were $76.3 million and $73.2 million for the nine months ended September 30, 2024

and 2023, respectively.

Rents and leases, related party — Rents and leases, related party, consists lease expense related to the Ventas Master Lease,

under which we lease 10 of our hospitals, and other lease agreements with Ventas for certain medical office buildings. Rents

and leases, related party were $111.4 million and $108.9 million for the nine months ended September 30, 2024 and 2023,

respectively.

Other operating expenses — Other operating expenses, as a percentage of total revenue, were 8.2% for the nine months ended

September 30, 2024 compared to 8.3% for the same prior year period.

Government stimulus income — Government stimulus income was $0.0 million and $8.5 million for the nine months ended

September 30, 2024 and 2023, respectively.

Interest expense — Interest expense was $52.1 million and $55.9 million for the nine months ended September 30, 2024 and

2023, respectively.

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Loss on extinguishment and modification of debt — On June 26, 2024, we executed an amendment to our ABL Credit

Agreement and prepaid $100.0 million of the outstanding principal on our Term Loan B Facility. Additionally, on September

18, 2024, we executed an amendment to our Term Loan B Credit Agreement. In connection with these transactions, we

incurred a loss on the debt extinguishment of $1.8 million related to the write-off of existing deferred financing costs and

original issue discounts and transaction costs of $1.2 million related to the modification of debt during the nine months ended

September 30, 2024.

Other non-operating gains — Other non-operating gains were $3.1 million and $0.5 million for the nine months ended

September 30, 2024 and 2023, respectively. The increase in other non-operating gains was primarily due to the recognition of

a gain on insurance recovery proceeds of $2.9 million during the nine months ended September 30, 2024 related to the

Cybersecurity Incident.

Income tax expense — We recorded income tax expense of $37.0 million, which equates to an effective tax rate of 18.9%, for

the nine months ended September 30, 2024 compared to income tax expense of $24.6 million, which equates to an effective

tax rate of 17.2%, for the same prior year period. The increase in income tax expense was primarily driven by an increase in

income before income taxes attributable to Ardent Health Partners, Inc., which resulted in an increase in taxes at the federal

statutory rate during the nine months ended September 30, 2024 compared to the same prior year period. Additionally, the

effective tax rate was further impacted by permanent differences resulting from the disallowance of certain equity-based

compensation incurred during the nine months ended September 30, 2024

Net income attributable to noncontrolling interests — Net income attributable to noncontrolling interests of $62.7 million for

the nine months ended September 30, 2024 compared to $60.1 million for the same prior year period consisted primarily of

$59.8 million and $57.5 million of net income attributable to minority partners’ interests in hospitals and ambulatory services

that are owned and operated though limited liability companies and consolidated by us for the nine months ended September

30, 2024 and 2023, respectively. Income from operations before income taxes related to these limited liability companies was

$207.0 million and $198.4 million for the nine months ended September 30, 2024 and 2023, respectively. The remaining

portion of net income attributable to noncontrolling interests consists of net income attributable to ALH Holdings, LLC’s (a

subsidiary of Ventas, a related party) minority interest in AHP Health Partners, our direct subsidiary, prior to the ALH

Contribution in July 2024.

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Supplemental Non-GAAP Information

We have included certain financial measures that have not been prepared in a manner that complies with U.S. generally

accepted accounting principles (“GAAP”), including Adjusted EBITDA and Adjusted EBITDAR. We define these terms as

follows:

Performance Measure

•“Adjusted EBITDA” is defined as net income plus (i) provision for income taxes, (ii) interest expense and (iii)

depreciation and amortization expense (or EBITDA), as adjusted to deduct noncontrolling interest earnings, and

excludes the effects of losses on the extinguishment and modification of debt; other non-operating losses (gains);

Cybersecurity Incident recoveries, net of incremental information technology and litigation costs; restructuring, exit

and acquisition-related costs; expenses incurred in connection with the implementation of Epic Systems (“Epic”),

our integrated health information technology system, equity-based compensation expense, and loss (income) from

disposed operations. See “Supplemental Non-GAAP  Performance Measure.”

Valuation Measure

•“Adjusted EBITDAR” is defined as Adjusted EBITDA further adjusted to add back rent expense payable to real

estate investment trusts ("REITs"), which consists of rent expense pursuant to the Ventas Master Lease, lease

agreements associated with the MOB Transactions (as defined below) and a lease arrangement with Medical

Properties Trust, Inc. ("MPT") for Hackensack Meridian Mountainside Medical Center. See “Supplemental Non-

GAAP Valuation Measure.”

Supplemental Non-GAAP Performance Measure

Adjusted EBITDA is a non-GAAP performance measure used by our management and external users of our financial

statements, such as investors, analysts, lenders, rating agencies and other interested parties, to evaluate companies in our

industry.

Adjusted EBITDA is a performance measure that is not defined under GAAP and is presented in this Quarterly Report

because our management considers it an important analytical indicator that is commonly used within the healthcare industry

to evaluate financial performance and allocate resources. Further, our management believes that Adjusted EBITDA is a

useful financial metric to assess our operating performance from period to period by excluding certain material non-cash

items and unusual or non-recurring items that we do not expect to continue in the future and certain other adjustments we

believe are not reflective of our ongoing operations and our performance.

Because not all companies use identical calculations, our presentation of the non-GAAP measure may not be comparable to

other similarly titled measures of other companies.

While we believe this is a useful supplemental performance measure for investors and other users of our financial

information, you should not consider the non-GAAP measure in isolation or as a substitute for net income or any other items

calculated in accordance with GAAP. Adjusted EBITDA has inherent material limitations as a performance measure, because

it adds back certain expenses to net income, resulting in those expenses not being taken into account in the performance

measure. We have borrowed money, so interest expense is a necessary element of our costs. Because we have material capital

and intangible assets, depreciation and amortization expense are necessary elements of our costs. Likewise, the payment of

taxes is a necessary element of our operations. Because Adjusted EBITDA excludes these and other items, it has material

limitations as a measure of our performance.

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The following table presents a reconciliation of Adjusted EBITDA, a performance measure, to net income, determined in

accordance with GAAP:

Three Months Ended<br><br>September 30, Nine Months Ended<br><br>September 30,
(in thousands) 2024 2023 2024 2023
Net income $46,005 $38,708 $158,817 $118,196
Adjusted EBITDA Addbacks:
Income tax expense 11,062 7,261 36,997 24,591
Interest expense, net 14,629 19,041 52,050 55,854
Depreciation and amortization 36,771 35,488 108,434 104,860
Noncontrolling interest earnings (19,683) (17,870) (62,678) (60,139)
Loss on extinguishment and modification of debt 1,490 3,388
Other non-operating losses (gains) (a) 47 (208) (522)
Cybersecurity Incident recoveries, net (b) (4,976) (4,976)
Restructuring, exit and acquisition-related costs (c) 3,796 1,511 11,694 11,473
Epic expenses (d) 485 437 1,500 1,415
Equity-based compensation 8,135 181 8,873 723
Loss (income) from disposed operations 3 3 1,989 (65)
Adjusted EBITDA $97,764 $84,760 $315,880 $256,386

(a)Other non-operating losses (gains) include gains and losses realized on certain non-recurring events or events that are non-operational in

nature, including gains realized on certain asset divestitures.

(b)Cybersecurity Incident recoveries, net represents insurance recovery proceeds associated with the Cybersecurity Incident, net of

incremental information technology and litigation costs.

(c)Restructuring, exit and acquisition-related costs represent (i) enterprise restructuring costs, including severance costs related to work

force reductions of $3.2 million and $1.3 million for the three months ended September 30, 2024 and 2023, respectively, and

$10.1 million and $10.6 million for the nine months ended September 30, 2024 and 2023, respectively, (ii) penalties and costs incurred

for terminating pre-existing contracts at acquired facilities of $0.2 million and $0.1 million for the three months ended September 30,

2024 and 2023, respectively, and $0.6 million and $0.6 million for the nine months ended September 30, 2024 and 2023, respectively,

and (iii) third-party professional fees and expenses, salaries and benefits, and other internal expenses incurred in connection with

potential and completed acquisitions of $0.4 million and $0.1 million for the three months ended September 30, 2024 and 2023,

respectively, and $1.0 million and $0.3 million for the nine months ended September 30, 2024 and 2023, respectively.

(d)Epic expenses consist of various costs incurred in connection with the implementation of Epic, our health information technology

system. These costs included professional fees of $0.5 million and $0.4 million for the three months ended September 30, 2024 and 2023,

respectively, and $1.5 million and $1.4 million for the nine months ended September 30, 2024 and 2023, respectively.  Epic expenses do

not include the ongoing costs of the Epic system.

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Liquidity and Capital Resources

Liquidity

Our primary sources of liquidity are available cash and cash equivalents, cash flows from our operations and available

borrowings under our ABL Facilities (as defined below). Our primary cash requirements are our operating expenses, the

service of our debt, capital expenditures on our existing properties, acquisitions of hospitals and other healthcare facilities,

and distributions to noncontrolling interests. We believe the combination of cash flow from operations and available cash and

borrowings will be adequate to meet our short-term liquidity needs. Our ability to make scheduled payments of principal, pay

interest on, or refinance, our indebtedness, pay distributions or fund planned capital expenditures will depend on our ability to

generate cash in the future. This ability is, to a certain extent, subject to general economic, financial, competitive, legislative,

regulatory and other factors that are beyond our control.

At September 30, 2024, we had total cash and cash equivalents of $563.1 million and available liquidity of $851.2 million.

Our available liquidity was comprised of $563.1 million of total cash and cash equivalents plus $288.1 million in available

capacity under the ABL Credit Agreement, which is reduced by outstanding borrowings and outstanding letters of credit. In

June 2024, we amended the ABL Credit Agreement to increase commitments available thereunder by $100.0 million and

extended its maturity date to June 26, 2029.  See "Senior Secured Credit Facilities" for additional information.  At September

30, 2024, our net leverage ratio, as calculated under our ABL Credit Agreement and Term Loan B Credit Agreement, was

1.6x, and our lease-adjusted net leverage ratio was 3.5x. Our lease adjusted net leverage is calculated as net debt as of

September 30, 2024, plus 8.0x trailing twelve month REIT rent expense as of the end of the third quarter of 2024, divided by

the trailing twelve month Adjusted EBITDAR as of September 30, 2024.

During the nine months ended September 30, 2024 and 2023, we received and recognized $0.0 million and $8.5 million,

respectively, of cash distributions from the Public Health and Social Services Emergency Fund (“Provider Relief Fund”), a

provision of the Coronavirus Aid, Relief and Economic Security Act (“CARES Act”), and other state and local programs.

For additional information regarding distributions from the Provider Relief Fund and the CARES Act, refer to Note 2 to our

unaudited condensed consolidated financial statements for the three and nine months ended September 30, 2024.

Cash Flows

The following table summarizes certain elements of the statements of cash flows (in thousands):

Nine Months Ended September 30,
2024 2023
Net cash provided by operating activities $195,457 $154,199
Net cash used in investing activities (115,016) (81,277)
Net cash provided by (used in) financing activities 45,124 (84,370)

Operating Activities

Cash flows provided by operating activities for the nine months ended September 30, 2024 totaled $195.5 million compared

to $154.2 million for the same prior year period. The increase in operating cash flows during the nine months ended

September 30, 2024 was primarily attributable to an increase in net income of $40.6 million.

Investing Activities

Cash flows used in investing activities for the nine months ended September 30, 2024 totaled $115.0 million compared to

$81.3 million for the same prior year period.  Capital expenditures for non-acquisitions were $106.2 million and $80.0

million for the nine months ended September 30, 2024 and 2023, respectively.

Financing Activities

Cash flows provided by financing activities for the nine months ended September 30, 2024 totaled $45.1 million compared to

cash flows used in financing activities of $84.4 million for the same prior year period.  Cash flows provided by financing

activities for the nine months ended September 30, 2024 included IPO proceeds, net of underwriting discounts and

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commissions, of $208.7 million, proceeds from insurance financing arrangements of $10.8 million, and proceeds from long-

term debt of $3.6 million.  Cash flows provided by financing activities were partially offset by payments of principal on long-

term debt of $106.3 million, which included a prepayment of $100.0 million on the $877.5 million outstanding borrowings

under our Term Loan B Facility, and payments of principal on insurance financing arrangements of $7.4 million. Cash flows

provided by financing activities for the nine months ended September 30, 2024 were partially offset by distributions paid to

noncontrolling interests of $53.1 million.

Cash flows used in financing activities for the nine months ended September 30, 2023 totaled $84.4 million and included

distributions paid to noncontrolling interests of $50.7 million, redemption of equity attributable to non-controlling interest of

$26.0 million, payments of principal on long-term debt of $10.5 million, and payments of principal on insurance financing

arrangements of $15.9 million, which were partially offset by proceeds from insurance financing arrangements of $24.7

million.

Capital Expenditures

We make significant, targeted investments to maintain and modernize our facilities, introduce new technologies, and expand

our service offerings. We expect to finance future capital expenditures with internally generated and borrowed funds. Capital

expenditures for property and equipment were $106.2 million and $80.0 million for the nine months ended September 30,

2024 and 2023, respectively.

Ventas Master Lease

Effective August 4, 2015, we sold the real property for ten of our hospitals to Ventas, which is a related party as, prior to our

IPO, it was a common unit holder of Ardent Health Partners, LLC and owned shares of common stock of AHP Health

Partners and had a representative serving on our board of managers. Concurrent with this transaction, we entered into a 20-

year master lease agreement that expires in August 2035 (with a renewal option for an additional ten years) to lease back the

real estate. We lease ten of our hospitals pursuant to the Ventas Master Lease. As of September 30, 2024, following the

consummation of the IPO and the underwriters’ exercise of their option to purchase additional shares, Ventas beneficially

owned approximately 6.5% of our outstanding common stock.

The Ventas Master Lease includes a number of significant operating and financial restrictions, including requirements that we

maintain a minimum portfolio coverage ratio of 2.2x and a guarantor fixed charge coverage ratio of 1.2x and do not exceed a

guarantor net leverage ratio of 6.75x. In addition, the Relative Rights Agreement entered into by and among Ventas, the

5.75% Senior Notes trustee and the administrative agents under our Senior Secured Credit Facilities (as defined below) in

connection with the series of debt transactions completed during the year ended 2021 to refinance our then-existing debt,

among other things, (i) sets forth the relative rights of Ventas and the administrative agents with respect to the properties and

collateral related to the Ventas Master Lease and securing our Senior Secured Credit Facilities, (ii) caps the amount of

indebtedness incurred or guaranteed by our subsidiaries that are tenants under the Ventas Master Lease ("Tenants") (together

with such Tenants’ guarantees of the notes and the Senior Secured Credit Facilities and all other indebtedness incurred or

guaranteed by such Tenants) at $375.0 million and (iii) imposes certain incurrence tests on the incurrence of additional

indebtedness by such Tenants and by us.

We recorded rent expense of $37.2 million and $36.4 million for the three months ended September 30, 2024 and 2023,

respectively, and $111.4 million and $108.9 million for the nine months ended September 30, 2024 and 2023, respectively,

related to the Ventas Master Lease and other lease agreements with Ventas for certain medical office buildings.

Senior Secured Credit Facilities

Effective July 8, 2021, we entered into the ABL Credit Agreement, which was amended most recently on June 26, 2024. The

ABL Credit Agreement (as so amended) consists of a $325.0 million senior secured asset-based revolving credit facility with

a five year maturity, comprised of (i) a $275.0 million non-UT Health East Texas borrowers tranche (the “non-UT Health

East Texas ABL Facility”) and (ii) a $50.0 million UT Health East Texas borrowers tranche available to our AHS East Texas

Health System, LLC subsidiary and certain of its subsidiaries (the “UT Health East Texas ABL Facility” and, together with

the non-UT Health East Texas ABL Facility, the “ABL Facilities”), each subject to a borrowing base. Effective as of June 26,

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2024, we amended the ABL Credit Agreement to increase the commitments available under the non-UT Health East Texas

ABL Facility from $175.0 million to $275.0 million and to extend the maturity of the ABL Facilities to June 26, 2029.

Effective August 24, 2021, we entered into the Term Loan B Facility. The credit agreement governing the Term Loan B

Facility provided funding up to a principal amount of $900.0 million. The Term Loan B Facility has a seven year maturity

with principal due in quarterly installments of 0.25% of the initial $900.0 million principal amount (subject to certain

reductions from time to time as a result of the application of prepayments), with the remaining balance due upon maturity of

the Term Loan B Facility. Effective June 8, 2023, we amended the Term Loan B Credit Agreement to replace LIBOR with

Term SOFR (each as defined in the amended Term Loan B Credit Agreement) as the reference interest rate and establish

further successor rates. On June 26, 2024, we prepaid $100.0 million of the $877.5 million outstanding borrowings under the

Term Loan B Facility using cash on hand. Additionally, on September 18, 2024, we executed an amendment to reprice our

Term Loan B Credit Agreement. The repricing reduced the applicable interest rate by 50 basis points from Term SOFR plus

3.25% to Term SOFR plus 2.75% and eliminated the credit spread adjustment. No modifications were made to the maturity

of the loans as a result of the repricing and all other terms were substantially unchanged.

We refer to the ABL Facilities and the Term Loan B Facility collectively herein as the “Senior Secured Credit Facilities.”

Subject to certain exceptions, the ABL Facilities are secured by first priority liens over substantially all of our and each

guarantor’s accounts and other receivables, chattel paper, deposit accounts and securities accounts, general intangibles,

instruments, investment property, commercial tort claims and letters of credit relating to the foregoing, along with books,

records and documents, and proceeds thereof (the “ABL Priority Collateral”), and a second priority lien over substantially all

of our and each guarantor’s other assets (including all of the capital stock of the domestic guarantors and first priority

mortgage liens on any fee-owned real property valued in excess of $5,000,000) (the “Term Priority Collateral”). The

obligations of the UT Health East Texas ABL Facility are not secured by the assets of the subsidiaries that are also Tenants

and certain other subsidiaries related to the Tenants. The obligations under the Term Loan B Facility and the ABL Facilities

in excess of the maximum aggregate dollar cap amount permitted to be guaranteed by the Tenants are not secured by the

assets of the Tenants.

The Term Loan B Facility is secured by a first priority lien on the Term Priority Collateral and a second priority lien on the

ABL Priority Collateral. Certain excluded assets are not included in the Term Priority Collateral or the ABL Priority

Collateral. The obligations under the Term Loan B Facility and the ABL Facilities in excess of the maximum aggregate dollar

cap amount permitted to be guaranteed by the Tenants are not secured by the assets of the Tenants.

Borrowings under the Term Loan B Facility bear interest at a rate per annum equal to, at our option, either (i) the base rate

determined by reference to the highest of (a) the federal funds effective rate plus 0.50%, (b) the “Prime Rate” in the United

States for U.S. dollar loans as publicly announced by Bank of America from time to time, and (c) Term SOFR plus 1.00% per

annum, in each case, plus an applicable margin, or (ii) Term SOFR (not to be less than 0.50% per annum) for the interest

period selected, plus an applicable margin. Under the Term Loan B Facility, the applicable margin is 2.50% for base rate

borrowings and 3.50% for Term SOFR borrowings.  Following the completion of the IPO, the applicable margin for the

remaining outstanding borrowings under the Term Loan B Facility was automatically reduced by 0.25% per annum.

Principal under the Term Loan B Facility is due in quarterly installments of 0.25% of the $900.0 million initial principal

amount (subject to certain reductions from time to time as a result of the application of prepayments), with the remaining

balance due upon maturity. The ABL Facilities do not require installment payments.

At the election of the borrowers under the applicable ABL Facility loan, the interest rate per annum applicable to loans under

the ABL Facilities is based on a fluctuating rate of interest determined by reference to either (i) the base rate plus an

applicable margin or (ii) Term SOFR (not to be lower than 0.00% per annum) for the interest period selected, plus an

applicable margin. The applicable margin is determined based on the percentage of the average daily availability of the

applicable ABL Facility. For the non-UT Health East Texas ABL Facility loan, the applicable margin ranges from 0.5% to

1.0% for base rate borrowings and 1.5% to 2.0% for Term SOFR borrowings. The applicable margin for the UT Health East

Texas ABL Facility loan ranges from 1.5% to 2.0% for base rate borrowings and 2.5% to 3.0% for Term SOFR borrowings.

Subject to certain exceptions (including with regard to the ABL Priority Collateral), thresholds and reinvestment rights, the

Term Loan B Facility is subject to mandatory prepayments with respect to:

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•100% of net cash proceeds of issuances of debt by AHP Health Partners or any of its restricted subsidiaries that are

not permitted by the Term Loan B Facility;

•100% (with step-downs to 50% and 0%, based upon achievement of specified senior secured net leverage ratio

levels) of net cash proceeds of certain asset sales;

•50% (with step-downs to 25% and 0%, based upon achievement of specified senior secured net leverage ratio

levels), net of certain voluntary prepayments and secured indebtedness, of annual excess cash flow of AHP Health

Partners and its subsidiaries commencing with the fiscal year ended December 31, 2022; and

•net cash proceeds received in connection with any exercise of the purchase option of the loans by Ventas under the

Relative Rights Agreement.

5.750% Senior Notes due 2029

AHP Health Partners, our direct wholly-owned subsidiary, issued the 5.75% Senior Notes in an exempt offering pursuant to

Rule 144A and Regulation S under the Securities Act that was completed on July 8, 2021. The terms of the 5.75% Senior

Notes are governed by an indenture, dated as of July 8, 2021 (the “Indenture”), among AHP Health Partners, us and certain of

AHP Health Partners' wholly-owned domestic subsidiaries, as guarantors, and U.S. Bank Trust Company, National

Association, as trustee. The Indenture provides that the 5.75% Senior Notes are general senior unsecured obligations of AHP

Health Partners, which are unconditionally guaranteed on a senior unsecured basis by us and certain subsidiaries of AHP

Health Partners.

The 5.75% Senior Notes mature on July 15, 2029 and bear interest at a rate of 5.750% per annum, payable semi-annually, in

cash in arrears, on January 15 and July 15 of each year, commencing on January 15, 2022.

AHP Health Partners may redeem the 5.75% Senior Notes, in whole or in part, at any time and from time to time, (1) prior to

July 15, 2024, at a redemption price equal to 100% of the principal amount of the 5.75% Senior Notes, plus accrued and

unpaid interest, if any, to the redemption date, plus a “make-whole” premium as set forth in the Indenture and the 5.75%

Senior Notes; and (2) on and after July 15, 2024, at the redemption prices set forth below, plus accrued and unpaid interest, if

any, to the redemption date, subject to compliance with certain conditions:

Date (if redeemed during the 12 month period beginning on July 15 of the years indicated below) Percentage
2024 102.875%
2025 101.438%
2026 and thereafter 100.000%

In addition, prior to July 15, 2024, AHP Health Partners could have redeemed on one or more occasions up to 40% of the

original aggregate principal amount of the 5.75% Senior Notes with the net proceeds of one or more equity offerings, as

described in the Indenture, at a redemption price equal to 105.750% of the principal amount thereof, plus accrued and unpaid

interest, if any, to the redemption date, provided that at least 50% of the aggregate original principal amount of the 5.75%

Senior Notes issued under the Indenture remained outstanding after each such redemption and the redemption occurred

within 180 days after the closing of such equity offering.

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Contractual Obligations and Contingencies

The following table provides a summary of our commitments and contractual obligations for debt, minimum lease payment

obligations under non-cancelable leases and other obligations as of September 30, 2024 (in thousands):

Payments Due by Period
Total Less than<br><br>1 Year 1-3 Years 3-5 Years After<br><br>5 Years
Long-term debt obligations, with interest $1,464,532 $25,332 $179,197 $933,820 $326,183
Deferred financing obligations, with interest 15,449 2,601 11,456 1,392
Operating leases 3,014,528 49,452 384,184 361,894 2,218,998
Estimated self-insurance liabilities 185,073 40,976 39,439 61,618 43,040
Total $4,679,582 $118,361 $614,276 $1,358,724 $2,588,221

Outstanding letters of credit are required principally by certain insurers and states to collateralize our workers' compensation

programs and self-insured retentions associated with our professional and general liability insurance programs. As of

September 30, 2024, we maintained outstanding letters of credit of approximately $40.1 million, which included interest of

$3.2 million.

Supplemental Non-GAAP Valuation Measure

Adjusted EBITDAR is a commonly used non-GAAP valuation measure used by our management, research analysts,

investors and other interested parties to evaluate and compare the enterprise value of different companies in our industry.

Adjusted EBITDAR excludes: (1) certain material noncash items and unusual or non-recurring items that we do not expect to

continue in the future; (2) certain other adjustments that do not impact our enterprise value; and (3) rent expense payable to

our REITs. We operate 30 acute care hospitals, 12 of which we lease from two REITs, Ventas and MPT, pursuant to long-

term lease agreements. Additionally, during 2022, we completed the sale of 18 medical office buildings to Ventas in

exchange for $204.0 million and concurrently entered into agreements to lease the real estate back from Ventas over a 12-

year initial term with eight options to renew for additional five-year terms (the "MOB Transactions"). Our management views

the long-term lease agreements with Ventas and MPT, as well as the MOB Transactions, as more like financing arrangements

than true operating leases, with the rent payable to such REITs being similar to interest expense. As a result, our capital

structure is different than many of our competitors, especially those whose real estate portfolio is predominately owned and

not leased. Excluding the rent payable to such REITs allows investors to compare our enterprise value to those of other

healthcare companies without regard to differences in capital structures, leasing arrangements and geographic markets, which

can vary significantly among companies. Our management also uses Adjusted EBITDAR as one measure in determining the

value of prospective acquisitions or divestitures. Finally, financial covenants in certain of our lease agreements, including the

Ventas Master Lease, use Adjusted EBITDAR as a measure of compliance.  Adjusted EBITDAR does not reflect our cash

requirements for leasing commitments. As such, our presentation of Adjusted EBITDAR should not be construed as a

performance or liquidity measure.

Because not all companies use identical calculations, our presentation of the non-GAAP measure may not be comparable to

other similarly titled measures of other companies.

While we believe this is a useful supplemental valuation measure for investors and other users of our financial information,

you should not consider the non-GAAP measure in isolation or as a substitute for net income or any other items calculated in

accordance with GAAP. Adjusted EBITDAR has inherent material limitations as a valuation measure, because it adds back

certain expenses to net income, resulting in those expenses not being taken into account in the valuation measure. The

payment of taxes and rent is a necessary element of our valuation. Because Adjusted EBITDAR excludes these and other

items, it has material limitations as a measure of our valuation.

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The following table presents a reconciliation of Adjusted EBITDAR, a valuation measure, to net income, determined in

accordance with GAAP:

Three Months<br><br>Ended<br><br>September 30, Nine Months<br><br>Ended<br><br>September 30,
(in thousands) 2024 2024
Net income $46,005 $158,817
Adjusted EBITDAR Addbacks:
Income tax expense 11,062 36,997
Interest expense, net 14,629 52,050
Depreciation and amortization 36,771 108,434
Noncontrolling interest earnings (19,683) (62,678)
Loss on extinguishment and modification of debt 1,490 3,388
Other non-operating losses (gains) (a) 47 (208)
Cybersecurity Incident recoveries, net (b) (4,976) (4,976)
Restructuring, exit and acquisition-related costs (c) 3,796 11,694
Epic expenses (d) 485 1,500
Equity-based compensation 8,135 8,873
Loss from disposed operations 3 1,989
Rent expense payable to REITs (e) 40,056 119,826
Adjusted EBITDAR $137,820 $435,706

(a)Other non-operating losses (gains) include gains and losses realized on certain non-recurring events or events that are non-operational in

nature, including gains realized on certain asset divestitures.

(b)Cybersecurity Incident recoveries, net represents insurance recovery proceeds associated with the Cybersecurity Incident, net of

incremental information technology and litigation costs.

(c)Restructuring, exit and acquisition-related costs represent (i) enterprise restructuring costs, including severance costs related to work

force reductions of $3.2 million and $10.1 million for the three and nine months ended September 30, 2024, respectively, (ii) penalties

and costs incurred for terminating pre-existing contracts at acquired facilities of $0.2 million and $0.6 million for the three and nine

months ended September 30, 2024, respectively, and (iii) third-party professional fees and expenses, salaries and benefits, and other

internal expenses incurred in connection with potential and completed acquisitions of $0.4 million and $1.0 million for the three and nine

months ended September 30, 2024, respectively.

(d)Epic expenses consist of various costs incurred in connection with the implementation of Epic, our health information technology

system. These costs included professional fees of $0.5 million and $1.5 million for the three and nine months ended September 30, 2024,

respectively.  Epic expenses do not include the ongoing costs of the Epic system.

(e)Rent expense payable to REITs consists of rent expense of $37.2 million and $111.4 million related to the Ventas Master Lease and lease

agreements associated with the MOB Transactions with Ventas for the three and nine months ended September 30, 2024, respectively,

and rent expense of  $2.8 million and $8.4 million related to a lease arrangement with MPT for the lease of Hackensack Meridian

Mountainside Medical Center for the three and nine months ended September 30, 2024, respectively.

Critical Accounting Policies and Estimates

The preparation of financial statements in accordance with GAAP requires us to make estimates and assumptions that affect

reported amounts and related disclosures. We regularly evaluate the accounting policies and estimates we use. In general, we

base the estimates on historical experience and on assumptions that we believe to be reasonable, given the particular

circumstances in which we operate. Actual results may vary from those estimates.  We consider our critical accounting

estimates to be those that (i) involve significant judgments and uncertainties, (ii) require estimates that are more difficult for

management to determine, and (iii) may produce materially different outcomes under different conditions or when using

different assumptions.

Refer to Management's Discussion and Analysis of Financial Condition and Results of Operations - Critical Accounting

Policies and Estimates and our audited consolidated financial statements and notes thereto as of and for the year ended

December 31, 2023 included in our Final Prospectus for a complete and comprehensive discussion of the accounting policies

and related estimates we believe are most critical to understanding our consolidated financial statements, financial condition

and results of operations and that require complex management judgment and assumptions or involve uncertainties. These

critical accounting estimates include revenue recognition, risk management and self-insured liabilities, income taxes, and

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unit-based compensation. There have been no changes to our critical accounting policies or their application since the date of

our Final Prospectus.

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ITEM 3.  QUANTITATIVE AND QUALITATIVE DISCLOSURES ABOUT MARKET RISK

We are subject to market risk from exposure to changes in interest rates based on our financing, investing and cash

management activities. We do not, however, hold or issue financial instruments or derivatives for trading or speculative

purposes. At September 30, 2024, the following components of our Senior Secured Credit Facilities bore interest at variable

rates at specified margins above either the agent bank’s alternate base rate or Term SOFR: (i) a $900.0 million, seven-year

term loan; and (ii) a $325.0 million, five-year asset-based revolving credit facility. As of September 30, 2024, we had

outstanding variable rate debt of $774.0 million.

At September 30, 2024, we had interest rate swap agreements with notional amounts totaling $521.1 million, expiring June

30, 2026. Under these swap agreements, we are required to make monthly fixed rate payments at annual rates ranging from

1.47% to 1.48% and the counterparties are obligated to make monthly floating rate payments to us based on one-month Term

SOFR, each subject to a floor of 0.39%.

Although changes in the alternate base rate or Term SOFR would affect the cost of funds borrowed in the future, we believe

the effect, if any, of reasonably possible near-term changes in interest rates on our variable rate debt on our consolidated

financial position, results of operations or cash flows would not be material. Based on the outstanding borrowings and impact

of the interest rate swaps in place at September 30, 2024, a one percent change in the interest rate would result in a $2.5

million increase or decrease in our annual interest expense.

We currently believe we have adequate liquidity to fund operations during the near term through the generation of operating

cash flows, cash on hand and access to our Senior Secured Credit Facilities. Our ability to borrow funds under our ABL

Facilities is subject to, among other things, the financial viability of the participating financial institutions. While we do not

anticipate any of our current lenders defaulting on their obligations, we are unable to provide assurance that any particular

lender will not default at a future date.

ITEM 4.  CONTROLS AND PROCEDURES

(a) Evaluation of Disclosure Controls and Procedures

Our management, with the participation of our principal executive officer and our principal financial officer, evaluated, as of

the end of the period covered by this Quarterly Report, the effectiveness of our disclosure controls and procedures. Based on

this evaluation of our disclosure controls and procedures as of September 30, 2024, our principal executive officer and

principal financial officer concluded that our disclosure controls and procedures as of such date were effective at the

reasonable assurance level. The term “disclosure controls and procedures,” as defined in Rules 13a-15(e) and 15d-15(e) under

the Securities Exchange Act of 1934, as amended (the “Exchange Act”), means controls and other procedures of a company

that are designed to ensure that information required to be disclosed by a company in the reports that it files or submits under

the Exchange Act are recorded, processed, summarized and reported within the time periods specified in the SEC’s rules and

forms. Management recognizes that any controls and procedures, no matter how well designed and operated, can provide

only reasonable assurance of achieving their objectives and management necessarily applies its judgment in evaluating the

cost-benefit relationship of possible controls and procedures.

(b) Changes in Internal Control over Financial Reporting

During the quarter ended September 30, 2024, there have been no changes in our internal control over financial reporting, as

such term is defined in Rules 13a-15(f) and 15(d)-15(f) promulgated under the Exchange Act, that have materially affected,

or are reasonably likely to materially affect, our internal control over financial reporting.

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PART II – OTHER INFORMATION

ITEM 1.  LEGAL PROCEEDINGS

The information set forth in the “Litigation and Regulatory Matters” section of Note 9 “Commitments and Contingencies” in

the notes to the unaudited consolidated financial statements in Part I, Item 1 of this Quarterly Report is incorporated by

reference herein.

ITEM 1A.  RISK FACTORS

There have been no material changes to our risk factors that we believe are material to our business, results of operations and

financial condition from the risk factors previously disclosed in the section entitled “Risk factors” included in the Final

Prospectus.

ITEM 2.  UNREGISTERED SALES OF EQUITY SECURITIES AND USE OF PROCEEDS

(a) Recent Sales of Unregistered Securities

On July 17, 2024, in connection with the IPO, ALH Holdings, LLC (a subsidiary of Ventas, Inc.) contributed all of its

outstanding common stock in AHP Health Partners (our direct subsidiary) to Ardent Health Partners, Inc. in exchange for

5,178,202 shares of common stock of Ardent Health Partners, Inc. (the “ALH Contribution”). The issuance of securities in

the ALH Contribution was deemed to be exempt from registration under the Securities Act of 1933, as amended, pursuant to

Section 4(a)(2) thereof, as a transaction by an issuer not involving any public offering.

(b) Use of Proceeds from Initial Public Offering of Common Stock

On July 17, 2024, our registration statement on Form S-1 (File No. 333-280425) related to the IPO was declared effective by

the SEC. Pursuant to such registration statement, we issued and sold 12,000,000 shares of common stock at a public offering

price of $16.00 per share on July 19, 2024. We received net proceeds of approximately $181.4 million, after deducting

underwriting discounts and commissions of approximately $10.6 million. On July 30, 2024, in conjunction with the

underwriters exercising their option to purchase additional shares, we issued an additional 1,800,000 shares of common stock

at the initial public offering price of $16.00 per share for additional net proceeds of approximately $27.2 million, after

deducting underwriting discounts and commissions of approximately $1.6 million. None of the expenses associated with the

IPO were paid to directors, officers, or persons owning 10% or more of any class of equity securities, or to our affiliates.

There has been no material change in the planned use of proceeds from the IPO from those described in the Final Prospectus,

dated July 17, 2024, filed with the SEC on July 18, 2024, pursuant to Rule 424(b) of the Securities Act. J.P. Morgan

Securities LLC, BofA Securities, Inc. and Morgan Stanley & Co. LLC acted as joint book-running managers for the IPO. For

additional details on the IPO, refer to Note 1 “Description of the Business and Basis of Presentation—Initial Public Offering

and Corporate Conversion” in the notes to the unaudited condensed consolidated financial statements included elsewhere in

this Quarterly Report.

ITEM 3.  DEFAULTS UPON SENIOR SECURITIES

None.

ITEM 4.  MINE SAFETY DISCLOSURES

Not applicable.

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ITEM 5.  OTHER INFORMATION

During the three months ended September 30, 2024, none of our directors or executive officers adopted, modified, or

terminated a “Rule 10b5-1 trading arrangement” or a “non-Rule 10b5-1 trading arrangement,” as each term is defined in Item

408(a) of Regulation S-K.

ITEM 6.  EXHIBITS

Exhibit<br><br>Number Description
2.1 Plan of Conversion (incorporated by reference to Exhibit 2.1 to the Registrant’s Quarterly Report on Form 10-Q filed on<br><br>August 14, 2024)
3.1 Certificate of Incorporation of Ardent Health Partners, Inc. (incorporated by reference to Exhibit 4.1 to the Registrant’s<br><br>Form S-8 filed on July 17, 2024)
3.2 Bylaws of Ardent Health Partners, Inc. (incorporated by reference to Exhibit 4.2 to the Registrant’s Form S-8 filed on July<br><br>17, 2024)
4.1 Specimen Stock Certificate (incorporated by reference to Exhibit 4.1 to the Registrant's Form S-1/A filed on July 8, 2024)
10.1† Form of Indemnification Agreement between the registrant and its directors and certain officers (incorporated by reference<br><br>to Exhibit 10.36 to the Registrant’s Form S-1/A filed on July 8, 2024)
10.2† Ardent Health Partners, Inc. 2024 Omnibus Incentive Award Plan (incorporated by reference to Exhibit 10.37 to the<br><br>Registrant’s Form S-1/A filed on July 8, 2024)
10.3† Form of Restricted Stock Award Agreement (Replacement Unvested C-1 Units) under the 2024 Omnibus Incentive Award<br><br>Plan (incorporated by reference to Exhibit 10.9 to the Registrant's Quarterly Report on Form 10-Q filed on August 14,<br><br>2024)
10.4† Form of Restricted Stock Award Agreement (Replacement Unvested C-2 Units) under the 2024 Omnibus Incentive Award<br><br>Plan (incorporated by reference to Exhibit 10.10 to the Registrant's Quarterly Report on Form 10-Q filed on August 14,<br><br>2024)
10.5† Form of Restricted Stock Unit Award Agreement (Employees) under the 2024 Omnibus Incentive Award Plan<br><br>(incorporated by reference to Exhibit 10.11 to the Registrant's Quarterly Report on Form 10-Q filed on August 14, 2024)
10.6† Form of Restricted Stock Unit Award Agreement (Non-Employee Directors) under the 2024 Omnibus Incentive Award<br><br>Plan (incorporated by reference to Exhibit 10.12 to the Registrant's Quarterly Report on Form 10-Q filed on August 14,<br><br>2024)
10.7†# Form of Performance Based Restricted Stock Unit Award Agreement under the 2024 Omnibus Incentive Award Plan<br><br>(incorporated by reference to Exhibit 10.13 to the Registrant's Quarterly Report on Form 10-Q filed on August 14, 2024)
10.8 Stock Ownership Guidelines (incorporated by reference to Exhibit 10.14 to the Registrant's Quarterly Report on Form 10-<br><br>Q filed on August 14, 2024)
10.9† Executive Severance Plan  (incorporated by reference to Exhibit 10.15 to the Registrant's Quarterly Report on Form 10-Q<br><br>filed on August 14, 2024)
10.10† Non-Employee Director Compensation Program (incorporated by reference to Exhibit 10.40 to the Registrant’s Form S-1/<br><br>A filed on July 8, 2024)
10.11 Strategic Advisory Services Letter Agreement, dated as of July 19, 2024, between EGI-AM Investments, L.L.C. and<br><br>Ardent Health Partners, Inc. (incorporated by reference to Exhibit 10.17 to the Registrant’s Quarterly Report on Form 10-Q<br><br>filed on August 14, 2024)
10.12 Nomination Agreement, dated as of July 19, 2024, among Ardent Health Partners, Inc., EGI-AM Investments, L.L.C. and<br><br>ALH Holdings, LLC (incorporated by reference to Exhibit 10.18 to the Registrant’s Quarterly Report on Form 10-Q filed<br><br>on August 14, 2024)
10.13 REIT Savings Letter Agreement, dated as of July 19, 2024, by and between Ardent Health Partners, Inc. and ALH<br><br>Holdings, LLC (incorporated by reference to Exhibit 10.19 to the Registrant’s Quarterly Report on Form 10-Q filed on<br><br>August 14, 2024)
10.14* Amendment No. 2 to Amended and Restated Term Loan Credit Agreement, dated as of September 18, 2024, among AHP<br><br>Health Partners, Inc., as Borrower, Ardent Health Partners, Inc., the Guarantors party thereto, the Lenders party thereto,<br><br>and Bank of America, N.A., as the Additional 2024 Term B Lender and as Administrative Agent
31.1* Certification of Principal Executive Officer pursuant to SEC Rule 13a 14(a)/15d 14(a)
31.2* Certification of Principal Financial Officer pursuant to SEC Rule 13a 14(a)/15d 14(a)
32.1** Certification of Principal Executive Officer Pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the<br><br>Sarbanes-Oxley Act of 2002
32.2** Certification of Principal Financial Officer Pursuant to 18 U.S.C. Section 1350, as adopted pursuant to Section 906 of the<br><br>Sarbanes-Oxley Act of 2002
101.INS* Inline XBRL Instance Document (the instance document does not appear in the Interactive Data File because its XBRL<br><br>tags are embedded within the Inline XBRL document)

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Exhibit<br><br>Number Description
101.SCH* Inline XBRL Taxonomy Extension Schema Document
101.CAL* Inline XBRL Taxonomy Extension Calculation Linkbase Document
101.DEF* Inline XBRL Taxonomy Extension Definition Linkbase Document
101.LAB* Inline XBRL Taxonomy Extension Label Linkbase Document
101.PRE* Inline XBRL Taxonomy Extension Presentation Linkbase Document
104* Cover Page Interactive Data File (formatted as Inline XBRL and contained in Exhibit 101) #  Portions of this exhibit (indicated by “[***]”) have been omitted as the registrant has determined that (i) the omitted information is not material and<br><br>(ii) the omitted information is the type that the registrant treats as private or confidential.
---
†  Indicates a management contract or compensatory plan, contract or arrangement
* Filed herewith
** This certification will not be deemed “filed” for purposes of Section 18 of the Exchange Act, or otherwise subject to the liability of that section. Such<br><br>certification will not be deemed to be incorporated by reference into any filing under the Securities Act of 1933, as amended, or the Exchange Act,<br><br>except to the extent specifically incorporated by reference into such filing.

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SIGNATURES

Pursuant to the requirements of the Securities Exchange Act of 1934, the registrant has duly caused this report to be signed on

its behalf by the undersigned thereunto duly authorized.

| ARDENT HEALTH PARTNERS, INC. | | --- || Date: November 7, 2024 | By: | /s/ Alfred Lumsdaine | | --- | --- | --- | | | | Alfred Lumsdaine | | | | Executive Vice President, Chief Financial Officer | | | | (Principal Financial Officer) |

ARDT - Exhibit 10.14 - Q3 24 Exhibit 10.14

Execution Version

This AMENDMENT NO. 2, dated as of September 18, 2024 (this “Amendment”), is

entered into by and among AHP HEALTH PARTNERS, INC., a Delaware corporation (the

“Borrower”), ARDENT HEALTH PARTNERS, INC. (f/k/a Ardent Health Partners, LLC), a Delaware

corporation (“Parent”), the Guarantors, the Lenders party hereto and BANK OF AMERICA, N.A., as

the Additional 2024 Term B Lender (as defined in Annex A) and as Administrative Agent (as defined in

the Existing Credit Agreement referred to below).

W I T N E S S E T H:

WHEREAS, the Borrower, Parent, the Guarantors, the Lenders from time to time party

thereto and the Administrative Agent are party to that certain Amended and Restated Term Loan Credit

Agreement dated as of August 24, 2021 (as amended, restated, amended and restated, supplemented or

otherwise modified from time to time prior to the date hereof, the “Existing Credit Agreement”);

WHEREAS, (i) each Converting Consenting Lender (as defined in Annex A) has agreed,

on the terms and conditions set forth herein, to consent to this Amendment and to have all of its

outstanding Initial Term Loans (as defined in Annex A) (or such lesser amount as notified and allocated

to such Converting Consenting Lender by the Lead Arrangers (as defined below)) converted to an

equivalent principal amount of 2024 Term B Loans (as defined in Annex A) effective as of the

Amendment No. 2 Effective Date (as defined below) (the “Converted 2024 Term B Loans”), (ii) each

Non-Converting Consenting Lender (as defined in Annex A) has agreed, on the terms and conditions set

forth herein, to consent to this Amendment and to have all of its outstanding Initial Term Loans prepaid

and will purchase by assignment from the Additional 2024 Term B Lender 2024 Term B Loans in a

principal amount equal to the principal amount of such Initial Term Loans (or such lesser amount as

notified and allocated to such Non-Converting Consenting Lender by the Lead Arrangers) and (iii) the

Additional 2024 Term B Lender has agreed to fund 2024 Term B Loans in a principal amount equal to the

principal amount of any outstanding Initial Term Loans that are not converted into 2024 Term B Loans on

the Amendment No. 2 Effective Date as described in clause (i) above (the “Additional 2024 Term B

Loans”), the proceeds of which will be used by the Borrower to repay in full such non-converted Initial

Term Loans;

WHEREAS, subject to the terms and conditions set forth herein, (i) the 2024 Term B

Loans shall constitute “Term Loans” and “Loans” and (ii) each 2024 Term B Lender shall become a

“Term Loan Lender” and a “Lender” (if such 2024 Term B Lender is not already a Lender or a Term

Loan Lender, as applicable, prior to the effectiveness of this Amendment) and shall have all the rights and

obligations of a Lender holding a Term Loan;

WHEREAS, pursuant to Sections 2.16 and 11.01 of the Existing Credit Agreement, the

Existing Credit Agreement may be amended by the Borrower, each Lender providing Refinancing Term

Loans and the Required Lenders, and acknowledged by the Administrative Agent;

WHEREAS, the Loan Parties, the Administrative Agent and the Lenders party hereto

desire to amend the Existing Credit Agreement on the terms set forth herein;

WHEREAS, BofA Securities, Inc., JPMorgan Chase Bank, N.A. and Morgan Stanley

Senior Funding, Inc. shall act as the joint lead arrangers and lead bookrunners for this Amendment (the

“Lead Arrangers”) and Capital One, National Association shall act as the co-manager for this

Amendment.

-2-

NOW, THEREFORE, in consideration of the premises and for other good and valuable

consideration, the sufficiency and receipt of all of which is hereby acknowledged, the parties hereto

hereby agree as follows:

SECTION 1.Defined Terms. Capitalized terms used but not defined herein shall have

the respective meanings assigned to such terms in the Existing Credit Agreement, as amended by this

Amendment (the “Amended Credit Agreement”).

SECTION 2.Amendments and Consents to the Existing Credit Agreement.  Effective

as of the Amendment No. 2 Effective Date (as defined below), the Existing Credit Agreement is hereby

amended by deleting the stricken text (indicated textually in the same manner as the following example:

stricken text) and adding the double-underlined text (indicated textually in the same manner as the

following example: double-underlined text) as set forth in the pages of the Existing Credit Agreement

attached as Annex A hereto.

SECTION 3.Conditions to the Amendment Becoming Effective.  This Amendment

shall become effective on the date (such date being referred to as the “Amendment No. 2 Effective

Date”), when each of the following conditions shall have been satisfied:

(a)(i) the Borrower and the Guarantors shall have executed and delivered

counterparts of this Amendment to the Administrative Agent, (ii) each Converting Consenting Lender and

each Non-Converting Consenting Lender shall have executed and delivered counterparts of this

Amendment to the Administrative Agent, (iii) the Additional 2024 Term B Lender shall have executed

and delivered a counterpart of this Amendment to the Administrative Agent, (iv) the Required Lenders

shall have executed and delivered a counterpart of this Amendment to the Administrative Agent and (v)

the Administrative Agent shall have executed a counterpart of this Amendment;

(b)Payment by the Borrower of all reasonable fees and documented and reasonable

out-of-pocket expenses due to the Administrative Agent and the Lead Arrangers, including, to the extent

invoiced at least two (2) Business Days prior to the Amendment No. 2 Effective Date, reimbursement or

payment of all reasonable out-of-pocket expenses (including the reasonable legal fees and expenses of

Cahill Gordon & Reindel llp, counsel to the Administrative Agent and the Lead Arrangers);

(c)the representations and warranties of the Loan Parties contained in Section 4

hereof shall be true and correct in all material respects (without duplication of any materiality qualifier

contained therein) on and as of the Amendment No. 2 Effective Date, except to the extent that such

representations and warranties expressly relate to an earlier date (in which event such representations and

warranties were true and correct in all material respects (without duplication of any materiality qualifier

contained therein) as of such earlier date);

(d)prior to and immediately after the Amendment No. 2 Effective Date, no Default

or Event of Default shall have occurred and be continuing;

(e)The Administrative Agent shall have received (i) copies of the Organization

Documents of the Borrower certified to be true and complete as of a recent date by the appropriate

Governmental Authority of the state or other jurisdiction of its incorporation or organization, where

applicable, and certified by a secretary or assistant secretary of the Borrower to be true and correct in all

material respects as of the Amendment No. 2 Effective Date (or, in the alternative, a certification by a

Responsible Officer that no modifications to the Organization Documents delivered on the Effective Date

-3-

have occurred since the Effective Date), (ii) copies of such certificates of resolutions or other action,

incumbency certificates and/or other certificates of Responsible Officers of the Borrower as the

Administrative Agent may reasonably request prior to the Amendment No. 2 Effective Date evidencing

the identity, authority and capacity of each Responsible Officer thereof authorized to act as a Responsible

Officer in connection with this Agreement and the other Loan Documents to which the Borrower is a

party and (iii) copies of such documents and certifications as the Administrative Agent may reasonably

request prior to the Amendment No. 2 Effective Date to evidence that the Borrower is duly organized or

formed, and is validly existing, in good standing and qualified to engage in business in its state of

organization or formation;

(f)The Borrower shall have, immediately after the making of 2024 Term B Loans

under the Amended Credit Agreement, (i) prepaid all Initial Term Loans (other than Initial Term Loans

that are Converted 2024 Term B Loans) outstanding immediately prior to the Amendment No. 2 Effective

Date and (ii) paid to all Initial Term Lenders all accrued and unpaid interest, fees or other outstanding

amounts on their Initial Term Loans outstanding immediately prior to the Amendment No. 2 Effective

Date to, but not including, the Amendment No. 2 Effective Date;

(g)The Administrative Agent shall have received, in form and substance reasonably

satisfactory to it, the results of customary UCC, tax and judgment lien searches;

(h)The Administrative Agent and each Lender providing 2024 Term B Loans shall

have received, at least three (3) Business Days prior to the Amendment No. 2 Effective Date, (i) all

documentation and other information required by bank regulatory authorities under applicable “know

your customer” and anti-money laundering rules and regulations, including the USA PATRIOT Act and

(ii) to the extent the Borrower qualifies as a “legal entity customer” under the Beneficial Ownership

Regulation, a Beneficial Ownership Certification in relation to the Borrower, in each case, to the extent

reasonably requested by such Person in writing at least ten (10) Business Days prior to the Amendment

No. 2 Effective Date; and

(i) The Administrative Agent shall have received for each Mortgaged Property (i) a

completed “life-of-loan” Federal Emergency Management Agency standard flood hazard determination

and (ii) to the extent a Mortgaged Property is located in an area identified by the Federal Emergency

Management Agency (or any successor agency) as a special flood hazard area with respect to which flood

insurance has been made available under the Flood Insurance Laws, a notice about special flood hazard

area status and flood disaster assistance duly executed by the Borrower and the applicable Loan Party

relating thereto together with a copy of, or a certificate as to coverage under, and a declaration page

relating to, the insurance policies to the extent required by Section 7.07(b) of the Existing Credit

Agreement. This condition has been satisfied.

For purposes of determining compliance with the conditions specified in this Section 3, by its

execution of this Amendment, each Converting Consenting Lender and each Non-Converting Consenting

Lender shall be deemed to have consented to, approved or accepted or to be satisfied with, each document

or other matter required thereunder to be consented to or approved by or acceptable or satisfactory to such

Converting Consenting Lender or such Non-Converting Consenting Lender, as applicable, unless the

Administrative Agent shall have received notice from such Converting Consenting Lender or such Non-

Converting Consenting Lender, as applicable, prior to the proposed Amendment No. 2 Effective Date

specifying its objection thereto.  For the avoidance of doubt, the Amendment No. 2 Effective Date is

September 18, 2024.

-4-

SECTION 4.Representations and Warranties:  On and as of the Amendment No. 2

Effective Date, after giving effect to this Amendment, each Loan Party represents and warrants as

follows:

(a)The execution, delivery and performance by each Loan Party of this Amendment

has been duly authorized by all necessary corporate or other organizational action, and does not (i)

contravene the terms of any of such Person’s Organization Documents; (ii) conflict with or result in any

breach or contravention of, or the creation of any Lien under (A) any material Contractual Obligation to

which such Person is a party or (B) any order, injunction, writ or decree of any Governmental Authority

or any arbitral award to which such Person or its property is subject; (iii) violate any Law (including,

without limitation, Regulation U or Regulation X issued by the FRB); (iv) result in a limitation on any

licenses, permits or other approvals applicable to the business, operations or properties of any Loan

Party; or (v) materially and adversely affect the ability of any Loan Party to participate in any Medical

Reimbursement Programs (except, in the cases of clauses (ii)(A), (iii) and (iv), as could not reasonably

be expected to have a Material Adverse Effect).

(b)This Amendment has been duly executed and delivered by each Loan Party that

is party hereto.  This Amendment constitutes a legal, valid and binding obligation of each Loan Party

that is party hereto, enforceable against each such Loan Party in accordance with its terms except as

enforceability may be limited by applicable Debtor Relief Laws or by equitable principles relating to

enforceability.

(c)The representations and warranties of the Borrower and each other Loan Party

contained in Article VI of the Amended Credit Agreement or any other Loan Document are true and

correct in all material respects (and in all respects if any such representation or warranty is already

qualified by materiality) on and as of the Amendment No. 2 Effective Date, except to the extent that such

representations and warranties specifically refer to an earlier date, in which case they shall be true and

correct in all material respects (and in all respects if any such representation or warranty is already

qualified by materiality) as of such earlier date.

(d)No Default or Event of Default exists or would result from the effectiveness of

this Amendment, including the incurrence of the 2024 Term B Loans.

(e)As of the Amendment No. 2 Effective Date, to the best knowledge of the

Borrower, the information included in any Beneficial Ownership Certification provided on or prior to the

Amendment No. 2 Effective Date to any Lender in connection with this agreement is true and correct in

all respects.

(f)Parent and its Subsidiaries, on a consolidated basis, are Solvent.

SECTION 5.Waivers.  The Lenders having Initial Term Loans that are prepaid in

connection with the making of the 2024 Term B Loans and not constituting Non-Converting Consenting

Lenders or Converting Consenting Lenders shall be entitled to the benefits of Section 3.05 of the Existing

Credit Agreement with respect thereto.  The Non-Converting Consenting Lenders and the Converting

Consenting Lenders hereby waive the benefits of Section 3.05 of the Existing Credit Agreement with

respect to the prepayment of their Initial Term Loans in connection with this Amendment. This

Amendment shall constitute a Prepayment Notice with respect to the Initial Term Loans and the Lenders

party to this Amendment hereby waive any additional Prepayment Notice requirement with respect to the

Initial Term Loans being prepaid in connection with this Amendment.

-5-

SECTION 6.Effect of Amendment.    Except as expressly set forth herein, this

Amendment (at the time it is effective and at the time it is operative) shall not alter, modify, amend or in

any way affect any of the terms, conditions, obligations, covenants or agreements contained in the

Existing Credit Agreement or any other provision of the Existing Credit Agreement or any other Loan

Document, all of which are ratified and affirmed in all respects and shall continue in full force and effect.

As of the Amendment No. 2 Effective Date, each reference in the Existing Credit Agreement to “this

Agreement,” “hereunder,” “hereof,” “herein,” or words of like import, and each reference in the other

Loan Documents to the Existing Credit Agreement (including, without limitation, by means of words like

“thereunder,” “thereof” and words of like import), shall mean and be a reference to the Existing Credit

Agreement as amended hereby, and this Amendment and the Existing Credit Agreement shall be read

together and construed as a single instrument.  This Amendment shall constitute a Loan Document on the

Amendment No. 2 Effective Date.

SECTION 7.Fees and Expenses.  The Borrower agrees to pay in accordance with the

terms of Section 11.04 of the Existing Credit Agreement all reasonable and documented out-of-pocket

costs and expenses of the Administrative Agent in connection with the preparation, reproduction,

execution and delivery of this Amendment (including Attorney Costs).

SECTION 8.Fungibility.  From and after the Amendment No. 2 Effective Date, the

parties shall treat all of the 2024 Term B Loans (whether issued for cash or in exchange for Initial Term

Loans) as one fungible tranche for U.S. federal income tax purposes.

SECTION 9.Counterparts.  This Amendment may be executed in any number of

counterparts and by different parties hereto on separate counterparts, each of which when so executed and

delivered shall be an original, but all of which shall together constitute one and the same instrument.  A

set of counterparts executed by all the parties hereto shall be lodged with the Borrower and the

Administrative Agent. Delivery of an executed signature page of this Amendment by facsimile

transmission or Electronic Transmission shall be as effective as delivery of a manually executed

counterpart hereof. This Agreement and any document, amendment, approval, consent, information,

notice, certificate, request, statement, disclosure or authorization related to this Agreement (each a

“Communication”), including Communications required to be in writing, may be in the form of an

Electronic Record (as defined below) and may be executed using Electronic Signatures (as defined

below), including, without limitation, facsimile and/or .pdf. Each of the Loan Parties, the Administrative

Agent and each of the Lenders party hereto agree that any Electronic Signature (including, without

limitation, facsimile or .pdf) on or associated with any Communication shall be valid and binding on such

Person to the same extent as a manual, original signature, and that any Communication entered into by

Electronic Signature, will constitute the legal, valid and binding obligation of such Person enforceable

against such Person in accordance with the terms thereof to the same extent as if a manually executed

original signature was delivered. Any Communication may be executed in as many counterparts as

necessary or convenient, including both paper and electronic counterparts, but all such counterparts are

one and the same Communication. For the avoidance of doubt, the authorization under this paragraph

may include, without limitation, use or acceptance of a manually signed paper Communication which has

been converted into electronic form (such as scanned into PDF format), or an electronically signed

Communication converted into another format, for transmission, delivery and/or retention. The

Administrative Agent and each of the Lenders may, at its option, create one or more copies of any

Communication in the form of an imaged Electronic Record (“Electronic Copy”), which shall be deemed

created in the ordinary course of such Person’s business, and destroy the original paper document. All

-6-

Communications in the form of an Electronic Record, including an Electronic Copy, shall be considered

an original for all purposes, and shall have the same legal effect, validity and enforceability as a paper

record. Notwithstanding anything contained herein to the contrary, the Administrative Agent is under no

obligation to accept an Electronic Signature in any form or in any format unless expressly agreed to by

the Administrative Agent pursuant to procedures approved by it; provided, further, without limiting the

foregoing, (i) to the extent the Administrative Agent has agreed to accept such Electronic Signature, the

Administrative Agent and the Lenders shall be entitled to rely on any such Electronic Signature

purportedly given by or on behalf of any Loan Party without further verification and (ii) upon the request

of the Administrative Agent any Electronic Signature shall be promptly followed by a manually executed,

original counterpart. For purposes hereof, “Electronic Record” and “Electronic Signature” shall have

the meanings assigned to them, respectively, by 15 USC §7006, as it may be amended from time to time.

SECTION 10.Notice of Refinancing.  Pursuant to this Amendment, the Borrower hereby

requests a Borrowing of 2024 Term B Loans in an aggregate principal amount of $777,500,000.00, with

such Borrowing to be made as Term SOFR Loans on the Amendment No. 2 Effective Date and to have

an Interest Period under the Amended Credit Agreement ending on September 30, 2024.  This

Amendment shall constitute a Loan Notice with respect to the 2024 Term B Loans and each 2024 Term

B Lender party hereto hereby waives any prior notice requirement under Section 2.02(a) of the Amended

Credit Agreement.

SECTION 11.Acknowledgement and Affirmation.  Each Loan Party hereto hereby

expressly acknowledges as of the Amendment No. 2 Effective Date, (i) all of its obligations under the

Security Agreements and the other Collateral Documents to which it is a party are reaffirmed and remain

in full force and effect on a continuous basis, (ii) its grant of Liens and security interests pursuant to the

Security Agreements and the other Collateral Documents are reaffirmed and remain in full force and

effect after giving effect to this Amendment, (iii) the Obligations include, among other things and without

limitation, the due and punctual payment of the principal of, interest on, and premium (if any) on, the

Loans (including, without limitation, the 2024 Term B Loans) and (iv) except as expressly set forth

herein, the execution of this Amendment shall not operate as a waiver of any right, power or remedy of

the Administrative Agent or Lenders, constitute a waiver of any provision of or be construed as, or be

intended to be construed as, a novation of any of the Loan Documents or serve to effect a novation of the

Obligations outstanding under the Existing Credit Agreement or instruments guaranteeing or securing the

same, which instruments shall remain and continue in full force and effect.  Without limiting the

generality of the foregoing, the Collateral Documents and all of the Collateral described therein do and

shall continue to secure the payment of all Obligations of the Loan Parties under the Existing Credit

Agreement and the other Loan Documents, in each case, as amended by this Amendment.

SECTION 12.Applicable Law.  THIS AMENDMENT SHALL BE GOVERNED BY,

AND CONSTRUED IN ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK

APPLICABLE TO AGREEMENTS MADE AND TO BE PERFORMED ENTIRELY WITHIN SUCH

STATE.

SECTION 13.Headings Descriptive.  The headings of the several Sections and

subsections of this Amendment are inserted for convenience only and shall not in any way affect the

meaning or construction of any provision of this Amendment.

[SIGNATURE PAGES FOLLOW]

[Ardent - Signature Page to Amendment No. 2]

IN WITNESS WHEREOF, the parties hereto have caused this Amendment to be executed by

their respective officers thereunto duly authorized, as of the date first above written.

AHP HEALTH PARTNERS, INC.

By:/s/ Ashley M. Crabtree

Name:Ashley M. Crabtree

Title:Senior Vice President, Treasurer

ARDENT HEALTH PARTNERS, INC.

By:/s/ Ashley M. Crabtree

Name:Ashley M. Crabtree

Title:Senior Vice President, Treasurer

ARDENT LEGACY HOLDINGS, LLC

LHP HOSPITAL GROUP, INC.

AHS NEWCO 17, LLC

AHS NEWCO 18, LLC

AHS OKLAHOMA, LLC

AHS HILLCREST HEALTHCARE SYSTEM, LLC

AHS MANAGEMENT COMPANY, INC.

AHS EAST TEXAS HEALTH SYSTEM, LLC

BSA HEALTH SYSTEM OF AMARILLO, LLC

AHS KANSAS HEALTH SYSTEM, INC.

SOUTHWEST MEDICAL ASSOCIATES, LLC

LOVELACE HEALTH SYSTEM, LLC

AHS ALBUQUERQUE HOLDINGS, LLC

LHS SERVICES, INC.

AHS CLAREMORE REGIONAL HOSPITAL, LLC

AHS OKLAHOMA HEART, LLC

AHS CUSHING HOSPITAL, LLC

AHS HENRYETTA HOSPITAL, LLC

AHS OKLAHOMA PHYSICIAN GROUP, LLC

AHS HILLCREST MEDICAL CENTER, LLC

AHS MANAGEMENT SERVICES OF

OKLAHOMA, LLC

AHS PRYOR HOSPITAL, LLC

BAILEY MEDICAL CENTER, LLC

AHS SOUTHCREST HOSPITAL, LLC

AHS TULSA HOLDINGS, LLC

BSA HOSPITAL, LLC

BSA HEALTH SYSTEM MANAGEMENT, LLC

BSA HEALTH SYSTEM HOLDINGS, LLC

BSA PHYSICIANS GROUP, INC.

BSA HARRINGTON PHYSICIANS, INC.

BSA AMARILLO DIAGNOSTIC CLINIC, INC.

[Ardent - Signature Page to Amendment No. 2]

LHP OPERATIONS CO., LLC

LHP MANAGEMENT SERVICES, LLC

LHP TEXAS PHYSICIANS, LLC

LHP MONTCLAIR LLC

LHP PASCACK VALLEY, LLC

LHP POCATELLO, LLC

LHP HH/KILLEEN, LLC

LHP BAY COUNTY, LLC

LHP IT SERVICES, LLC

LHP TEXAS MD SERVICES, INC.

ATHENS HOSPITAL, LLC

CARTHAGE HOSPITAL, LLC

HENDERSON HOSPITAL, LLC

JACKSONVILLE HOSPITAL, LLC

PITTSBURG HOSPITAL, LLC

QUITMAN HOSPITAL, LLC

TYLER REGIONAL HOSPITAL, LLC

REHABILITATION HOSPITAL, LLC

SPECIALTY HOSPITAL, LLC

EAST TEXAS HOLDINGS, LLC

ETMC PHYSICIAN GROUP, INC.

EAST TEXAS AIR ONE, LLC

NEW MEXICO HEART INSTITUTE, LLC

AHS TEXAS, LLC

AHS BSA, LLC

AHS PSO, LLC

AHS ACQUISITIONS, LLC

By:/s/ Ashley M. Crabtree

Name:Ashley M. Crabtree

Title:Senior Vice President, Treasurer

[Ardent - Signature Page to Amendment No. 2]

BANK OF AMERICA, N.A.,

as the Additional 2024 Term B Lender

By:  /s/ Craig DelDuca

Name:Craig DelDuca

Title:Vice President

BANK OF AMERICA, N.A.,

as Administrative Agent

By:  /s/ Don B. Pinzon

Name:Don B. Pinzon

Title:Vice President

[Ardent – Form of Signature Page to Amendment No. 2]

IN WITNESS WHEREOF, the undersigned has caused this Amendment to be executed

and delivered by a duly authorized officer as of the date first written above.

Term Loan Lenders

☐Consent and Convert (Cashless Settlement) The undersigned hereby elects to be a “Converting

Consenting Lender” and irrevocably and unconditionally consents to this Amendment and agrees

to the conversion of the full principal amount (or such lesser amount as notified and allocated to

the undersigned by the Lead Arrangers) of its Initial Term Loans effective as of the Amendment

No. 2 Effective Date.

☐Consent and Reallocation. The undersigned hereby elects to be a “Non-Converting Consenting

Lender” and irrevocably and unconditionally (a) consents to this Amendment and the prepayment

of the full principal amount of its Initial Term Loans and (b) agrees to purchase by way of

assignment from the Additional 2024 Term B Lender in accordance with the terms of the

Amended Credit Agreement, 2024 Term B Loans in a principal amount equal to the principal

amount of its Initial Term Loans prepaid (or such lesser amount as notified and allocated to the

undersigned by the Lead Arrangers).

[NAME OF LENDER]

By:

Name:

Title:

Name of Fund Manager (if any): ___________________

[If a second signature is necessary:

By:

Name:

Title: ]

[Ardent - Signature Page to Amendment No. 2]

ANNEX A

CREDIT AGREEMENT

[Ardent - Signature Page to Amendment No. 2]

ANNEX A

Deal CUSIP Number:

00130MAH7 Initial Term Loan CUSIP

Number: 00130MAJ3 2024 Term B Loan

CUSIP Number: 00130MAK0

AMENDED AND RESTATED TERM LOAN CREDIT AGREEMENT

Dated as of August 24, 2021,

as amended by Amendment No. 1, dated as of June 8, 2023, and

as amended by Amendment No. 2, dated as of September 18,

2024,

among

AHP HEALTH PARTNERS, INC.,

as Borrower,

ARDENT HEALTH PARTNERS, INC.

(f/k/a ARDENT HEALTH PARTNERS, LLC),

as Parent,

and

CERTAIN OF ITS SUBSIDIARIES,

as the Guarantors,

BANK OF AMERICA, N.A.,

as Administrative Agent,

and

The Other Lenders Party Hereto

Arranged by:

BANK OF AMERICA, N.A.,

BARCLAYS BANK PLC, and

JPMORGAN CHASE BANK,

N.A.,

as Joint Lead Arrangers and Joint Book Runners

[Ardent - Signature Page to Amendment No. 2]

CAPITAL ONE, N.A. and

REGIONS CAPITAL

MARKETS,

as Co-Managers

i

TABLE OF CONTENTS

Page

ARTICLE I

DEFINITIONS AND ACCOUNTING TERMS

1.01Defined Terms2

1.02Other Interpretive Provisions50

1.03Accounting Terms5051

1.04Rounding5152

1.05References to Agreements and Laws5152

1.06Times of Day5152

1.07Basket Classification52

1.08Limited Condition Acquisitions5253

1.09Divisions5354

1.10Amendment and Restatement5354

1.11Interest Rates54

ARTICLE II

THE COMMITMENTS AND BORROWINGS

2.01Term Loans5455

2.02Borrowings; Conversions and Continuations of Loans5455

2.03[Reserved]5657

2.04[Reserved]5657

2.05Prepayments5657

2.06Termination or Reduction of Commitments5860

2.07Repayment of Loans5860

2.08Interest5960

2.09Fees5961

2.10Computation of Interest and Fees5961

2.11Evidence of Debt5961

2.12Payments Generally6061

2.13Sharing of Payments6263

2.14Incremental Borrowings6264

2.15Defaulting Lenders6466

2.16Refinancing Amendments6567

2.17Extended Term Loans6768

2.18Relative Rights Agreement Assignment6870

ARTICLE III

TAXES, YIELD PROTECTION AND ILLEGALITY

3.01Taxes7072

3.02Illegality7375

3.03Inability To Determine Rates7375

ii

Page

3.04Increased Cost and Reduced Return; Capital Adequacy7577

3.05Funding Losses7677

3.06Matters Applicable to All Requests for Compensation7678

3.07Survival7778

ARTICLE IV

GUARANTY

4.01The Guaranty7778

4.02Obligations Unconditional7779

4.03Reinstatement7980

4.04Certain Additional Waivers7980

4.05Remedies7980

4.06Rights of Contribution7981

4.07Guarantee of Payment; Continuing Guarantee8082

4.08Limited Guarantee by Tenant Subsidiaries8082

ARTICLE V

CONDITIONS PRECEDENT

5.01Conditions to Effective Date8182

ARTICLE VI

REPRESENTATIONS AND WARRANTIES

6.01Existence, Qualification and Power8384

6.02Authorization; No Contravention8385

6.03Governmental Authorization; Other Consents8385

6.04Binding Effect8485

6.05Financial Statements; No Material Adverse Effect8485

6.06Litigation8486

6.07Contractual Obligations8586

6.08Ownership of Property; Liens8586

6.09Environmental Compliance8586

6.10Insurance8687

6.11Taxes8687

6.12ERISA Compliance8688

6.13Subsidiaries8788

6.14Margin Regulations; Investment Company Act8788

6.15Disclosure8789

6.16Compliance with Laws8889

6.17Intellectual Property; Licenses, Etc.8890

6.18Solvency8990

6.19Perfection of Security Interests in the Collateral8990

6.20[Reserved]9091

6.21Brokers’ Fees9091

6.22Labor Matters9091

iii

Page

6.23Fraud and Abuse9091

6.24Licensing and Accreditation9092

6.25Anti-Terrorism Laws; Anti-Corruption9192

6.26Affected Financial Institutions9192

6.27HMO Entities9193

ARTICLE VII

AFFIRMATIVE COVENANTS

7.01Financial Statements9293

7.02Certificates; Other Information9394

7.03Notices9697

7.04Payment of Taxes9798

7.05Preservation of Existence, Etc.9798

7.06Maintenance of Properties9899

7.07Maintenance of Insurance9899

7.08Compliance with Laws98100

7.09Books and Records99100

7.10Inspection Rights99101

7.11Use of Proceeds100101

7.12Additional Subsidiaries; Additional Guarantors100101

7.13ERISA Compliance101102

7.14Pledged Assets101102

7.15Annual Appraisals103104

7.16Change in Nature of Business103104

7.17Post-Closing Matters103104

7.18Compliance with Terms of Master Lease103104

ARTICLE VIII

NEGATIVE COVENANTS

8.01Liens103105

8.02Investments107108

8.03Indebtedness111112

8.04Fundamental Changes115116

8.05Dispositions116117

8.06Restricted Payments116117

8.07[Reserved]119120

8.08Transactions with Affiliates119120

8.09Burdensome Agreements120121

8.10[Reserved]121122

8.11[Reserved]121122

8.12[Reserved]121122

8.13Prepayment of Subordinated Indebtedness, Etc.121122

8.14Organization Documents; Fiscal Year; Amendments to Master Lease121122

8.15Limitations on Parent122123

8.16Limitations on the ETMC JV122123

iv

8.17Required Payment Intercompany Note124125

8.18HMO Entities124125

ARTICLE IX

EVENTS OF DEFAULT AND REMEDIES

9.01Events of Default124125

9.02Remedies upon Event of Default127128

9.03Application of Funds128129

ARTICLE X

ADMINISTRATIVE AGENT

10.01Appointment and Authorization of Administrative Agent128129

10.02Delegation of Duties129130

10.03Liability of Administrative Agent129130

10.04Reliance by Administrative Agent129130

10.05Notice of Default130131

10.06Credit Decision; Disclosure of Information by Administrative Agent130131

10.07Indemnification of Administrative Agent131132

10.08Administrative Agent in Its Individual Capacity131132

10.09Successor Administrative Agent131132

10.10Administrative Agent May File Proofs of Claim; Credit Bidding132133

10.11Collateral and Guaranty Matters133134

10.12Other Agents; Joint Book Runners and Managers134135

10.13No Advisory or Fiduciary Responsibility134135

10.14Exculpatory Provisions135136

10.15Rights as Lender136137

10.16Withholding Taxes136137

10.17Intercreditor Agreement; Relative Rights Agreement136137

10.18Certain ERISA Matters137138

10.19Recovery of Erroneous Payments138139

ARTICLE XI

MISCELLANEOUS

11.01Amendments, Etc.139140

11.02Notices and Other Communications; Facsimile Copies141142

11.03No Waiver; Cumulative Remedies142143

11.04Attorney Costs, Expenses and Taxes142143

11.05Indemnification by the Borrower142143

11.06Payments Set Aside143144

11.07Successors and Assigns143145

11.08Confidentiality148149

11.09Setoff149150

11.10Interest Rate Limitation149150

11.11Counterparts149150

11.12Integration150151

v

11.13Survival of Representations and Warranties150151

11.14Severability150151

11.15[Reserved]151152

11.16Replacement of Lenders151152

11.17Governing Law151152

11.18Waiver of Right to Trial by Jury152153

11.19[Reserved]152153

11.20Publicity152153

11.21USA PATRIOT Act Notice152153

11.22Acknowledgement and Consent to Bail-In of Affected Financial Institutions152153

11.23Acknowledgement Regarding Any Supported QFCs153154

SCHEDULES

1.01Mortgaged Properties

1.10Released Mortgaged Properties

2.01Commitments and Pro Rata Shares

6.10Insurance

6.13Subsidiaries

6.17IP Rights

6.22Collective Bargaining Agreements and Multiemployer Plans

6.24(a)Accreditations

7.17Post Closing Items

8.01Liens Existing on the Effective Date

8.02Investments Existing on the Effective Date

8.03Indebtedness Existing on the Effective Date

11.02Certain Addresses for Notices; Taxpayer ID Number

EXHIBITS

A[Reserved]

B-1Form of Non-Tenant Subsidiary Pledge Agreement

B-2Form of Tenant Subsidiary Pledge Agreement

C-1Form of Non-Tenant Subsidiary Security Agreement

C-2Form of Tenant Subsidiary Security Agreement

DForm of Loan Notice

EForm of Prepayment Notice

F[Reserved]

G[Reserved]

HForm of Term Note

IForm of Excess Cash Certificate

A-1Form of Non-Tenant Joinder Agreement

A-2Form of Tenant Joinder Agreement

KForm of Intercompany Note

L[Reserved]

MForm of Assignment and Assumption

NForm of Lender Assignment and Assumption

OForm of United States Tax Compliance Certificate

PForm of Intercreditor Agreement

QForm of Solvency Certificate

RForm of Relative Rights Agreement

1

AMENDED AND RESTATED TERM LOAN CREDIT AGREEMENT

This AMENDED AND RESTATED TERM LOAN CREDIT AGREEMENT is entered into as of

August 24, 2021, as amended by Amendment No. 1, dated as of June 8, 2023, and as amended by

Amendment No. 2, dated as of September 18, 2024, among AHP HEALTH PARTNERS, INC., a

Delaware corporation (the “Borrower”), ARDENT HEALTH PARTNERS, INC. (f/k/a Ardent Health

Partners, LLC), a Delaware limited liability companycorporation (“Parent”), as Parent, the Guarantors

(defined herein), the Lenders (defined herein) and BANK OF AMERICA, N.A., as Administrative Agent.

WHEREAS, the Borrower is party to that certain Term Loan Credit Agreement, dated as of June

28, 2018 (as amended, supplemented or modified prior to the date hereof, the “Existing Credit

Agreement”), among Parent, Borrower, the lenders from time to time party thereto and Barclays Bank

PLC, as administrative agent, pursuant to which the lenders thereunder have extended or committed to

extend certain credit facilities to the Borrower;

WHEREAS, on the Effective Date, the Borrower requested that the Existing Credit Agreement be

amended and restated and in connection with such amendment and restatement that the Lenders extend

credit in the form of the Term Loans (as defined herein) on the Effective Date (as defined herein) in an

initial aggregate principal amount of $900,000,000;

WHEREAS, on the Effective Date, the proceeds of the Term Loans were used (i) to prepay in full

all existing Term Loans (including accrued and unpaid interest, fees, expenses and other amounts related

thereto, other than contingent obligations not then due and payable) outstanding under the Existing Credit

Agreement on the Effective Date, (ii) to pay fees, commissions and expenses in connection with the

foregoing (clauses (i) and (ii) collectively, the “Effective Date Refinancing”) and (iii) for general

corporate purposes; and

WHEREAS, the Lenders have indicated their willingness to lend on the terms and subject to the

conditions set forth herein;

NOW, THEREFORE, in consideration of the mutual covenants and agreements herein contained,

the parties hereto covenant and agree as follows:

ARTICLE I

DEFINITIONS AND ACCOUNTING TERMS

1.01Defined Terms

As used in this Agreement, the following terms shall have the meanings set forth below:

“2024 Term B Commitment” means (a) with respect to each Converting Consenting Lender, the

commitment of such Lender to convert its Initial Term Loans to an equal aggregate principal amount of

2024 Term B Loans on the Amendment No. 2 Effective Date pursuant to Amendment No. 2, (b) with

respect to the Additional 2024 Term B Lender, its Additional 2024 Term B Commitment and (c) in the

case of any Lender that becomes a Lender after the Amendment No. 2 Effective Date, the amount

specified as such Lender’s “2024 Term B Commitment” in the Assignment and Assumption pursuant to

which such Lender assumed a portion of the aggregate 2024 Term B Commitment, in each case, as the

2

same may be changed from time to time pursuant to the terms hereof. The aggregate amount of the 2024

Term B Commitments on the Amendment No. 2 Effective Date is $777,500,000.00.

“2024 Term B Lender” means any Lender that has a 2024 Term B Commitment or any Lender

that has purchased a 2024 Term B Loan pursuant to one or more Assignment and Assumptions in

accordance with the terms hereof.

“2024 Term B Loans” means the term loans made by the 2024 Term B Lenders to the Borrower

on the Amendment No. 2 Effective Date pursuant to Section 2.01(b).

“2026 Notes” means $475.0 million in aggregate principal amount of the Borrower’s 9.75%

senior notes due 2026 pursuant to the 2026 Notes Indenture on the Original Closing Date.

“2026 Notes Indenture” means the indenture among the Borrower, as issuer, Parent, the

guarantors listed therein and the trustee referred to therein pursuant to which the 2026 Notes were issued,

as such indenture may be amended or supplemented from time to time.

“2029 Notes” means $300.0 million in aggregate principal amount of the Borrower’s 5.750%

senior notes due 2029 pursuant to the 2029 Notes Indenture on July 8, 2021.

“2029 Notes Indenture” means the indenture among the Borrower, as issuer, Parent, the

guarantors listed therein and the trustee referred to therein pursuant to which the 2029 Notes are issued, as

such indenture may be amended or supplemented from time to time.

“ABL Administrative Agent” means Bank of America, in its capacity as administrative agent

under the ABL Documents (or any successor or replacement “Administrative Agent” thereunder).

“ABL Collateral Agent” means Bank of America, in its capacity as collateral agent under the

ABL Documents (or any successor or replacement “Collateral Agent” thereunder).

“ABL Credit Agreement” means (i) that certain amended and restated ABL credit agreement,

dated as of July 8, 2021, among the Borrower, AHS East Texas Health System, LLC, Parent, certain

Subsidiaries of the Borrower as borrowers or guarantors, the lenders party thereto, the ABL Collateral

Agent and the ABL Administrative Agent, as amended, restated, supplemented or modified from time to

time to the extent permitted by the Intercreditor Agreement, and (ii) any other credit agreement,

promissory note, indenture or other agreement or instrument evidencing or governing the terms of any

Indebtedness or other financial accommodation that has been incurred to extend (subject to the limitations

set forth in the Intercreditor Agreement), replace, restructure, renew or refinance in whole or in part the

Indebtedness and other obligations outstanding under (x) the credit agreement referred to in clause (i) or

(y) any subsequent ABL Credit Agreement, unless such agreement or instrument expressly provides that

it is not intended to be and is not an ABL Credit Agreement hereunder. Any reference to the ABL Credit

Agreement hereunder shall be deemed a reference to any ABL Credit Agreement then in existence.

“ABL Documents” means the ABL Credit Agreement and the other Loan Documents (as defined

in the ABL Credit Agreement) or any similar term, including each mortgage and other security

documents, guaranties and the notes issued thereunder.

“ABL Facility” means the senior secured revolving loan facility under the ABL Credit

Agreement or any amendment, supplement, modification, substitution, replacement, restatement or

3

refinancing thereof, in whole or in part, from time to time, including in connection with a

“Refinancing” (as defined in the Intercreditor Agreement) of the ABL Credit Agreement.

“ABL Priority Collateral” has the meaning ascribed to such term in the Intercreditor Agreement.

“Acceptable Intercreditor Agreement” means an intercreditor agreement in form reasonably

acceptable to the Administrative Agent and the Borrower, which intercreditor agreement may, if

determined by the Administrative Agent, be posted to the Lenders not less than ten Business Days before

execution thereof and, if the Required Lenders shall not have objected to such intercreditor agreement

within ten Business Days after posting, then the Required Lenders shall be deemed to have agreed that the

Administrative Agent’s entry into such intercreditor agreement is reasonable and to have consented to such

intercreditor agreement and to the Administrative Agent’s execution thereof.

“Acquired Entity or Business” means the acquisition of any Person, Property, Business or

physical asset by the Borrower or any Restricted Subsidiary.

“Acquisition” by any Person, means the acquisition by such Person, in a single transaction or in a

series of related transactions, of all or any substantial portion of the Property of another Person or any

Voting Stock of another Person, in each case whether or not involving a merger or consolidation with

such other Person and whether for cash, property, services, assumption of Indebtedness, securities or

otherwise.

“Act” has the meaning specified in Section 11.21.

“Additional Lender” has the meaning specified in Section 2.14(c).

“Additional 2024 Term B Commitment” means, with respect to the Additional 2024 Term B

Lender, its commitment to make a 2024 Term B Loan on the Amendment No. 2 Effective Date in an

amount equal to $52,640,477.27.

“Additional 2024 Term B Lender” means the Person identified as such on the signature page to

Amendment No. 2.

“Adjusted Earnings for the Ardent Facilities” shall have the meaning ascribed to such term in the

ETMC JV Agreement as of February 26, 2018.

“Administrative Agent” means Bank of America in its capacity as administrative agent under any

of the Loan Documents, or any successor administrative agent.

“Administrative Agent’s Office” means the Administrative Agent’s address and, as appropriate,

account as set forth on Schedule 11.02 or such other address or account of which the Administrative

Agent may from time to time notify the Borrower and the Lenders.

“Administrative Questionnaire” means an Administrative Questionnaire in a form supplied by the

Administrative Agent.

“Affected Financial Institution” means (a) any EEA Financial Institution or (b) any UK Financial

Institution.

“Affiliate” means, with respect to any Person, another Person that directly or indirectly through

one or more intermediaries, Controls or is Controlled by or is under common Control with the Person

4

specified. “Control” means the possession, directly or indirectly, of the power to direct or cause the

direction of the management or policies of a Person, whether through the ability to exercise voting power,

by contract or otherwise. “Controlling” and “Controlled” have meanings correlative thereto.

“Agency Transfer” has the meaning set forth in the Amendment and Restatement Agreement.

“Agent Parties” has the meaning set forth in Section 7.02.

“Agent-Related Persons” means the Administrative Agent and the Joint Book Runners, together

with their respective Affiliates and the officers, directors, employees, agents and attorneys-in-fact of such

Persons and Affiliates.

“Agreement” means this Amended and Restated Term Loan Credit Agreement, as amended,

modified, supplemented and extended from time to time.

“AHS East Texas” means AHS East Texas Health System, LLC, a Texas limited liability

company, and its successors and permitted assigns.

“Amendment and Restatement Agreement” means that certain Amendment and Restatement

Agreement, dated as of August 24, 2021, among the Borrower, the Guarantors, the Lenders party thereto,

the Administrative Agent and the Resigning Administrative Agent.

“Amendment and Restatement Transactions” means (i) the entry into the Amendment and

Restatement Agreement, (ii) the consummation of the Agency Replacement (as defined in the

Amendment and Restatement Agreement), the Other Appointment and Resignation Documentation, (iii)

the Effective Date Refinancing, (iv) the incurrence of the Initial Term Loans on the Effective Date and (v)

the payment of related fees and expenses.

“Amendment No. 1” means that certain Amendment No. 1 to Amended and Restated Term Loan

Credit Agreement, dated as of June 8, 2023, entered into by the Administrative Agent.

“Amendment No. 2” means that certain Amendment No. 2 to Amended and Restated Term Loan

Credit Agreement, dated as of September 18, 2024, entered into by the Borrower, the Guarantors, the

Lenders party thereto and the Administrative Agent.

“Amendment No. 2 Effective Date” has the meaning assigned to such term in Amendment No. 2.

“Amendment No. 2 Lead Arrangers” means BofA Securities, Inc., JPMorgan Chase Bank, N.A.

and Morgan Stanley Senior Funding, Inc. in their capacity as joint lead arrangers and bookrunners under

Amendment No. 2.

“Anti-Terrorism Laws” means any requirement of Law related to terrorism financing or money

laundering including the Act, The Currency and Foreign Transactions Reporting Act (also known as the

“Bank Secrecy Act”, 31 U.S.C. §§ 5311-5330 and 12 U.S.C. §§ 1818(s), 1820(b) and 1951-1959), the

Trading With the Enemy Act (50 U.S.C. § 1 et seq., as amended) and Executive Order 13224 (effective

September 24, 2001), the International Emergency Economic Powers Act and Executive Orders and

regulations issued thereunder.

“Applicable Rate” means (1) at any time from the Effective Date to, but not including, the

Amendment No. 2 Effective Date, a percentage per annum equal to (a) for Term SOFR Loans, 3.50%,

and (b) for Base Rate Loans, 2.50%; provided, that, upon the consummation of an initial Public Equity

5

Offering (as certified by the Borrower to the Administrative Agent in a certificate signed by a

Responsible Officer), the Applicable Rate will be automatically reduced by 0.25% per annum; and (2) at

any time from and after the Amendment No. 2 Effective Date, a percentage per annum equal to (a) for

Term SOFR Loans, 2.75%, and (b) for Base Rate Loans, 1.75%.

“Approved Hospital Swap” means any exchange of one or more healthcare facilities and related

Property owned by any Loan Party for one or more healthcare facilities and related Property owned by

one or more Persons other than a Loan Party; provided that (a) the Borrower shall have delivered to the

Administrative Agent a certificate of a Responsible Officer, in detail reasonably satisfactory to the

Administrative Agent, demonstrating that, upon giving effect to any such exchange on a Pro Forma Basis,

Consolidated EBITDA will be not less than 90% of Consolidated EBITDA prior to such exchange and

(b) the aggregate book value of all assets disposed of by the Loan Parties pursuant to these exchanges

subsequent to the Effective Date (determined as of the date of any such exchange, net of any liabilities of

the Loan Parties assumed by the Person to which the relevant assets were transferred) shall not exceed

10% of the total assets of the Borrower and its Restricted Subsidiaries on a consolidated basis as of the

Effective Date. Furthermore, if any transaction involves both an exchange and payment of consideration,

such transaction shall be deemed to be an Approved Hospital Swap only to the extent that it involves such

an exchange.

“Ardent” means Ardent Medical Services, Inc., a Delaware corporation.

“Ardent ABL Facility Silo” means the Legacy Credit Facility (as defined in the ABL Credit

Agreement).

“Ardent Acquisition Agreement” means that certain purchase and sale agreement, dated March

27, 2015, among Ardent, AHS Medical Holdings LLC, a Delaware limited liability company, and Ventas,

as amended, restated, supplemented or otherwise modified from time to time.

“Assignment and Assumption” means an Assignment and Assumption substantially in the form

of Exhibit M, or such other form or mechanism that shall be reasonably satisfactory to the Administrative

Agent.

“Attorney Costs” means and includes all reasonable fees and documented out-of-pocket expenses

and disbursements of one counsel for the Administrative Agent and the Joint Book Runners, and to the

extent reasonably determined by the Administrative Agent to be necessary, one firm of local counsel in

each relevant material jurisdiction (which may include a single special counsel acting in multiple

jurisdictions) and, in the case of an actual conflict of interest where an Indemnitee affected by such

conflict notifies the Borrower of the existence of such conflict and thereafter retains its own counsel, one

additional conflicts counsel in each applicable jurisdiction for all of the affected Indemnitees similarly

situated.

“Attributable Indebtedness” means, on any date, (a) in respect of any Capital Lease of any

Person, the capitalized amount thereof that would appear on a balance sheet of such Person prepared as of

such date in accordance with GAAP, (b) in respect of any Synthetic Lease, the capitalized amount of the

remaining lease payments under the relevant lease that would appear on a balance sheet of such Person

prepared as of such date in accordance with GAAP if such lease were accounted for as a Capital Lease

and (c) in respect of any Securitization Transaction of any Person, the outstanding principal amount of

such financing, after taking into account reserve accounts and making appropriate adjustments,

determined by the Administrative Agent in its reasonable judgment.

6

“Audited Financial Statements” means the consolidated audited financial statements of Parent and

its Subsidiaries for the fiscal years ended December 31, 2018, December 31, 2019 and December 31,2020.

“Available Incremental Amount” has the meaning set forth in Section 2.14(a).

“Available Tenor” means, as of any date of determination and with respect to the then-current

Benchmark, as applicable, (x) if the then-current Benchmark is a term rate, any tenor for such Benchmark

that is or may be used for determining the length of an Interest Period or (y) otherwise, any payment

period for interest calculated with reference to such Benchmark, as applicable, pursuant to this Agreement

as of such date.

“Bail-In Action” means the exercise of any Write-Down and Conversion Powers by the

applicable Resolution Authority in respect of any liability of an Affected Financial Institution.

“Bail-In Legislation” means (a) with respect to any EEA Member Country implementing Article

55 of Directive 2014/59/EU of the European Parliament and of the Council of the European Union, the

implementing law, regulation, rule or requirement for such EEA Member Country from time to time

which is described in the EU Bail-In Legislation Schedule and (b) with respect to the United Kingdom,

Part I of the United Kingdom Banking Act 2009 (as amended from time to time) and any other law,

regulation or rule applicable in the United Kingdom relating to the resolution of unsound or failing banks,

investment firms or other financial institutions or their affiliates (other than through liquidation,

administration or other insolvency proceedings).

“Bank of America” means Bank of America, N.A. and its successors.

“Bankruptcy Code” means Title 11 of the United States Code or any successor provision.

“Barclays” means Barclays Bank PLC and its successors.

“Base Rate” means, for any day, a fluctuating rate per annum equal to the highest of (a) the

Federal Funds Rate plus 1/2 of 1%, (b) the rate of interest in effect for such day as publicly announced

from time to time by Bank of America as its “prime rate”, and (c) Term SOFR plus 1.00%. The “prime

rate” is a rate set by Bank of America based upon various factors including Bank of America’s costs and

desired return, general economic conditions and other factors, and is used as a reference point for pricing

some loans, which may be priced at, above, or below such announced rate. Any change in such prime

rate announced by Bank of America shall take effect at the opening of business on the day specified in the

public announcement of such change. If the Base Rate is being used as an alternate rate of interest

pursuant to Section 3.03 hereof, then the Base Rate shall be the greater of clauses (a) and (b) above and

shall be determined without reference to clause (c) above.

“Base Rate Loan” means a Loan that bears interest based on the Base Rate.

“Benchmark” means, initially, Term SOFR; provided that if a replacement of the Benchmark has

occurred pursuant to Section 3.03(c) then “Benchmark” means the applicable Benchmark Replacement to

the extent that such Benchmark Replacement has replaced such prior benchmark rate. Any reference to

“Benchmark” shall include, as applicable, the published component used in the calculation thereof.

“Benchmark Replacement” means the sum of (a) the alternate benchmark rate and (b) an

adjustment (which may be a positive or negative value or zero), in each case, that has been selected by the

Administrative Agent and the Borrower as the replacement Benchmark giving due consideration to any

7

evolving or then-prevailing market convention, including any applicable recommendations made by a

Relevant Governmental Body, for U.S. dollar-denominated syndicated credit facilities at such time;

provided that, if the Benchmark Replacement would be less than 0.50%, the Benchmark

Replacement will be deemed to be 0.50% for the purposes of this Agreement and the other Loan

Documents.

Any Benchmark Replacement shall be applied in a manner consistent with market practice;

provided that to the extent such market practice is not administratively feasible for the Administrative

Agent, such Benchmark Replacement shall be applied in a manner as otherwise reasonably determined by

the Administrative Agent.

“Benchmark Replacement Conforming Changes” means, with respect to any Benchmark

Replacement, any technical, administrative or operational changes (including changes to the definition of

“Base Rate,” the definition of “Business Day,” the definition of “Interest Period,” timing and frequency

of determining rates and making payments of interest, timing of borrowing requests or prepayment,

conversion or continuation notices, the applicability and length of lookback periods, the applicability of

breakage provisions, and other technical, administrative or operational matters) that the Administrative

Agent decides may be appropriate to reflect the adoption and implementation of such Benchmark

Replacement and to permit the administration thereof by the Administrative Agent in a manner

substantially consistent with market practice (or, if the Administrative Agent decides that adoption of any

portion of such market practice is not administratively feasible or if the Administrative Agent determines

that no market practice for the administration of such Benchmark Replacement exists, in such other

manner of administration as the Administrative Agent decides is reasonably necessary in connection with

the administration of this Agreement and the other Loan Documents).

“Benchmark Transition Event” means, with respect to any then-current Benchmark, the

occurrence of a public statement or publication of information by or on behalf of the administrator of the

then-current Benchmark or a Governmental Authority with jurisdiction over such administrator

announcing or stating that all Available Tenors are or will no longer be representative, or made available,

or used for determining the interest rate of loans, or shall or will otherwise cease, provided that, at the

time of such statement or publication, there is no successor administrator that is satisfactory to the

Administrative Agent, that will continue to provide any representative tenors of such Benchmark after

such specific date.

“Beneficial Ownership Certification” means a certification regarding beneficial ownership as

required by the Beneficial Ownership Regulation.

“Beneficial Ownership Regulation” means 31 C.F.R. § 1010.230.

“Benefit Plan” means any of (a) an “employee benefit plan” (as defined in ERISA) that is subject

to Title I of ERISA, (b) a “plan” as defined in and subject to Section 4975 of the Code or (c) any Person

whose assets include (for purposes of ERISA Section 3(42) or otherwise for purposes of Title I of ERISA

or Section 4975 of the Code) the assets of any such “employee benefit plan” or “plan”.

“BHC Act Affiliate” has the meaning set forth in Section 11.23.

“Borrower” has the meaning specified in the introductory paragraph hereto.

“Borrower Materials” has the meaning set forth in Section 7.02.

8

“Borrower’s Portion of Excess Cash Flow” means, as any date of determination, an amount equal

to $375,000,000 plus the amount of Excess Cash Flow for each fiscal year of the Borrower commencing

with the fiscal year ending on or about December 31, 2021 and prior to such date of determination in

respect of which the financial statements required by Section 7.01(a) for such fiscal year shall have been

delivered to the Administrative Agent in accordance with the terms of such Section that is not required to

be applied to repay Term Loans pursuant to Section 2.05(b)(v), so long as such amount has not been

utilized on or prior to the date of determination to make Restricted Payments pursuant to Section 8.06(f),

Investments pursuant to Section 8.02(u), Permitted Acquisitions pursuant to clause (v)(x) of the definition

thereof or prepayments of Subordinated Indebtedness pursuant to Section 8.13(b); provided that upon the

consummation of the Ventas Purchase Option Assignment the Borrower’s Portion of Excess Cash Flow

shall automatically be reduced by the aggregate amount of the Borrower’s Portion of Excess Cash Flow

attributable to the Tenant Subsidiaries.

“Borrowing” means a borrowing consisting of simultaneous Loans of the same Type and, in the

case of Term SOFR Loans, having the same Interest Period made by each of the Lenders pursuant to

Section 2.01.

“BSA Entities” means (i) BSA Health System of Amarillo, LLC, (ii) BSA Health System

Holdings LLC, (iii) BSA Hospital, LLC, (iv) BSA Health System Management, LLC, (v) BSA Physicians

Group, Inc., (vi) BSA Harrington Physicians, Inc., (vii) BSA Amarillo Diagnostic Clinic, Inc., (viii) BSA

Physician Holding Company, LLC, (ix) each other Person (if any) in respect of which any BSA Equity

Purchaser directly acquires equity interests pursuant to the BSAHS Acquisition Agreement and (x) each

direct and indirect Subsidiary of the entities set forth in the foregoing clauses (i) through (ix).

“BSA Entities Future Capital Expenditures” means the amount of Capital Expenditures

anticipated to be made by the BSA Entities during the following calendar year (for example if Excess

Cash Flow is being calculated for the 2022 fiscal year, Capital Expenditures for the 2023 fiscal year);

provided that to constitute BSA Entities Future Capital Expenditures, such Capital Expenditures must be

evidenced in a written budget prepared by the Borrower that is reasonably satisfactory to the

Administrative Agent.

“BSA Equity Purchaser” means AHS Amarillo Health System, LLC and/or any other (if any)

direct or indirect wholly-owned Subsidiaries of the Borrower that acquires any equity interests in any

BSA Entity pursuant to the BSAHS Acquisition Agreement.

“BSAHS Acquisition Agreement” means the Contribution and Sale Agreement, dated as of

October 22, 2012, among the BSA Equity Purchasers party thereto, the BSA Entities party thereto and

Baptist St. Anthony’s Health System, a Texas not-for-profit corporation, as amended, restated,

supplemented or otherwise modified from time to time.

“Business Day” means any day other than a Saturday, Sunday or other day on which commercial

banks are authorized to close under the Laws of, or are in fact closed in, New York.

“Businesses” means, at any time, a collective reference to the businesses operated by the

Borrower and its Subsidiaries at such time.

“Capital Assets” means, with respect to any person, all equipment, fixed assets and Real Property

or improvements of such person, or replacements or substitutions therefor or additions thereto, that, in

9

accordance with GAAP, have been or should be reflected as additions to property, plant or equipment on

the balance sheet of such person.

“Capital Expenditures” means, for any period, without duplication, all expenditures made directly

or indirectly by the Borrower and its Restricted Subsidiaries during such period for Capital Assets

(whether paid in cash or other consideration, financed by the incurrence of Indebtedness or accrued as a

liability), but excluding any portion of such increase attributable solely to acquisitions of property, plant

and equipment in Permitted Acquisitions.

“Capital Lease” means, as applied to any Person, any lease of any Property by that Person as

lessee which, in accordance with GAAP, is required to be accounted for as a capital lease on the balance

sheet of that Person, excluding any leases which are required under GAAP to be accounted for as a capital

lease on the balance sheet of that Person solely during any construction periods.

“Capital Stock” means (i) in the case of a corporation, capital stock, (ii) in the case of an

association or business entity, any and all shares, interests, participations, rights or other equivalents

(however designated) of capital stock, (iii) in the case of a partnership, partnership interests (whether

general or limited), (iv) in the case of a limited liability company, membership interests and (v) any other

interest or participation that confers on a Person the right to receive a share of the profits and losses of, or

distributions of assets of, the issuing Person.

“Captive Insurance Subsidiary” means any Subsidiary established by the Borrower or any of its

Subsidiaries for the sole purpose of providing insurance coverage to the Borrower and its Subsidiaries.

“Cash Equivalents” means, as at any date, (a) securities issued or directly and fully guaranteed or

insured by the United States or any agency or instrumentality thereof (provided that the full faith and

credit of the United States is pledged in support thereof) having maturities of not more than twelve

months from the date of acquisition, (b) Dollar denominated time deposits and certificates of deposit of

(i) any Lender, (ii) any domestic commercial bank of recognized standing having capital and surplus in

excess of $500,000,000 or (iii) any bank whose short-term commercial paper rating from S&P is at least

A-2 or the equivalent thereof or from Moody’s is at least P-2 or the equivalent thereof (any such bank

being an “Approved Bank”), in each case with maturities of not more than 365 days from the date of

acquisition, (c) commercial paper and variable or fixed rate notes issued by any Approved Bank (or by

the parent company thereof) or any variable rate notes issued by, or guaranteed by, any domestic

corporation rated A-2 (or the equivalent thereof) or better by S&P or P-2 (or the equivalent thereof) or

better by Moody’s and maturing within twelve months of the date of acquisition, (d) repurchase

agreements entered into by any Person with a bank or trust company (including any of the Lenders) or

recognized securities dealer having capital and surplus in excess of $500,000,000 for direct obligations

issued by or fully guaranteed by the United States in which such Person shall have a perfected first

priority security interest (subject to no other Liens) and having, on the date of purchase thereof, a fair

market value of at least 100% of the amount of the repurchase obligations, (e) Investments, classified in

accordance with GAAP as current assets, in money market investment programs registered under the

Investment Company Act of 1940, as amended, which are administered by reputable financial institutions

having capital of at least $500,000,000 and the portfolios of which are limited to Investments of the

character described in the foregoing subdivisions (a) through (d) and (f) with respect to (i) the Borrower

and its Restricted Subsidiaries, marketable debt securities regularly traded on a national securities

exchange or in the over-the-counter market.

10

“CFC” means a “controlled foreign corporation” within the meaning of Section 957 of the

Internal Revenue Code.

“CHAMPUS” means the United States Department of Defense Civilian Health and Medical

Program of the Uniformed Services or any successor thereto including, without limitation, TRICARE.

“Change of Control” means an event or series of events by which:

(a)prior to the consummation of an initial Public Equity Offering:

(i)the Sponsor Group shall fail to own beneficially, directly or indirectly, at

least 50.1% of the outstanding Voting Stock of the Parent, after giving effect to the

conversion and exercise of all outstanding warrants, options and other securities of the

Parent, convertible into or exercisable for Voting Stock of the Parent (whether or not

such securities are then currently convertible or exercisable); or

(ii)the Parent shall fail to own directly 85% of the outstanding Capital Stock

of the Borrower determined on a fully diluted basis after giving effect to the conversion

and exercise of all outstanding warrants, options and other securities of the Borrower,

convertible into or exercisable for Capital Stock of the Borrower (whether or not such

securities are then currently convertible or exercisable); or

(iii)any of Samuel Zell, trusts established for the benefit of the family of

Samuel Zell, and/or any entity Controlled by any of the foregoing ceases to Control the

Sponsor; or

(b)upon and after the consummation of an initial Public Equity Offering of the

common stock of the Parent or any parent thereof:

(i)the Parent becomes aware (by way of a report or another filing pursuant

to Section 13(d) of the Exchange Act, proxy, vote, written notice or otherwise) of the

acquisition by any “person” or “group” of related persons (as such terms are used in

Sections 13(d) and 14(d) of the Exchange Act) other than the Sponsor Group of the

beneficial ownership (as defined in Rules 13d-3 and 13d-5 under the Exchange Act,

except that such person or group shall be deemed to have “beneficial ownership” of all

shares that any such person or group has the right to acquire, whether such right is

exercisable immediately or only after the passage of time), directly or indirectly, of more

than 50% of the total voting power of the Voting Stock of the Parent (or its successor by

merger, consolidation or purchase of all or substantially all of their assets); or

(ii)unless the Permitted Merger has occurred concurrently with or in

connection therewith, the Parent shall fail to own directly 85% of the outstanding Capital

Stock of the Borrower, determined on a fully diluted basis after giving effect to the

conversion and exercise of all outstanding warrants, options and other securities of the

Borrower, convertible into or exercisable for Capital Stock of the Borrower (whether or

not such securities are then currently convertible or exercisable); or

11

(c)upon and after the consummation of an initial Public Equity Offering of the

common stock of the Borrower: the Borrower becomes aware (by way of a report or another

filing pursuant to Section 13(d) of the Exchange Act, proxy, vote, written notice or otherwise) of

the acquisition by any “person” or “group” of related persons (as such terms are used in Sections

13(d) and 14(d) of the Exchange Act) other than the Sponsor Group of the beneficial ownership

(as defined in Rules 13d-3 and 13d-5 under the Exchange Act, except that such person or group

shall be deemed to have “beneficial ownership” of all shares that any such person or group has

the right to acquire, whether such right is exercisable immediately or only after the passage of

time), directly or indirectly, of more than 50% of the total voting power of the Voting Stock of

the Borrower (or its successor by merger, consolidation or purchase of all or substantially all of

their assets); or

(d)the occurrence of a “Change of Control” (or any comparable term) under, and as

defined in, the ABL Credit Agreement, the 2029 Notes Indenture (and/or any other Indebtedness

incurred pursuant to Section 8.03(t)) or any Subordinated Indebtedness Document in respect of

Indebtedness in excess of the Threshold Amount.

“Class” when used in reference to any Loan or Borrowing, refers to whether such Loan, or the

Loans comprising such Borrowing, are Term Loans, Incremental Term Loans, Refinancing Term Loans,

Ventas Purchase Option Term Loans or Non-Ventas Purchase Option Term Loans designated as a

separate Class and, when used in reference to any Commitment, refers to whether such Commitment is a

Commitment for such applicable Term Loans, Incremental Term Loans, Refinancing Term Loans, Ventas

Purchase Option Term Loans or Non-Ventas Purchase Option Term Loans. Notwithstanding anything to

the contrary, the 2024 Term B Loans made on the Amendment No. 2 Effective Date and all the 2024

Term B Loans converted from Initial Term Loans on the Amendment No. 2 Effective Date shall

constitute a single Class.

“CME” means CME Group Benchmark Administration Limited.

“CMS” means the Centers for Medicare and Medicaid Services and any successor thereof.

“Collateral” means a collective reference to all real and personal Property with respect to which

Liens in favor of the Administrative Agent are purported to be granted pursuant to and in accordance with

the terms of the Collateral Documents (other than Excluded Property). For the avoidance of doubt, the

Pledged ETMC Distribution Account and the equity interests owned by the Loan Parties in the ETMC JV

shall be a part of Collateral.

“Collateral Assignment Documents” means the collateral assignments of notes and liens executed

by the Loan Parties executed in favor of the Administrative Agent, as amended, modified, restated or

supplemented from time to time.

“Collateral Documents” means a collective reference to the Security Agreements, the Pledge

Agreements, the Mortgage Instruments, the Collateral Assignment Documents and such other security

documents as may be executed and delivered by the Loan Parties pursuant to the terms of Section 7.14.

“Commitment” means, as to each Lender, the Term Loan Commitment of such Lender.

“Commodity Agreement” means any commodity futures contract, commodity swap, commodity

option or other similar agreement or arrangement entered into by the Borrower or any Restricted

Subsidiary designed or intended to protect the Borrower or any of its Restricted Subsidiaries against

12

fluctuations in the price of commodities actually used in the ordinary course of business of the Borrower

and its Restricted Subsidiaries.

“Communications” has the meaning specified in Section 7.02.

“Company Action Level” means the Company Action Level risk-based capital threshold, as

defined by NAIC.

“Consolidated Capital Expenditures” means, for any period, for the Borrower and its Restricted

Subsidiaries on a consolidated basis, all Capital Expenditures, as determined in accordance with GAAP;

provided, however, that Consolidated Capital Expenditures shall not include (i) expenditures made with

proceeds of any Disposition to the extent such proceeds are reinvested within the period required by the

definition of “Net Cash Proceeds,” (ii) expenditures relating to any Involuntary Disposition to the extent

such expenditures are used to restore, replace or rebuild property to the condition of such property

immediately prior to any damage, loss, destruction or condemnation, (iii) all other capital expenditures, as

determined in accordance with GAAP, to the extent such expenditures are or are expected to be (provided

that such amounts are actually funded within a reasonably proximate time of such expenditure) funded,

directly or indirectly, with the proceeds of any Equity Issuance or any capital contribution to any Loan

Party, (iv) expenditures that constitute Permitted Acquisitions, (v) Capital Expenditures made by any

Person that becomes a Restricted Subsidiary after the Original Closing Date prior to the time such Person

becomes a Restricted Subsidiary and (vi) expenditures that are paid for or contractually required to be

reimbursed to the Borrower or any of its Restricted Subsidiaries by a third party (including landlords).

“Consolidated EBITDA” means, for any period, without duplication, for Parent and its Restricted

Subsidiaries on a consolidated basis determined in accordance with GAAP, an amount equal to

Consolidated Net Income for such period plus (A) other than with respect to clause (xiv) below, to the

extent deducted (and not added back) in calculating such Consolidated Net Income for such period, (i)

Consolidated Interest Expense for such period, (ii) the provision for federal, state, local and foreign

income taxes payable by the Borrower and its Restricted Subsidiaries for such period, (iii) the amount of

depreciation and amortization expense for such period, (iv) any non-recurring fees, charges and cash

expenses made or incurred in connection with the Transactions, Amendment and Restatement

Transactions, Investments, Dispositions, Restricted Payments, fundamental changes and incurrences of

Indebtedness permitted under this Agreement and issuances of Capital Stock and dispositions not

prohibited by this Agreement (whether or not consummated), (v) any other non-cash charges,

impairments or write-offs for such period (except to the extent such charges, impairments or write-offs

relate to a cash payment in a future period), (vi) non-recurring or extraordinary cash expenses in respect

of severance payments and other costs associated with any restructuring of the Borrower’s and its

Restricted Subsidiaries’ operations, (vii) expenses and charges related to prior periods in an aggregate

amount not to exceed $15.0 million for any such period during the term of this Agreement, (viii) all non-

recurring or extraordinary charges, expenses or losses in such period, and, without duplication, any

charges or expenses paid or payable by the Borrower or its Restricted Subsidiaries in cash during such

measurement period in connection with the integration of Epic Systems IT, (ix) the amount of any non-

controlling or minority interest expense consisting of Restricted Subsidiary income attributable to non-

controlling interests of third parties in any Restricted Subsidiaries deducted (and not added back) in such

period in calculating Consolidated Net Income, (x) Sponsor Fees and transaction fees permitted hereunder

(whether paid or accrued), (xi) all fees and expenses and one-time payments reasonably incurred and

payable in connection with any amendment, restatement, waiver, consent, supplement or other

modification to this Agreement, the ABL Facility, the 2026 Notes Indenture, the 2029 Notes Indenture or

any other Indebtedness, (xii) charges, losses or expenses to the extent indemnified or insured or

reimbursed or reimbursable by third parties pursuant to indemnification or reimbursement provisions or

13

similar agreements or insurance; provided that, such Person in good faith expects to receive

reimbursement for such charges, losses or expenses within the next four fiscal quarters, (xiii) letter of

credit fees, (xiv) the amount of net cost savings, synergies and operating expense reductions projected by

the Borrower in good faith to be realized as a result of specified actions taken or to be taken (which cost

savings, synergies or operating expense reductions shall be calculated on a pro forma basis as though

such cost savings, synergies or operating expense reductions had been realized on the first day of such

period), net of the amount of actual benefits realized during such period from such actions; provided that

(A) such cost savings, synergies or operating expense reductions are reasonably identifiable and

factually supportable, (B) such actions have been taken or are to be taken within 24 months after the date

of determination to take such action and (C) the aggregate amount added back pursuant to this clause

(xiv) may not exceed 25% of Consolidated EBITDA for the period of the four fiscal quarters most

recently ended calculated on a pro forma basis (before giving effect to such add backs), provided,

however, that subclauses (B) and (C) of the immediately preceding proviso shall not apply to cost

savings, synergies or operating expense reductions in connection with the ETMC Acquisition and the

Topeka Acquisition, (xv) upfront fees or charges arising from any Securitization Transaction for such

period, and any other amounts for such period comparable to or in the nature of interest under any

Securitization Transaction, and losses on dispositions or sale of assets in connection with any

Securitization Transaction for such period, to the extent the same were deducted (and not added back) in

computing such Consolidated Net Income, (xvi) fees and expenses and non-cash mark-to-market losses

relating to any Swap Contracts permitted hereunder, (xvii) any expenses, charges or other costs related

to any Equity Issuance, (xviii) any expenses, charges or other costs related to internal reorganizations or

restructurings, and (xix) expenses relating to retention bonuses paid in connection with acquisitions,

recapitalizations and other financing transactions; and minus (B) non-recurring or extraordinary gains in

such period.

“Consolidated Indebtedness” means Indebtedness of the Borrower and its Restricted Subsidiaries

on a consolidated basis.

“Consolidated Interest Charges” means, for any period, for the Borrower and its Restricted

Subsidiaries on a consolidated basis, an amount equal to, without duplication, (i) all interest, premium

payments, debt discount, fees, charges and related expenses of the Borrower and its Restricted

Subsidiaries in connection with borrowed money (including capitalized interest, but excluding

amortization of capitalized financing costs) or in connection with the deferred purchase price of assets, in

each case to the extent treated as interest in accordance with GAAP, plus (ii) the portion of rent expense

of the Borrower and its Restricted Subsidiaries with respect to such period under Capital Leases that is

treated as interest in accordance with GAAP minus (iii) interest income of the Borrower and its Restricted

Subsidiaries for such period determined on a consolidated basis in accordance with GAAP.

“Consolidated Interest Expense” means, with respect to Parent and its Restricted Subsidiaries for

any period, the sum of (1) interest expense of Parent and its Restricted Subsidiaries for such period

determined on a consolidated basis in accordance with GAAP (including (a) all commissions, discounts,

fees and other charges in connection with letters of credit and similar instruments, (b) accretion or

amortization of original issue discount resulting from the incurrence of Indebtedness at less than par, (c)

the interest component of obligations in respect of Capital Leases, (d) non-cash interest payments and (e)

net payments, if any made (less net payments received) pursuant to obligations under permitted Interest

Rate Agreements), minus (2) to the extent included in cash interest expense of Parent and its Restricted

Subsidiaries for such period determined on a consolidated basis in accordance with GAAP and not added

to net income (or loss) in the calculation of Consolidated EBITDA, (i) amounts paid to obtain Interest

Rate Agreements, Currency Agreements and Commodity Agreements, (ii) any one-time cash costs

associated with breakage in respect of Interest Rate Agreements, Currency Agreements and Commodity

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Agreements for interest rates and any payments with respect to make-whole premiums or other breakage

costs in respect of any Indebtedness, (iii) all non-recurring cash interest expense consisting of liquidated

damages for failure to timely comply with registration rights obligations, (iv) any “additional interest”

owing pursuant to a registration rights agreement, (v) any expense resulting from the discounting of any

Indebtedness in connection with the application of recapitalization accounting or, if applicable, purchase

accounting, (vi) penalties and interest relating to taxes and any other amounts of non-cash interest

resulting from the effects of acquisition method accounting or pushdown accounting, (vii) amortization or

expensing of deferred financing fees, amendment and consent fees, debt issuance costs, commissions, fees

and expenses and discounted liabilities, (viii) any expensing of bridge, arrangement, structuring,

commitment or other financing fees, (ix) any non-cash interest expense and any capitalized interest,

whether paid in cash or accrued, (x) any accretion or accrual of, or accrued interest on, discounted

liabilities not constituting Indebtedness during such period, (xi) any non-cash interest expense attributable

to the movement of the mark to market valuation of obligations under Interest Rate Agreements, Currency

Agreements and Commodity Agreements or other derivative instruments pursuant to Financial

Accounting Standards Board’s Accounting Standards Codification 815 (Derivatives and Hedging) and

(xii) any fees related to a Securitization Transaction, minus (3) interest income of Parent and its Restricted

Subsidiaries for such period.

“Consolidated Net Income” means, for any period, for the Borrower and its Restricted

Subsidiaries on a consolidated basis, the net income from continuing operations of the Borrower and its

Restricted Subsidiaries (excluding extraordinary gains and extraordinary losses) for that period; provided

that there shall be excluded any income (or loss) of any Person other than the Borrower or any Restricted

Subsidiary or that is accounted for by the equity method, or noncontrolling interest method, of

accounting, but any such income so excluded shall be included in such period or any later period to the

extent of any cash or Cash Equivalents paid as dividends or distributions in the relevant period to the

Borrower or any Restricted Subsidiary (other than the ETMC JV) of the Borrower. For the avoidance of

doubt, “Consolidated Net Income” shall not include any income allocable to minority interests in any

Subsidiaries (including, without limitation, income attributable to ETMC Subsidiaries which is allocated

or which will be allocated to unaffiliated third parties).

“Consolidated Net Leverage Ratio” means, as of any date of determination, the ratio of (a) the

sum of (i) Consolidated Indebtedness as of such date minus (ii) unrestricted cash and Cash Equivalents

held by Borrower and its Restricted Subsidiaries on such date (provided that (x) any cash or Cash

Equivalents in (i) the LHP Cash Management Transfer System or (ii) that are held by an ETMC

Subsidiary that are not in the Pledged ETMC Distribution Account or, in each case, another deposit

account subject to a control agreement in favor of the Administrative Agent (a “Controlled Account”)

shall be deemed to be restricted cash, and (y) any cash or Cash Equivalents received from CARES Act

related funding (including any cash and Cash Equivalents in respect of Medicare accelerated payments

and payroll tax deferrals) shall be deemed to be restricted cash for so long as such cash and cash

equivalents are required to be repaid) to (b) Consolidated EBITDA for the period of the four fiscal

quarters most recently ended.

“Consolidated Scheduled Funded Indebtedness Payments” means, as of any date for the four

fiscal quarter period ending on such date with respect to the Borrower and its Restricted Subsidiaries on a

consolidated basis, the sum of all scheduled or mandatory payments of principal on Funded Indebtedness

(excluding any voluntary prepayments and mandatory prepayments required pursuant to Section 2.05), as

determined in accordance with GAAP.

“Consolidated Working Capital” means, at any time, the excess of (i) current assets (excluding

cash and Cash Equivalents) of the Borrower and its Restricted Subsidiaries on a consolidated basis at such

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time over (ii) current liabilities of the Borrower and its Restricted Subsidiaries on a consolidated basis at

such time, all as determined in accordance with GAAP, in each case, calculated exclusive of any change

in the Swap Termination Value of Swap Contracts. “Consolidated Working Capital” for any fiscal year

shall be subject to adjustment for the impact of any non-cash reclassification of short-term and long-term

asset and liability accounts.

“Contractual Obligation” means, as to any Person, any provision of any security issued by such

Person or of any agreement, instrument or other undertaking to which such Person is a party or by which

it or any of its property is bound.

“Control” has the meaning specified in the definition of “Affiliate.”

“Controlled Account” has the meaning specified in the definition of “Consolidated Net Leverage

Ratio”.

“Converted Initial Term Loan” means each Initial Term Loan held by a Converting Consenting

Lender on the Amendment No. 2 Effective Date immediately prior to the conversion of the corresponding

2024 Term B Loan on such date.

“Converting Consenting Lender” means a Lender that has elected to be a “Converting Consenting

Lender” on its signature page to Amendment No. 2.

“Corresponding Tenor” with respect to any Available Tenor means, as applicable, either a tenor

(including overnight) or an interest payment period having approximately the same length (disregarding

business day adjustment) as such Available Tenor.

“Covered Entity” has the meaning set forth in Section 11.23.

“Covered Party” has the meaning set forth in Section 11.23(a).

“Credit Party” has the meaning set forth in Section 10.19.

“Currency Agreement” means in respect of a Person any foreign exchange contract, currency

swap agreement, futures contract or option contract with respect to foreign exchange rates or currency

values, or other similar agreement as to which such Person is a party or a beneficiary.

“Daily Simple SOFR” with respect to any applicable determination date means SOFR published

on such date on the Federal Reserve Bank of New York’s website (or any successor source).

“Debt Fund Affiliate” any affiliate of the Borrower or the Sponsor that is primarily engaged in, or

advises funds or other investment vehicles that are engaged in, making, purchasing, holding or otherwise

investing in commercial loans, bonds and similar extensions of credit in the ordinary course and with

respect to which the Sponsor and its Affiliates (other than Debt Fund Affiliates) does not, directly or

indirectly, possess the power to direct or cause the direction of the investment policies of such entity.

“Debt Issuance” means the issuance by the Borrower or any Restricted Subsidiary of any

Indebtedness other than Indebtedness permitted under Section 8.03.

“Debtor Relief Laws” means the Bankruptcy Code, and all other liquidation, conservatorship,

bankruptcy, assignment for the benefit of creditors, moratorium, rearrangement, receivership, insolvency,

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reorganization or similar debtor relief Laws of the United States or other applicable jurisdictions from time

to time in effect and affecting the rights of creditors generally.

“Default” means any event or condition that constitutes an Event of Default or that, with the

giving of any notice, the passage of time, or both, would be an Event of Default.

“Default Rate” means an interest rate equal to (a) the Base Rate plus (b) the Applicable Rate, if

any, applicable to Base Rate Loans plus (c) 2% per annum; provided, however, that with respect to a

Term SOFR Loan, the Default Rate shall be an interest rate equal to the interest rate (including any

Applicable Rate) otherwise applicable to such Loan plus 2% per annum, in each case to the fullest extent

permitted by applicable Laws.

“Default Right” has the meaning set forth in Section 11.23.

“Defaulting Lender” means, subject to Section 2.15(b), any Lender that, as determined by the

Administrative Agent, (a) has failed to perform any of its funding obligations hereunder, including in

respect of its Loans, within three Business Days of the date required to be funded by it hereunder, (b) has

notified the Borrower, or the Administrative Agent or any Lender that it does not intend to comply with

its funding obligations or has made a public statement to that effect with respect to (x) its funding

obligations hereunder or (y) under other agreements in which it is obligated to extend credit (unless in the

case of this clause (y), such obligation is the subject of a good faith dispute), (c) has failed, within three

(3) Business Days after request by the Administrative Agent, to confirm in a manner satisfactory to the

Administrative Agent that it will comply with its funding obligations hereunder; provided that such

Lender shall cease being a Defaulting Lender under this clause (c) upon receipt of such confirmation by

the Administrative Agent, or (d) has, or has a direct or indirect parent company that has, (i) become the

subject of a proceeding under any Debtor Relief Law, (ii) had a receiver, conservator, trustee,

administrator, assignee for the benefit of creditors or similar Person charged with reorganization or

liquidation of its business or a custodian appointed for it, (iii) taken any action in furtherance of, or

indicated its consent to, approval of or acquiescence in any such proceeding or appointment unless, in the

case of this clause (d), the Borrower and the Administrative Agent shall be satisfied that such Lender

intends, and has such approvals required to enable it, to perform its obligations as a Lender hereunder or

(iv) becomes the subject of a Bail-In Action; provided that a Lender shall not be a Defaulting Lender

solely by virtue of the ownership or acquisition of any equity interest in that Lender or any direct or

indirect parent company thereof by a Governmental Authority so long as such ownership interest does not

result in or provide such Lender with immunity from the jurisdiction of courts within the United States or

from the enforcement or judgments or writs of attachment on its assets or permit such Lender (or such

Governmental Authority) to reject, repudiate, disavow or disaffirm any contracts or agreements made

with such Lender.

“Disposition” or “Dispose” means the sale, transfer, license, lease or other disposition (including

any Sale and Leaseback Transaction) of any Property by the Borrower or any Restricted Subsidiary

(including the Capital Stock of any Subsidiary), including any sale, assignment, transfer or other disposal,

with or without recourse, of any notes or accounts receivable or any rights and claims associated

therewith, but excluding (i) the sale, lease, license, transfer or other disposition of inventory in the

ordinary course of business of the Borrower and its Restricted Subsidiaries, (ii) the sale, lease, license,

transfer or other disposition of machinery and equipment or closure of a unit or division, in each case, no

longer used or useful in the conduct of business of the Borrower and its Restricted Subsidiaries, (iii) any

sale, lease, license, transfer or other disposition of Property by (x) the Borrower or any Restricted

Subsidiary to any Loan Party (other than an ETMC Loan Party); provided that the Loan Parties shall

cause to be executed and delivered such documents, instruments and certificates as the Administrative

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Agent may request so as to cause the Loan Parties to be in compliance with the terms of Section 7.14 after

giving effect to such transaction, (y) any non-Loan Party to any non-Loan Party, any ETMC Loan Party

to any ETMC Loan Party, or any non-Loan Party to any ETMC Loan Party and (z) any Loan Party

(including, without limitation, any ETMC Loan Party) to any non-Loan Party (including, without

limitation any ETMC Subsidiary) or any ETMC Loan Party not exceeding $7,500,000 in any fiscal year,

(iv) any Involuntary Disposition by the Borrower or any Restricted Subsidiary, (v) any Disposition by the

Borrower or any Restricted Subsidiary constituting a Permitted Investment, (vi) non-exclusive licenses or

sublicenses to use the patents, trade secrets, know-how and other intellectual property of the Borrower or

any of its Restricted Subsidiaries in the ordinary course of business, (vii) any sale, lease, license, transfer

or other disposition of Property by any Foreign Subsidiary to another Foreign Subsidiary, (viii) the

disposition of disposable inventory in bulk to a third party which disposable inventory shall then be

consigned from such third party to the Borrower or any Restricted Subsidiary for the benefit of or use by

such Person in the ordinary course of such Person’s patient care operations, (ix) any transaction (or series

of related transactions) involving property (including, without limitation, leases) with an aggregate book

value not exceeding $7,500,000, (x) (A) dispositions or discounts without recourse of accounts receivable

(including, without limitation, Self-Pay Accounts (as defined in the ABL Credit Agreement)) in

connection with the compromise or collection thereof in the ordinary course of business, and (B)

dispositions of Self-Pay Accounts, with recourse, to collection servicers, provided such accounts have

previously been, or are concurrently with such disposition, written off by the company or accounted for as

“uncollectible” or “bad debt”, (xi) any contribution of Borrower’s Portion of Excess Cash Flow to effect

any transaction undertaken pursuant to Section 8.06(f), Investments pursuant to Section 8.02(u),

Permitted Acquisitions pursuant to clause (v)(x) of the definition thereof or payment of Subordinated

Indebtedness pursuant to Section 8.13(b), (xii) Dispositions made in order to effectuate any Permitted

IRB Transaction, (xiii) any Disposition of Capital Stock to the directors of any Loan Party or any

Restricted Subsidiary to qualify such directors where required by applicable law, (xiv) Dispositions of

cash and Cash Equivalents in the ordinary course of business (including, without limitation, the LHP

Cash Management Transfer System), (xv) Dispositions of vacant property or property containing

buildings that would require demolition or substantial improvements having a fair market value, in the

aggregate, not in excess of $25,000,000, (xvi) Dispositions made by Loan Parties to ETMC Loan Parties

pursuant to the intercompany loans permitted under Section 8.03 or investments permitted under Section

8.02, (xvii) Dispositions made by AHS East Texas or any other ETMC Subsidiary subject to Section 8.16,

to (x) the ETMC JV or (y) any non-Loan Party, in each case made pursuant to the ETMC JV Agreement

and (xviii) Dispositions pursuant to a Securitization Transaction in an aggregate amount not to exceed,

together with all Investments pursuant to Section 8.02(jj) and Section 8.02(kk), the greater of (A)

$75,000,000 and (B) 25.0% of Consolidated EBITDA; provided that Dispositions permitted by this clause

(xviii) shall solely be in respect of Collateral of a type that would not constitute ABL Priority Collateral.

“Disqualified Capital Stock” means any Capital Stock that, by its terms (or by the terms of any

security or other Capital Stock into which it is convertible or for which it is exchangeable), or upon the

happening of any event or condition (a) matures or is mandatorily redeemable (other than solely for

Qualified Capital Stock), pursuant to a sinking fund obligation or otherwise (except as a result of a

change of control or asset sale so long as any rights of the holders thereof upon the occurrence of a

change of control or asset sale event shall be subject to the prior repayment in full of the Loans and all

other Obligations that are accrued and payable and the termination of the Commitments), (b) is

redeemable at the option of the holder thereof (other than solely for Qualified Capital Stock), in whole or

in part, (c) provides for scheduled payments of dividends in cash, or (d) is or becomes convertible into or

exchangeable for Indebtedness or any other Capital Stock that would constitute Disqualified Capital

Stock, in each case, prior to the date that is ninety-one (91) days after the Maturity Date (or if any

Incremental Term Loans shall be outstanding as of the date of issuance of such Capital Stock, the

maturity date applicable to such Incremental Term Loans); provided that if such Capital Stock is issued

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pursuant to a plan for the benefit of employees of Parent, the Borrower or any Subsidiary or by any such

plan to such employees, such Capital Stock shall not constitute Disqualified Capital Stock solely because

it may be required to be repurchased by Parent, the Borrower or any Subsidiary in order to satisfy

applicable statutory or regulatory obligations.

“Disqualified Institution” means (a) those persons identified by the Borrower in writing on or

after the Effective Date to the Administrative Agent as competitors (and any such entities’ Affiliates that

are clearly identifiable on the basis of name) of the Borrower and its Subsidiaries, (b) those banks,

financial institutions and other persons identified by the Sponsor or the Borrower to any Joint Book

Runner in writing on or prior to the commencement of primary syndication of the Initial Term Loans

prior to the Effective Date (and any such entities’ Affiliates that are clearly identifiable on the basis of

name) or (c) any Affiliates of any Joint Book Runner that are engaged as principals primarily in private

equity, mezzanine financing or venture capital.

“Dollar” and “$” mean lawful money of the United States.

“Domestic Restricted Subsidiary” means any Domestic Subsidiary that is a Restricted Subsidiary.

“Domestic Subsidiary” means any Subsidiary that is organized under the laws of the United

States, any state thereof or the District of Columbia.

“Earn-Out Obligations” means, with respect to an Acquisition, all obligations of the Borrower or

any Restricted Subsidiary to make earn-out or other contingency payments pursuant to the documentation

relating to such Acquisition, not including any amounts payable in any form of Capital Stock. For

purposes of determining the aggregate consideration paid for an Acquisition, the amount of any Earn-Out

Obligations shall be deemed to be the reasonably anticipated liability in respect thereof as determined by

the Borrower in good faith at the time of such Acquisition. For purposes of determining the liability of

the Borrower and its Restricted Subsidiaries for any Earn-Out Obligation thereafter, the amount of Earn-

Out Obligations shall be deemed to be the aggregate liability in respect thereof as recorded on the balance

sheet of the Borrower and its Restricted Subsidiaries in accordance with GAAP.

“EEA Financial Institution” means (a) any credit institution or investment firm established in any

EEA Member Country which is subject to the supervision of an EEA Resolution Authority, (b) any entity

established in an EEA Member Country which is a parent of an institution described in clause (a) of this

definition, or (c) any financial institution established in an EEA Member Country which is a subsidiary of

an institution described in clauses (a) or (b) of this definition and is subject to consolidated supervision

with its parent.

“EEA Member Country” means any of the member states of the European Union, Iceland,

Liechtenstein and Norway.

“EEA Resolution Authority” means any public administrative authority or any Person entrusted

with public administrative authority of any EEA Member Country (including any delegee) having

responsibility for the resolution of any EEA Financial Institution.

“Effective Date” means August 24, 2021, the date of the effectiveness of this Agreement.

“Electronic Copy” has the meaning set forth in Section 11.11.

“Electronic Record” has the meaning set forth in Section 11.11.

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“Electronic Signature” has the meaning set forth in Section 11.11.

“Eligible Assignee” has the meaning specified in Section 11.07(g).

“Embargoed Person” means any party that (i) is publicly identified on the most current list of

“Specially Designated Nationals and Blocked Persons” published by the U.S. Treasury Department’s

Office of Foreign Assets Control (“OFAC”) or resides, is organized or chartered, or has a place of

business in a country or territory that is the subject of comprehensive OFAC sanctions or embargo

programs or (ii) is publicly identified as prohibited from doing business with the United States under the

International Emergency Economic Powers Act, the Trading With the Enemy Act, or any other

requirement of Law.

“Environmental Laws” means any and all federal, state, local, foreign and other applicable

statutes, laws, regulations, ordinances, rules, judgments, orders, decrees, permits, concessions, grants,

franchises, licenses, agreements or binding governmental restrictions relating to pollution and the

protection of the environment or the release of any materials into the environment, including those related

to Hazardous Materials, air emissions, waste and discharges to water or public systems.

“Environmental Liability” means any liability, contingent or otherwise (including any liability for

damages, costs of environmental remediation, fines, penalties or indemnities), of the Borrower, any other

Loan Party or any of their respective Subsidiaries directly or indirectly resulting from or based upon (a)

violation of any Environmental Law, (b) the generation, use, handling, transportation, storage, treatment

or disposal of any Hazardous Materials, (c) exposure to any Hazardous Materials, (d) the release or

threatened release of any Hazardous Materials into the environment or (e) any contract, agreement or

other consensual arrangement pursuant to which liability is assumed or imposed with respect to any of the

foregoing.

“Epic Systems IT” means electronic records systems software manufactured by Epic Systems

Corporation, the related hardware and infrastructure used to operate the system, and the integration of

other third party systems into such software, hardware and infrastructure.

“Equity Issuance” means any issuance by the Parent or any Loan Party (or upon or after a Public

Equity Offering of the Borrower, the Borrower) of shares of its Capital Stock. The term “Equity

Issuance” shall not be deemed to include any Disposition.

“ERISA” means the Employee Retirement Income Security Act of 1974, as amended from time to

time.

“ERISA Affiliate” means any trade or business (whether or not incorporated) under common

control with the Borrower within the meaning of Section 414(b) or (c) of the Internal Revenue Code (and

Sections 414(m) and (o) of the Internal Revenue Code for purposes of provisions relating to Section 412

of the Internal Revenue Code).

“ERISA Event” means (a) a Reportable Event with respect to a Pension Plan; (b) a withdrawal by

the Borrower or any ERISA Affiliate from a Pension Plan subject to Section 4063 of ERISA during a

plan year in which it was a substantial employer (as defined in Section 4001(a)(2) of ERISA) or a

cessation of operations that is treated as such a withdrawal under Section 4062(e) of ERISA; (c) a

complete or partial withdrawal by the Borrower or any ERISA Affiliate from a Multiemployer Plan or

notification that a Multiemployer Plan is insolvent; (d) the filing of a notice of intent to terminate, the

treatment of a Pension Plan or Multiemployer Plan amendment as a termination under Sections 4041 or

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4041A of ERISA, or the commencement of proceedings by the PBGC to terminate a Pension Plan or

Multiemployer Plan; (e) an event or condition which constitutes grounds under Section 4042 of ERISA

for the termination of, or the appointment of a trustee to administer, any Pension Plan or Multiemployer

Plan; or (f) the imposition of any liability under Title IV of ERISA, other than for PBGC premiums due

but not delinquent under Section 4007 of ERISA, upon the Borrower or any ERISA Affiliate.

“ETMC Acquisition” means the purchase of hospital assets and operations and the equity

interests of certain subsidiaries of East Texas Medical Center Regional Healthcare System

(“ETMCRHS”), a Texas nonprofit corporation and East Texas Medical Center Regional Health Services,

Inc. (“ETMCRHS Inc.”), a Texas corporation.

“ETMC Loan Parties” means so long as the ETMC JV Agreement is effective, AHS East Texas

and each of the Material Domestic Subsidiaries of AHS East Texas, in each case, that were formed or

acquired in the ETMC Acquisition, that are subject (directly or indirectly) to the ETMC JV Agreement,

and that are not Excluded Subsidiaries. For the avoidance of doubt, any Subsidiary that is not subject

(directly or indirectly) to the ETMC JV Agreement shall not be considered an ETMC Loan Party.

“ETMC JV” means East Texas Health System, LLC.

“ETMC JV Agreement” means the Amended and Restated Limited Liability Company

Agreement between UT Tyler and AHS East Texas dated as of February 26, 2018 (as amended, restated,

supplemented, replaced or otherwise modified from time to time).

“ETMC Subsidiaries” means, collectively, AHS East Texas and its direct and indirect

Subsidiaries.

“EU Bail-In Legislation Schedule” means the EU Bail-In Legislation Schedule published by the

Loan Market Association (or any successor person), as in effect from time to time.

“Event of Default” has the meaning specified in Section 9.01.

“Excess Cash Certificate” means a certificate substantially in the form of Exhibit I.

“Excess Cash Flow” means, in each case without duplication, with respect to any fiscal year

period of the Borrower and its Restricted Subsidiaries on a consolidated basis, an amount equal to (a)

Consolidated EBITDA for such fiscal year minus (b) Consolidated Capital Expenditures (excluding any

BSA Entities Future Capital Expenditures deducted in calculating Excess Cash Flow for the prior fiscal

year period) for such fiscal year to the extent not financed by an incurrence of Indebtedness or issuance of

Capital Stock minus (c) the cash portion of Consolidated Interest Charges for such fiscal year minus (d)

Federal, state and other taxes to the extent the same are paid in cash during such period by or on behalf of

Parent and its Subsidiaries on a consolidated basis for such fiscal year minus (e) Consolidated Scheduled

Funded Indebtedness Payments (other than payments in respect of intercompany debt pursuant to Section

8.02(ee)) made in cash for such fiscal year to the extent not financed by an incurrence of Indebtedness or

issuance of Capital Stock minus (f) increases in Consolidated Working Capital for such fiscal year minus

(g) to the extent otherwise included in Consolidated EBITDA for such fiscal year, insurance proceeds

received by the Borrower or any of its Restricted Subsidiaries during such fiscal year that have been

applied to repair, restore or replace the applicable property or asset or to acquire Real Property,

equipment or other tangible assets to be used or useful in the business of the Borrower and its Restricted

Subsidiaries, or in respect of which a written contract or agreement for such repair, replacement,

restoration or acquisition has been entered into for the application of such insurance proceeds, minus (h)

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the aggregate amount of all Sponsor Fees and transaction fees paid in cash during such fiscal year as

permitted under Section 8.06(e), minus (i) all other cash items added back to Consolidated EBITDA

pursuant to clauses (iv) and (vi) through (xvi) of the definition thereof, minus (j) the amount of Restricted

Payments paid during such fiscal year as permitted under Section 8.06 (c), (d), (e) and (h) to the extent

such Restricted Payments were financed with internally generated cash flow of the Borrower and its

Restricted Subsidiaries during such fiscal year, minus (k) the aggregate amount of all proceeds received in

respect of intercompany dispositions for such fiscal year to the extent otherwise increasing Excess Cash

Flow for such fiscal year (such that intercompany dispositions shall have a neutral impact on Excess Cash

Flow) and the amount of mandatory prepayments of Term Loans during such fiscal year as a result of

Dispositions or Involuntary Dispositions, minus (l) the aggregate amount of Acquisitions made during

such fiscal year as permitted pursuant to Section 8.02 to the extent such Acquisitions were financed with

internally generated cash flow of the Borrower and its Restricted Subsidiaries, and except to the extent

such Acquisitions were financed with the proceeds of Indebtedness, Equity Issuances or Dispositions of

the Borrower and its Restricted Subsidiaries, minus (m) cash payments by the Borrower and its Restricted

Subsidiaries in respect of discontinued operations during such period to the extent increasing

Consolidated EBITDA, minus (n) BSA Entities Future Capital Expenditures in an amount not to exceed

$7,500,000, minus (o) for the avoidance of doubt, any cash expenditure made by the Borrower or any

Restricted Subsidiary (that is not funded by the issuance of equity interests of the Borrower or Parent or

an incurrence of Indebtedness) for the purchase of Capital Stock of a Joint Venture in connection with the

exercise of put/call provisions in such Joint Venture’s Joint Venture Agreement, plus (p) cash payments

received by the Borrower and its Restricted Subsidiaries in respect of discontinued operations during such

period to the extent decreasing Consolidated EBITDA plus (q) decreases in Consolidated Working

Capital for such fiscal year plus (r) any unutilized BSA Entities Future Capital Expenditures from the

prior fiscal year period.

“Excluded ETMC Account” has the meaning specified in the definition of “Excluded Property”.

“Excluded Property” means, with respect to any Loan Party, including any Person that becomes a

Loan Party after the Original Closing Date as contemplated by Section 7.12, (a) any fee-owned Real

Property (i) with a fair market value of less than $5,000,000 so long as the fair market value of all such

Real Property owned by Loan Parties that is Excluded Property does not exceed $35,000,000 in the

aggregate or (ii) that is anticipated in good faith to be subject to an MOB Disposition within 18 months

after the Effective Date or, if later, the date such Real Property was acquired (provided that if such Real

Property is not subject to an MOB Disposition with such 18 month period, such Real Property shall no

longer be deemed to be Excluded Property) and all leasehold interests in Real Property ; (b) (A)

commercial tort claims with a value of less than $10,000,000 and (B) motor vehicles and other assets

subject to certificates of title, helicopters and other aircraft, and letter of credit rights (in each case, other

than to the extent such rights can be perfected by filing a UCC-1 financing statement); (c) pledges and

security interests prohibited by applicable law, rule, regulation (in each case, except to the extent such

prohibition is unenforceable after giving effect to applicable provisions of the Uniform Commercial Code

of any applicable jurisdiction or similar laws) or which could require governmental (including regulatory)

consent, approval, license or authorization to be pledged (unless such consent, approval, license or

authorization has been received and after giving effect to the applicable anti-assignment provisions of the

Uniform Commercial Code of any applicable jurisdiction); (d) subject to the last sentence of this

definition, equity interests in any Person other than wholly-owned Subsidiaries to the extent not permitted

by the terms of such Person’s organizational or joint venture documents after giving effect to the

applicable anti-assignment provisions of the Uniform Commercial Code of any applicable jurisdiction; (e)

any lease, license or other agreement to the extent that a grant of a security interest therein would violate

or invalidate such lease, license or agreement or create a right of termination in favor of any other party

thereto (other than the Borrower or any Affiliate thereof) after giving effect to the applicable anti-

22

assignment provisions of the Uniform Commercial Code of any applicable jurisdiction or similar laws; (f)

those assets as to which the Administrative Agent and the Borrower reasonably agree that the cost or

other consequence of obtaining such a security interest or perfection thereof are excessive in relation to

the value afforded thereby; (g) any governmental licenses or state or local franchises, charters and

authorizations, to the extent security interests in such licenses, franchises, charters or authorizations are

prohibited or restricted thereby after giving effect to the applicable anti-assignment provisions of the

Uniform Commercial Code of any applicable jurisdiction or similar laws; (h) “intent-to-use” trademark

applications prior to the filing and acceptance of a statement of use; (i) any amount on deposit from time

to time in the Hillcrest Account; (j) solely to the extent required to be excluded from Collateral by the

Relative Rights Agreement, (i) the Purchased Option Assets, (ii) any Landlord Exclusive Assets, (iii) any

Authorizations, (iv) any Facility Provider Agreements, (v) any leasehold mortgage interest or any other

claim in the Master Lease or (vi) any real or personal property (including equipment and fixtures) owned

by the Landlord (as each such term used in this clause (j) is defined in the Relative Rights Agreement);

(k) any equipment or other asset subject to Liens securing the ETMC Acquisition, Permitted Acquisitions,

Sale and Leaseback Transactions, Securitization Transactions (solely with respect to Collateral of a type

that would not constitute ABL Priority Collateral), capital lease obligations or other purchase money debt,

in each case, to the extent such transaction is permitted under this Agreement, if the contract or other

agreement providing for such debt or capital lease obligation prohibits or requires the consent of any third

party as a condition to the creation of any other security interest on such equipment or asset (provided in

the case of acquired assets, such prohibition was in existence at the time of such acquisition and not

created in contemplation thereof) and, in each case, such prohibition or requirement is permitted under the

Loan Documents; (l) all of the equity interests in and assets of Sherman/Grayson Health System, LLC,

LHP Sherman/Grayson, LLC; and (m) any management agreement in respect of a Joint Venture that is

directly or indirectly owned (in part) by LHP and any management agreement in respect of a Physician

Group (other than, for the avoidance of doubt, any fees from such management agreement and other

amounts payable to the manager); provided that, each Loan Party shall use commercially reasonable

efforts to ensure that any management agreement in respect of a Joint Venture or Physician Group entered

into after the Original Closing Date shall not have any restrictions on granting any liens on, or security

interests in, the rights of such Loan Party in such management agreement. In addition, notwithstanding

anything to the contrary contained in this Agreement or in any other Loan Documents, (1) no landlord,

mortgagee or bailee waivers shall be required, (2) no notices shall be required to be sent to account

debtors or other contractual third parties prior to the occurrence and during the continuance of any Event

of Default, (3) no foreign-law governed Collateral Documents or perfection under foreign law shall be

required, (4) the portion of any cash held by any ETMC Subsidiary that represents cash that would be

required to be distributed by the ETMC JV for the benefit of unaffiliated third parties that are not Loan

Parties pursuant to the ETMC JV Agreement shall not be considered Collateral, (5) no control agreements

shall be required to be placed on any deposit or security accounts held by an ETMC Subsidiary (other

than in respect of the Pledged ETMC Distribution Account) so long as such ETMC Subsidiary is subject

to the terms of the ETMC JV Agreement (each, an “Excluded ETMC Account”), (6) the equity interests

owned by any Loan Party in the ETMC JV shall not constitute Excluded Property and (7) no control

agreements shall be required in connection with any “Excluded Deposit Account” (as defined in the ABL

Credit Agreement).

“Excluded Subsidiary” means any (i) Captive Insurance Subsidiary (or any Subsidiary thereof),

(ii) Domestic Subsidiary of any Foreign Subsidiary of the Borrower that is a CFC, (iii) FSHCO, (iv)

subject to the proviso in the definition of “Joint Venture”, Subsidiary that is prohibited by the constituent

documents of such entity (to the extent such agreement was entered into in good faith and not with the

purpose of avoiding the giving of a guarantee), applicable law, rule, regulation or contract (with respect to

any such contract, only to the extent existing on the Original Closing Date or the date the applicable

Person becomes a direct or indirect Subsidiary of the Borrower and so long as any such restriction in any

23

contract is not entered into in contemplation of such Subsidiary becoming a Subsidiary) from

guaranteeing the Loans or which would require governmental (including regulatory) consent, approval,

license or authorization to provide a guarantee (unless such consent, approval, license or authorization has

been received and upon such receipt, such Subsidiary shall be subject to Section 7.12), (v) non-Wholly

Owned Subsidiary, (vi) Subsidiary where the Borrower and the Administrative Agent reasonably agree

that the cost or other consequence of providing a guarantee is excessive in relation to the value afforded

thereby, (vii)an Unrestricted Subsidiary, (viii) each of the Subsidiaries identified as “Excluded” on

Schedule 6.13, and (ix) each Receivables Subsidiary. Notwithstanding the foregoing, after the Ventas

Purchase Option Assignment, in no event shall any Tenant Subsidiary constitute an Excluded Subsidiary

with respect to the Ventas Purchase Option Term Loans.

“Excluded Taxes” means, with respect to the Administrative Agent, any Lender or any other

recipient of any payment to be made by or on account of any obligation of any Loan Party hereunder or

under any other Loan Document, (a) Taxes imposed on or measured by its overall net income, and

franchise Taxes imposed on it (in lieu of net income Taxes), by a jurisdiction (or any political subdivision

thereof) as a result of such recipient being organized, having its principal office in, or in the case of any

Lender, having its applicable Lending Office in, such jurisdiction, (b) other than an assignee pursuant to a

request by the Borrower under Section 11.16, any U.S. or non-U.S. federal withholding tax that is

imposed on amounts payable to a Lender pursuant to any Laws in effect at the time such Lender becomes

a party hereto (or designates a new Lending Office), except to the extent that such Lender (or its assignor,

if any) was entitled, immediately prior to the designation of a new Lending Office (or assignment), to

receive additional amounts from any applicable Loan Party with respect to such withholding pursuant to

Section 3.01(a), (c) any withholding Tax that is attributable to such Person’s failure to comply with

Section 3.01(e), (d) any Taxes in the nature of branch profits tax within the meaning of Section 884(a) of

the Internal Revenue Code imposed by any jurisdiction described in clause (a), and (e) any U.S. federal

withholding Tax imposed under FATCA.

“Exclusion Event” means an event or related events resulting in the exclusion of the Borrower or

any of its Subsidiaries from participation in any Medical Reimbursement Program.

“Existing Credit Agreement” has the meaning set forth in the preliminary statements to this

Agreement.

“Existing Incremental Term Loan Maturity Date” has the meaning set forth in Section 2.17(a).

“Existing Term Loan Maturity Date” has the meaning set forth in Section 2.17(a).

“Extended Incremental Term Loan Maturity Date” has the meaning set forth in Section 2.17(b).

“Extended Term Loan Maturity Date” has the meaning set forth in Section 2.17(b).

“Extending Term Lenders” has the meaning set forth in Section 2.17(b).

“Facilities” means, at any time, a collective reference to the facilities and real properties owned,

leased or operated by the Borrower or any Subsidiary.

“FATCA” means Sections 1471 through 1474 of the Internal Revenue Code, as of the date of this

Agreement, or any amended or successor version that is substantively comparable and not materially

more onerous to comply with, any current or future regulations or official interpretations thereof, any

agreements entered into pursuant to current Section 1471(b)(1) of the Internal Revenue Code (or any

24

amended or successor version described above), and any intergovernmental agreements (and any related

laws or official administrative guidance) implementing the foregoing.

“Federal Funds Rate” means, for any day, the rate calculated by the Federal Reserve Bank of New

York based on such day’s federal funds transactions by depository institutions (as determined in such

manner as the Federal Reserve Bank of New York shall set forth on its public website from time to time)

and published on the next succeeding Business Day by the Federal Reserve Bank of New York as the

federal funds effective rate; provided, that if the Federal Funds Rate for any day is less than zero, the

Federal Funds Rate for such day will be deemed to be zero.

“Fee Letter” means that certain fee letter dated as of the Effective Date between the Borrower and

the Administrative Agent.

“FIRREA” means the Federal Institutions Reform, Recovery and Enforcement Act of 1989, as

amended.

“Fixed Charge Coverage Ratio” means as of any date of determination, with respect to the

Borrower and its Restricted Subsidiaries, the ratio of (x) the aggregate amount of Consolidated EBITDA

of the Borrower and its Restricted Subsidiaries for the period of the most recent four consecutive fiscal

quarters ending prior to the date of such determination for which financial statements have been delivered

pursuant to Section 7.01(a) or (b) to (y) Fixed Charges for such four fiscal quarters.

“Fixed Charges” means, with respect to any specified Person for any period, the sum, without

duplication, of:

(1)the Consolidated Interest Expense of such Person and its Restricted Subsidiaries for such

period;

(2)the Consolidated Interest Expense of such Person and its Restricted Subsidiaries that was

capitalized during such period; and

(3)all dividends paid, in cash, Cash Equivalents or Indebtedness during such period on any

series of Disqualified Capital Stock of such Person or on Preferred Stock of its Non-Guarantor Restricted

Subsidiaries payable to a party other than the Borrower or a Restricted Subsidiary on a consolidated basis

and in accordance with GAAP.

(4)if since the beginning of such period any Person (that subsequently became a Subsidiary

(excluding all Unrestricted Subsidiaries) or was merged or consolidated with or into the Borrower or any

Subsidiary (excluding all Unrestricted Subsidiaries) since the beginning of such period) will have

incurred any Indebtedness or discharged any Indebtedness, made any disposition or any Investment or

acquisition of assets or property that would have required an adjustment pursuant to clause (1), (2) or (3)

above if made by the Borrower or a Subsidiary (excluding all Unrestricted Subsidiaries) during such

period, Consolidated EBITDA and Fixed Charges for such period will be calculated after giving pro

forma effect thereto as if such transaction occurred on the first day of such period.

For purposes of this definition, whenever pro forma effect is to be given to any calculation under this

definition, the pro forma calculations will be determined in good faith by a responsible financial or

accounting Officer of the Borrower to reflect, without duplication, cost savings, synergies and operating

expense reductions resulting from such Investment, acquisition, disposition, merger or consolidation, in

each case calculated in accordance with and permitted by the definition of “Consolidated EBITDA.” If

25

any Indebtedness bears a floating rate of interest and is being given pro forma effect, the interest expense

on such Indebtedness will be calculated as if the rate in effect on the date of determination had been the

applicable rate for the entire period (taking into account any Interest Rate Agreement applicable to such

Indebtedness if such Interest Rate Agreement has a remaining term in excess of 12 months). If any

Indebtedness that is being given pro forma effect bears an interest rate at the option of the Borrower, the

interest rate shall be calculated by applying such optional rate chosen by the Borrower.

“Flood Insurance Laws” means collectively, (i) National Flood Insurance Reform Act of 1994

(which comprehensively revised the National Flood Insurance Act of 1968 and the Flood Disaster

Protection Act of 1973) as now or hereafter in effect or any successor statute thereto, (ii) the Flood

Insurance Reform Act of 2004 as now or hereafter in effect or any successor statute thereto and (iii) the

Biggert-Waters Flood Insurance Reform Act of 2012 as now or hereafter in effect or any successor statute

thereto.

“Foreign Subsidiary” means any Subsidiary that is not a Domestic Subsidiary.

“FRB” means the Board of Governors of the Federal Reserve System of the United States.

“FSHCO” means any Domestic Subsidiary that owns no material assets other than the equity

interests of one or more Foreign Subsidiaries of the Borrower that is a CFC.

“Funded Indebtedness” means, as to any Person at a particular time, without duplication, all of

the following, whether or not included as indebtedness or liabilities in accordance with GAAP:

(a)all obligations for borrowed money, whether current or long-term (including the

Obligations) and all obligations of such Person evidenced by bonds, debentures, notes, loan

agreements or other similar instruments (excluding, for the avoidance of doubt, in all cases any

undrawn amounts under the ABL Facility or any other revolving credit facilities);

(b)all purchase money Indebtedness;

(c)the principal portion of all obligations under conditional sale or other title

retention agreements relating to Property purchased by the Borrower or any Restricted Subsidiary

(other than customary reservations or retentions of title under agreements with suppliers entered

into in the ordinary course of business);

(d)all obligations arising under bankers’ acceptances, bank guaranties, surety bonds

and similar instruments, but excluding all obligations arising under letters of credit;

(e)all obligations in respect of the deferred purchase price of property or services

(other than trade accounts payable and accrued expenses in the ordinary course of business and

purchase price adjustments), including without limitation, any Earn-Out Obligations;

(f)all Attributable Indebtedness with respect to Capital Leases, Synthetic Leases

and Sale Leaseback Transactions;

(g)all Attributable Indebtedness with respect to Securitization Transactions;

(h)all preferred stock or other equity interests providing for mandatory redemptions,

sinking fund or like payments prior to the Maturity Date for Term Loans or, if any Incremental

Term Loans shall be outstanding, the maturity date for such Incremental Term Loans

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(“Redeemable Stock”); provided that Redeemable Stock shall not include any preferred stock or

other equity interest subject to mandatory redemption if (i) such mandatory redemption may be

satisfied by delivering common stock or some other equity interest not subject to mandatory

redemption or (ii) such mandatory redemption is triggered solely by reason of a “change of

control” and is not required to be paid until after the Obligations are paid in full;

(i)all Funded Indebtedness of others to the extent secured by (or for which the

holder of such Funded Indebtedness has an existing right, contingent or otherwise, to be secured

by) any Lien on, or payable out of the proceeds of production from, Property owned or acquired

by the Borrower or any Restricted Subsidiary, whether or not the obligations secured thereby

have been assumed (other than any rights of LeaseCo under the Relative Rights Agreement);

(j)all Guarantees with respect to Indebtedness of the types specified in clauses (a)

through (i) above of another Person; and

(k)all Indebtedness of the types referred to in clauses (a) through (j) above of any

partnership or joint venture (other than a joint venture that is itself a corporation or limited

liability company) in which such Person is a general partner or joint venturer, except to the extent

that Indebtedness is expressly made non-recourse to such Person.

For purposes hereof, (x) the amount of any direct obligation arising under bankers’ acceptances, bank

guaranties, surety bonds and similar instruments, but excluding all obligations arising under letters of

credit, shall be the maximum amount available to be drawn thereunder and (y) the amount of any

Guarantee shall be the amount of the Indebtedness subject to such Guarantee.

“GAAP” means generally accepted accounting principles in the United States set forth in the

opinions and pronouncements of the Accounting Principles Board and the American Institute of Certified

Public Accountants and statements and pronouncements of the Financial Accounting Standards Board,

consistently applied.

“Governmental Authority” means any nation or government, any state or other political

subdivision thereof, any agency, authority, instrumentality, regulatory body, court, administrative

tribunal, central bank or other entity exercising executive, legislative, judicial, taxing, regulatory or

administrative powers or functions of or pertaining to government.

“Governmental Reimbursement Program Cost” means with respect to and payable by the

Borrower and its Restricted Subsidiaries the sum of:

(i)all amounts (including punitive and other similar amounts) agreed to be paid or

payable (A) in settlement of claims or (B) as a result of a final, non-appealable judgment, award

or similar order, in each case, relating to participation in Medical Reimbursement Programs;

(ii)all final, non-appealable fines, penalties, forfeitures or other amounts rendered

pursuant to criminal indictments or other criminal proceedings relating to participation in Medical

Reimbursement Programs; and

(iii)the amount of final, non-appealable recovery, damages, awards, penalties,

forfeitures or similar amounts rendered in any litigation, suit, arbitration, investigation, review or

other legal or administrative proceeding of any kind relating to participation in Medical

Reimbursement Programs.

27

“Guarantee” means, as to any Person, (a) any obligation, contingent or otherwise, of such Person

guaranteeing or having the economic effect of guaranteeing any Indebtedness or other obligation payable

by another Person (the “primary obligor”) in any manner, whether directly or indirectly, and including

any obligation of such Person, direct or indirect, (i) to purchase or pay (or advance or supply funds for the

purchase or payment of) such Indebtedness or other payment obligation, (ii) to purchase or lease property,

securities or services for the purpose of assuring the obligee in respect of such Indebtedness or other

payment obligation of the payment or performance of such Indebtedness or other payment obligation, (iii)

to maintain working capital, equity capital or any other financial statement condition or liquidity or level

of income or cash flow of the primary obligor so as to enable the primary obligor to pay such

Indebtedness or other payment obligation, or (iv) entered into for the purpose of assuring in any other

manner the obligee in respect of such Indebtedness or other obligation of the payment thereof or to

protect such obligee against loss in respect thereof (in whole or in part), or (b) any Lien on any assets of

such Person securing any Indebtedness or other payment obligation of any other Person, whether or not

such Indebtedness or other obligation is assumed by such Person. The amount of any Guarantee shall be

deemed to be an amount equal to the stated or determinable amount of the related primary payment

obligation, or portion thereof, in respect of which such Guarantee is made or, if not stated or

determinable, the maximum reasonably anticipated liability in respect thereof as determined by the

guaranteeing Person in good faith. The term “Guarantee” as a verb has a corresponding meaning.

“Guaranteed Obligations” has the meaning set forth in Section 4.06.

“Guarantors” means Parent and each Material Domestic Subsidiary of the Borrower identified on

the signature pages hereto as a “Guarantor” and each other Person that joins as a Guarantor pursuant to

Section 7.12, together with their successors and permitted assigns; provided that no Excluded Subsidiary

(including the ETMC JV) shall be required to be a Guarantor.

“Guaranty” means the Guaranty made by the Guarantors in favor of the Administrative Agent and

the Lenders pursuant to Article IV hereof.

“Hazardous Materials” means all explosive or radioactive substances or wastes and all hazardous

or toxic substances, wastes or other pollutants, including petroleum or petroleum distillates, asbestos or

asbestos-containing materials, polychlorinated biphenyls, per- or polyfluoroalkyl substances, radon gas,

infectious or medical wastes and all other substances or wastes of any nature regulated pursuant to any

Environmental Law.

“HHS” means the United States Department of Health and Human Services and any successor

thereof.

“Hillcrest Account” means that certain Deposit Account with the Bank of Oklahoma in the name

of AHS Hillcrest Medical Center, LLC, and having the account number 209932452, into which funds in

an initial amount approximately equal to $25,000,000 have been deposited and from which funds will be

paid or payable to the Underlying Claim Holder (as defined in the Ardent Acquisition Agreement as in

effect on the Original Closing Date) (including any fines, penalties, assessments, fees, expenses, costs,

judgments, awards and interest and any amount paid with respect to any settlement of a Proceeding (as

defined in the Ardent Acquisition Agreement as in effect on the Original Closing Date)) with respect to

the Underlying Claim (as defined in the Ardent Acquisition Agreement as in effect on the Original

Closing Date).

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996, as amended by

the Health Information Technology for Economic and Clinical Health Act amendments to the American

28

Recovery and Reinvestment Act of 2009, and as the same may be amended, modified or supplemented

from time to time, and any successor statute thereto, and any and all rules or regulations promulgated

from time to time thereunder.

“HIPAA Standards” has the meaning specified in Section 7.08.

“HMO” means any health maintenance organization, managed care organization, any Person

doing business as a health maintenance organization or managed care organization, or any Person

required to qualify or be licensed as a health maintenance organization or managed care organization

under applicable federal or state law (including, without limitation, HMO Regulations).

“HMO Business” means the business of owning and operating an HMO or other similar regulated

entity or business.

“HMO Entity” means a Person that is capitalized or licensed as an HMO, conducting HMO

Business or providing managed care services.

“HMO Regulations” means all laws, regulations, directives and administrative orders applicable

under federal or state law to any HMO Entity (and any regulations, orders and directives promulgated or

issued pursuant to any of the foregoing) and all applicable sections of Subchapter XI of Title 42 of the

United States Code (and any regulations, orders and directives promulgated or issued pursuant thereto,

including, without limitation, Part 417 of Chapter IV of Title 42 of the Code of Federal Regulations).

“Hospital” means a hospital, outpatient clinic, outpatient surgical center, long-term care facility,

diagnostic facility, medical office building or other facility or business that is used or useful in or related

to the provision of healthcare services.

“Impacted Loans” has the meaning set forth in Section 3.03(a).

“Incremental Amendment” has the meaning specified in Section 2.14(d).

“Incremental Term Loan Extension Effective Date” has the meaning set forth in Section 2.17(b).

“Incremental Term Loans” has the meaning specified in Section 2.14(a).

“Indebtedness” means, as to any Person at a particular time, without duplication, all of the

following, whether or not included as indebtedness or liabilities in accordance with GAAP:

(a)all Funded Indebtedness and all obligations arising under letters of credit

(including standby and commercial);

(b)net obligations under any Swap Contract;

(c)all Guarantees with respect to outstanding Indebtedness of the types specified in

clauses (a) and (b) above of any other Person; and

(d)all Indebtedness of the types referred to in clauses (a) through (c) above of any

partnership or joint venture (other than a joint venture that is itself a corporation or limited

liability company) in which the Borrower or a Restricted Subsidiary is a general partner or joint

venturer, unless such Indebtedness is expressly made non-recourse to the Borrower or such

Restricted Subsidiary.

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For purposes hereof (x) the amount of any direct obligations arising under letters of credit

(including standby and commercial) shall be the maximum amount available to be drawn thereunder, (y)

the amount of any net obligation under any Swap Contract on any date shall be deemed to be the Swap

Termination Value thereof as of such date and (z) the amount of any Guarantee shall be the amount of the

Indebtedness subject to such Guarantee; provided that, notwithstanding the foregoing, Indebtedness shall

be deemed not to include any Physician Support Obligations or any obligations arising under the Master

Lease (and, for the avoidance of doubt, any Physician Support Obligations and obligations arising under

the Master Lease shall be exempt from Section 8.03).

“Indemnified Liabilities” has the meaning set forth in Section 11.05.

“Indemnified Taxes” means any Taxes other than Excluded Taxes and Other Taxes.

“Indemnitees” has the meaning set forth in Section 11.05.

“Indenture Trustee” means U.S. Bank National Association, as trustee under the 2029 Notes

Indenture.

“Initial Term Commitment” means (a) as to each Person, the obligation of such Person to have

made an Initial Term Loan on the Effective Date to the Borrower pursuant to Section 2.01 in the principal

amount set forth opposite such Person’s name on Schedule 2.01 under the heading “Initial Term

Commitment” and (b) in the case of any Lender that becomes a Lender after the Effective Date, the

amount specified as such Lender’s “Initial Term Commitment” in the Assignment and Assumption

pursuant to which such Lender assumed a portion of the aggregate Initial Term Commitment, in each case

as the same may be changed from time to time pursuant to the terms hereof. The aggregate amount of the

Initial Term Commitments on the Effective Date is $900,000,000.

“Initial Term Lender” means any Lender that hashad an Initial Term Commitment or any Lender

that has purchased an Initial Term Loan pursuant to one or more Assignment and Assumptions in

accordance with the terms hereof, in each case, prior to the Amendment No. 2 Effective Date.

“Initial Term Loans” means the Term Loans made by the Initial Term Lenders to the Borrower on

the Effective Date pursuant to Section 2.01(a).

“Insurer” means a Person that insures a Patient against certain of the costs incurred in the receipt

by such Patient of Medical Services, or that has an agreement with a Loan Party to compensate such Loan

Party for providing services to a Patient.

“Intercompany Note” means a promissory note substantially in the form of Exhibit K, or such

other promissory note that shall be reasonably satisfactory to the Administrative Agent; it being

understood that (x) the Required Payment Intercompany Note and (y) the intercompany notes evidencing

(i) the Working Capital Intercompany Loans and (ii) the intercompany loan permitted under Section

8.02(ee)(iii) constitute “Intercompany Notes.”

“Intercompany Security Documents” means each security agreement, pledge agreement,

mortgage, deed of trust or other security document reasonably requested by, and in form and substance

reasonably satisfactory to, the Administrative Agent, in each case executed by a Non-Guarantor

Restricted Subsidiary in favor of any Loan Party in accordance with the terms hereof, with such

modifications thereto as are necessary to be in compliance with applicable state law (any such

modifications to be reasonably acceptable to the Administrative Agent).

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“Intercreditor Agreement” means (i) if the ABL Credit Agreement in effect is the ABL Credit

Agreement described in clause (i) of the definition thereof, the Intercreditor Agreement dated the Original

Closing Date among the Administrative Agent, the ABL Administrative Agent and the other parties from

time to time party thereto substantially in the form attached hereto as Exhibit P (as amended, restated,

amended and restated, supplemented or otherwise modified from time to time) and (ii) in all other cases,

any Refinancing Intercreditor Agreement.

“Interest Payment Date” means (a) as to any Loan other than a Base Rate Loan, the last Business

Day (subject to Section 2.12(b)) of each Interest Period applicable to such Loan and the Maturity Date for

such Loan; provided, however, that if any Interest Period for a Term SOFR Loan exceeds three months,

the respective dates that fall every three months after the beginning of such Interest Period shall also be

Interest Payment Dates; and (b) as to any Base Rate Loan, the first day of each calendar quarter and the

Maturity Date with respect to such Base Rate Loan.

“Interest Period” means as to each Term SOFR Loan, the period commencing on the date such

Term SOFR Loan is disbursed or converted to or continued as a Term SOFR Loan and ending on the date

one, three, six or, if available to, and upon the consent of the Administrative Agent and all applicable

Lenders, such other period that is twelve months or less, as selected by the Borrower in its Loan Notice;

provided that:

(i)any Interest Period that would otherwise end on a day that is not a Business Day

shall be extended to the next succeeding Business Day unless such Business Day falls in another

calendar month, in which case such Interest Period shall end on the next preceding Business Day;

(ii)any Interest Period that begins on the last Business Day of a calendar month (or

on a day for which there is no numerically corresponding day in the calendar month at the end of

such Interest Period) shall end on the last Business Day of the calendar month at the end of such

Interest Period; and

(iii)no Interest Period shall extend beyond the Maturity Date with respect to such

Term SOFR Loan.

“Interest Rate Agreement” means, with respect to any Person any interest rate protection

agreement, interest rate future agreement, interest rate option agreement, interest rate swap agreement,

interest rate cap agreement, interest rate collar agreement, interest rate hedge agreement or other similar

agreement or arrangement as to which such Person is party or a beneficiary.

“Internal Revenue Code” means the Internal Revenue Code of 1986, as amended.

“Investment” means, as to any Person, any direct or indirect acquisition or investment by such

Person, whether by means of (a) the purchase or other acquisition of Capital Stock of another Person, (b)

a loan, advance or capital contribution to, Guarantee or assumption of debt of, or purchase or other

acquisition of any other debt or equity participation or interest in, another Person, including any

partnership or joint venture interest in such other Person, or (c) an Acquisition; provided that,

notwithstanding anything to the contrary set forth herein or in any other Loan Document, the LHP Cash

Management Transfer System shall not constitute Investments. For purposes of covenant compliance, the

amount of any Investment shall be the amount actually invested, without adjustment for subsequent

increases or decreases in the value of such Investment.

31

“Involuntary Disposition” means any loss of, damage to or destruction of, or any condemnation

or other taking for public use of, any Property of the Borrower or any Restricted Subsidiary which gives

rise to the receipt by the Borrower or any Restricted Subsidiary of insurance proceeds or condemnation

awards to replace or repair such Property.

“IP Rights” has the meaning set forth in Section 6.17.

“IRS” means the United States Internal Revenue Service.

“Joint Book Runners” means Bank of America, Barclays and JPMorgan, in their capacities as

joint lead arrangers and joint book runners under any of the Loan Documents.

“Joint Venture” of a Person means a corporation, partnership, joint venture, limited liability

company or other business entity (a) of which less than a majority of the shares of Capital Stock having

ordinary voting power for the election of directors or other governing body (other than Capital Stock

having such power only by reason of the happening of a contingency) are at the time beneficially owned,

directly, or indirectly through one or more intermediaries, or both, by such Person and (b) which is not

otherwise a Subsidiary of such Person; provided, however, that Parent and the other Loan Parties shall

cause each of their respective Subsidiaries and Affiliates to use commercially reasonable efforts to ensure

that any Joint Venture Agreements entered into after the Effective Date shall not have any restrictions on

granting any liens on, or security interests in, the Capital Stock held directly or indirectly by a Loan Party

in such Joint Venture. Unless otherwise specified, all references herein to a “Joint Venture” or to “Joint

Ventures” shall refer to a Joint Venture or Joint Ventures of the Borrower.

“Joint Venture Agreements” means the Organization Documents of any Joint Venture existing

from time to time.

“JPMorgan” means JPMorgan Chase Bank, N.A. and its successors.

“JV Clinical Management Agreement” means that certain UTHSCT Clinical Operations

Management Agreement, dated as of February 26, 2018, between ETMC JV and UT Tyler.

“JV Management Agreement” means that certain Company Management Agreement, dated as of

February 26, 2018, between ETMC JV and AHS East Texas.

“JV Sub-Management Agreement” means that certain Company Management Agreement, dated

as of February 26, 2018, between ETMC JV and AHS Management Company, Inc.

“Laws” means, collectively, all international, foreign, federal, state and local statutes, treaties,

rules, guidelines, regulations, ordinances, codes and administrative or judicial precedents or authorities,

including the interpretation or administration thereof by any Governmental Authority charged with the

enforcement, interpretation or administration thereof, and all applicable administrative orders, directed

duties, requests, licenses, authorizations and permits of, and agreements with, any Governmental

Authority, in each case whether or not having the force of law.

“LCT Election” has the meaning specified in Section 1.08.

“LCT Test Date” has the meaning specified in Section 1.08.

32

“LeaseCo” means collectively, the entities listed on the Schedule of Landlords attached to the

Relative Rights Agreement, each a wholly-owned affiliate of Ventas, and their successors, replacements

and permitted assigns in such capacity.

“Lender” means (a) each of the Persons identified as a “Lender” on the signature pages to the

Amendment and Restatement Agreement and their successors and permitted assigns and (b) other Term

Loan Lenders,

“Lending Office” means, as to any Lender, the office or offices of such Lender described as such

in such Lender’s Administrative Questionnaire, or such other office or offices as a Lender may from time

to time notify the Borrower and the Administrative Agent.

“LHP” means LHP Hospital Group, Inc.

“LHP/ETMC ABL Facility Silo” means the ETMC Credit Facility (as defined in the ABL Credit

Agreement).

“LHP Cash Management Transfer System” means the ordinary course transfer of funds among

LHP, its Subsidiaries and Joint Ventures, in each case consistent with past practices.

“Lien” means any mortgage, pledge, hypothecation, collateral assignment, deposit arrangement,

encumbrance, lien (statutory or other), charge, or preference, priority or other security interest or

preferential arrangement of any kind or nature whatsoever (including any conditional sale or other title

retention agreement, and any financing lease having substantially the same economic effect as any of the

foregoing).

“Limited Condition Acquisition” means any acquisition of an Acquired Entity or Business the

consummation of which is not conditioned on the availability of financing.

“Loan Documents” means this Agreement, the Amendment and Restatement Agreement,

Amendment No. 1, Amendment No. 2, each Term Note, the Collateral Documents, the Intercreditor

Agreement, the Relative Rights Agreement, each Loan Notice, each Excess Cash Certificate, the Fee

Letter and each other document, instrument or agreement from time to time executed by the Parent, the

Borrower or any other Loan Party and delivered in connection with this Agreement (including, without

limitation, in connection with the Ventas Purchase Option Term Loans).

“Loan Notice” means a notice of (a) a Borrowing of a Term Loan, (b) a conversion of Loans from

one Type to the other, or (c) a continuation of Term SOFR Loans, pursuant to Section 2.02(a), which

shall be substantially in the form of Exhibit D or such other form as may be reasonably approved by the

Administrative Agent (including any form on an electronic platform or electronic transmission system as

shall be reasonably approved by the Administrative Agent), appropriately completed and signed by a

Responsible Officer of the Borrower.

“Loan Parties” means, collectively, the Borrower and the Guarantors.

“Loans” means an extension of credit by a Lender to the Borrower under Article II in the form of

a Term Loan or Incremental Term Loan, as applicable. For the avoidance of doubt, after the

consummation of the Ventas Purchase Option and the transactions contemplated by Section 2.18, any

reference to “Loans” shall be deemed to refer to Ventas Purchase Option Term Loans and/or Non-Ventas

Purchase Option Term Loans, as applicable.

33

“Master Lease” means that certain Master Lease Agreement, dated as of August 4, 2015, among

LeaseCo and certain of Affiliates of the Borrower, regarding the lease of LeaseCo’s Real Property to the

Borrower and its Subsidiaries, as amended, restated, supplemented or otherwise modified from time to

time.

“Material Adverse Effect” means (a) a material adverse change in, or a material adverse effect

upon, the operations, business, properties, liabilities (actual or contingent), or financial condition of the

Borrower and its Restricted Subsidiaries, taken as a whole; (b) a material impairment of the ability of the

Borrower and the Guarantors taken as a whole to perform their obligations under the Loan Documents; (c)

a material adverse effect upon the legality, validity, binding effect or enforceability against the Borrower or

any Guarantor of any Loan Document to which it is a party or (d) a material impairment of the rights of or

benefits or remedies available to the Lenders or the Administrative Agent taken as a whole under any Loan

Document.

“Material Domestic Subsidiary” means any Wholly Owned Domestic Subsidiary of the Borrower

that is a Restricted Subsidiary and (a) as of the end of any fiscal quarter period, has total assets with a

book value averaging greater than 2.5% of the total assets of the Borrower and its Restricted Subsidiaries

taken as a whole or (b) has revenues for the most recent twelve-month period greater than 2.5% of the

total revenues for the most recent twelve-month period in the aggregate of the Borrower and its Restricted

Subsidiaries taken as a whole; provided that if, at any time and from time to time after the Effective Date,

Wholly Owned Domestic Subsidiaries that are Restricted Subsidiaries but are not Guarantors solely

because they do not meet the thresholds set forth in clauses (a) or (b), together with the other Domestic

Subsidiaries that are Restricted Subsidiaries but are not Guarantors (including (x) all Captive Insurance

Subsidiaries (and any Subsidiaries thereof), but excluding (y) all non-Wholly Owned Subsidiaries and

Joint Ventures) have in the aggregate total assets with a book value averaging greater than 5% of the total

assets of the Borrower and its Restricted Subsidiaries taken as a whole or have in the aggregate revenues

for the most recent twelve-month period greater than 5% of the total revenues for the most recent twelve-

month period of the Borrower and its Restricted Subsidiaries taken as a whole, then the Borrower shall,

not later than forty-five (45) days after the date by which financial statements for such quarter are

required to be delivered pursuant to this Agreement (or such longer period as the Administrative Agent

may agree in its reasonable discretion), (i) designate in writing to the Administrative Agent one or more

of such Wholly Owned Domestic Subsidiaries that are Restricted Subsidiaries as “Material Domestic

Subsidiaries” to the extent required such that the foregoing condition ceases to be true and (ii) comply

with the provisions of Section 7.12 applicable to such Subsidiary (other than Excluded Subsidiaries).

“Maturity and Weighted Average Life to Maturity Limitations” has the meaning set forth in

Section 2.14(b).

“Maturity Date” means the date that is the seven year anniversary of the Effective Date, or, if

such day is not a Business Day, the immediately succeeding Business Day.

“Maximum Rate” has the meaning set forth in Section 11.10.

“Medicaid” means that means-tested entitlement program under Title XIX of the Social Security

Act, which provides federal grants to states for medical assistance based on specific eligibility criteria, as set

forth at Section 1396, et seq. of Title 42 of the United States Code, as amended, and any statute succeeding

thereto.

“Medicaid Provider Agreement” means an agreement entered into between a state agency or other

such entity administering the Medicaid program and a health care provider or supplier under which the

34

health care provider or supplier agrees to provide services for Medicaid patients in accordance with the

terms of the agreement and Medicaid Regulations.

“Medicaid Regulations” means, collectively, (i) all federal statutes (whether set forth in Title XIX

of the Social Security Act or elsewhere) affecting Medicaid and any statutes succeeding thereto; (ii) all

applicable provisions of all federal rules, regulations, manuals and orders of all Governmental Authorities

promulgated pursuant to or in connection with the statutes described in clause (i) above and all federal

administrative, reimbursement and other guidelines of all Governmental Authorities having the force of

law promulgated pursuant to or in connection with the statutes described in clause (i) above; (iii) all state

statutes and plans for medical assistance enacted in connection with the statutes and provisions described

in clauses (i) and (ii) above; and (iv) all applicable provisions of all rules, regulations, manuals and orders

of all Governmental Authorities promulgated pursuant to or in connection with the statutes described in

clause (iii) above and all state administrative, reimbursement and other guidelines of all Governmental

Authorities having the force of law promulgated pursuant to or in connection with the statutes described

in clause (ii) above, in each case as may be amended, supplemented or otherwise modified from time to

time.

“Medical Reimbursement Programs” means a collective reference to the Medicare, Medicaid and

TRICARE programs and any other health care program operated by or financed in whole or in part by

any foreign or domestic federal, state or local government and any other non-government funded third

party payor programs.

“Medical Services” means medical and health care services provided to a Patient, including, but

not limited to, medical and health care services provided to a Patient and performed by a Loan Party

which are covered by a policy of insurance issued by an Insurer, and includes physician services, nurse

and therapist services, dental services, hospital services, skilled nursing facility services, comprehensive

outpatient rehabilitation services, home health care services, residential and out-patient behavioral

healthcare services, and medicine or health care equipment provided by a Loan Party to a Patient for a

necessary or specifically requested valid and proper medical or health purpose.

“Medicare” means that government-sponsored entitlement program under Title XVIII of the

Social Security Act, which provides for a health insurance system for eligible individuals, as set forth at

Section 1395, et seq. of Title 42 of the United States Code, as amended, and any statute succeeding

thereto.

“Medicare Provider Agreement” means an agreement entered into between CMS or other such

entity administering the Medicare program on behalf of CMS, and a health care provider or supplier

under which the health care provider or supplier agrees to provide services for Medicare patients in

accordance with the terms of the agreement and Medicare Regulations.

“Medicare Regulations” means, collectively, all federal statutes (whether set forth in Title XVIII

of the Social Security Act or elsewhere) affecting Medicare and any statutes succeeding thereto; together

with all applicable provisions of all rules, regulations, manuals and orders and administrative,

reimbursement and other guidelines having the force of law of all Governmental Authorities (including,

without limitation, CMS, the OIG, HHS, or any person succeeding to the functions of any of the

foregoing) promulgated pursuant to or in connection with any of the foregoing having the force of law, as

each may be amended, supplemented or otherwise modified from time to time.

“MFN Provisions” has the meaning set forth in Section 2.14(b).

35

“MOB Disposition” has the meaning set forth in Section 8.05(iii).

“Moody’s” means Moody’s Investors Service, Inc. and any successor thereto.

“Mortgage Instrument” means the fully executed and notarized mortgages, deeds of trust or deeds

to secure debt executed by a Loan Party in favor of the Administrative Agent, as the same may be

amended, modified, restated or supplemented from time to time.

“Mortgaged Property” means (a) the Real Property identified on Schedule 1.01 and (b) each

owned Real Property of the Loan Parties which shall be required to be encumbered by a Mortgage

Instrument delivered after the Original Closing Date pursuant to Section 7.14.

“Multiemployer Plan” means any employee benefit plan of the type described in Section

4001(a)(3) of ERISA, to which the Borrower or any ERISA Affiliate makes or is obligated to make

contributions, or during the preceding five plan years, has made or been obligated to make contributions.

“NAIC” means the National Association of Insurance Commissioners, a national organization of

insurance regulators.

“Net Cash Proceeds” means the aggregate cash or Cash Equivalents proceeds received by the

Borrower or any Restricted Subsidiary in respect of any Disposition (including the sale of the Capital

Stock in any Joint Venture), Debt Issuance or Involuntary Disposition, net of (a) direct costs incurred in

connection therewith (including, without limitation, legal, accounting and investment banking fees, and

sales commissions), (b) taxes paid or payable as a result thereof and (c) in the case of any Disposition or

Involuntary Disposition by the Borrower or any Restricted Subsidiary thereof, the amount necessary to

retire any Indebtedness secured by a Permitted Lien (ranking senior to any Lien of the Administrative

Agent) on the related Property; it being understood that “Net Cash Proceeds” shall include, without

limitation, any cash or Cash Equivalents received upon the sale or other disposition of any non-cash

consideration received by the Borrower or any Restricted Subsidiary in any Disposition, Debt Issuance or

Involuntary Disposition; provided, however, that if in connection with a Disposition or Involuntary

Disposition the Borrower shall deliver a certificate of a Responsible Officer to the Administrative Agent

at the time of receipt thereof setting forth the Borrower’s intention to reinvest such proceeds in productive

assets of a kind then used or usable in the business of the Borrower and its Restricted Subsidiaries

(including assets acquired in a Permitted Acquisition), such proceeds shall not constitute Net Cash

Proceeds if (x) within one (1) year of receipt thereof such proceeds are so reinvested and (y) no Event of

Default shall have occurred and shall be continuing at the time of such certificate or at the time such

proceeds are contractually committed to be used; provided further that if prior to the end of such one (1)

year period, such proceeds have not been reinvested but have been contractually committed to be so

reinvested, such proceeds shall not constitute Net Cash Proceeds except to the extent not actually

reinvested within an additional 180-day period following such one (1) year period, at which time such

proceeds shall be deemed to be Net Cash Proceeds.

“Non-Converting Consenting Lender” means a Lender that has elected to be a “Non-Converting

Consenting Lender” on its signature page to Amendment No. 2.

“Non-Debt Fund Affiliate” shall mean an Affiliate of the Borrower that is not a Debt Fund

Affiliate or a Purchasing Borrower Party.

“Non-Extending Term Lenders” has the meaning set forth in Section 2.17(b).

36

“Non-Guarantor Restricted Subsidiary” means any Restricted Subsidiary of the Borrower which

is not a Loan Party.

“Non-Ventas Purchase Option Term Loans” means the Term Loans outstanding after giving

effect to the Ventas Purchase Option Assignment that are not Ventas Purchase Option Term Loans.

“Non-Recourse Debt” means Indebtedness of a Person:

(1)as to which neither the Borrower nor any Restricted Subsidiary (a) provides any

Guarantee or credit support of any kind (including any undertaking, Guarantee, indemnity, agreement or

instrument that would constitute Indebtedness) or (b) is directly or indirectly liable (as a guarantor or

otherwise); and

(2)no default with respect to which (including any rights that the holders thereof may have

to take enforcement action against an Unrestricted Subsidiary) would permit (upon notice, lapse of time

or both) any holder of any other Indebtedness of the Borrower or any Restricted Subsidiary to declare a

default under such other Indebtedness or cause the payment thereof to be accelerated or payable prior to

its Stated Maturity.

“Non-Tenant Joinder Agreement” means a joinder agreement substantially in the form of Exhibit

J-1 executed and delivered by a Domestic Restricted Subsidiary (other than a Tenant Subsidiary) in

accordance with the provisions of Section 7.12.

“Non-Tenant Subsidiary Pledge Agreement” means the Pledge Agreement in the form of Exhibit

B-1 dated as of the Original Closing Date executed in favor of the Administrative Agent by each of the

Loan Parties (other than the Tenant Subsidiaries), as amended, modified, restated or supplemented from

time to time.

“Non-Tenant Subsidiary Security Agreement” means the Security Agreement substantially in the

form of Exhibit C-1 dated as of the Original Closing Date executed in favor of the Administrative Agent

by each of the Loan Parties (other than any Tenant Subsidiaries), as amended, modified, restated or

supplemented from time to time.

“Obligations” means all advances to, and debts, liabilities, obligations, covenants and duties of,

any Loan Party arising under any Loan Document or otherwise with respect to any Loan, whether direct

or indirect (including those acquired by assumption), absolute or contingent, due or to become due, now

existing or hereafter arising and including interest and fees that accrue after the commencement by or

against any Loan Party or any Affiliate thereof of any proceeding under any Debtor Relief Laws naming

such Person as the debtor in such proceeding, regardless of whether such interest and fees are allowed

claims in such proceeding.

“OID” has the meaning assigned in Section 2.14(b).

“OIG” means the Office of Inspector General of HHS and any successor thereof.

“Organization Documents” means (a) with respect to any corporation, the certificate or articles of

incorporation and the bylaws (or equivalent or comparable constitutive documents with respect to any

non-U.S. jurisdiction); (b) with respect to any limited liability company, the certificate or articles of

formation or organization and operating agreement; and (c) with respect to any partnership, joint venture,

trust or other form of business entity, the partnership, joint venture or other applicable agreement of

37

formation or organization and any agreement, instrument, filing or notice with respect thereto filed in

connection with its formation or organization with the applicable Governmental Authority in the

jurisdiction of its formation or organization and, if applicable, any certificate or articles of formation or

organization of such entity.

“Original Closing Date” means June 28, 2018.

“Other Appointment and Resignation Documentation” has the meaning assigned to such term in

the Amendment and Restatement Agreement.

“Other Taxes” has the meaning set forth in Section 3.01(b).

“Outstanding Amount” means with respect to any Loans on any date, the aggregate outstanding

principal amount thereof after giving effect to any borrowings and prepayments or repayments of any

Loans occurring on such date.

“PACE Financing” shall mean a financing secured by a real estate tax assessment on a property in

accordance with state and local Laws.

“Parent” has the meaning provided in the introductory paragraph hereto.

“Participant” has the meaning assigned in Section 11.07(d).

“Participant Register” has the meaning set forth in Section 11.07(d).

“Patient” means any Person receiving Medical Services from a Loan Party and all Persons legally

liable to pay a Loan Party for such Medical Services other than Insurers.

“PBGC” means the Pension Benefit Guaranty Corporation.

“Pension Plan” means any “employee pension benefit plan” (as such term is defined in Section

3(2) of ERISA), other than a Multiemployer Plan, that is subject to Title IV of ERISA and is sponsored or

maintained by the Borrower or any ERISA Affiliate or to which the Borrower or any ERISA Affiliate

contributes or has an obligation to contribute, or in the case of a multiple employer or other plan

described in Section 4064(a) of ERISA, has made contributions at any time during the immediately

preceding five plan years.

“Permitted Acquisition” means, subject to Section 1.08, an Acquisition of at least a majority of

the Voting Stock and the Capital Stock of a Person that becomes a Restricted Subsidiary or an

Acquisition of a substantial portion of the Property of a Person by a Borrower or a Restricted Subsidiary;

provided that (i) the Property acquired (or the Property of the Person acquired) in such Acquisition is

used or useful in the same or a substantially similar line of business (or complementary, supplemental or

ancillary thereto) as the Loan Parties and their Subsidiaries, (ii) in the case of an Acquisition of the

Capital Stock of another Person, the board of directors (or other comparable governing body) of such

other Person shall have duly approved such Acquisition, (iii) immediately prior to and after giving effect

to any such Acquisition, no Event of Default shall have occurred and be continuing, (iv) if the aggregate

consideration for such Acquisition (including Earn-Out Obligations exceeding $10,000,000 in the

aggregate, cash and non-cash consideration, any deferred capital expenditures and any assumption of

liabilities, but excluding (A) any Equity Issuance made to the applicable seller as part of the purchase

price, (B) any portion of the purchase price funded, directly or indirectly, with the proceeds of any

38

Equity Issuance and (C) any purchase price and/or working capital adjustments) exceeds $10,000,000 in

the aggregate, such Person’s operations, assets and property shall not be subject (directly or indirectly) to

the ETMC JV Agreement and (v) the acquired Person and its Subsidiaries and/or the entity that acquires

such Property, as applicable, shall become Guarantors and pledge Collateral to the extent required

pursuant to Section 7.12 and Section 7.14; provided further that the aggregate amount of Permitted

Acquisitions of Non-Guarantor Restricted Subsidiaries and of entities that become ETMC Subsidiaries

and Permitted Acquisitions by Non-Guarantor Restricted Subsidiaries or ETMC Subsidiaries, when

taken together with the aggregate amount of Investments pursuant to Section 8.02(i) shall not exceed the

greater of (x) $140,000,000 and (y) 30% of Consolidated EBITDA.

“Permitted Investments” means, at any time, Investments by the Borrower and its Restricted

Subsidiaries permitted to exist at such time pursuant to the terms of Section 8.02.

“Permitted IRB Transaction” means any transaction in which (x) a Governmental Authority

issues industrial revenue bonds or other similar tax-exempt securities (the “Applicable Securities”) in

connection with the financing of assets (the “Applicable Assets”) that would not otherwise qualify as

Collateral (including any issuances in connection with financing the business acquired pursuant to the

Topeka Acquisition) and (y) the Borrower or a Restricted Subsidiary purchases in cash (the “Applicable

Cash”) such Applicable Securities; provided that (a) no Person other than the Borrower or a Restricted

Subsidiary may hold such Applicable Securities or be entitled to exercise any rights or remedies with

respect thereto, (b) no assets other than the Applicable Assets or the Applicable Cash may secure such

Applicable Securities and (c) neither the Borrower nor any Restricted Subsidiary may be an obligor with

respect to such Applicable Securities.

“Permitted Liens” means, at any time, Liens in respect of Property of the Borrower and its

Restricted Subsidiaries permitted to exist at such time pursuant to the terms of Section 8.01.

“Permitted Merger” has the meaning set forth in Section 8.04.

“Permitted Sale Leaseback” means any Sale and Leaseback Transaction consummated by the

Borrower or any Restricted Subsidiary after the Original Closing Date; provided that (a) no Default or

Event of Default shall have occurred or be continuing or would result therefrom, (b) after giving pro

forma effect thereto, the Senior Secured Net Leverage Ratio (calculated on a Pro Forma Basis) does not

exceed 3.75:1.00, (c) no less than 75% of the aggregate consideration received in such Sale and

Leaseback Transaction shall be in cash and Cash Equivalents, (d) the Borrower or the applicable

Restricted Subsidiary shall receive at least fair market value (as determined by the Borrower in good

faith) for any property disposed of in such Sale and Leaseback Transaction and (e) the Net Cash Proceeds

thereof shall be applied in accordance with Section 2.05(b)(ii).

“Person” means any natural person, corporation, limited liability company, trust, joint venture,

association, company, partnership, Governmental Authority or other entity.

“Physician Groups” means MPV New Jersey MD Services, P.C., and any other similar

professional corporation, limited liability company, partnership or other entity that provides or arranges

medical services in a state that only permits the equity interests of such entity to be held by one or more

licensed physicians or licensed professionals or professional entities.

39

“Physician Support Obligation” means:

(1)a loan to or on behalf of, or a Guarantee of Indebtedness of or income of, (x) a

physician or healthcare professional providing service to patients in the service area of a Hospital

operated by the Borrower or any Restricted Subsidiary or (y) any independent practice association or

other entity that is majority owned by any Person or group of Persons described in clause (x), in either

case made or given by the Borrower or any Restricted Subsidiary

(a)in the ordinary course of its business; and

(b)pursuant to a written agreement having a period not to exceed five years; or

(2)Guarantees by the Borrower or any Restricted Subsidiary of leases and loans to

acquire property (real or personal) for or on behalf of a physician, healthcare professional or any

independent practice association or other entity that is majority owned by any Person or group of Persons

described in clause (x) above providing service to patients in the service area of a Hospital operated by

the Borrower or any Restricted Subsidiary.

“Plan” means any “employee benefit plan” (as such term is defined in Section 3(3) of ERISA)

established or maintained by the Borrower.

“Platform” has the meaning specified in Section 7.02.

“Pledge Agreements” means the Tenant Subsidiary Pledge Agreement and the Non-Tenant

Subsidiary Pledge Agreement.

“Pledged ETMC Distribution Account” has the meaning specified in Section 8.16.

“Preferred Stock” as applied to the Capital Stock of any corporation, means Capital Stock of any

class or classes (however designated) that is preferred as to the payment of dividends upon liquidation,

dissolution or winding up.

“Prepayment Notice” means a notice by the Borrower to prepay Loans, which shall be

substantially in the form of Exhibit E (or such other form as the Administrative Agent may approve).

“Privacy Standards” has the meaning specified in Section 7.08.

“Pro Forma Basis” means, for all purposes hereof, that any Disposition, Involuntary Disposition

or Acquisition, any Approved Hospital Swap and the incurrence of any Loan or any Subordinated

Indebtedness shall be deemed to have occurred as of the first day of the most recent four fiscal quarter

period in respect of which financial statements have been delivered (or are already required to have been

delivered) hereunder preceding the date of such transaction or incurrence. In connection with the

foregoing, (a) with respect to any Disposition or Involuntary Disposition, (i) income statement and cash

flow statement items (whether positive or negative) attributable to the Property disposed of shall be

excluded to the extent relating to any period occurring prior to the date of such transaction and (ii)

Indebtedness which is retired shall be excluded and deemed to have been retired as of the first day of the

applicable period and (b) with respect to any Acquisition, (i) income statement items attributable to the

Person or Property acquired shall be included to the extent relating to any period applicable in such

calculations to the extent (A) such items are not otherwise included in such income statement items for

the Borrower and its Subsidiaries in accordance with GAAP or in accordance with any defined terms set

forth in Section 1.01 and (B) such items are supported by financial statements or other information

40

reasonably satisfactory to the Administrative Agent and (ii) any Indebtedness incurred or assumed by the

Borrower or any Subsidiary (including the Person or Property acquired) in connection with such

transaction and any Indebtedness of the Person or Property acquired which is not retired in connection

with such transaction (A) shall be deemed to have been incurred as of the first day of the applicable

period and (B) if such Indebtedness has a floating or formula rate, shall have an implied rate of interest

for the applicable period for purposes of this definition determined by utilizing the rate which is or would

be in effect with respect to such Indebtedness as at the relevant date of determination. Furthermore, pro

forma calculations of Consolidated EBITDA shall not give effect to anticipated cost savings, synergies,

operating expense reductions and/or increases to Consolidated EBITDA for the applicable period, except

in cases where factually supportable and identifiable pro forma cost savings and/or increases to

Consolidated EBITDA for the applicable period with respect to an Acquisition (in each case reasonably

expected to occur within 24 months of the respective date of such Acquisition) that are attributable to

such Acquisition are demonstrated in writing by the Borrower (with supporting calculations) to the

Administrative Agent at the time of the relevant Acquisition; provided, further, that the add backs for cost

savings and/or increases to Consolidated EBITDA for any applicable period for all Acquisitions (other

than the ETMC Acquisition and the Topeka Acquisition) shall not, without the written consent of the

Required Lenders, exceed twenty-five percent (25%) of Consolidated EBITDA prior to giving effect to

such Acquisition for the applicable period.

“Pro Rata Share” means, with respect to such Lender’s outstanding Term Loan at any time, a

fraction (expressed as a percentage, carried out to the ninth decimal place), the numerator of which is the

principal amount of the Term Loan held by such Lender at such time and the denominator of which is the

aggregate principal amount of the Term Loans outstanding at such time. The Pro Rata Share of each

Lender as of the Effective Date is set forth opposite the name of such Lender on Schedule 2.01.

“Property” means any interest of any kind in any property or asset, whether real, personal or

mixed, or tangible or intangible.

“PTE” means a prohibited transaction class exemption issued by the U.S. Department of Labor,

as any such exemption may be amended from time to time.

“Public Equity Offering” means an underwritten public offering of common stock of and by the

Parent (or any parent thereof) or the Borrower pursuant to a registration statement filed with the SEC in

accordance with the Securities Act, which yields not less than $50,000,000 in Net Cash Proceeds to the

Parent (or any parent thereof) or the Borrower, as applicable.

“Public Lender” has the meaning set forth in Section 7.02.

“Purchasing Borrower Party” shall mean the Borrower or any Subsidiary of the Borrower that

becomes an Eligible Assignee or Participant pursuant to Section 11.07(i).

“QFC” has the meaning set forth in Section 11.23.

“QFC Credit Support” has the meaning set forth in Section 11.23.

“Qualified Capital Stock” means any Capital Stock that is not Disqualified Capital Stock.

“Qualified ECP Guarantor” means, at any time, each Loan Party with total assets exceeding

$10,000,000 or that qualifies at such time as an “eligible contract participant” under the

41

Commodity Exchange Act and can cause another person to qualify as an “eligible contract

participant” at such time under §1a(18)(A)(v)(II) of the Commodity Exchange Act.

“Real Property” means, collectively, all right, title and interest (including any leasehold, mineral

or other estate) in and to any and all parcels of or interests in real property owned, leased or occupied by

any Person, whether by lease, license or other means, together with, in each case, all easements,

hereditaments and appurtenances relating thereto, all improvements and appurtenant fixtures and

equipment, all general intangibles and contract rights and other property and rights incidental to the

ownership, lease or operation thereof.

“Receivables Subsidiary” means any special purpose Wholly Owned Subsidiary of the Borrower

(i) that acquires accounts receivable generated by the Borrower or any of its Subsidiaries, (ii) that engages

in no operations or activities other than those related to a Securitization Transaction and (iii) except

pursuant to Standard Securitization Undertakings, (x) no portion of the obligations (contingent or

otherwise) of which is recourse to or obligates the Borrower or any of its Restricted Subsidiaries in any

way, and (y) with which neither the Borrower nor any of its Restricted Subsidiaries has any contract,

agreement, arrangement or understanding other than on terms no less favorable to the Borrower or such

Restricted Subsidiary than those that might be obtained at the time from Persons who are not Affiliates of

the Borrower.

“Redeemable Stock” has the meaning specified in the definition of “Funded Indebtedness.”

“Refinancing Amendment” has the meaning assigned to such term in Section 2.16(c).

“Refinancing Effective Date” has the meaning assigned to such term in Section 2.16(a).

“Refinancing Intercreditor Agreement” means an intercreditor agreement among, inter alia, the

Administrative Agent and one or more representatives for holders of the ABL Facility, in form and

substance reasonably acceptable to the Administrative Agent, as such intercreditor agreement may be

amended, modified or supplemented from time to time in accordance with the terms hereof and thereof.

The Refinancing Intercreditor Agreement shall be substantially consistent with the Intercreditor

Agreement (but which may give effect to modifications determined by the Administrative Agent to be

reasonably consistent with then current market practices and customs) and otherwise reasonably

satisfactory to the Administrative Agent and the Borrower.

“Refinancing Term Loans” has the meaning assigned to such term in Section 2.16(a).

“Register” has the meaning set forth in Section 11.07(c).

“Relative Rights Agreement” means that certain relative rights agreement substantially in the

form of Exhibit R hereto, dated as of the Original Closing Date, among, inter alia, the Administrative

Agent, the ABL Administrative Agent, the ABL Collateral Agent, the Indenture Trustee and LeaseCo,

setting out the relative rights and privileges of the Administrative Agent, the ABL Administrative Agent,

the ABL Collateral Agent, the Indenture Trustee and LeaseCo with respect to certain rights and remedies

in respect of the permitted Creditor Obligations (as defined therein) and the Lease Obligations (as defined

therein), as amended, restated, supplemented or otherwise modified from time to time.

“Relevant Governmental Body” means the FRB or the Federal Reserve Bank of New York, or a

committee officially endorsed or convened by the FRB or the Federal Reserve Bank of New York, or any

successor thereto.

42

“Replacement Lender” has the meaning specified in Section 11.16.

“Reportable Event” means any of the events set forth in Section 4043(c) of ERISA or the

regulations issued thereunder, other than events for which the thirty-day notice period has been waived.

“Repricing Event” means (i) any prepayment or repayment of the Term Loans with the proceeds

of, or any conversion of Term Loans into, any new or replacement Indebtedness the primary purpose of

which is to reduce the all-in-yield applicable to the Term Loans and (ii) any amendment to this

Agreement the primary purpose of which is to reduce the all-in-yield applicable to the Term Loans (other

than any prepayment, repayment or amendment of this Agreement in connection with any transaction that

would, if consummated, constitute a Change of Control or initial Public Equity Offering).

“Required Lenders” means, at any time, Lenders holding in the aggregate more than fifty percent

(50%) of the outstanding Term Loans and participations therein as such aggregate outstanding Term

Loans may be increased pursuant to Incremental Term Loans. The outstanding Term Loans held or

deemed held by, any Defaulting Lender and the outstanding Term Loans held or deemed held by any

Non-Debt Fund Affiliate shall be excluded for purposes of making a determination of Required Lenders.

“Required Payment Intercompany Note” means that certain amended and restated promissory

note, dated as of June 28, 2018, made by AHS East Texas in favor of AHS Legacy Operations, LLC in an

initial aggregate principal amount equal to $205,000,000, as amended, restated, supplemented or modified

from time to time.

“Rescindable Amount” has the meaning specified in Section 2.12(d)(i).

“Resolution Authority” means an EEA Resolution Authority or, with respect to any UK Financial

Institution, a UK Resolution Authority.

“Responsible Officer” means the chief executive officer, president, chief financial officer, chief

operating officer, controller, senior vice president, vice president or treasurer of a Loan Party and, solely

for purposes of notices given pursuant to Article II, any other officer or employee of the applicable Loan

Party so designated by any of the foregoing officers in a notice to the Administrative Agent or any other

officer or employee of the applicable Loan Party designated in or pursuant to an agreement between the

applicable Loan Party and the Administrative Agent. Any document delivered hereunder that is signed

by a Responsible Officer of a Loan Party shall be conclusively presumed to have been authorized by all

necessary corporate, partnership and/or other action on the part of such Loan Party and such Responsible

Officer shall be conclusively presumed to have acted on behalf of such Loan Party.

“Restricted Payment” means any dividend or other distribution (whether in cash, securities or

other property) with respect to any Capital Stock of the Parent, the Borrower or any Restricted

Subsidiary, or any payment (whether in cash, securities or other property), including any sinking fund or

similar deposit, on account of the purchase, redemption, retirement, acquisition, cancellation or

termination of any such Capital Stock or of any option, warrant or other right to acquire any such Capital

Stock.

“Restricted Subsidiary” means any Subsidiary of the Borrower other than an Unrestricted

Subsidiary. The ETMC JV shall be considered a Restricted Subsidiary for all purposes of this Agreement

and the other Loan Documents.

43

“S&P” means Standard & Poor’s Ratings Services, a Standard & Poor’s Financial Services LLC

business.

“Sale and Leaseback Transaction” means, with respect to the Borrower or any Restricted

Subsidiary, any arrangement, directly or indirectly, with any person whereby the Borrower or such

Restricted Subsidiary shall sell or transfer any property, real or personal, used or useful in its business,

whether now owned or hereafter acquired, and thereafter rent or lease such property or other property that

it intends to use for substantially the same purpose or purposes as the property being sold or transferred.

“SEC” means the Securities and Exchange Commission or any Governmental Authority

succeeding to any of its principal functions.

“Secured Parties” means the Administrative Agent and the Lenders.

“Securities Act” means the Securities Act of 1933, as amended, and the rules and regulations

promulgated thereunder.

“Securitization Transaction” means any transaction or series of transactions that may be entered

into by the Borrower or any Restricted Subsidiary pursuant to which the Borrower or any Restricted

Subsidiary may sell, convey or otherwise transfer pursuant to customary terms to a Receivables

Subsidiary or any other Person, or grant a security interest in, any accounts receivable (whether now

existing or arising in the future) of the Borrower or any of its Restricted Subsidiaries, and any assets

related thereto, including all collateral securing such accounts receivable, all contracts and all guarantees

or other obligations in respect of such accounts receivable, all proceeds of such accounts receivable and

other assets that are customarily transferred or in respect of which security interests are customarily

granted in connection with sales, factoring or securitization transactions involving accounts receivable;

provided that no portion of the obligations (contingent or otherwise) is recourse to or obligates the

Borrower or any of its Restricted Subsidiaries in any way other than pursuant to the Standard

Securitization Undertakings.

“Security Agreements” means, collectively, the Tenant Subsidiary Security Agreement and the

Non-Tenant Subsidiary Security Agreement.

“Security Standards” has the meaning set forth in Section 7.08.

“Senior Secured Net Leverage Ratio” means, as of any date of determination, the ratio of (a) the

sum of (i) Consolidated Indebtedness that is secured by a Lien on any property or assets of the Borrower

or any of its Restricted Subsidiaries as of such date minus (ii) unrestricted cash and Cash Equivalents held

by the Borrower and its Restricted Subsidiaries on such date (provided that (x) any cash or Cash

Equivalents in (i) the LHP Cash Management Transfer System or (ii) that are held by an ETMC

Subsidiary that are not in the Pledged ETMC Distribution Account or, in each case, a Controlled Account

shall be deemed to be restricted cash, and (y) any cash or Cash Equivalents received from CARES Act

related funding (including any cash and Cash Equivalents in respect of Medicare accelerated payments

and payroll tax deferrals) shall be deemed to be restricted cash for so long as such cash and cash

equivalents are required to be repaid) to (b) Consolidated EBITDA for the period of the four fiscal

quarters most recently ended.

“Significant Subsidiary” means any Restricted Subsidiary that would be a “Significant

Subsidiary” of the Borrower within the meaning of Rule 1-02 under Regulation S-X promulgated by the

U.S. Securities and Exchange Commission, as in effect on the Effective Date.

44

“Similar Business” means any business conducted or proposed to be conducted by the Borrower

and its Restricted Subsidiaries on the Effective Date or any business that is similar, reasonably related,

incidental, complementary or ancillary thereto, or that constitutes a reasonable extension or expansion

thereof.

“SOFR” means the Secured Overnight Financing Rate as administered by the Federal Reserve

Bank of New York (or a successor administrator).

“SOFR Adjustment” means 0.11448% (11.448 basis points) for an Interest Period of one-month’s

duration, 0.26161% (26.161 basis points) for an Interest Period of three-months’ duration, 0.42826%

(42.826 basis points) for an Interest Period of six-months’ duration, and 0.71513% (71.513 basis points)

for an Interest Period of twelve-months’ duration.

“Solvent” or “Solvency” means, with respect to any Person as of a particular date, that on such

date (a) such Person is able to pay its debts and other liabilities, contingent obligations and other

commitments as they mature in the ordinary course of business, (b) such Person does not intend to, and

does not believe that it will, incur debts or liabilities beyond such Person’s ability to pay as such debts

and liabilities mature in their ordinary course, (c) such Person is not engaged in a business or a

transaction, and is not about to engage in a business or a transaction, for which such Person’s Property

would constitute unreasonably small capital after giving due consideration to the prevailing practice in the

industry in which such Person is engaged or is to engage, (d) the fair value measured on a going concern

basis of the Property of such Person is greater than the total amount of liabilities, including, without

limitation, contingent liabilities, of such Person and (e) the present fair salable value measured on a going

concern basis of the assets of such Person is not less than the amount that will be required to pay the

probable liability of such Person on its debts as they become absolute and matured. In computing the

amount of contingent liabilities at any time, it is intended that such liabilities will be computed at the

amount which, in light of all the facts and circumstances existing at such time, represents the amount that

can reasonably be expected to become an actual or matured liability.

“Specified Loan Party” means any Loan Party that is not an “eligible contract participant” under

the Commodity Exchange Act (determined prior to giving effect to Section 4.08).

“Specified Representations” means those representations and warranties made by the Loan Parties

in Sections 6.01, 6.02, 6.03, 6.04, 6.06(a), 6.14, 6.18, 6.19(i) and 6.25.

“Sponsor” means EGI-AM Investments, L.L.C. and any Affiliate thereof.

“Sponsor Fees” means the fees payable by the Parent or any of the Restricted Subsidiaries of the

Parent to the Sponsor or any Affiliate of the Sponsor pursuant to a management or services agreement

approved by the board of directors of the Parent or any Restricted Subsidiary of the Parent, in each case,

to the extent such fees are for services provided to Parent and its Restricted Subsidiaries.

“Sponsor Group” means the collective reference to (i) the Sponsors and (ii) any other Person that

directly or indirectly, is in control of, is controlled by, or is under common control with, the Sponsor

(other than portfolio companies). For purposes of this definition, “control” of a Person means the power,

directly or indirectly, to direct or cause the direction of the management and policies of such Person

whether by contract or otherwise.

45

“Standard Securitization Undertakings” means all representations, warranties, covenants and

indemnities entered into by the Borrower or any Restricted Subsidiary which are customary in

securitization transactions involving accounts receivable.

“Stated Maturity” means, with respect to any security, the date specified in the agreement

governing or certificate relating to such Indebtedness as the fixed date on which the final payment of

principal of such security is due and payable, including pursuant to any mandatory redemption provision,

but shall not include any contingent obligations to repay, redeem or repurchase any such principal prior to

the date originally scheduled for the payment thereof.

“Subordinated Indebtedness” means any unsecured Indebtedness of the Borrower or any

Restricted Subsidiary which by its terms is expressly subordinated in right of payment to the prior

payment of the Obligations under this Agreement and the other Loan Documents; provided that (i) no

Default or Event of Default shall have occurred and be continuing immediately prior to or after giving

effect to such issuance, (ii) the definitive documentation (including without limitation the subordination

provisions) for such Subordinated Indebtedness shall be not more restrictive, taken as a whole, than this

Agreement, (iii) such Subordinated Indebtedness shall mature after the date that is ninety (90) days after

the Maturity Date applicable to Term Loans (or if any Incremental Term Loans shall be outstanding as of

the date of issuance of such Subordinated Indebtedness, the maturity date applicable to such Incremental

Term Loans), (iv) such Subordinated Indebtedness shall contain no interim amortization or prepayment

events (other than customary change of control or asset sale events) and (v) such Subordinated

Indebtedness shall contain no financial maintenance covenants. For the avoidance of doubt, Subordinated

Indebtedness shall not include any intercompany Indebtedness among the Loan Parties.

“Subordinated Indebtedness Documents” means all agreements, documents and instruments

evidencing or governing any Subordinated Indebtedness, as such Subordinated Indebtedness Documents

may be amended, restated, supplemented or modified from time to time in accordance with the terms

hereof.

“Subsequent Transaction” has the meaning specified in Section 1.08.

“Subsidiary” of a Person means a corporation, partnership, joint venture, limited liability

company or other business entity of which a majority of the shares of Capital Stock having ordinary

voting power for the election of directors or other governing body (other than Capital Stock having such

power only by reason of the happening of a contingency) are at the time beneficially owned, or the

management of which is otherwise controlled, directly, or indirectly through one or more intermediaries,

or both, by such Person; provided, however, that the Physician Groups are not owned or controlled by the

Loan Parties and shall not be deemed Subsidiaries or Restricted Subsidiaries of the Loan Parties for any

purpose under the Loan Documents (although the Physician Groups are not Subsidiaries of the Loan

Parties, if the Loan Parties manage the non-clinical aspects of a Physician Group, the terms and

conditions of Articles III, VII, VIII and IX hereof will apply as if the Physicians Groups were Non-

Guarantor Restricted Subsidiaries), except that such entities may be included in any Loan Party’s or

Parent’s consolidated financial statements. Unless the context requires otherwise, a “Subsidiary” shall be

deemed to be a Subsidiary of the Borrower. The ETMC JV shall be considered a Subsidiary for all

purposes of this Agreement and the other Loan Documents.

“Subsidiary Redesignation” shall have the meaning assigned to such term in the definition of

“Unrestricted Subsidiary” contained in this Section 1.01.

46

“Successor Agency Agreement” has the meaning assigned to such term in the Amendment and

Restatement Agreement.

“Supported QFC” has the meaning set forth in Section 11.23.

“Swap Contract” means (a) any and all rate swap transactions, basis swaps, credit derivative

transactions, forward rate transactions, commodity swaps, commodity options, forward commodity

contracts, equity or equity index swaps or options, bond or bond price or bond index swaps or options or

forward bond or forward bond price or forward bond index transactions, interest rate options, forward

foreign exchange transactions, cap transactions, floor transactions, collar transactions, currency swap

transactions, cross-currency rate swap transactions, currency options, spot contracts, or any other similar

transactions or any combination of any of the foregoing (including any options to enter into any of the

foregoing), whether or not any such transaction is governed by or subject to any master agreement, and (b)

any and all transactions of any kind, and the related confirmations, which are subject to the terms and

conditions of, or governed by, any form of master agreement published by the International Swaps and

Derivatives Association, Inc., any International Foreign Exchange Master Agreement, or any other master

agreement (any such master agreement, together with any related schedules, a “Master Agreement”),

including any such obligations or liabilities under any Master Agreement.

“Swap Obligations” means with respect to any Guarantor any obligation to pay or perform under

any agreement, contract or transaction that constitutes a “swap” within the meaning of Section 1a(47) of

the Commodity Exchange Act.

“Swap Termination Value” means, in respect of any one or more Swap Contracts, after taking

into account the effect of any legally enforceable netting agreement relating to such Swap Contracts, (a)

for any date on or after the date such Swap Contracts have been closed out and termination value(s)

determined in accordance therewith, such termination value(s), and (b) for any date prior to the date

referenced in clause (a), the amount(s) determined as the mark-to-market value(s) for such Swap

Contracts, as determined based upon one or more mid-market or other readily available quotations

provided by any recognized dealer in such Swap Contracts (which may include a Lender or any Affiliate

of a Lender).

“Synthetic Lease” means any synthetic lease, tax retention operating lease, off-balance sheet loan

or similar off-balance sheet financing arrangement whereby the arrangement is considered borrowed

money indebtedness for tax purposes but is classified as an operating lease or does not otherwise appear

on the balance sheet under GAAP.

“Taxes” means all present or future taxes, levies, imposts, duties, deductions, withholdings,

assessments, fees or other charges imposed by any Governmental Authority, and all liabilities with

respect thereto (including any interest, fines, additions to tax or penalties).

“Tax Group” has the meaning set forth in Section 8.06(d).

“Tenant Joinder Agreement” means a joinder agreement substantially in the form of Exhibit J-2

executed and delivered by a Domestic Restricted Subsidiary that is a Tenant Subsidiary in accordance

with the provisions of Section 7.12.

“Tenant Subsidiaries” means, collectively, those Subsidiaries of Parent that are “Tenants” as

defined in the Master Lease as in effect on the Original Closing Date and any other Subsidiaries of Parent

that become Tenants under the Master Lease and the Subsidiaries of such “Tenants”. For the avoidance

47

of doubt, no Loan Party (whether existing on the Original Closing Date or formed or acquired after the

Original Closing Date) may be subsequently designated as a Tenant Subsidiary hereunder.

“Tenant Subsidiary Pledge Agreement” means the Pledge Agreement in the form of Exhibit B-2

dated as of the Original Closing Date executed in favor of the Administrative Agent by each of the Tenant

Subsidiaries that is a Loan Party and each Loan Party that is the direct parent of a Tenant Subsidiary, as

amended, modified, restated or supplemented from time to time.

“Tenant Subsidiary Security Agreement” means the Security Agreement substantially in the form

of Exhibit C-2 dated as of the Original Closing Date executed in favor of the Administrative Agent by

each of the Tenant Subsidiaries that is a Loan Party, as amended, modified, restated or supplemented

from time to time.

“Term B-1 Lender” means any Lender that had made a Term B-1 Loan or any Lender that has

purchased a Term B-1 Loan pursuant to one or more Assignment and Assumptions in accordance with the

terms hereof, in each case prior to the Effective Date.

“Term B-1 Loans” means the term loans made by the Term B-1 Lenders to the Borrower on

February 23, 2021.

“Term Loans” means any Initial Term Loan, 2024 Term B Loan or any Incremental Term Loan,

as the context may require. For the avoidance of doubt, after the consummation of the Ventas Purchase

Option and the transactions contemplated by Section 2.18, any reference to “Term Loans” shall be

deemed to refer to Ventas Purchase Option Term Loans and/or Non-Ventas Purchase Option Term Loans,

as applicable.

“Term Loan Commitments” means the commitment of a Term Loan Lender to make Term Loans,

including for the avoidance of doubt, the Initial Term Commitment or 2024 Term B Commitment.

“Term Loan Extension Effective Date” has the meaning set forth in Section 2.17(b).

“Term Loan Lender” means any Lender that had a Term Loan Commitment or any Lender that

has purchased a Term Loan pursuant to one or more Assignment and Assumptions in accordance with the

terms hereof.Initial Term Lender or any 2024 Term B Lender, as the context may require.

“Term Note” has the meaning specified in Section 2.11.

“Term SOFR” means, (a) for any Interest Period with respect to a Term SOFR Loan, the rate per

annum equal to the Term SOFR Screen Rate two U.S. Government Securities Business Days prior to the

commencement of such Interest Period with a term equivalent to such Interest Period; provided that if the

rate is not published prior to 11:00 a.m. on such determination date then Term SOFR means the Term

SOFR Screen Rate on the first U.S. Government Securities Business Day immediately prior thereto, in

each case, plus the SOFR Adjustment for such Interest Period and (b) for any interest calculation with

respect to a Base Rate Loan on any date, the rate per annum equal to the Term SOFR Screen Rate two

U.S. Government Securities Business Days prior to such date with a term of one month commencing that

day; provided that if the rate is not published prior to 11:00 a.m. on such determination date then Term

SOFR means the Term SOFR Screen Rate on the first U.S. Government Securities Business Day

immediately prior thereto, in each case, plus the SOFR Adjustment for such term; provided that if Term

SOFR determined in accordance with either of the foregoing provisions (a) or (b) of this definition would

otherwise be less than 0.50%, the Term SOFR shall be deemed 0.50% for purposes of this Agreement.

48

“Term SOFR Loan” means a Loan that bears interest at a rate based on clause (a) of the definition

of Term SOFR.

“Term SOFR Screen Rate” means the forward-looking SOFR term rate administered by CME (or

any successor administrator satisfactory to the Administrative Agent) and published on the applicable

Reuters screen page (or such other commercially available source providing such quotations as may be

designated by the Administrative Agent from time to time).

“Threshold Amount” means $60,000,000.

“Topeka Acquisition” means the acquisition by Topeka Health System, LLC of substantially all

of the assets used in the operation of (i) St. Francis Health Center, Inc., (ii) St. Francis Physician Clinics,

(iii) St. Francis Accountable Health Network, Inc., and (iv) an operating division of Med-Care of Kansas,

Inc., doing business as Integrated Nuclear Enterprises.

“Transaction” means, collectively, (a) the entry into and performance of the Relative Rights

Agreement, (b) the entry into and funding under the Existing Credit Agreement, the ABL Credit

Agreement dated as of June 28, 2018 among the Borrower, AHS East Texas Health System, LLC, Parent,

certain Subsidiaries of the Borrower as borrowers or guarantors, the lenders party thereto, the collateral

agent thereunder and the administrative agent thereunder, as amended, restated, supplemented or modified

from time to time, and the 2026 Notes Indenture, (c) the repayment of the indebtedness existing on June

28, 2018 of the Borrower and its Subsidiaries and (d) the payment of related fees and expenses.

“TRICARE” means the United States Department of Defense health care program for service

families including, but not limited to, TRICARE Prime, TRICARE Extra and TRICARE Standard, and

any successor to or predecessor thereof (including, without limitation, CHAMPUS).

“Triggering Event” has the meaning ascribed to such term in the Relative Rights Agreement as in

effect on the Original Closing Date.

“Type” means, with respect to any Loan, its character as a Base Rate Loan or a Term SOFR Loan.

“U.S. Government Securities Business Day” means any Business Day, except any Business Day

on which any of the Securities Industry and Financial Markets Association, the New York Stock

Exchange or the Federal Reserve Bank of New York is not open for business because such day is a legal

holiday under the federal laws of the United States or the laws of the State of New York, as applicable.

“U.S. Special Resolution Regimes” has the meaning set forth in Section 11.23.

“UK Financial Institution” means any BRRD Undertaking (as such term is defined under the

PRA Rulebook (as amended from time to time) promulgated by the United Kingdom Prudential

Regulation Authority) or any person falling within IFPRU 11.6 of the FCA Handbook (as amended from

time to time) promulgated by the United Kingdom Financial Conduct Authority, which includes certain

credit institutions and investment firms, and certain affiliates of such credit institutions or investment

firms.

“UK Resolution Authority” means the Bank of England or any other public administrative

authority having responsibility for the resolution of any UK Financial Institution.

49

“Unaudited Financial Statements” means the consolidated unaudited financial statements of

Parent and its Subsidiaries for the fiscal quarters ending March 31, 2021 and June 30, 2021.

“Unfunded Pension Liability” means the excess of a Pension Plan’s benefit liabilities under

Section 4001(a)(16) of ERISA, over the current value of that Pension Plan’s assets, determined in

accordance with the assumptions used for funding the Pension Plan pursuant to Section 412 of the

Internal Revenue Code for the applicable plan year.

“Uniform Commercial Code” means the Uniform Commercial Code as in effect from time to time

in the State of New York.

“United States” and “U.S.” mean the United States of America.

“United States Tax Compliance Certificate” has the meaning set forth in Section 3.01(e)(ii)(III).

“Unrestricted Subsidiary” means (1) any Subsidiary of the Borrower identified as an Unrestricted

Subsidiary on Schedule 6.13, (2) any other Subsidiary of the Borrower, whether now owned or acquired

or created after the Effective Date, that is designated by the Borrower as an Unrestricted Subsidiary

hereunder by written notice to the Administrative Agent; provided, that the ETMC JV may not be

designated as an Unrestricted Subsidiary, provided further that the Borrower shall only be permitted to so

designate a new Unrestricted Subsidiary after the Effective Date so long as (a) no Default or Event of

Default has occurred and is continuing or would result therefrom, (b) immediately after giving effect to

such designation, the Fixed Charge Coverage Ratio shall not be less than 2.00:1.00, (c) such Subsidiary or

any of its Subsidiaries has not Guaranteed any Capital Stock or Indebtedness of or have any Investment

in, the Borrower or any Restricted Subsidiary and does not hold any Liens on any property or assets of

the Borrower or any Restricted Subsidiary, (d) all the Indebtedness of such Subsidiary and its Subsidiaries

shall, at the date of designation, and will for so long as it is an Unrestricted Subsidiary, consist of Non-

Recourse Debt, (e) the aggregate fair market value of all outstanding Investments of the Borrower and its

Restricted Subsidiaries in such Subsidiary complies with Section 8.02 and Section 8.06, (f) such

Subsidiary is a Person with respect to which neither the Borrower nor any of its Restricted Subsidiaries

has any direct or indirect obligation to maintain or preserve such Person’s financial condition or to cause

such Person to achieve any specified levels of operating results, (g) except as permitted by Section 8.08,

on the date such Subsidiary is designated an Unrestricted Subsidiary, such Subsidiary is not a party to any

agreement, contract, arrangement or understanding with the Borrower or any Restricted Subsidiary with

terms substantially less favorable to the Borrower or such Restricted Subsidiary, when taken as a whole,

than those that would have been obtained from Persons who are not Affiliates of the Borrower and (h) the

Borrower shall have delivered to the Administrative Agent a certificate executed by a Responsible Officer

of the Borrower, certifying compliance with the requirements of preceding clauses (a) through (g) and (3)

any Subsidiary of an Unrestricted Subsidiary. The Borrower may designate or redesignate any

Unrestricted Subsidiary to be a Restricted Subsidiary for purposes of this Agreement (each, a “Subsidiary

Redesignation”); provided, that other than with respect to any Tenant Subsidiary after the Ventas

Purchase Option Assignment (i) no Default or Event of Default has occurred and is continuing or would

result therefrom, (ii) immediately after giving effect to such designation, the Fixed Charge Coverage

Ratio shall not be less than 2.00:1.00 and (iii) the Borrower shall have delivered to the Administrative

Agents an officer’s certificate executed by a Responsible Officer of the Borrower, certifying to the best of

such officer’s knowledge, compliance with the requirement of preceding clauses (i) and (ii); provided,

further, that other than with respect to any Tenant Subsidiary after the Ventas Purchase Option

Assignment no Unrestricted Subsidiary that has been designated as a Restricted Subsidiary pursuant to a

Subsidiary Redesignation may again be designated as an Unrestricted Subsidiary; provided further, that

after a Ventas Purchase Option Assignment, no Tenant Subsidiary shall be designated as an Unrestricted

50

Subsidiary for purposes of the separate loan documentation documenting the Ventas Purchase Option

Term Loans pursuant to Section 2.18(b)(3). The designation of any Unrestricted Subsidiary as a

Restricted Subsidiary shall constitute the incurrence at the time of designation of any Investment,

Indebtedness or Liens of such Subsidiary existing at such time.

“UT Tyler” means The University of Texas Health Science Center at Tyler.

“UT Tyler Properties” means those properties of UT Tyler subject to the ETMC JV Agreement.

“Ventas” means Ventas, Inc., a Delaware corporation.

“Ventas Asset Purchase Gross Proceeds Amount” has the meaning ascribed to such term in

Section 2.05(b)(iv).

“Ventas Asset Purchase” means the consummation of the transactions contemplated by Section

2.3 of the Relative Rights Agreement (as in effect on the Original Closing Date), including the exercise

and consummation of the “Landlord Asset Purchase Option” (as defined in the Relative Rights

Agreement as in effect on the Original Closing Date).

“Ventas Assignees” shall have the meaning ascribed to such term in Section 2.18(a).

“Ventas Purchase Option” means the consummation of the transactions contemplated by Section

2.6 of the Relative Rights Agreement (as in effect on the Original Closing Date).

“Ventas Purchase Option ABL Amount” has the meaning ascribed to such term in Section

2.18(a).

“Ventas Purchase Option ABL Loans” has the meaning ascribed to such term in Section 8.03(p).

“Ventas Purchase Option Amendment” has the meaning ascribed to such term in Section 2.18(c).

“Ventas Purchase Option Assignment” has the meaning ascribed to such term in Section 2.18(a).

“Ventas Purchase Option Gross Proceeds Amount” has the meaning ascribed to such term in

Section 2.18(a).

“Ventas Purchase Option Term Loan Agent” means an institution appointed by the Ventas

Assignee to act as administrative agent and collateral agent with respect to the Ventas Purchase Option

Term Loans.

“Ventas Purchase Option Term Loan Amount” has the meaning ascribed to such term in Section

2.18(a).

“Ventas Purchase Option Term Loans” has the meaning ascribed to such term in Section 2.18(a).

“Voting Stock” means, with respect to any Person, Capital Stock issued by such Person the

holders of which are ordinarily, in the absence of contingencies, entitled to vote for the election of

directors (or persons performing similar functions) of such Person, even though the right so to vote has

been suspended by the happening of such a contingency; provided, however, that Voting Stock shall not

include any preferred class of Capital Stock of any Person solely by reason of the right of such class to

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elect one or more members of the board of directors (or similar governing body) of such Person, unless

such class is generally entitled to vote on any matter submitted to the holders of common classes of

Capital Stock.

“Weighted Average Life to Maturity” means, when applied to any Indebtedness at any date, the

number of years obtained by dividing: (a) the sum of the products obtained by multiplying (i) the amount

of each then remaining installments, sinking fund, serial maturity or other required payments of principal,

including payment at final maturity, in respect thereof, by (ii) the number of years (calculated to the

nearest one-twelfth) that will elapse between such date and the making of such payment; by (b) the then

outstanding principal amount of such Indebtedness.

“Wholly Owned Domestic Subsidiary” means any Wholly Owned Subsidiary that is a Domestic

Subsidiary.

“Wholly Owned Subsidiary” means any Person 100% of whose Capital Stock (other than

directors’ qualifying shares) is at the time owned by the Borrower directly or indirectly through other

Persons 100% of whose Capital Stock is at the time owned, directly or indirectly, by the Borrower.

“Write-Down and Conversion Powers” means (a) with respect to any EEA Resolution Authority,

the write-down and conversion powers of such EEA Resolution Authority from time to time under the

Bail-In Legislation for the applicable EEA Member Country, which write-down and conversion powers

are described in the EU Bail-In Legislation Schedule and (b) with respect to the United Kingdom, any

powers of the applicable Resolution Authority under the Bail-In Legislation to cancel, reduce, modify or

change the form of a liability of any UK Financial Institution or any contract or instrument under which

that liability arises, to convert all or part of that liability into shares, securities or obligations of that

person or any other person, to provide that any such contract or instrument is to have effect as if a right

had been exercised under it or to suspend any obligation in respect of that liability or any of the powers

under that Bail-In Legislation that are related to or ancillary to any of those powers.

“Working Capital Intercompany Loans” has the meaning set forth in Section 8.02(ee).

1.02Other Interpretive Provisions

With reference to this Agreement and each other Loan Document, unless otherwise specified

herein or in such other Loan Document:

(a)The meanings of defined terms are equally applicable to the singular and plural

forms of the defined terms.

(b)(i) The words “herein,” “hereto,” “hereof” and “hereunder” and words of similar

import when used in any Loan Document shall refer to such Loan Document as a whole and not

to any particular provision thereof.

(ii)Article, Section, Exhibit and Schedule references are to the Loan Document in

which such reference appears.

(iii)The term “including” is by way of example and not limitation.

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(iv)The term “documents” includes any and all instruments, documents, agreements,

certificates, notices, reports, financial statements and other writings, however evidenced, whether

in physical or electronic form.

(c)In the computation of periods of time from a specified date to a later specified

date, the word “from” means “from and including”; the words “to” and “until” each mean “to but

excluding”; and the word “through” means “to and including.”

(d)Section headings herein and in the other Loan Documents are included for

convenience of reference only and shall not affect the interpretation of this Agreement or any

other Loan Document.

(e)All certifications to be made hereunder by a Responsible Officer or

representative of a Loan Party shall be made by such person in his or her capacity solely as a

Responsible Officer or a representative of such Loan Party, on such Loan Party’s behalf and not

in such person’s individual capacity.

(f)Any reference herein or in any other Loan Document to the satisfaction,

repayment, or payment in full of the Obligations shall mean the satisfaction, repayment, or

payment in full of the Obligations (other than unasserted contingent indemnification obligations).

1.03Accounting Terms

(a)Except as otherwise specifically prescribed herein, all accounting terms not specifically or

completely defined herein shall be construed in conformity with, and all financial data (including

financial ratios and other financial calculations) required to be submitted pursuant to this Agreement shall

be prepared in conformity with, GAAP applied on a consistent basis, as in effect from time to time,

applied in a manner consistent with that used in preparing the Audited Financial Statements; provided,

however, that calculations of Attributable Indebtedness under any Synthetic Lease or the implied interest

component of any Synthetic Lease shall be made by the Borrower in accordance with accepted financial

practice and consistent with the terms of such Synthetic Lease.

(b)The Borrower will provide a written summary of material changes in GAAP that affect

the Borrower’s financial accounting and in the consistent application thereof with each annual Excess

Cash Certificate delivered in accordance with Section 7.02(b). If at any time any change in GAAP would

affect the computation of any financial ratio or requirement set forth in any Loan Document, and either

the Borrower or the Required Lenders shall so request, the Administrative Agent, the Lenders and the

Borrower shall negotiate in good faith to amend such ratio or requirement to preserve the original intent

thereof in light of such change in GAAP (subject to the approval of the Required Lenders); provided that,

until so amended, (i) such ratio or requirement shall continue to be computed in accordance with GAAP

prior to such change therein and (ii) the Borrower shall provide to the Administrative Agent and the

Lenders financial statements and other documents required under this Agreement or as reasonably

requested hereunder setting forth a reconciliation between calculations of such ratio or requirement made

before and after giving effect to such change in GAAP.

(c)Notwithstanding the above, the parties hereto acknowledge and agree that all

computations of amounts and ratios referred to in Article VII and Article VIII shall be made in a manner

such that any obligations relating to a lease that was accounted for by a Person as an operating lease as of

the Original Closing Date and any similar operating lease entered into after the Original Closing Date by

any Person (including, for the avoidance of doubt, any lease in connection with a sale leaseback

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transaction) shall be accounted for as obligations relating to an operating lease and not as a Capital Lease

and shall not constitute Indebtedness.

(d)Notwithstanding anything to the contrary contained herein or in any other Loan

Document, all financial statements required to be delivered pursuant to this Agreement or any other Loan

Document need not be prepared in compliance with Regulation S-X of the Securities Act of 1933, as

amended, or include adjustments for purchase accounting (including adjustments of the type

contemplated by Financial Accounting Standards Board Accounting Standards Codification 805,

Business Combinations (formerly SFAS 141R)).

1.04Rounding

Any financial ratios required to be maintained by the Loan Parties pursuant to this Agreement

shall be calculated by dividing the appropriate component by the other component, carrying the result to

one place more than the number of places by which such ratio is expressed herein and rounding the result

up or down to the nearest number (with a rounding-up if there is no nearest number).

1.05References to Agreements and Laws

Unless otherwise expressly provided herein, (a) references to Organization Documents,

agreements (including the Loan Documents) and other contractual instruments shall be deemed to include

all subsequent amendments, restatements, extensions, supplements and other modifications thereto, but

only to the extent that such amendments, restatements, extensions, supplements and other modifications

are not prohibited by any Loan Document; and (b) references to any Law shall include all statutory and

regulatory provisions consolidating, amending, replacing, supplementing or interpreting such Law.

1.06Times of Day

Unless otherwise specified, all references herein to times of day shall be references to Eastern

time (daylight or standard, as applicable). When any payment to be made hereunder or the performance

of any covenant, duty or obligation is stated to be due on a day that is not a Business Day or delivery of

any notice, document, certificate or other writing is stated to be required on a day that is not a Business

Day, the due date of such payment, performance or delivery shall extend to the immediately succeeding

Business Day.

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1.07Basket Classification.

Notwithstanding anything to the contrary, (a) unless specifically stated otherwise herein, any

dollar, number, percentage or other amount available under any carve-out, basket, exclusion or exception

to any negative covenant in this Agreement or the other Loan Documents may be accumulated, added,

combined, aggregated or used together by any Loan Party and its Subsidiaries without limitation for any

purpose not prohibited hereby, (b) any action or event permitted by this Agreement or the other Loan

Documents need not be permitted solely by reference to one provision permitting such action or event but

may be permitted in part by one such provision and in part by one or more other provisions of this

Agreement and the other Loan Documents and (c) the Borrower shall be permitted to redesignate any

Indebtedness, Liens, Restricted Payments, Investments and prepayments or repayments of Subordinated

Indebtedness originally designated as incurred under any exception under Section 8.01 (other than

Section 8.01(a)), Section 8.02, Section 8.03 (other than Section 8.03(a)), Section 8.06 and Section 8.13 as

having been incurred under another applicable exception under Section 8.01 (other than Section 8.01(a)),

Section 8.02, Section 8.03 (other than Section 8.03(a)), Section 8.06 and Section 8.13 so long as at the

time of such redesignation, the Borrower would be permitted to incur Indebtedness, Liens, Restricted

Payments, Investments or prepayments or repayments of Subordinated Indebtedness under such other

exception within the same Section of this Agreement. With respect to any incurrence of Indebtedness or

creation of Lien permitted by the provisions of this Agreement in reliance on the pro forma calculation of

the Senior Secured Net Leverage Ratio, the Consolidated Net Leverage Ratio and/or the Fixed Charge

Coverage Ratio, as applicable, pro forma effect shall not be given to any Indebtedness being incurred or

Lien created (or expected to be incurred or created) substantially simultaneously or contemporaneously

with the incurrence of any such Indebtedness or creation of such Lien, as applicable, in reliance on any

“fixed dollar basket” set forth in this Agreement (including any “baskets” measured as a percentage of

Consolidated EBITDA or total assets).

1.08Limited Condition Acquisitions. As it relates to any action being taken solely in connection

with a Limited Condition Acquisition, for purposes of:

(i)determining compliance with any provision of this Agreement which requires the

calculation of any financial ratio or financial test,

(ii)testing availability under baskets set forth in this Agreement (including baskets

determined by reference to Consolidated EBITDA or total assets), or

(iii)testing whether a Default or Event of Default has occurred and, with respect to

any Incremental Term Loan to finance such Limited Condition Acquisition, testing whether any

representation or warranty in any Loan Document is correct as of such date,

in each case, at the option of the Borrower (the Borrower’s election to exercise such option in connection

with any Limited Condition Acquisition, an “LCT Election”), the date of determination of whether any

such action is permitted hereunder, any such Default or Event of Default exists and any such

representation or warranty is correct shall be deemed to be the date the definitive agreements for such

Limited Condition Acquisition are entered into (the “LCT Test Date”), and if, after giving pro forma

effect to the Limited Condition Acquisition (and the other transactions to be entered into in connection

therewith, including any incurrence of Indebtedness and the use of proceeds thereof, as if they had

occurred on the first day of the most recently ended four fiscal quarter period prior to the LCT Test Date),

the Borrower or the applicable Restricted Subsidiary would have been permitted to take such action on

the relevant LCT Test Date in compliance with such ratio, test or basket, such ratio, test or basket shall be

deemed to have been complied with or if no such Default or Event of Default shall exist on such LCT

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Test Date or such representation or warranty is correct as of such LCT Test Date then such condition shall

be deemed satisfied on the date of consummation of such LCT Test Date for purposes of clause (iii)

above; provided that if financial statements for one or more subsequent fiscal periods shall have become

available, the Borrower may elect, in its sole discretion, to redetermine all such ratios, tests or baskets on

the basis of such financial statements, in which case, such date of redetermination shall thereafter be

deemed to be the applicable LCT Test Date. For the avoidance of doubt, if the Borrower has made an

LCT Election and any of the ratios, tests or baskets for which compliance was determined or tested as of

the LCT Test Date would have failed to have been complied with as a result of fluctuations in any such

ratio, test or basket, including due to fluctuations in Consolidated EBITDA or total assets of the Borrower

or the Person subject to such Limited Condition Acquisition, at or prior to the consummation of the

relevant transaction or any Default or Event of Default has occurred and is continuing or any such

representation or warranty in any Loan Document is not correct on the date of such Limited Condition

Acquisition, such baskets, tests or ratios or requirement will not be deemed to have failed to have been

complied with as a result of such circumstance. If the Borrower has made an LCT Election for any

Limited Condition Acquisition, then in connection with any calculation of any ratio, test or basket

availability with respect to any transaction permitted hereunder (each, a “Subsequent Transaction”)

following the relevant LCT Test Date and prior to the earlier of the date on which such Limited Condition

Acquisition is consummated or the date that the definitive agreement for such Limited Condition

Acquisition is terminated or expires without consummation of such Limited Condition Acquisition, for

purposes of determining whether such Subsequent Transaction is permitted under this Agreement, any

such ratio, test or basket shall be required to be satisfied on a pro forma basis assuming such Limited

Condition Acquisition and other transactions in connection therewith (including any incurrence of

Indebtedness and the use of proceeds thereof) have been consummated.

1.09Divisions

For all purposes under the Loan Documents, in connection with any division or plan of division

under Delaware law (or any comparable event under a different jurisdiction’s laws): (a) if any asset, right,

obligation or liability of any Person becomes the asset, right, obligation or liability of a different Person,

then it shall be deemed to have been transferred from the original Person to the subsequent Person, and

(b) if any new Person comes into existence, such new Person shall be deemed to have been organized on

the first date of its existence by the holders of its equity interests at such time.

1.10Amendment and Restatement

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This Agreement shall amend and restate the Existing Credit Agreement in its entirety, with the

parties hereby agreeing that there is not, nor is there intended to be, a novation of the Existing Credit

Agreement or any other Loan Document under the Existing Credit Agreement and from and after the

effectiveness of this Agreement, the rights and obligations of the parties under the Existing Credit

Agreement shall be subsumed and governed by this Agreement. From and after the effectiveness of this

Agreement, the “Obligations” under the Existing Credit Agreement shall continue as Obligations under

the Loan Documents under this Agreement and the Loan Documents until otherwise paid in accordance

with the terms hereof. The Collateral Documents and the grant of Liens on all of the Collateral described

therein do and shall continue to secure the payment of all Obligations. Without limiting the generality of

the foregoing, the parties hereto acknowledge and agree that the Liens securing the “Obligations” (as

defined in the Existing Credit Agreement) of any Loan Party, shall from and after the Effective Date

secure the payment and performance of all Obligations (as defined in this Agreement) of such Loan Party

for the benefit of the Administrative Agent and the Secured Parties, and each Loan Party reaffirms its

prior grant of the Liens granted by it pursuant to the “Collateral Documents” (as defined in the Existing

Credit Agreement) and all such Liens shall continue in full force and effect after giving effect to this

Agreement and are hereby confirmed and reaffirmed by each of the Loan Parties. The parties hereto

further acknowledge and agree that all “Collateral Documents” (as defined in the Existing Credit

Agreement) shall remain in full force and effect after the Effective Date in favor of and for the benefit of

the Administrative Agent and the Secured Parties (with each reference therein to the administrative agent,

the credit agreement or a loan document being a reference to the Administrative Agent, this Agreement or

the other Loan Documents, as applicable), in each case, as such Collateral Documents are modified on the

Effective Date, and each Loan Party hereby confirms and ratifies its obligations thereunder.

Notwithstanding the foregoing, the Mortgaged Properties set forth on Schedule 1.10 will be released from

the Mortgage Instruments on the Effective Date.

1.11Interest Rates

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The Administrative Agent does not warrant, nor accept responsibility, nor shall the

Administrative Agent have any liability with respect to the administration, submission or any other matter

related to any reference rate referred to herein or with respect to any rate (including, for the avoidance of

doubt, the selection of such rate and any related spread or other adjustment) that is an alternative or

replacement for or successor to any such rate (including, without limitation, any Benchmark

Replacement) (or any component of any of the foregoing) or the effect of any of the foregoing, or of any

Benchmark Replacement Conforming Changes. The Administrative Agent and its affiliates or other

related entities may engage in transactions or other activities that affect any reference rate referred to

herein, or any alternative, successor or replacement rate (including, without limitation, any Benchmark

Replacement) (or any component of any of the foregoing) or any related spread or other adjustments

thereto, in each case, in a manner adverse to the Borrower. The Administrative Agent may select

information sources or services in its reasonable discretion to ascertain any reference rate referred to

herein or any alternative, successor or replacement rate (including, without limitation, any Benchmark

Replacement) (or any component of any of the foregoing), in each case pursuant to the terms of this

Agreement, and shall have no liability to the Borrower, any Lender or any other person or entity for

damages of any kind, including direct or indirect, special, punitive, incidental or consequential damages,

costs, losses or expenses (whether in tort, contract or otherwise and whether at law or in equity), for any

error or other action or omission related to or affecting the selection, determination, or calculation of any

rate (or component thereof) provided by any such information source or service.

ARTICLE II

THE COMMITMENTS AND BORROWINGS

2.01Term Loans

(a)Subject to the terms and conditions set forth herein and in the Amendment and

Restatement Agreement, each Lender having an Initial Term Commitment severally agrees to make an

Initial Term Loan to the Borrower in Dollars on the Effective Date in a principal amount requested by the

Borrower not to exceed such Lender’s Initial Term Commitment. Any remaining unutilized amount of

the Initial Term Commitment shall thereafter cease to be available. Amounts paid or prepaid in respect of

the Initial Term Loans may not be reborrowed.

(b)(x) Each Additional 2024 Term B Lender agrees, on the terms and conditions set forth in

Amendment No. 2, to make a 2024 Term B Loan to the Borrower on the Amendment No. 2 Effective

Date in Dollars in a principal amount not to exceed its Additional 2024 Term B Commitment on the

Amendment No. 2 Effective Date, (y) each Converting Consenting Lender agrees, on the terms and

conditions set forth in Amendment No. 2, to have all of its outstanding Initial Term Loans (or such lesser

amount as notified and allocated to such Converting Consenting Lender by the Amendment No. 2 Lead

Arrangers) converted into an equivalent principal amount of 2024 Term B Loans effective as of the

Amendment No. 2 Effective Date and (z) each Non-Converting Consenting Lender agrees, on the terms

and conditions set forth in Amendment No. 2, to have all of its outstanding Initial Term Loans prepaid

with proceeds of the 2024 Term B Loans and will purchase by assignment from the Additional 2024

Term B Lender 2024 Term B Loans in a principal amount equal to the principal amount of such Initial

Term Loans (or such lesser amount as notified and allocated to such Non-Converting Consenting Lender

by the Amendment No. 2 Lead Arrangers). Amounts paid or prepaid in respect of the 2024 Term B Loans

may not be reborrowed.

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2.02Borrowings; Conversions and Continuations of Loans

(a)Each Borrowing, each conversion of Loans from one Type to the other, and each

continuation of Term SOFR Loans shall be made upon the Borrower’s irrevocable (except as otherwise

permitted under Article III) notice to the Administrative Agent, which shall be given by a Loan Notice.

Each such notice must be received by the Administrative Agent not later than (i) 12:00 p.m. two Business

Days prior to the requested date of any Borrowing of, conversion to or continuation of Term SOFR Loans

(provided that such notice of a Borrowing of Term SOFR Loans to be made on the Effective Date (in the

case of Initial Term Loans) or the Amendment No. 2 Effective Date (in the case of 2024 Term B Loans)

must be received by the Administrative Agent no later than 12:00 p.m. one (1) Business Day prior to the

Effective Date (in the case of Initial Term Loans) or the Amendment No. 2 Effective Date (in the case of

2024 Term B Loans)) and (ii) 11:00 a.m. on the requested date of any Borrowing of Base Rate Loans;

provided, however, that if the Borrower wishes to request Term SOFR Loans having an Interest Period

other than one, three or six months in duration as provided in the definition of “Interest Period,” the

applicable notice must be received by the Administrative Agent not later than 12:00 p.m. four Business

Days prior to the requested date of such Borrowing, conversion or continuation, whereupon the

Administrative Agent shall give prompt notice to the appropriate Lenders of such request and determine

whether the requested Interest Period is acceptable to all of them. Not later than 11:00 a.m., three

Business Days before the requested date of such Borrowing, conversion or continuation, the

Administrative Agent shall notify the Borrower whether or not the requested Interest Period has been

consented to by all the Lenders. Each Borrowing of, conversion to or continuation of Term SOFR Loans

shall be in a principal amount of $1,000,000 or a whole multiple of $500,000 in excess thereof. Each

Borrowing of or conversion to Base Rate Loans shall be in a principal amount of $250,000 or a whole

multiple of $250,000 in excess thereof. Each Loan Notice shall specify (i) whether the Borrower is

requesting a Borrowing, a conversion of Loans from one Type to the other, or a continuation of Term

SOFR Loans, (ii) the requested date of the Borrowing, conversion or continuation, as the case may be

(which shall be a Business Day), (iii) the principal amount of Loans to be borrowed, converted or

continued, (iv) the Type of Loans to be borrowed or to which existing Loans are to be converted, and (v)

if applicable, the duration of the Interest Period with respect thereto. If the Borrower fails to specify a

Type of a Loan in a Loan Notice or if the Borrower fails to give a timely notice requesting a conversion

or continuation, then the applicable Loans shall be made as, or converted to, Base Rate Loans. Any such

automatic conversion to Base Rate Loans shall be effective as of the last day of the Interest Period then in

effect with respect to the applicable Term SOFR Loans. If the Borrower requests a Borrowing of,

conversion to, or continuation of, Term SOFR Loans in any such Loan Notice, but fails to specify an

Interest Period, it will be deemed to have specified an Interest Period of one month.

(b)Following receipt of a Loan Notice, the Administrative Agent shall promptly notify each

Lender of the amount of its Pro Rata Share of the applicable Loans, and if no timely notice of a

conversion or continuation is provided by the Borrower, the Administrative Agent shall notify each

Lender of the details of any automatic conversion to Base Rate Loans described in the preceding

subsection. In the case of a Borrowing, each Lender shall make the amount of its Loan available to the

Administrative Agent in immediately available funds at the Administrative Agent’s Office not later than

1:00 p.m. on the Business Day specified in the applicable Loan Notice. Upon satisfaction of the

applicable conditions to such Borrowing, the Administrative Agent shall make all funds so received

available to the Borrower in like funds as received by the Administrative Agent either by (i) crediting the

account of the Borrower on the books of Bank of America with the amount of such funds or (ii) wire

transfer of such funds, in each case in accordance with instructions provided to (and reasonably

acceptable to) the Administrative Agent by the Borrower. Except as otherwise provided herein, a Term

SOFR Loan may be continued or converted only on the last day of the Interest Period for such Term

SOFR Loan. During the existence of an Event of Default, no Term Loan may be requested as, converted

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to or continued as Term SOFR Loans without the consent of the Lenders (other than Defaulting Lenders)

holding in the aggregate at least a majority of the outstanding Term Loans, if any, and such Lenders may

demand that any or all of the then outstanding Term Loans that are Term SOFR Loans be converted

immediately to Base Rate Loans.

(c)The Administrative Agent shall promptly notify the Borrower and the Lenders of the

interest rate applicable to any Interest Period for Term SOFR Loans upon determination of such interest

rate. The determination of Term SOFR by the Administrative Agent shall be conclusive in the absence of

manifest error.

(d)After giving effect to all Borrowings, all conversions of Term Loans from one Type to

the other, and all continuations of Term Loans as the same Type, there shall not be more than eight (8)

Interest Periods in effect with respect to the Term Loans; provided that all 2024 Term B Loans made on

the Amendment No. 2 Effective Date and all 2024 Term B Loans converted from Initial Term Loans on

the Amendment No. 2 Effective Date shall be of the same Type and have the same Interest Period as set

forth in the definition of “Interest Period” herein.

2.03[Reserved]

2.04[Reserved]

2.05Prepayments

(a)Voluntary Prepayments of Term Loans.

(i)Voluntary Prepayments.

The Borrower may, upon notice from the Borrower to the Administrative Agent in the form of a

written Prepayment Notice, at any time or from time to time voluntarily prepay the Term Loans in whole

or in part without premium (except as otherwise set forth below) or penalty; provided that (x) such

Prepayment Notice shall contain the information required by the immediately succeeding sentence and

must be received by the Administrative Agent not later than 12:00 p.m. (A) two Business Days prior to

any date of prepayment of Term SOFR Loans, and (B) on the date of prepayment of Base Rate Loans; (y)

any such prepayment of Term SOFR Loans shall be in a principal amount of $1,000,000 or a whole

multiple of $500,000 in excess thereof (or, if less, the entire principal amount thereof then outstanding);

and (z) any prepayment of Base Rate Loans shall be in a principal amount of $250,000 or a whole

multiple of $250,000 in excess thereof (or, if less, the entire principal amount thereof then outstanding).

Each such Prepayment Notice shall specify the date and amount of such prepayment and the Type(s) of

Term Loans to be prepaid. The Administrative Agent will promptly notify each Lender of its receipt of

each such notice, and of the amount of such Lender’s Pro Rata Share of such prepayment. If such

Prepayment Notice is given by the Borrower, the Borrower shall make such prepayment and the payment

amount specified in such Prepayment Notice shall be due and payable on the date specified therein,

except that any such Prepayment Notice may state that such notice is conditioned upon the occurrence or

non-occurrence of any event specified therein (including the effectiveness of other credit facilities), in

which case such notice may be revoked by the Borrower on or prior to the date of prepayment if such

condition is not satisfied. Any prepayment of a Term SOFR Loan shall be accompanied by all accrued

interest thereon, together with any additional amounts required pursuant to Section 3.05. Each such

prepayment shall be applied to the Loans of the Lenders in accordance with their respective Pro Rata

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Shares. Each such prepayment of the Term Loans shall be applied to the principal installments thereof

under Section 2.07(b) as directed by the Borrower in its sole discretion, and if no direction is given by the

Borrower in direct order of maturity.

(ii)Repricing Event.

If any Term Loans are repriced pursuant to a Repricing Event (other than, for the avoidance of

doubt, the incurrence of the Initial2024 Term B Loans on the Amendment No. 2 Effective Date) prior to

the six (6) month anniversary of the Amendment No. 2 Effective Date, whether or not such Repricing

Event is pursuant to the Loan Documents, the Borrower shall pay, ratably to each Lender whose Term

Loans are the subject of such Repricing Event, a prepayment premium of 1.00% of the aggregate

principal amount of Term Loans so subject to such Repricing Event. The unutilized portion of the Term

Loan Commitments may be irrevocably reduced or terminated by the Borrower at any time without

penalty.

(b)Mandatory Prepayments of Loans.

(i)[Reserved].

(ii)Dispositions and Involuntary Dispositions. On or before the third (3rd) Business Day

following receipt by the Borrower or any Restricted Subsidiary (other than the ETMC JV) of such Net

Cash Proceeds, the Borrower shall make prepayments of the Term Loans in an aggregate amount equal to

100% of the Net Cash Proceeds of all Dispositions and Involuntary Dispositions (other than any proceeds

of any business interruption insurance, any proceeds of MOB Dispositions or any proceeds received from

the Federal Emergency Management Agency or other third parties in reimbursement of, or otherwise in

connection with, costs incurred by the Loan Parties in support of the recovery of the Bay Medical facility)

to the extent that the Net Cash Proceeds of all Dispositions and Involuntary Dispositions received after

the Effective Date exceed $7,500,000 (excluding (1) any proceeds of any business interruption insurance

and proceeds in respect of medical office buildings, (2) any proceeds of a Permitted Sale Leaseback

pursuant to which the aggregate fair market value of all property subject to such Permitted Sale

Leaseback sold or otherwise disposed of by the Borrower and its Restricted Subsidiaries is less than

$25,000,000 or (3) any proceeds received from the Federal Emergency Management Agency or other

third parties in reimbursement of, or otherwise in connection with, costs incurred by the Loan Parties in

support of the recovery of the Bay Medical facility); provided that such percentage shall be reduced to (i)

fifty percent (50%) if on the date such Disposition or Involuntary Disposition is consummated the Senior

Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is less than or equal to 2.25:1:00 as of the

last day of the most recently ended fiscal quarter for which financial statements have been delivered

pursuant to Section 7.01(b) or (ii) zero percent (0%) if on the date such Disposition or Involuntary

Disposition is consummated the Senior Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is

less than or equal to 1.75:1:00 as of the last day of the most recently ended fiscal quarter for which

financial statements have been delivered pursuant to Section 7.01(b) (such prepayments to be applied as

set forth in clause (vii) below).

(iii)Debt Issuances. On or before the third (3rd) Business Day following receipt by the

Borrower or any Restricted Subsidiary (other than the ETMC JV) of the Net Cash Proceeds of any Debt

Issuance, the Borrower shall make prepayments of the Term Loans in an aggregate amount equal to 100%

of such Net Cash Proceeds (such prepayments to be applied as set forth in clause (vii) below).

(iv)Relative Rights Agreement Prepayments. On or before the second (2nd) Business Day

following receipt by Parent, the Borrower, any Subsidiary or any of their respective Affiliates of the

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aggregate gross cash proceeds in respect of LeaseCo’s (or any of its Affiliates’) exercise of and

consummation of the Ventas Asset Purchase (the “Ventas Asset Purchase Gross Proceeds Amount”), the

Borrower shall make payments of the Term Loans in an aggregate amount equal to 100% of such Ventas

Asset Purchase Gross Proceeds Amount; provided that if such Ventas Asset Purchase Gross Proceeds

Amount is received by the Administrative Agent from LeaseCo, the Administrative Agent shall disburse

the Ventas Asset Purchase Gross Proceeds Amount in accordance with this Section 2.05.

(v)Excess Cash Flow. Within 120 days (or, to the extent the Borrower is prohibited from

accessing cash from its Restricted Subsidiaries in a manner that would prevent the Borrower from making

the prepayment referred to in this clause (v), on or before July 15) after the end of each fiscal year

commencing with the fiscal year ending on or about December 31, 2022, the Borrower shall make

prepayments of the Term Loans in an aggregate amount equal to the difference between (a) fifty percent

(50%) of Excess Cash Flow for such fiscal year; provided that such percentage shall be reduced to (i)

twenty-five percent (25%) if the Senior Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is

less than or equal to 2.25:1:00 as of the last day of such fiscal year or (ii) zero percent (0%) if the Senior

Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is less than or equal to 1.75:1:00 as of the

last day of such fiscal year, minus (b) the amount of any voluntary prepayments of the Term Loans or of

other Indebtedness secured by a Lien on the Collateral ranking pari passu with the Liens on the Collateral

securing the Term Loans or the amount of prepayments of the ABL Facility and any other revolving

Indebtedness made in such fiscal year (in each case, other than those prepayments made with the proceeds

of Indebtedness), but in the case of any such prepayment of revolving credit facilities (including the ABL

Facility), solely to the extent that the commitments thereunder are permanently reduced in the amount of

such prepayment. Such prepayments shall be applied as set forth in clause (vii) below.

(vi)[Reserved].

(vii)Application of Mandatory Prepayments. All amounts required to be paid pursuant to this

Section 2.05(b) shall be applied, with respect to all amounts prepaid pursuant to Sections

2.05(b)(ii), (iii), (iv) and (v), to the Term Loans in each case first to Base Rate Loans and then to

Term SOFR Loans in direct order of Interest Period maturities.

(viii)Joint Ventures. Notwithstanding any other provision of this Section 2.05(b) to the

contrary, to the extent that any or all of the Net Cash Proceeds from a Disposition or Involuntary

Disposition subject to prepayment pursuant to clause (ii) or any Excess Cash Flow subject to prepayment

pursuant to clause (v) is attributable to a Joint Venture or its subsidiaries, the amount of any such

prepayment of Net Cash Proceeds or Excess Cash Flow required to be paid pursuant to Section 2.05(b)(ii)

or (v) shall be limited to the portion of such Net Cash Proceeds or Excess Cash Flow that such Joint

Venture is able to distribute to another wholly-owned subsidiary pursuant to the Organization Documents

of such Joint Venture, it being understood that if such Joint Venture is unable to make such distribution,

at the time of the required prepayment, but subsequently is permitted to make such distribution, such Joint

Venture shall promptly distribute such amounts to the Borrower and the Borrower shall apply such

amounts to the prepayment of Term Loans pursuant to this Section 2.05(b).

All prepayments under this Section 2.05(b) shall be subject to Section 3.05, but otherwise without

premium or penalty (except in the case of Section 2.05(b)(iii) to the extent set forth in Section 2.05(a)(ii)),

and shall be accompanied by interest on the principal amount prepaid through the date of prepayment. If

the Borrower is required to make a mandatory prepayment of Term SOFR Loans under this Section 2.05,

the Borrower shall have the right, in lieu of making such prepayment in full, to deposit an amount equal

to such mandatory prepayment with the Administrative Agent in a cash collateral account maintained

(pursuant to documentation reasonably satisfactory to the Administrative Agent) by and in the sole

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dominion and control of the Administrative Agent or one of its Affiliates (with appropriate control

agreements). Any amounts so deposited shall be held by the Administrative Agent as collateral for the

prepayment of such Term SOFR Loans and shall be applied to the prepayment of the applicable Term

SOFR Loans at the end of the current Interest Periods applicable thereto.

All prepayments of Term Loans pursuant to this Section 2.05(b) shall be applied to the payments

in Section 2.07(b) in direct order of maturity.

2.06Termination or Reduction of Commitments

Unless previously terminated, (i) the Initial Term Commitments shall terminate at 5:00 p.m., New

York City time, on the Effective Date. and (ii) the 2024 Term B Commitments shall terminate at 5:00

p.m., New York City time, on the Amendment No. 2 Effective Date.

2.07Repayment of Loans

(a)The Borrower shall repay the outstanding principal amount of the Term Loans in full on

the Maturity Date or on such earlier date in the event the loans are accelerated pursuant to Section 9.02.

(b)On the last Business Day of each March, June, September and December, beginning with

December 31, 2021, the Borrower shall repay the Term Loans in the aggregate principal amount equal to

the product of (i) 0.25% times (ii) the aggregate outstanding principal amount of the Term Loans

outstanding on the Effective Date; provided, that in the event of any prepayment of the Term Loans, the

amount of certain installments shall be reduced as set forth in this Agreement. As of the Amendment No.

2 Effective Date, such quarterly installments have been reduced to zero. The remaining balance shall be

repaid in full on the Maturity Date.

2.08Interest

(a)Subject to the provisions of Section 2.08(b), (i) each Term SOFR Loan shall bear interest

on the outstanding principal amount thereof for each Interest Period at a rate per annum equal to the sum

of Term SOFR for such Interest Period plus the Applicable Rate and (ii) each Base Rate Loan shall bear

interest on the outstanding principal amount thereof from the applicable borrowing date at a rate per

annum equal to the Base Rate plus the Applicable Rate.

(b)Upon the occurrence and during the continuation of an Event of Default at the direction

of the Required Lenders, the Borrower shall pay interest on the principal amount of all overdue and

outstanding Obligations at a fluctuating interest rate per annum at all times equal to the Default Rate to

the fullest extent permitted by applicable Laws.

(c)Interest on each Loan shall be due and payable in arrears on each Interest Payment Date

applicable thereto and at such other times as may be specified herein. Interest hereunder shall be due and

payable in accordance with the terms hereof before and after judgment, and before and after the

commencement of any proceeding under any Debtor Relief Law.

(d)The Borrower shall pay to the Term Loan Lenders immediately prior to the effectiveness

of Amendment and Restatement Agreement all accrued and unpaid interest on the Term B-1 Loans to, but

not including, the Effective Date on the Effective Date.

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(e)The Borrower shall pay to the Term Loan Lenders immediately prior to the effectiveness

of Amendment No. 2 all accrued and unpaid interest on the Initial Term Loans to, but not including, the

Amendment No. 2 Effective Date on such Amendment No. 2 Effective Date.

2.09Fees

The Borrower shall pay to the Administrative Agent for its own account fees in the amounts and

at the times specified in the Fee Letter. Such fees shall be fully earned when paid and shall be

non-refundable for any reason whatsoever.

2.10Computation of Interest and Fees

All computations of interest for Base Rate Loans (including Base Rate Loans determined by

reference to Term SOFR) shall be made on the basis of a year of 365 or 366 days, as the case may be, and

actual days elapsed. All other computations of fees and interest shall be made on the basis of a 360-day

year and actual days elapsed (which results in more fees or interest, as applicable, being paid than if

computed on the basis of a 365-day year). Interest shall accrue on each Loan for the day on which the

Loan is made, and shall not accrue on a Loan, or any portion thereof, for the day on which the Loan or

such portion is paid; provided that any Loan that is repaid on the same day on which it is made shall,

subject to Section 2.12(a), bear interest for one day.

2.11Evidence of Debt

The Borrowings made by each Lender shall be evidenced by one or more accounts or records

maintained by such Lender and by the Administrative Agent in the ordinary course of business. The

accounts or records maintained by the Administrative Agent and each Lender shall be conclusive absent

manifest error of the amount of the Borrowings made by the Lenders to the Borrower and the interest and

payments thereon. Any failure to so record or any error in doing so shall not, however, limit or otherwise

affect the obligation of the Borrower hereunder to pay any amount owing with respect to the Obligations.

In the event of any conflict between the accounts and records maintained by any Lender and the accounts

and records of the Administrative Agent in respect of such matters, the accounts and records of the

Administrative Agent shall control in the absence of manifest error. Upon the request of any Lender

made through the Administrative Agent, the Borrower shall execute and deliver to such Lender (through

the Administrative Agent) a promissory note, which shall evidence such Lender’s Loans in addition to

such accounts or records. Each such promissory note shall be substantially in the form of Exhibit H (a

“Term Note”). Each Lender may attach schedules to its Term Note and endorse thereon the date, Type (if

applicable), amount and maturity of its Term Loans and payments with respect thereto.

2.12Payments Generally

(a)All payments to be made by the Borrower shall be made without condition or deduction

for any counterclaim, defense (other than payment in full), recoupment or setoff. Except as otherwise

expressly provided herein, all payments by the Borrower hereunder shall be made to the Administrative

Agent, for the account of the respective Lenders to which such payment is owed, at the Administrative

Agent’s Office in Dollars and in immediately available funds not later than 12:00 p.m. on the date

specified herein. The Administrative Agent will promptly distribute to each Lender its Pro Rata Share (or

other applicable share as provided herein) of such payment in like funds as received by wire transfer to

such Lender’s Lending Office. All payments received by the Administrative Agent after 12:00 p.m. shall

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in each case be deemed received on the next succeeding Business Day and any applicable interest or fee

shall continue to accrue.

(b)Subject to the definition of “Interest Period,” if any payment to be made by the Borrower

shall come due on a day other than a Business Day, payment shall be made on the next following

Business Day, and such extension of time shall be reflected in computing interest or fees, as the case may

be.

(c)If at any time insufficient funds are received by and available to the Administrative Agent

to pay fully all amounts of principal, interest and fees then due hereunder, such funds shall be applied (i)

first, toward costs and expenses (including Attorney Costs and amounts payable under Article III)

incurred by the Administrative Agent and each Lender, (ii) second, toward repayment of interest and fees

then due hereunder, ratably among the parties entitled thereto in accordance with the amounts of interest

and fees then due to such parties, and (iii) third, toward repayment of principal then due hereunder,

ratably among the parties entitled thereto in accordance with the amounts of principal then due to such

parties.

(d)Unless the Borrower or any Lender has notified the Administrative Agent, prior to the

time any payment is required to be made by it to the Administrative Agent hereunder, that the Borrower

or such Lender, as the case may be, will not make such payment, the Administrative Agent may assume

that the Borrower or such Lender, as the case may be, has timely made such payment and may (but shall

not be so required to), in reliance thereon, make available a corresponding amount to the Person entitled

thereto. If and to the extent that such payment was not in fact made to the Administrative Agent in

immediately available funds, then:

(i)with respect to any payment that the Administrative Agent makes for the account

of the Lenders hereunder as to which the Administrative Agent determines (which determination

shall be conclusive absent manifest error) that any of the following applies (such payment

referred to as the “Rescindable Amount”): (1) the Borrower has not in fact made such payment;

(2) the Administrative Agent has made a payment in excess of the amount so paid by the

Borrower (whether or not then owed); or (3) the Administrative Agent has for any reason

otherwise erroneously made such payment; then each of the Lenders severally agrees to repay to

the Administrative Agent forthwith on demand the Rescindable Amount so distributed to such

Lender, in immediately available funds with interest thereon, for each day from and including the

date such amount is distributed to it to but excluding the date of payment to the Administrative

Agent, at the greater of the Federal Funds Rate and a rate determined by the Administrative

Agent in accordance with banking industry rules on interbank compensation; and

(ii)if any Lender failed to make such payment, such Lender shall forthwith on

demand pay to the Administrative Agent the amount thereof in immediately available funds,

together with interest thereon for the period from the date such amount was made available by the

Administrative Agent to the Borrower to the date such amount is recovered by the Administrative

Agent (the “Compensation Period”) at a rate per annum equal to the Federal Funds Rate from

time to time in effect. If such Lender pays such amount to the Administrative Agent, then such

amount shall constitute such Lender’s Loan included in the applicable Borrowing. If such Lender

does not pay such amount forthwith upon the Administrative Agent’s demand therefor, the

Administrative Agent may make a demand therefor upon the Borrower, and the Borrower shall

pay such amount to the Administrative Agent, together with interest thereon for the

Compensation Period at a rate per annum equal to the rate of interest applicable to the applicable

Borrowing. Nothing herein shall be deemed to relieve any Lender from its obligation to fulfill its

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Commitment or to prejudice any rights which the Administrative Agent or the Borrower may

have against any Lender as a result of any default by such Lender hereunder.

A notice of the Administrative Agent to any Lender or the Borrower with respect to any amount

owing under this Section 2.12(d) shall be conclusive, absent manifest error.

(e)If any Lender makes available to the Administrative Agent funds for any Loan to be made

by such Lender as provided in the foregoing provisions of this Article II, and such funds are not made

available to the Borrower by the Administrative Agent because the conditions to the applicable

Borrowing set forth in Article V are not satisfied or waived in accordance with the terms hereof, the

Administrative Agent shall return such funds (in like funds as received from such Lender) to such Lender,

without interest.

(f)The obligations of the Lenders hereunder to make Term Loans are several and not joint.

The failure of any Lender to make any Loan required hereunder shall not relieve any other Lender of its

corresponding obligation to do so on such date, and no Lender shall be responsible for the failure of any

other Lender to so make its Loan or purchase its participation.

(g)Nothing herein shall be deemed to obligate any Lender to obtain the funds for any Loan

in any particular place or manner or to constitute a representation by any Lender that it has obtained or

will obtain the funds for any Loan in any particular place or manner.

(h)Notwithstanding any provision to the contrary contained herein or in any other of the

Loan Documents, if at any time following the occurrence and during the continuation of an Event of

Default, but prior to the exercise of remedies as provided for in Section 9.02, payment is made by the

Borrower and is applied to payment of principal or interest on the Loans, such payment shall be applied

ratably to the unpaid principal or interest, as the case may be, of the Loans (and breakage, termination or

other payments and any interest accrued thereon).

2.13Sharing of Payments

If, other than as expressly provided elsewhere herein, any Lender shall obtain on account of the

Loans made by it, any payment (whether voluntary, involuntary, through the exercise of any right of

setoff, or otherwise) in excess of its ratable share (or other share contemplated hereunder) thereof, such

Lender shall immediately (a) notify the Administrative Agent of such fact, and (b) purchase from the

other Lenders such participations in the Loans made by them, as shall be necessary to cause such

purchasing Lender to share the excess payment in respect of such Loans, pro rata with each of them;

provided, however, that if all or any portion of such excess payment is thereafter recovered from the

purchasing Lender under any of the circumstances described in Section 11.06 (including pursuant to any

settlement entered into by the purchasing Lender in its discretion), such purchase shall to that extent be

rescinded and each other Lender shall repay to the purchasing Lender the purchase price paid therefor,

together with an amount equal to such paying Lender’s ratable share (according to the proportion of (i)

the amount of such paying Lender’s required repayment to (ii) the total amount so recovered from the

purchasing Lender) of any interest or other amount paid or payable by the purchasing Lender in respect of

the total amount so recovered, without further interest thereon. The Borrower agrees that any Lender so

purchasing a participation from another Lender may, to the fullest extent permitted by applicable law,

exercise all its rights of payment (including the right of setoff, but subject to Section 11.09) with respect

to such participation as fully as if such Lender were the direct creditor of the Borrower in the amount of

such participation. The Administrative Agent will keep records (which shall be conclusive and binding in

the absence of manifest error) of participations purchased under this Section 2.13 and will in each case

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notify the Lenders following any such purchases or repayments. Each Lender that purchases a

participation pursuant to this Section 2.13 shall from and after such purchase have the right to give all

notices, requests, demands, directions and other communications under this Agreement with respect to the

portion of the Obligations purchased to the same extent as though the purchasing Lender were the original

owner of the Obligations purchased.

2.14Incremental Borrowings

(a)The Borrower may at any time or from time to time after the Effective Date, by notice to

the Administrative Agent (whereupon the Administrative Agent shall promptly deliver a copy to the

Lenders), request one or more additional tranches of term loans or increases to an existing tranche of term

loans (the “Incremental Term Loans”); provided that (w) at the time that any such Incremental Term Loan

is made, no Default or Event of Default shall have occurred and be continuing, except that in the case of

Incremental Term Loans incurred to make a Permitted Acquisition or a Permitted Investment, in which

case at the time such Incremental Term Loan is made, no Event of Default pursuant to Sections 9.01(a) or

(f) shall have occurred and be continuing, (x) at the time that any such Incremental Term Loan is made,

the representations and warranties of the Borrower and each other Loan Party contained in Article VI or

any other Loan Document shall be true and correct in all material respects on and as of such dates, except

to the extent that such representations and warranties specifically refer to an earlier date, in which case

they shall be true and correct in all material respects as of such earlier date; provided that to the extent

that any representation and warranty is qualified as to “materiality” or “Material Adverse Effect”, such

representation and warranty shall be true and correct in all respects on such respective dates, and except

that for purposes of this section, the representations and warranties contained in clause (a) of Section 6.05

shall be deemed to refer to the most recent statements furnished pursuant to clauses (a) and (b),

respectively, of Section 7.01; provided, further, that, in the case of Incremental Term Loans incurred to

make a Permitted Acquisition or a Permitted Investment, such representations and warranties to be made

at the time that any such Incremental Term Loan is made shall be limited to the Specified Representations

and the “acquisition agreement representations” (or similar representations) conformed as appropriate for

such transaction; and (y) the Borrower shall have delivered to the Administrative Agent a certificate of a

Responsible Officer, in detail reasonably satisfactory to the Administrative Agent, demonstrating that the

incurrence of such Incremental Term Loans requested does not violate the provisions of the Relative

Rights Agreement or the Master Lease. The aggregate amount of the Incremental Term Loans shall not

exceed the greater of (x)(A) $500,000,000 and (B) 100% of Consolidated EBITDA plus (y) an unlimited

amount, so long as in the case of this clause (y) only, the Borrower has at the time such Incremental Term

Loan is made, a Senior Secured Net Leverage Ratio equal to or less than 3.75:1.00 calculated on a Pro

Forma Basis; provided that for purposes of this clause (y), net cash proceeds of Incremental Term Loans

incurred at such time shall not be netted against the applicable amount of Consolidated Indebtedness for

purposes of such calculation of the Senior Secured Net Leverage Ratio plus (z) the aggregate amount of

voluntary prepayments of Term Loans other than from the proceeds of the incurrence of Indebtedness

(provided, however, that if amounts incurred under clause (y) are incurred concurrently with the

incurrence of Incremental Term Loans under clause (x) and/or (z), the Senior Secured Net Leverage Ratio

shall be calculated without giving effect to such amounts incurred in reliance on the foregoing clause (x)

and/or (z); provided, further, for the avoidance of doubt, to the extent the proceeds of any Incremental

Term Loans are being utilized to repay Indebtedness, such calculations shall give pro forma effect to such

repayments) (the amount available under clauses (x), (y) and (z), the “Available Incremental Amount”).

The Borrower may elect to use clause (y) of the Available Incremental Amount regardless of whether the

Borrower has capacity under clauses (x) or (z) of the Available Incremental Amount. Further, the

Borrower may elect to use clause (y) of the Available Incremental Amount prior to using clause (x) or (z)

of the Available Incremental Amount, and if both clause (y) and clause (x) and/or (z) of the Available

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Incremental Amount are available and the Borrower does not make an election, then the Borrower will be

deemed to have elected to use clause (y) of the Available Incremental Amount.

(b)The Incremental Term Loans shall (i) be on terms and pursuant to documentation to be

determined by the Borrower and the Lenders thereunder; provided that, to the extent such terms and

documentation (except to the extent permitted by clauses (ii) and (iii) below) are not consistent with this

Agreement, they shall be reasonably satisfactory to the Borrower and the Administrative Agent, (ii) (A)

not mature earlier than the Maturity Date for any outstanding Term Loans and (B) have a Weighted

Average Life to Maturity no shorter than the remaining Weighted Average Life to Maturity of any

outstanding Term Loans; provided that this clause (ii) shall not apply to up to $150,000,000 of

Indebtedness, in the aggregate, in respect of all Incremental Term Loans and any Indebtedness incurred

pursuant to Section 8.03(u) and (v) (this clause (ii), the “Maturity and Weighted Average Life to Maturity

Limitations”), (iii) only be guaranteed by the Guarantors, (iv) have interest rates and an amortization

schedule (subject to clause (ii) above) applicable to the Incremental Term Loans determined by the

Borrower and the Lenders thereunder; provided that, if the Applicable Rate related to any Incremental

Term Loans incurred within twelve (12) months of the Effective Date exceeds the Applicable Rate

relating to any outstanding Term Loans immediately prior to the effectiveness of the applicable

Incremental Amendment by more than 0.50% per annum, the Applicable Rate relating to such Term

Loans shall be adjusted to be equal to the Applicable Rate relating to such Incremental Term Loans minus

0.50% per annum; provided, further, that the immediately preceding proviso shall not apply if (x) such

Incremental Term Loans mature more than 12 months after the Maturity Date or (y) the aggregate

principal amount of such Incremental Term Loans (together with the aggregate principal amount of all

other Incremental Term Loans excluded in reliance on this clause (y) and term loan Indebtedness secured

on a pari passu basis with the Liens securing the Term Loans pursuant to Section 8.03(u) and (v)) does

not exceed $150,000,000 in the aggregate (the provisions under this proviso and the immediately

preceding proviso collectively, the “MFN Provisions”); provided, further, that in determining the

Applicable Rate for Incremental Term Loans or Term Loans solely for purposes of the two immediately

preceding provisos, (w) original issue discount (“OID”) or upfront fees (which shall be deemed to

constitute like amounts of OID) paid by the Borrower to all Lenders (and not any one Lender) providing

Term Loans or Incremental Term Loans in the initial primary syndication thereof shall be included and

equated to interest (with OID being equated to interest based on an assumed four-year life to maturity),

(x) customary arrangement or commitment fees payable to the Joint Book Runners in connection with the

Term Loans or to one or more arrangers (or their Affiliates) of the Incremental Term Loans shall be

excluded, (y) if the lowest permissible Base Rate is greater than 1.50% per annum and the lowest

permissible Term SOFR is greater than 0.50% per annum, in each case the difference between the “floor”

and 0.50%, in the case of Term SOFR Loans, and such floor and 1.50% per annum, in the case of Base

Rate Loans, shall be equated to Applicable Rate for purposes of the two immediately preceding provisos

and (v) the Incremental Term Loans may be secured only by Collateral and may only be secured by either

a pari passu or a junior Lien on the Collateral, in each case on terms and pursuant to documentation

(including an Acceptable Intercreditor Agreement if applicable) reasonably satisfactory to the Borrower

and the lenders providing such Incremental Term Loans; provided that, to the extent such terms and

documentation are not consistent with this Agreement (except as they relate to maturity, Weighted

Average Life to Maturity or interest rates), they shall not be more favorable, taken as a whole (as

reasonably determined by the Borrower), to the lenders providing such Incremental Term Loans than the

terms of the Term Loans (other than with respect to terms and conditions applicable after the maturity of

the Term Loans) unless such more favorable terms are added for the benefit of the Term Loans, which

shall not require the consent of the Lenders and any such Incremental Term Loans may contain any

financial maintenance covenants, so long as such covenants are also added for the benefit of the Lenders,

which shall not require consent of the Lenders.

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(c)Except as otherwise provided herein, a Term SOFR Loan may be continued or converted

only on the last day of the Interest Period for such Term SOFR Loan. During the existence of an Event of

Default, no Term Loan may be requested as, converted to or continued as Term SOFR Loans without the

consent of the Lenders (other than Defaulting Lenders) holding in the aggregate at least a majority of the

outstanding Term Loans, if any, and such Lenders may demand that any or all of the then outstanding

Term Loans that are Term SOFR Loans be converted immediately to Base Rate Loans.

(d)The Administrative Agent shall promptly notify the Borrower and the Lenders of the

interest rate applicable to any Interest Period for Term SOFR Loans upon determination of such interest

rate. The determination of Term SOFR by the Administrative Agent shall be conclusive in the absence of

manifest error.

(e)After giving effect to all Borrowings, all conversions of Term Loans from one Type to

the other, and all continuations of Term Loans as the same Type, there shall not be more than eight (8)

Interest Periods in effect with respect to the Term Loans; provided that all 2024 Term B Loans made on

the Amendment No. 2 Effective Date and all 2024 Term B Loans converted from Initial Term Loans on

the Amendment No. 2 Effective Date shall be of the same Type and have the same Interest Period as set

forth in the definition of “Interest Period” herein.

2.03[Reserved]

2.04[Reserved]

2.05Prepayments

(a)Voluntary Prepayments of Term Loans.

(i)Voluntary Prepayments.

The Borrower may, upon notice from the Borrower to the Administrative Agent in the form of a

written Prepayment Notice, at any time or from time to time voluntarily prepay the Term Loans in whole

or in part without premium (except as otherwise set forth below) or penalty; provided that (x) such

Prepayment Notice shall contain the information required by the immediately succeeding sentence and

must be received by the Administrative Agent not later than 12:00 p.m. (A) two Business Days prior to

any date of prepayment of Term SOFR Loans, and (B) on the date of prepayment of Base Rate Loans; (y)

any such prepayment of Term SOFR Loans shall be in a principal amount of $1,000,000 or a whole

multiple of $500,000 in excess thereof (or, if less, the entire principal amount thereof then outstanding);

and (z) any prepayment of Base Rate Loans shall be in a principal amount of $250,000 or a whole

multiple of $250,000 in excess thereof (or, if less, the entire principal amount thereof then outstanding).

Each such Prepayment Notice shall specify the date and amount of such prepayment and the Type(s) of

Term Loans to be prepaid. The Administrative Agent will promptly notify each Lender of its receipt of

each such notice, and of the amount of such Lender’s Pro Rata Share of such prepayment. If such

Prepayment Notice is given by the Borrower, the Borrower shall make such prepayment and the payment

amount specified in such Prepayment Notice shall be due and payable on the date specified therein,

except that any such Prepayment Notice may state that such notice is conditioned upon the occurrence or

non-occurrence of any event specified therein (including the effectiveness of other credit facilities), in

which case such notice may be revoked by the Borrower on or prior to the date of prepayment if such

condition is not satisfied. Any prepayment of a Term SOFR Loan shall be accompanied by all accrued

interest thereon, together with any additional amounts required pursuant to Section 3.05. Each such

prepayment shall be applied to the Loans of the Lenders in accordance with their respective Pro Rata

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Shares. Each such prepayment of the Term Loans shall be applied to the principal installments thereof

under Section 2.07(b) as directed by the Borrower in its sole discretion, and if no direction is given by the

Borrower in direct order of maturity.

(ii)Repricing Event.

If any Term Loans are repriced pursuant to a Repricing Event (other than, for the avoidance of

doubt, the incurrence of the Initial2024 Term B Loans on the Amendment No. 2 Effective Date) prior to

the six (6) month anniversary of the Amendment No. 2 Effective Date, whether or not such Repricing

Event is pursuant to the Loan Documents, the Borrower shall pay, ratably to each Lender whose Term

Loans are the subject of such Repricing Event, a prepayment premium of 1.00% of the aggregate

principal amount of Term Loans so subject to such Repricing Event. The unutilized portion of the Term

Loan Commitments may be irrevocably reduced or terminated by the Borrower at any time without

penalty.

(b)Mandatory Prepayments of Loans.

(i)[Reserved].

(ii)Dispositions and Involuntary Dispositions. On or before the third (3rd) Business Day

following receipt by the Borrower or any Restricted Subsidiary (other than the ETMC JV) of such Net

Cash Proceeds, the Borrower shall make prepayments of the Term Loans in an aggregate amount equal to

100% of the Net Cash Proceeds of all Dispositions and Involuntary Dispositions (other than any proceeds

of any business interruption insurance, any proceeds of MOB Dispositions or any proceeds received from

the Federal Emergency Management Agency or other third parties in reimbursement of, or otherwise in

connection with, costs incurred by the Loan Parties in support of the recovery of the Bay Medical facility)

to the extent that the Net Cash Proceeds of all Dispositions and Involuntary Dispositions received after

the Effective Date exceed $7,500,000 (excluding (1) any proceeds of any business interruption insurance

and proceeds in respect of medical office buildings, (2) any proceeds of a Permitted Sale Leaseback

pursuant to which the aggregate fair market value of all property subject to such Permitted Sale

Leaseback sold or otherwise disposed of by the Borrower and its Restricted Subsidiaries is less than

$25,000,000 or (3) any proceeds received from the Federal Emergency Management Agency or other

third parties in reimbursement of, or otherwise in connection with, costs incurred by the Loan Parties in

support of the recovery of the Bay Medical facility); provided that such percentage shall be reduced to (i)

fifty percent (50%) if on the date such Disposition or Involuntary Disposition is consummated the Senior

Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is less than or equal to 2.25:1:00 as of the

last day of the most recently ended fiscal quarter for which financial statements have been delivered

pursuant to Section 7.01(b) or (ii) zero percent (0%) if on the date such Disposition or Involuntary

Disposition is consummated the Senior Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is

less than or equal to 1.75:1:00 as of the last day of the most recently ended fiscal quarter for which

financial statements have been delivered pursuant to Section 7.01(b) (such prepayments to be applied as

set forth in clause (vii) below).

(iii)Debt Issuances. On or before the third (3rd) Business Day following receipt by the

Borrower or any Restricted Subsidiary (other than the ETMC JV) of the Net Cash Proceeds of any Debt

Issuance, the Borrower shall make prepayments of the Term Loans in an aggregate amount equal to 100%

of such Net Cash Proceeds (such prepayments to be applied as set forth in clause (vii) below).

(iv)Relative Rights Agreement Prepayments. On or before the second (2nd) Business Day

following receipt by Parent, the Borrower, any Subsidiary or any of their respective Affiliates of the

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aggregate gross cash proceeds in respect of LeaseCo’s (or any of its Affiliates’) exercise of and

consummation of the Ventas Asset Purchase (the “Ventas Asset Purchase Gross Proceeds Amount”), the

Borrower shall make payments of the Term Loans in an aggregate amount equal to 100% of such Ventas

Asset Purchase Gross Proceeds Amount; provided that if such Ventas Asset Purchase Gross Proceeds

Amount is received by the Administrative Agent from LeaseCo, the Administrative Agent shall disburse

the Ventas Asset Purchase Gross Proceeds Amount in accordance with this Section 2.05.

(v)Excess Cash Flow. Within 120 days (or, to the extent the Borrower is prohibited from

accessing cash from its Restricted Subsidiaries in a manner that would prevent the Borrower from making

the prepayment referred to in this clause (v), on or before July 15) after the end of each fiscal year

commencing with the fiscal year ending on or about December 31, 2022, the Borrower shall make

prepayments of the Term Loans in an aggregate amount equal to the difference between (a) fifty percent

(50%) of Excess Cash Flow for such fiscal year; provided that such percentage shall be reduced to (i)

twenty-five percent (25%) if the Senior Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is

less than or equal to 2.25:1:00 as of the last day of such fiscal year or (ii) zero percent (0%) if the Senior

Secured Net Leverage Ratio (calculated on a Pro Forma Basis) is less than or equal to 1.75:1:00 as of the

last day of such fiscal year, minus (b) the amount of any voluntary prepayments of the Term Loans or of

other Indebtedness secured by a Lien on the Collateral ranking pari passu with the Liens on the Collateral

securing the Term Loans or the amount of prepayments of the ABL Facility and any other revolving

Indebtedness made in such fiscal year (in each case, other than those prepayments made with the proceeds

of Indebtedness), but in the case of any such prepayment of revolving credit facilities (including the ABL

Facility), solely to the extent that the commitments thereunder are permanently reduced in the amount of

such prepayment. Such prepayments shall be applied as set forth in clause (vii) below.

(vi)[Reserved].

(vii)Application of Mandatory Prepayments. All amounts required to be paid pursuant to this

Section 2.05(b) shall be applied, with respect to all amounts prepaid pursuant to Sections

2.05(b)(ii), (iii), (iv) and (v), to the Term Loans in each case first to Base Rate Loans and then to

Term SOFR Loans in direct order of Interest Period maturities.

(viii)Joint Ventures. Notwithstanding any other provision of this Section 2.05(b) to the

contrary, to the extent that any or all of the Net Cash Proceeds from a Disposition or Involuntary

Disposition subject to prepayment pursuant to clause (ii) or any Excess Cash Flow subject to prepayment

pursuant to clause (v) is attributable to a Joint Venture or its subsidiaries, the amount of any such

prepayment of Net Cash Proceeds or Excess Cash Flow required to be paid pursuant to Section 2.05(b)(ii)

or (v) shall be limited to the portion of such Net Cash Proceeds or Excess Cash Flow that such Joint

Venture is able to distribute to another wholly-owned subsidiary pursuant to the Organization Documents

of such Joint Venture, it being understood that if such Joint Venture is unable to make such distribution,

at the time of the required prepayment, but subsequently is permitted to make such distribution, such Joint

Venture shall promptly distribute such amounts to the Borrower and the Borrower shall apply such

amounts to the prepayment of Term Loans pursuant to this Section 2.05(b).

All prepayments under this Section 2.05(b) shall be subject to Section 3.05, but otherwise without

premium or penalty (except in the case of Section 2.05(b)(iii) to the extent set forth in Section 2.05(a)(ii)),

and shall be accompanied by interest on the principal amount prepaid through the date of prepayment. If

the Borrower is required to make a mandatory prepayment of Term SOFR Loans under this Section 2.05,

the Borrower shall have the right, in lieu of making such prepayment in full, to deposit an amount equal

to such mandatory prepayment with the Administrative Agent in a cash collateral account maintained

(pursuant to documentation reasonably satisfactory to the Administrative Agent) by and in the sole

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dominion and control of the Administrative Agent or one of its Affiliates (with appropriate control

agreements). Any amounts so deposited shall be held by the Administrative Agent as collateral for the

prepayment of such Term SOFR Loans and shall be applied to the prepayment of the applicable Term

SOFR Loans at the end of the current Interest Periods applicable thereto.

All prepayments of Term Loans pursuant to this Section 2.05(b) shall be applied to the payments

in Section 2.07(b) in direct order of maturity.

2.06Termination or Reduction of Commitments

Unless previously terminated, (i) the Initial Term Commitments shall terminate at 5:00 p.m., New

York City time, on the Effective Date. and (ii) the 2024 Term B Commitments shall terminate at 5:00

p.m., New York City time, on the Amendment No. 2 Effective Date.

2.07Repayment of Loans

(a)The Borrower shall repay the outstanding principal amount of the Term Loans in full on

the Maturity Date or on such earlier date in the event the loans are accelerated pursuant to Section 9.02.

(b)On the last Business Day of each March, June, September and December, beginning with

December 31, 2021, the Borrower shall repay the Term Loans in the aggregate principal amount equal to

the product of (i) 0.25% times (ii) the aggregate outstanding principal amount of the Term Loans

outstanding on the Effective Date; provided, that in the event of any prepayment of the Term Loans, the

amount of certain installments shall be reduced as set forth in this Agreement. As of the Amendment No.

2 Effective Date, such quarterly installments have been reduced to zero. The remaining balance shall be

repaid in full on the Maturity Date.

2.08Interest

(a)Subject to the provisions of Section 2.08(b), (i) each Term SOFR Loan shall bear interest

on the outstanding principal amount thereof for each Interest Period at a rate per annum equal to the sum

of Term SOFR for such Interest Period plus the Applicable Rate and (ii) each Base Rate Loan shall bear

interest on the outstanding principal amount thereof from the applicable borrowing date at a rate per

annum equal to the Base Rate plus the Applicable Rate.

(b)Upon the occurrence and during the continuation of an Event of Default at the direction

of the Required Lenders, the Borrower shall pay interest on the principal amount of all overdue and

outstanding Obligations at a fluctuating interest rate per annum at all times equal to the Default Rate to

the fullest extent permitted by applicable Laws.

(c)Interest on each Loan shall be due and payable in arrears on each Interest Payment Date

applicable thereto and at such other times as may be specified herein. Interest hereunder shall be due and

payable in accordance with the terms hereof before and after judgment, and before and after the

commencement of any proceeding under any Debtor Relief Law.

(d)The Borrower shall pay to the Term Loan Lenders immediately prior to the effectiveness

of Amendment and Restatement Agreement all accrued and unpaid interest on the Term B-1 Loans to, but

not including, the Effective Date on the Effective Date.

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(e)The Borrower shall pay to the Term Loan Lenders immediately prior to the effectiveness

of Amendment No. 2 all accrued and unpaid interest on the Initial Term Loans to, but not including, the

Amendment No. 2 Effective Date on such Amendment No. 2 Effective Date.

2.09Fees

The Borrower shall pay to the Administrative Agent for its own account fees in the amounts and

at the times specified in the Fee Letter. Such fees shall be fully earned when paid and shall be

non-refundable for any reason whatsoever.

2.10Computation of Interest and Fees

All computations of interest for Base Rate Loans (including Base Rate Loans determined by

reference to Term SOFR) shall be made on the basis of a year of 365 or 366 days, as the case may be, and

actual days elapsed. All other computations of fees and interest shall be made on the basis of a 360-day

year and actual days elapsed (which results in more fees or interest, as applicable, being paid than if

computed on the basis of a 365-day year). Interest shall accrue on each Loan for the day on which the

Loan is made, and shall not accrue on a Loan, or any portion thereof, for the day on which the Loan or

such portion is paid; provided that any Loan that is repaid on the same day on which it is made shall,

subject to Section 2.12(a), bear interest for one day.

2.11Evidence of Debt

The Borrowings made by each Lender shall be evidenced by one or more accounts or records

maintained by such Lender and by the Administrative Agent in the ordinary course of business. The

accounts or records maintained by the Administrative Agent and each Lender shall be conclusive absent

manifest error of the amount of the Borrowings made by the Lenders to the Borrower and the interest and

payments thereon. Any failure to so record or any error in doing so shall not, however, limit or otherwise

affect the obligation of the Borrower hereunder to pay any amount owing with respect to the Obligations.

In the event of any conflict between the accounts and records maintained by any Lender and the accounts

and records of the Administrative Agent in respect of such matters, the accounts and records of the

Administrative Agent shall control in the absence of manifest error. Upon the request of any Lender

made through the Administrative Agent, the Borrower shall execute and deliver to such Lender (through

the Administrative Agent) a promissory note, which shall evidence such Lender’s Loans in addition to

such accounts or records. Each such promissory note shall be substantially in the form of Exhibit H (a

“Term Note”). Each Lender may attach schedules to its Term Note and endorse thereon the date, Type (if

applicable), amount and maturity of its Term Loans and payments with respect thereto.

2.12Payments Generally

(a)All payments to be made by the Borrower shall be made without condition or deduction

for any counterclaim, defense (other than payment in full), recoupment or setoff. Except as otherwise

expressly provided herein, all payments by the Borrower hereunder shall be made to the Administrative

Agent, for the account of the respective Lenders to which such payment is owed, at the Administrative

Agent’s Office in Dollars and in immediately available funds not later than 12:00 p.m. on the date

specified herein. The Administrative Agent will promptly distribute to each Lender its Pro Rata Share (or

other applicable share as provided herein) of such payment in like funds as received by wire transfer to

such Lender’s Lending Office. All payments received by the Administrative Agent after 12:00 p.m. shall

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in each case be deemed received on the next succeeding Business Day and any applicable interest or fee

shall continue to accrue.

(b)Subject to the definition of “Interest Period,” if any payment to be made by the Borrower

shall come due on a day other than a Business Day, payment shall be made on the next following

Business Day, and such extension of time shall be reflected in computing interest or fees, as the case may

be.

(c)If at any time insufficient funds are received by and available to the Administrative Agent

to pay fully all amounts of principal, interest and fees then due hereunder, such funds shall be applied (i)

first, toward costs and expenses (including Attorney Costs and amounts payable under Article III)

incurred by the Administrative Agent and each Lender, (ii) second, toward repayment of interest and fees

then due hereunder, ratably among the parties entitled thereto in accordance with the amounts of interest

and fees then due to such parties, and (iii) third, toward repayment of principal then due hereunder,

ratably among the parties entitled thereto in accordance with the amounts of principal then due to such

parties.

(d)Unless the Borrower or any Lender has notified the Administrative Agent, prior to the

time any payment is required to be made by it to the Administrative Agent hereunder, that the Borrower

or such Lender, as the case may be, will not make such payment, the Administrative Agent may assume

that the Borrower or such Lender, as the case may be, has timely made such payment and may (but shall

not be so required to), in reliance thereon, make available a corresponding amount to the Person entitled

thereto. If and to the extent that such payment was not in fact made to the Administrative Agent in

immediately available funds, then:

(i)with respect to any payment that the Administrative Agent makes for the account

of the Lenders hereunder as to which the Administrative Agent determines (which determination

shall be conclusive absent manifest error) that any of the following applies (such payment

referred to as the “Rescindable Amount”): (1) the Borrower has not in fact made such payment;

(2) the Administrative Agent has made a payment in excess of the amount so paid by the

Borrower (whether or not then owed); or (3) the Administrative Agent has for any reason

otherwise erroneously made such payment; then each of the Lenders severally agrees to repay to

the Administrative Agent forthwith on demand the Rescindable Amount so distributed to such

Lender, in immediately available funds with interest thereon, for each day from and including the

date such amount is distributed to it to but excluding the date of payment to the Administrative

Agent, at the greater of the Federal Funds Rate and a rate determined by the Administrative

Agent in accordance with banking industry rules on interbank compensation; and

(ii)if any Lender failed to make such payment, such Lender shall forthwith on

demand pay to the Administrative Agent the amount thereof in immediately available funds,

together with interest thereon for the period from the date such amount was made available by the

Administrative Agent to the Borrower to the date such amount is recovered by the Administrative

Agent (the “Compensation Period”) at a rate per annum equal to the Federal Funds Rate from

time to time in effect. If such Lender pays such amount to the Administrative Agent, then such

amount shall constitute such Lender’s Loan included in the applicable Borrowing. If such Lender

does not pay such amount forthwith upon the Administrative Agent’s demand therefor, the

Administrative Agent may make a demand therefor upon the Borrower, and the Borrower shall

pay such amount to the Administrative Agent, together with interest thereon for the

Compensation Period at a rate per annum equal to the rate of interest applicable to the applicable

Borrowing. Nothing herein shall be deemed to relieve any Lender from its obligation to fulfill its

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Commitment or to prejudice any rights which the Administrative Agent or the Borrower may

have against any Lender as a result of any default by such Lender hereunder.

A notice of the Administrative Agent to any Lender or the Borrower with respect to any amount

owing under this Section 2.12(d) shall be conclusive, absent manifest error.

(e)If any Lender makes available to the Administrative Agent funds for any Loan to be made

by such Lender as provided in the foregoing provisions of this Article II, and such funds are not made

available to the Borrower by the Administrative Agent because the conditions to the applicable

Borrowing set forth in Article V are not satisfied or waived in accordance with the terms hereof, the

Administrative Agent shall return such funds (in like funds as received from such Lender) to such Lender,

without interest.

(f)The obligations of the Lenders hereunder to make Term Loans are several and not joint.

The failure of any Lender to make any Loan required hereunder shall not relieve any other Lender of its

corresponding obligation to do so on such date, and no Lender shall be responsible for the failure of any

other Lender to so make its Loan or purchase its participation.

(g)Nothing herein shall be deemed to obligate any Lender to obtain the funds for any Loan

in any particular place or manner or to constitute a representation by any Lender that it has obtained or

will obtain the funds for any Loan in any particular place or manner.

(h)Notwithstanding any provision to the contrary contained herein or in any other of the

Loan Documents, if at any time following the occurrence and during the continuation of an Event of

Default, but prior to the exercise of remedies as provided for in Section 9.02, payment is made by the

Borrower and is applied to payment of principal or interest on the Loans, such payment shall be applied

ratably to the unpaid principal or interest, as the case may be, of the Loans (and breakage, termination or

other payments and any interest accrued thereon).

2.13Sharing of Payments

If, other than as expressly provided elsewhere herein, any Lender shall obtain on account of the

Loans made by it, any payment (whether voluntary, involuntary, through the exercise of any right of

setoff, or otherwise) in excess of its ratable share (or other share contemplated hereunder) thereof, such

Lender shall immediately (a) notify the Administrative Agent of such fact, and (b) purchase from the

other Lenders such participations in the Loans made by them, as shall be necessary to cause such

purchasing Lender to share the excess payment in respect of such Loans, pro rata with each of them;

provided, however, that if all or any portion of such excess payment is thereafter recovered from the

purchasing Lender under any of the circumstances described in Section 11.06 (including pursuant to any

settlement entered into by the purchasing Lender in its discretion), such purchase shall to that extent be

rescinded and each other Lender shall repay to the purchasing Lender the purchase price paid therefor,

together with an amount equal to such paying Lender’s ratable share (according to the proportion of (i)

the amount of such paying Lender’s required repayment to (ii) the total amount so recovered from the

purchasing Lender) of any interest or other amount paid or payable by the purchasing Lender in respect of

the total amount so recovered, without further interest thereon. The Borrower agrees that any Lender so

purchasing a participation from another Lender may, to the fullest extent permitted by applicable law,

exercise all its rights of payment (including the right of setoff, but subject to Section 11.09) with respect

to such participation as fully as if such Lender were the direct creditor of the Borrower in the amount of

such participation. The Administrative Agent will keep records (which shall be conclusive and binding in

the absence of manifest error) of participations purchased under this Section 2.13 and will in each case

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notify the Lenders following any such purchases or repayments. Each Lender that purchases a

participation pursuant to this Section 2.13 shall from and after such purchase have the right to give all

notices, requests, demands, directions and other communications under this Agreement with respect to the

portion of the Obligations purchased to the same extent as though the purchasing Lender were the original

owner of the Obligations purchased.

2.14Incremental Borrowings

(a)The Borrower may at any time or from time to time after the Effective Date, by notice to

the Administrative Agent (whereupon the Administrative Agent shall promptly deliver a copy to the

Lenders), request one or more additional tranches of term loans or increases to an existing tranche of term

loans (the “Incremental Term Loans”); provided that (w) at the time that any such Incremental Term Loan

is made, no Default or Event of Default shall have occurred and be continuing, except that in the case of

Incremental Term Loans incurred to make a Permitted Acquisition or a Permitted Investment, in which

case at the time such Incremental Term Loan is made, no Event of Default pursuant to Sections 9.01(a) or

(f) shall have occurred and be continuing, (x) at the time that any such Incremental Term Loan is made,

the representations and warranties of the Borrower and each other Loan Party contained in Article VI or

any other Loan Document shall be true and correct in all material respects on and as of such dates, except

to the extent that such representations and warranties specifically refer to an earlier date, in which case

they shall be true and correct in all material respects as of such earlier date; provided that to the extent

that any representation and warranty is qualified as to “materiality” or “Material Adverse Effect”, such

representation and warranty shall be true and correct in all respects on such respective dates, and except

that for purposes of this section, the representations and warranties contained in clause (a) of Section 6.05

shall be deemed to refer to the most recent statements furnished pursuant to clauses (a) and (b),

respectively, of Section 7.01; provided, further, that, in the case of Incremental Term Loans incurred to

make a Permitted Acquisition or a Permitted Investment, such representations and warranties to be made

at the time that any such Incremental Term Loan is made shall be limited to the Specified Representations

and the “acquisition agreement representations” (or similar representations) conformed as appropriate for

such transaction; and (y) the Borrower shall have delivered to the Administrative Agent a certificate of a

Responsible Officer, in detail reasonably satisfactory to the Administrative Agent, demonstrating that the

incurrence of such Incremental Term Loans requested does not violate the provisions of the Relative

Rights Agreement or the Master Lease. The aggregate amount of the Incremental Term Loans shall not

exceed the greater of (x)(A) $500,000,000 and (B) 100% of Consolidated EBITDA plus (y) an unlimited

amount, so long as in the case of this clause (y) only, the Borrower has at the time such Incremental Term

Loan is made, a Senior Secured Net Leverage Ratio equal to or less than 3.75:1.00 calculated on a Pro

Forma Basis; provided that for purposes of this clause (y), net cash proceeds of Incremental Term Loans

incurred at such time shall not be netted against the applicable amount of Consolidated Indebtedness for

purposes of such calculation of the Senior Secured Net Leverage Ratio plus (z) the aggregate amount of

voluntary prepayments of Term Loans other than from the proceeds of the incurrence of Indebtedness

(provided, however, that if amounts incurred under clause (y) are incurred concurrently with the

incurrence of Incremental Term Loans under clause (x) and/or (z), the Senior Secured Net Leverage Ratio

shall be calculated without giving effect to such amounts incurred in reliance on the foregoing clause (x)

and/or (z); provided, further, for the avoidance of doubt, to the extent the proceeds of any Incremental

Term Loans are being utilized to repay Indebtedness, such calculations shall give pro forma effect to such

repayments) (the amount available under clauses (x), (y) and (z), the “Available Incremental Amount”).

The Borrower may elect to use clause (y) of the Available Incremental Amount regardless of whether the

Borrower has capacity under clauses (x) or (z) of the Available Incremental Amount. Further, the

Borrower may elect to use clause (y) of the Available Incremental Amount prior to using clause (x) or (z)

of the Available Incremental Amount, and if both clause (y) and clause (x) and/or (z) of the Available

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Incremental Amount are available and the Borrower does not make an election, then the Borrower

will be deemed to have elected to use clause (y) of the Available Incremental Amount.

(b)The Incremental Term Loans shall (i) be on terms and pursuant to documentation to be

determined by the Borrower and the Lenders thereunder; provided that, to the extent such terms and

documentation (except to the extent permitted by clauses (ii) and (iii) below) are not consistent with this

Agreement, they shall be reasonably satisfactory to the Borrower and the Administrative Agent, (ii) (A)

not mature earlier than the Maturity Date for any outstanding Term Loans and (B) have a Weighted

Average Life to Maturity no shorter than the remaining Weighted Average Life to Maturity of any

outstanding Term Loans; provided that this clause (ii) shall not apply to up to $150,000,000 of

Indebtedness, in the aggregate, in respect of all Incremental Term Loans and any Indebtedness incurred

pursuant to Section 8.03(u) and (v) (this clause (ii), the “Maturity and Weighted Average Life to Maturity

Limitations”), (iii) only be guaranteed by the Guarantors, (iv) have interest rates and an amortization

schedule (subject to clause (ii) above) applicable to the Incremental Term Loans determined by the

Borrower and the Lenders thereunder; provided that, if the Applicable Rate related to any Incremental

Term Loans incurred within twelve (12) months of the Effective Date exceeds the Applicable Rate

relating to any outstanding Term Loans immediately prior to the effectiveness of the applicable

Incremental Amendment by more than 0.50% per annum, the Applicable Rate relating to such Term

Loans shall be adjusted to be equal to the Applicable Rate relating to such Incremental Term Loans minus

0.50% per annum; provided, further, that the immediately preceding proviso shall not apply if (x) such

Incremental Term Loans mature more than 12 months after the Maturity Date or (y) the aggregate

principal amount of such Incremental Term Loans (together with the aggregate principal amount of all

other Incremental Term Loans excluded in reliance on this clause (y) and term loan Indebtedness secured

on a pari passu basis with the Liens securing the Term Loans pursuant to Section 8.03(u) and (v)) does

not exceed $150,000,000 in the aggregate (the provisions under this proviso and the immediately

preceding proviso collectively, the “MFN Provisions”); provided, further, that in determining the

Applicable Rate for Incremental Term Loans or Term Loans solely for purposes of the two immediately

preceding provisos, (w) original issue discount (“OID”) or upfront fees (which shall be deemed to

constitute like amounts of OID) paid by the Borrower to all Lenders (and not any one Lender) providing

Term Loans or Incremental Term Loans in the initial primary syndication thereof shall be included and

equated to interest (with OID being equated to interest based on an assumed four-year life to maturity),

(x) customary arrangement or commitment fees payable to the Joint Book Runners in connection with the

Term Loans or to one or more arrangers (or their Affiliates) of the Incremental Term Loans shall be

excluded, (y) if the lowest permissible Base Rate is greater than 1.50% per annum and the lowest

permissible Term SOFR is greater than 0.50% per annum, in each case the difference between the “floor”

and 0.50%, in the case of Term SOFR Loans, and such floor and 1.50% per annum, in the case of Base

Rate Loans, shall be equated to Applicable Rate for purposes of the two immediately preceding provisos

and (v) the Incremental Term Loans may be secured only by Collateral and may only be secured by either

a pari passu or a junior Lien on the Collateral, in each case on terms and pursuant to documentation

(including an Acceptable Intercreditor Agreement if applicable) reasonably satisfactory to the Borrower

and the lenders providing such Incremental Term Loans; provided that, to the extent such terms and

documentation are not consistent with this Agreement (except as they relate to maturity, Weighted

Average Life to Maturity or interest rates), they shall not be more favorable, taken as a whole (as

reasonably determined by the Borrower), to the lenders providing such Incremental Term Loans than the

terms of the Term Loans (other than with respect to terms and conditions applicable after the maturity of

the Term Loans) unless such more favorable terms are added for the benefit of the Term Loans, which

shall not require the consent of the Lenders and any such Incremental Term Loans may contain any

financial maintenance covenants, so long as such covenants are also added for the benefit of the Lenders,

which shall not require consent of the Lenders.

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(a)Each notice from the Borrower pursuant to this Section 2.14 shall set forth the requested

amount and proposed terms of the relevant Incremental Term Loans. Incremental Term Loans may be

made by an existing Lender (and no Term Loan Lender shall have any obligation to make an Incremental

Term Loan) or by any other bank or other financial institution reasonably acceptable to the

Administrative Agent and the Borrower (any such other bank or other financial institution being called an

“Additional Lender”).

(b)Commitments in respect of Incremental Term Loans shall become Commitments under

this Agreement pursuant to an amendment (an “Incremental Amendment”) to this Agreement and, as

appropriate, the other Loan Documents, executed by Parent, the Borrower, each Guarantor, each Lender

agreeing to provide such Commitment, if any, each Additional Lender, if any, and the Administrative

Agent. The Incremental Amendment may, without the consent of any other Lenders, effect such

amendments to this Agreement and the other Loan Documents as may be necessary or appropriate, in the

reasonable opinion of the Administrative Agent and the Borrower, to effect the provisions of this Section

2.14 (including, without limitation, to preserve “fungibility” or to add premiums in respect of existing

Term Loans in connection with an increase to such Term Loans).

(c)This Section 2.14 shall supersede any provisions in Sections 2.13 and 11.01 to the

contrary.

2.15Defaulting Lenders

(a)Adjustments. Notwithstanding anything to the contrary contained in this Agreement, if

any Lender becomes a Defaulting Lender, then, until such time as that Lender is no longer a Defaulting

Lender, to the extent permitted by applicable Law:

(i)Waivers and Amendments. That Defaulting Lender’s right to approve or

disapprove any amendment, waiver or consent with respect to this Agreement shall be restricted

as set forth in Section 11.01.

(ii)Reallocation of Payments. Any payment of principal, interest, fees or other

amounts received by the Administrative Agent for the account of that Defaulting Lender (whether

voluntary or mandatory, at maturity, pursuant to Article IX or otherwise, and including any

amounts made available to the Administrative Agent by that Defaulting Lender pursuant to

Section 11.09), shall be applied at such time or times as may be determined by the Administrative

Agent in consultation with the Borrower as follows: first, to the payment of any amounts owing

by that Defaulting Lender to the Administrative Agent hereunder; second, if so determined by the

Administrative Agent as the Borrower may request (so long as no Default or Event of Default

exists), to the funding of any Loan in respect of which that Defaulting Lender has failed to fund

its portion thereof as required by this Agreement, as determined by the Administrative Agent;

third, if so determined by the Administrative Agent and the Borrower, to be held in a non-interest

bearing deposit account and released in order to satisfy obligations of that Defaulting Lender to

fund Loans under this Agreement; fourth, to the payment of any amounts owing to the Lenders,

as a result of any judgment of a court of competent jurisdiction obtained by any Lender, against

that Defaulting Lender as a result of that Defaulting Lender’s breach of its obligations under this

Agreement; fifth, so long as no Default or Event of Default exists, to the payment of any amounts

owing to the Borrower as a result of any judgment of a court of competent jurisdiction obtained

by the Borrower against that Defaulting Lender as a result of that Defaulting Lender’s breach of

its obligations under this Agreement; and sixth, to that Defaulting Lender or as otherwise directed

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by a court of competent jurisdiction; provided that if (x) such payment is a payment of the

principal amount of any Loans in respect of which that Defaulting Lender has not fully funded its

appropriate share and (y) such Loans were made at a time when the conditions to such Borrowing

were satisfied or waived, such payment shall be applied solely to pay the Loans of all non-

Defaulting Lenders on a pro rata basis prior to being applied to the payment of any Loans of that

Defaulting Lender. Any payments, prepayments or other amounts paid or payable to a Defaulting

Lender that are applied (or held) to pay amounts owed by a Defaulting Lender or to post cash

collateral pursuant to this Section 2.15(a)(ii) shall be deemed paid to and redirected by that

Defaulting Lender, and each Lender irrevocably consents hereto.

(b)Defaulting Lender Cure. If the Borrower, and the Administrative Agent, agree in writing

in their sole discretion that a Defaulting Lender should no longer be deemed to be a Defaulting Lender,

the Administrative Agent will so notify the parties hereto, whereupon as of the effective date specified in

such notice and subject to any conditions set forth therein (which may include arrangements with respect

to any cash collateral), that Lender will, to the extent applicable, purchase that portion of outstanding

Loans of the other Lenders or take such other actions as the Administrative Agent may determine to be

necessary to cause the Loans to be held on a pro rata basis by the Lenders), whereupon that Lender will

cease to be a Defaulting Lender; provided that no adjustments will be made retroactively with respect to

fees accrued or payments made by or on behalf of the Borrower while that Lender was a Defaulting

Lender; and provided, further, that except to the extent otherwise expressly agreed by the affected parties

and subject to Section 11.22, no change hereunder from Defaulting Lender to Lender will constitute a

waiver or release of any claim of any party hereunder arising from that Lender’s having been a Defaulting

Lender.

2.16Refinancing Amendments

(a)Notwithstanding anything to the contrary in this Agreement, the Borrower may by written

notice to the Administrative Agent (which may be in the form of an amendment to this Agreement

pursuant to this Section 2.16) establish one or more additional tranches of term loans under this

Agreement in minimum amounts of $10,000,000 (such loans, “Refinancing Term Loans”), the net

proceeds of which are used to refinance in whole or in part any Class of Term Loans on a pro rata basis (it

being understood that, with the consent of the Borrower and subject to allocation by the Borrower, any

existing Lender holding Term Loans of such Class may elect to convert all or any portion of such Term

Loans into the applicable Refinancing Term Loans on a “cashless roll” basis). Each such notice shall

specify the date (each, a “Refinancing Effective Date”) on which the Borrower proposes that the

Refinancing Term Loans shall be made, which shall be a date not earlier than three (3) Business Days

after the date on which such notice is provided to the Administrative Agent (or such shorter period agreed

to the Administrative Agent); provided that:

(i)the final maturity date of the Refinancing Term Loans shall be no earlier than the

maturity date applicable to the Class of Term Loans being refinanced;

(ii)the Weighted Average Life to Maturity of such Refinancing Term Loans shall be

no shorter than the then-remaining Weighted Average Life to Maturity of the Class of Term

Loans being refinanced (except to the extent of nominal amortization for periods where

amortization has been eliminated or reduced as a result of prepayment of the Class of Term Loans

being refinanced);

(iii)the aggregate principal amount of the Refinancing Term Loans shall not exceed

the outstanding principal amount of the Term Loans being refinanced plus amounts used to pay

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fees, premiums, costs and expenses (including original issue discount) and accrued interest

associated therewith;

(iv)all other terms applicable to such Refinancing Term Loans (other than provisions

relating to premiums, original issue discount, upfront fees, interest rates and any other pricing

terms, which shall be as agreed between the Borrower and the Lenders providing such

Refinancing Term Loans) taken as a whole shall (as determined by the Borrower in good faith) be

substantially similar to, or not more favorable to the lenders of such Refinancing Term Loans

than the terms, taken as a whole, applicable to the Term Loans being refinanced (except (i) to the

extent such covenants and other terms apply to any period after the latest maturity date applicable

to any Class of Term Loans unless such more favorable terms are added for the benefit of the

Term Loans, which shall not require the consent of the Lenders and (ii) a financial maintenance

covenant may be added for the benefit of such Refinancing Term Loans, so long as such financial

maintenance covenant is also added to any other Class of Term Loans that remain outstanding);

(v)there shall be no borrower (other than the Borrower) and no guarantors (other

than the Guarantors) in respect of such Refinancing Term Loans, unless such borrower or

guarantor is an entity organized or formed in the United States and becomes a co-Borrower or

Guarantor (as applicable) under the Loan Documents and is otherwise reasonably acceptable to

the Administrative Agent;

(vi)Refinancing Term Loans shall not be secured by any asset other than the

Collateral; and

(vii)Refinancing Term Loans shall be secured by Collateral on a pari passu basis with

the outstanding Term Loans and may participate on a pro rata basis or on a less than pro rata basis

(but not on a greater than pro rata basis) in any mandatory prepayments or voluntary prepayments

hereunder, as specified in the applicable Refinancing Amendment.

(b)The Borrower may approach any Lender or any other person that would be a permitted

assignee pursuant to Section 11.07 to provide all or a portion of the Refinancing Term Loans; provided,

that any Lender offered or approached to provide all or a portion of the Refinancing Term Loans may

elect or decline, in its sole discretion, to provide a Refinancing Term Loan. Any Refinancing Term Loans

made on any Refinancing Effective Date shall be designated an additional Class of Term Loans for all

purposes of this Agreement; provided, further, that any Refinancing Term Loans may, to the extent

provided in the applicable Refinancing Amendment governing such Refinancing Term Loans, be

designated as an increase in any previously established Class of Term Loans made to the Borrower and in

connection with any such increase, the Borrower may amend, without the consent of any Lender, the

terms of such previously established Class of Term Loans to include premiums and/or to increase the

pricing thereof.

(c)The Borrower and each Lender providing the applicable Refinancing Term Loans shall

execute and deliver to the Administrative Agent an amendment to this Agreement (a “Refinancing

Amendment”) and such other documentation as the Administrative Agent shall reasonably request in

writing. Any Refinancing Amendment shall not require the consent of any Lender other than Lenders

providing such Refinancing Term Loans and may effect such amendments to the Loan Documents as may

be necessary or appropriate, in the reasonable judgment of the Administrative Agent and the Borrower, to

effect the provisions of this Section 2.16. Each Lender providing such Refinancing Term Loans that is not

already a Lender hereunder on the Refinancing Effective Date shall become a Lender under this

Agreement pursuant to the Refinancing Amendment. Each Refinancing Amendment shall be binding on

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the Lenders, the Loan Parties and the other parties hereto. Notwithstanding anything to the contrary set

forth in this Agreement or any other Loan Document (including without limitation this Section 2.16),

there shall be no condition to any incurrence of any Refinancing Term Loan at any time or from time to

time other than those set forth in clause (a) above, as applicable.

(d)The Borrower may replace any Lender that does not consent to convert their Term Loans

in to Refinancing Term Loans in accordance with Section 11.16.

2.17Extended Term Loans

(a)At any time and from time to time after the Effective Date, the Borrower may, upon

notice to the Administrative Agent (which shall promptly notify the Term Loan Lenders or any

Additional Lender, as applicable), request an extension of the Maturity Date or the maturity date

applicable to any Incremental Term Loans, as applicable, then in effect (such existing Maturity Date

being the “Existing Term Loan Maturity Date” and such existing maturity date applicable to any

Incremental Term Loans being the “Existing Incremental Term Loan Maturity Date”) to a date specified

in such notice. Within 10 Business Days of delivery of such notice (or such other period as the Borrower

and the Administrative Agent shall mutually agree upon), each Term Loan Lender or Additional Lender,

as applicable, shall notify the Administrative Agent whether it consents to such extension (which consent

may be given or withheld in such Term Loan Lender’s or Additional Lender’s, as applicable, sole and

absolute discretion). Any Term Loan Lender or Additional Lender, as applicable, not responding within

the above time period shall be deemed not to have consented to such extension. The Administrative

Agent shall promptly notify the Borrower and the Term Loan Lenders or the Additional Lenders of the

Term Loan Lenders’ or the Additional Lenders’ responses, as applicable.

(b)The Maturity Date or Existing Incremental Term Loan Maturity Date, as applicable, shall

be extended only with respect to the Term Loans or Incremental Term Loans, as applicable, held by the

Term Loan Lenders or Additional Lenders, as applicable, that have consented thereto (the Term Loan

Lenders or Additional Lenders, as applicable, that so consent being the “Extending Term Lenders” and

the Term Loan Lenders or Additional Lenders, as applicable, that declined being the “Non-Extending

Term Lenders”) (it being understood and agreed that, except for the consents of the Extending Term

Lenders, no other consents shall be required hereunder for such extensions). If so extended, (A) the

scheduled Maturity Date with respect to the Term Loans held by the Extending Term Lenders shall be

extended to the date specified in the notice referred to in Section 2.17(a) above, which shall become the

new Maturity Date (such date, the “Extended Term Loan Maturity Date”) and (B) the scheduled maturity

date with respect to any Incremental Term Loans held by the Extending Term Lenders shall be extended

to the date specified in the notice referred to in Section 2.17(a) above, which shall become the new

maturity date applicable to such Incremental Term Loans (such date, the “Extended Incremental Term

Loan Maturity Date”). The Administrative Agent and the Borrower shall promptly confirm to (y) the

Term Loan Lenders such extension, specifying the effective date of such extension (the “Term Loan

Extension Effective Date”), the then scheduled Maturity Date and the Extended Term Loan Maturity Date

(after giving effect to such extension) and (z) the applicable Additional Lenders such extension,

specifying the effective date of such extension (the “Incremental Term Loan Extension Effective Date”),

the then scheduled maturity date applicable to such Incremental Term Loans and the Extended

Incremental Term Loan Maturity Date (after giving effect to such extension). The interest margins and/or

“floors” with respect to any Term Loans or Incremental Term Loans, as applicable, extended pursuant to

this Section 2.17 may be different than the interest margins and/or “floors” for the existing Term Loans or

Incremental Term Loans, as applicable, and upfront fees may be paid to the Extending Term Lenders, in

each case to the extent provided in the Borrower’s notice. Except as to interest rates, fees, premiums,

prepayments and final maturity (which shall be subject to this Section 2.17), the terms of the Term Loans

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held by the Extending Term Lenders shall be substantially identical to the terms of the Term Loans held

by the Non-Extending Term Lenders. As a condition precedent to such extension, the Borrower shall

deliver to the Administrative Agent a certificate of the Borrower dated as of the Term Loan Extension

Effective Date or the Incremental Term Loan Extension Effective Date, as applicable, signed by a

Responsible Officer of the Borrower certifying and attaching the resolutions adopted by the Borrower

approving or consenting to such extension and certifying that, before and after giving effect to such

extension, the representations and warranties contained in Article VI made by it are true and correct in all

material respects on and as of the Term Loan Extension Effective Date or the Incremental Term Loan

Extension Effective Date, as applicable, except to the extent that such representations and warranties

specifically refer to an earlier date, and no Default or Event of Default exists or will exist as of the Term

Loan Extension Effective Date or the Incremental Term Loan Extension Effective Date, as applicable.

The Borrower shall pay to the Administrative Agent for the account of each Non-Extending Term Lender

the then unpaid principal amount of such Non-Extending Term Lender’s Term Loans or Incremental

Term Loans, as applicable, outstanding on the Existing Term Loan Maturity Date or the Existing

Incremental Term Loan Maturity Date, as applicable (and pay any additional amounts required pursuant

to Section 2.16). Notwithstanding the terms of Section 11.01, the Borrower and the Administrative Agent

shall be entitled (without the consent of any other Lenders) to enter into any amendments to this

Agreement that the Administrative Agent believes are necessary to appropriately reflect, or provide for

the integration of, any extension of a Maturity Date or maturity date applicable to any Incremental Term

Loans, as applicable, pursuant to this Section 2.17.

(c)The Borrower may replace any Non-Extending Term Lender in accordance with Section

11.16.

2.18Relative Rights Agreement Assignment.

(a)Immediately following the receipt by the Administrative Agent of an amount equal to (i)

(x) the aggregate gross cash proceeds in respect of LeaseCo’s (or any of its Affiliates’) exercise of and

consummation of the Ventas Purchase Option (the “Ventas Purchase Option Gross Proceeds Amount”)

less (y) the aggregate principal amount (the “Ventas Purchase Option ABL Amount”) of loans

outstanding under the Ardent ABL Facility Silo (such amount equal to the Ventas Purchase Option Gross

Proceeds Amount less the Ventas Purchase Option ABL Amount, the “Ventas Purchase Option Term

Loan Amount”), and (ii) all accrued and unpaid interest, fees and other amounts (including amounts

payable under Section 3.05) due on such Ventas Purchase Option Term Loans to and including the date of

such assignment from the Borrower, the Term Loan Lenders shall assign (such assignment, the “Ventas

Purchase Option Assignment”) Term Loans in an aggregate principal amount equal to the Ventas

Purchase Option Term Loan Amount (such Term Loans, the “Ventas Purchase Option Term Loans”) on a

pro rata basis to Ventas or one of its Affiliates (the “Ventas Assignees”). The Ventas Purchase Option

Assignment shall occur immediately upon the receipt by the Administrative Agent of the amounts

described in the immediately preceding sentence and no Assignment and Assumption Agreement shall be

required in connection with such assignment. In addition, in connection with and simultaneously with the

Ventas Purchase Option Assignment, the Term Loan Lenders (other than a Ventas Assignee) and the

Administrative Agent shall (A) assign to the Ventas Assignee (i) all of their rights to and interests in the

guarantees and Liens provided by the Tenant Subsidiaries, (ii) all of the Liens securing the Term Loans

by the pledge of the Capital Stock of the Tenant Subsidiaries and (iii) all of the Liens securing Term

Loans by Collateral of the Tenant Subsidiaries and (B) to the extent applicable, release any right, title and

interest with respect to the Obligations and guarantees of each Tenant Subsidiary (including, if applicable,

the release of such Term Loan Lender’s or Administrative Agent’s right in, title to and liens on the

Collateral of the Tenant Subsidiaries) in respect of any Term Loans held by such Term Loan Lender or

Administrative Agent which are not assigned to the Ventas Assignee in accordance with the foregoing

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clause (A); provided that the relevant Term Loan Lenders and the Administrative Agent shall release and

discharge each Tenant Subsidiary, and its successors and assigns (collectively, the “Tenant Released

Parties”) from any and all claims, causes of action, damages and liabilities of any nature whatsoever

against the Tenant Released Parties which relates, directly or indirectly, to the guarantees, the

Obligations, the Loan Documents or the transactions relating thereto (other than any claims, causes of

action, damages or liabilities related to indemnity obligations, to the extent directly attributable to any

Tenant Subsidiary, in each case, in respect of the guarantees, Obligations, the Loan Documents or the

transactions relating thereto (excluding for the avoidance of doubt, reimbursement of expenses in

connection with amending, negotiating preparing or administering any Loan Documents) from actions

arising prior to the exercise of the Ventas Purchase Option (and unrelated thereto)).

(b)Upon consummation of the Ventas Purchase Option Assignment (i) the Ventas Purchase

Option Term Loans (A) shall be (x) guaranteed by the Loan Parties (other than the Tenant Subsidiaries)

on an unsecured, silent second, passive and fully subordinated (on terms to be mutually agreed among the

Ventas Assignee, the Tenant Subsidiaries, the other Loan Parties, the Required Lenders (excluding the

Ventas Assignee or any Lender of the Ventas Purchase Option Term Loans) and the Administrative

Agent) basis (other than with respect to the pledge of the Capital Stock of the Tenant Subsidiaries) to all

Obligations hereunder, the obligations under the ABL Facility and the 2029 Notes Indenture and certain

other Indebtedness of the Loan Parties subject to the Relative Rights Agreement and (y) guaranteed by

the Tenant Subsidiaries and (B) shall only be secured by Liens on (x) the assets and property of such

Tenant Subsidiaries that constitute Collateral for the Term Loans immediately prior to the Ventas

Purchase Option Assignment and (y) the Capital Stock of the Tenant Subsidiaries; (ii) the Non-Ventas

Purchase Option Term Loans shall not be guaranteed by the Tenant Subsidiaries or be secured by Liens

on any assets or property of the Tenant Subsidiaries or the Capital Stock of the Tenant Subsidiaries (iii)

the borrower of the Ventas Purchase Option Term Loans shall be a Tenant Subsidiary designated by the

Ventas Assignee, (iv) the Ventas Purchase Option Term Loans and the Non-Ventas Purchase Option

Term Loans shall be outstanding under this Agreement as separate Classes of Term Loans, (v) neither the

Ventas Purchase Option Term Loans nor the Non-Ventas Purchase Option Term Loans shall have a

maturity date earlier than the maturity date of the then outstanding Term Loans or a shorter Weighted

Average Life to Maturity than the then outstanding Term Loans, (vi) the Tenant Subsidiaries shall

become Unrestricted Subsidiaries with respect to the Non-Ventas Purchase Option Term Loans (without

being required to satisfy any of the conditions set forth in the definition of “Unrestricted Subsidiaries”)

and (vii) this Agreement shall be amended, amended and restated, supplemented or otherwise modified on

the date of the consummation of the Ventas Purchase Option Assignment by a Ventas Purchase Option

Amendment which documents the terms and conditions of the Ventas Purchase Option Term Loans;

provided that such amendments shall be on terms mutually agreed between the Ventas Assignee and the

Borrower (and to the extent affecting the Administrative Agent, the Administrative Agent) and shall

include, without limitation, the following provisions (1) that the Ventas Purchase Option Term Loans will

deem Parent and each of its Subsidiaries, other than the Tenant Subsidiaries as Unrestricted Subsidiaries,

(2) limitations on the incurrence of Liens on and pledges in respect of the Capital Stock of Tenant

Subsidiaries, (3) separate voting and consent rights with respect to the Non-Ventas Purchase Option Term

Loans and the Ventas Purchase Option Term Loans and any other provisions necessary to ensure that the

Non-Ventas Purchase Option Term Loans and the Ventas Purchase Option Term Loans are separate

Classes of Term Loans hereunder (including, without limitation, permitting non-pro rata mandatory and

voluntary payments between each such class of Term Loans) and (4) provide for “cross defaults” between

the Non-Ventas Purchase Option Term Loans and the Ventas Purchase Option Term Loans; provided that

such amendments shall not directly or indirectly affect the Term Loan Lenders holding Non-Ventas

Purchase Option Term Loans other than to provide that the Non-Ventas Purchase Option Term Loans and

Ventas Purchase Option Term Loans shall be treated as separate Classes of Term Loans and to provide

“cross defaults” contemplated by clause (4) above; provided further that, for the avoidance of doubt,

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additional covenants and restrictions solely with respect to the Tenant Subsidiaries shall not be deemed to

directly or indirectly affect the Term Loan Lenders holding Non-Ventas Purchase Option Term Loans.

(c)Notwithstanding the foregoing, concurrently with consummation of the Ventas Purchase

Option, the Borrower, the Guarantors, the Ventas Assignee, the Ventas Purchase Option Term Loan

Agent and the Administrative Agent shall execute and deliver an amendment, amendment and

restatement, supplement or other modification to this Agreement (the “Ventas Purchase Option

Amendment”) and such other documentation as the Administrative Agent or the Ventas Purchase Option

Term Loan Agent shall reasonably request (including as set forth in clause (b) above). Any Ventas

Purchase Option Amendment shall not require the consent of any Lender and may effect such

amendments to the Loan Documents as may be necessary or appropriate, in the reasonable judgment of

the Administrative Agent, the Ventas Purchase Option Term Loan Agent, the Borrower and the Ventas

Assignee, to effect the provisions of this Section 2.18; provided that except as set forth in this Section

2.18, the terms applicable to the Non-Ventas Purchase Option Term Loans immediately after giving effect

to such Ventas Purchase Option Amendment shall not be any less favorable to Term Loan Lenders

holding Non-Ventas Purchase Option Term Loans than the terms applicable to such Term Loans

immediately prior to giving effect to such Ventas Purchase Option Amendment. The Ventas Purchase

Option Amendment shall be binding on the Lenders, Ventas, the Loan Parties and the other parties hereto.

ARTICLE III

TAXES, YIELD PROTECTION AND ILLEGALITY

3.01Taxes

(a)Unless required by Law (as determined in good faith by the applicable withholding agent),

any and all payments by any Loan Party to or for the account of the Administrative Agent or any Lender

under any Loan Document shall be made free and clear of and without deduction or withholding for any

and all present or future Taxes. If the applicable withholding agent shall be required by any Laws to

deduct any Taxes from or in respect of any sum payable under any Loan Document to the Administrative

Agent or any Lender, (i) if the Tax in question is an Indemnified Tax or an Other Tax, the sum payable by

the applicable Loan Party shall be increased as necessary so that after all required deductions (including

deductions applicable to additional sums payable under this Section 3.01) have been made, each Lender

(or in the case of a payment made to the Administrative Agent for its own account, the Administrative

Agent) receives an amount equal to the sum it would have received had no such deductions been made,

(ii) the applicable withholding agent shall make such deductions, (iii) the applicable withholding agent

shall timely pay the full amount deducted to the relevant taxation authority or other authority in

accordance with applicable Laws, and (iv) within thirty days after the date of such payment, the

applicable Loan Party (if the Loan Party is the applicable withholding agent) shall furnish to the

Administrative Agent (which shall forward the same to such Lender) the original or a certified copy of a

receipt evidencing payment thereof, or if no receipt is available, other evidence of payment reasonably

satisfactory to the Administrative Agent.

(b)In addition, the Borrower agrees to pay any and all present or future stamp, court or

documentary Taxes and any other excise, property or similar Taxes which arise from any payment made

under any Loan Document or from the execution, delivery, performance, enforcement or registration of,

or otherwise with respect to, any Loan Document (hereinafter referred to as “Other Taxes”).

(c)The Borrower agrees to indemnify the Administrative Agent and each Lender for (i) the

full amount of Indemnified Taxes and Other Taxes (including any Indemnified Taxes or Other Taxes

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imposed or asserted by any jurisdiction on amounts payable under this Section 3.01) paid or payable by

the Administrative Agent and such Lender and (ii) any liability (including additions to Tax, penalties,

interest and expenses) arising therefrom or with respect thereto, in each case whether or not such

Indemnified Taxes or Other Taxes were correctly or legally imposed or asserted by the relevant

Governmental Authority. Payment under this Section 3.01(c) shall be made within thirty days after the

date the Lender or the Administrative Agent makes a demand therefor.

(d)If any Lender determines, in its good faith discretion, that it has received a refund of any

Indemnified Taxes or Other Taxes as to which it has been indemnified by the Borrower or with respect to

which any Loan Party has paid additional amounts pursuant to this Section 3.01, it shall pay (subject to

the Lender’s right of set-off) over such refund to the Borrower or such Loan Party (but only to the extent

of indemnity payments made, or additional amounts paid, by such Person under this Section 3.01 with

respect to the Indemnified Taxes or Other Taxes giving rise to such refund), net of all reasonable and

documented out-of-pocket expenses (including Taxes) of the Lender and without interest (other than any

interest paid by the relevant Governmental Authority with respect to such refund net of any Taxes

payable by such Lender); provided that the Borrower or any Loan Party, upon the request of the Lender,

agrees to repay the amount paid over to such Person (plus any penalties, interest or other charges imposed

by the relevant Governmental Authority) to the Lender in the event the Lender is required to repay such

refund to such Governmental Authority. This Section 3.01(d) shall not be construed to require the Lender

to make available its tax returns (or any other information relating to its Taxes which it deems

confidential) to the Borrower or any other Person.

(e)Each Lender shall, at such times as are reasonably requested by the Borrower or the

Administrative Agent, provide the Borrower and the Administrative Agent with any documentation

prescribed by Law, or reasonably requested by the Borrower or the Administrative Agent, certifying as to

any entitlement of such Lender to an exemption from, or reduction in, any withholding Tax with respect

to any payments to be made to such Lender under the Loan Documents. Each such Lender shall,

whenever a lapse in time or change in circumstances renders such documentation (including any specific

documentation required below in this Section 3.01(e)) expired, obsolete or inaccurate in any material

respect, deliver promptly to the Borrower and the Administrative Agent updated or other appropriate

documentation (including any new documentation reasonably requested by the applicable withholding

agent) or promptly notify the Borrower and the Administrative Agent of its legal ineligibility to do so.

Unless the applicable withholding agent has received forms or other documents satisfactory to it

indicating that payments under any Loan Document to or for a Lender are not subject to withholding tax

or are subject to such Tax at a rate reduced by an applicable tax treaty, the Borrower, Administrative

Agent or other applicable withholding agent may withhold amounts required to be withheld by applicable

Law from such payments at the applicable statutory rate. Each Lender hereby authorizes the

Administrative Agent to deliver to the Borrower and to any successor Administrative Agent any

documentation provided to the Administrative Agent pursuant to this Section 3.01(e).

Without limiting the generality of the foregoing:

(i)Each Lender that is a United States person (as defined in Section 7701(a)(30) of

the Internal Revenue Code) shall deliver to the Borrower and the Administrative Agent on or

before the date on which it becomes a party to this Agreement two properly completed and duly

signed original copies of Internal Revenue Service Form W-9 (or any successor form) certifying

that such Lender is exempt from U.S. federal backup withholding.

(ii)Each Lender that is not a United States person (as defined in Section 7701(a)(30)

of the Internal Revenue Code) shall deliver to the Borrower and the Administrative Agent on or

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before the date on which it becomes a party to this Agreement (and from time to time thereafter

when required by Law or upon the reasonable request of the Borrower or the Administrative

Agent) whichever of the following is applicable:

(I)two duly completed copies of Internal Revenue Service Form W-8BEN

or W-8BEN-E (or any successor forms) claiming eligibility for benefits of an income tax

treaty to which the United States of America is a party;

(II)two duly completed copies of Internal Revenue Service Form W-8ECI

(or any successor forms);

(III)in the case of a Lender claiming the benefits of the exemption for portfolio

interest under Section 881(c) of the Internal Revenue Code, (x) a certificate, in

substantially the form of Exhibit O (any such certificate a “United States Tax Compliance

Certificate”), or any other form approved by the Administrative Agent, to the effect that

such Lender is not (A) a “bank” within the meaning of Section 881(c)(3)(A) of the

Internal Revenue Code, (B) a “10 percent shareholder” of a Borrower within the meaning

of Section 881(c)(3)(B) of the Internal Revenue Code, or (C) a “controlled foreign

corporation” described in Section 881(c)(3)(C) of the Internal Revenue Code, and that no

payments in connection with the Loan Documents are effectively connected with such

Lender’s conduct of a U.S. trade or business and (y) two duly completed copies of

Internal Revenue Service Form W-8BEN or W-8BEN-E (or any successor forms);

(IV)to the extent a Lender is not the beneficial owner (for example, where the

Lender is a partnership, or is a Participant holding a participation granted by a

participating Lender), Internal Revenue Service Form W-8IMY (or any successor forms)

of the Lender, accompanied by a Form W-8ECI, W-8BEN or W-8BEN-E, United States

Tax Compliance Certificate, Form W-9, Form W-8IMY (or other successor forms) or any

other required information from each beneficial owner, as applicable (provided that, if the

Lender is a partnership (and not a participating Lender) and one or more direct or indirect

partner(s) are claiming the portfolio interest exemption, the United States Tax

Compliance Certificate shall be provided by such Lender on behalf of such direct or

indirect partner(s)); or

(V)any other form prescribed by applicable requirements of U.S. federal

income tax law as a basis for claiming exemption from or a reduction in U.S. federal

withholding Tax duly completed together with such supplementary documentation as

may be prescribed by applicable requirements of Law to permit the Borrower and the

Administrative Agent to determine the withholding or deduction required to be made.

Notwithstanding any other provision of this Section 3.01(e), a Lender shall not be required to

deliver any form that such Lender is not legally eligible to deliver.

(f)If a payment made to a Lender under any Loan Document would be subject to U.S.

federal withholding Tax imposed by FATCA if such Lender were to fail to comply with the applicable

reporting requirements of FATCA (including those contained in Section 1471(b) or 1472(b) of the

Internal Revenue Code, as applicable), such Lender shall deliver to the Borrower and the Administrative

Agent at the time or times prescribed by law and at such time or times reasonably requested by the

Borrower or the Administrative Agent such documentation prescribed by applicable law (including as

prescribed by Section 1471(b)(3)(C)(i) of the Internal Revenue Code) and such additional documentation

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reasonably requested by the Borrower or the Administrative Agent as may be necessary for the Borrower

and the Administrative Agent to comply with their obligations under FATCA, to determine that such

Lender has complied with such Lender’s obligations under FATCA and to determine the amount, if any,

to deduct and withhold from such payment. Solely for purposes of this clause (f), “FATCA” shall include

any amendments made to FATCA after the date of this Agreement.

(g)If the Borrower (or any other Loan Party) is required to pay any amount to any Lender or

the Administrative Agent pursuant to this Section 3.01, then such Lender shall use reasonable efforts

(consistent with legal and regulatory restrictions) to change the jurisdiction of its Lending Office so as to

eliminate any such additional payment which may thereafter accrue, if such change in the sole reasonable

judgment of such Lender (i) is not otherwise disadvantageous to such Lender and (ii) would not result in

any unreimbursed cost or expense to such Lender.

(h)For the avoidance of doubt, any payments made by the Administrative Agent to any

Lender shall be treated as payments made by the applicable Loan Party.

3.02Illegality

If any Lender determines that any Law has made it unlawful, or that any Governmental Authority

has asserted that it is unlawful, for any Lender or its applicable Lending Office to make, maintain or fund

Term SOFR Loans, or to determine or charge interest rates based upon Term SOFR, then, on notice

thereof by such Lender to the Borrower through the Administrative Agent, any obligation of such Lender

to make or continue Term SOFR Loans or to convert Base Rate Loans to Term SOFR Loans shall be

suspended until such Lender notifies the Administrative Agent and the Borrower that the circumstances

giving rise to such determination no longer exist. Upon receipt of such notice, the Borrower shall, upon

demand from such Lender (with a copy to the Administrative Agent), prepay or, if applicable, convert all

Term SOFR Loans of such Lender to Base Rate Loans, either on the last day of the Interest Period

therefor, if such Lender may lawfully continue to maintain such Term SOFR Loans to such day, or

immediately, if such Lender may not lawfully continue to maintain such Term SOFR Loans. Upon any

such prepayment or conversion, the Borrower shall also pay accrued interest on the amount so prepaid or

converted. Each Lender agrees to designate a different Lending Office if such designation will avoid the

need for such notice and will not, in the good faith judgment of such Lender, otherwise be materially

disadvantageous to such Lender.

3.03Inability To Determine Rates

(a)If in connection with any request for a Term SOFR Loan or a conversion to or

continuation thereof, (i) the Administrative Agent determines that (A) Dollar deposits are not being

offered to banks in the relevant interbank market for the applicable amount and Interest Period of such

Term SOFR Loan, or (B) (x) adequate and reasonable means do not exist for determining Term SOFR for

any requested Interest Period with respect to a proposed Term SOFR Loan or in connection with an

existing or proposed Base Rate Loan and (y) the circumstances described in Section 3.03(c)(i) do not

apply (in each case with respect to this clause (i), “Impacted Loans”), or (ii) the Administrative Agent or

the Required Lenders determine that for any reason Term SOFR for any requested Interest Period with

respect to a proposed Term SOFR Loan does not adequately and fairly reflect the cost to such Lenders of

funding such Term SOFR Loan, the Administrative Agent will promptly so notify the Borrower and each

Lender. Thereafter, (x) the obligation of the Lenders to make or maintain Term SOFR Loans shall be

suspended (to the extent of the affected Term SOFR Loans or Interest Periods), and (y) in the event of a

determination described in the preceding sentence with respect to the Term SOFR component of the Base

Rate, the utilization of the Term SOFR component in determining the Base Rate shall be suspended, in

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each case until the Administrative Agent (or, in the case of a determination by the Required Lenders

described in clause (ii) of Section 3.03(a), until the Administrative Agent upon instruction of the Required

Lenders) revokes such notice. Upon receipt of such notice, the Borrower may revoke any pending

request for a Borrowing of, conversion to or continuation of Term SOFR Loans (to the extent of the

affected Term SOFR Loans or Interest Periods) or, failing that, will be deemed to have converted such

request into a request for a Borrowing of Base Rate Loans in the amount specified therein.

(b)Notwithstanding the foregoing, if the Administrative Agent has made the determination

described in clause (i) of Section 3.03(a), the Administrative Agent, in consultation with the Borrower,

may establish an alternative interest rate for the Impacted Loans, in which case, such alternative rate of

interest shall apply with respect to the Impacted Loans until (i) the Administrative Agent revokes the

notice delivered with respect to the Impacted Loans under clause (i) of the first sentence of Section

3.03(a), (ii) the Administrative Agent or the Required Lenders notify the Administrative Agent and the

Borrower that such alternative interest rate does not adequately and fairly reflect the cost to such Lenders

of funding the Impacted Loans, or (iii) any Lender determines that any Law has made it unlawful, or that

any Governmental Authority has asserted that it is unlawful, for such Lender or its applicable Lending

Office to make, maintain or fund Loans whose interest is determined by reference to such alternative rate

of interest or to determine or charge interest rates based upon such rate or any Governmental Authority

has imposed material restrictions on the authority of such Lender to do any of the foregoing and provides

the Administrative Agent and the Borrower written notice thereof.

(c)Notwithstanding anything to the contrary herein or in any other Loan Document:

(i)[Reserved].

(ii)Upon the occurrence of a Benchmark Transition Event, the Benchmark

Replacement will replace the then-current Benchmark for all purposes hereunder and under any

Loan Document in respect of any Benchmark setting at or after 5:00 p.m. on the fifth (5th)

Business Day after the date notice of such Benchmark Replacement is provided to the Lenders

without any amendment to, or further action or consent of any other party to, this Agreement or

any other Loan Document so long as the Administrative Agent has not received, by such time,

written notice of objection to such Benchmark Replacement from Lenders comprising the

Required Lenders (and any such objection shall be conclusive and binding absent manifest error);

provided that solely in the event that the then-current Benchmark at the time of such Benchmark

Transition Event is Term SOFR, the Benchmark Replacement therefor shall be the sum of (x)

Daily Simple SOFR and (y) 0.11448% (11.448 basis points), unless the Administrative Agent

determines that such alternative rate is not available. If the Benchmark Replacement is Daily

Simple SOFR, all interest payments will be payable on a monthly basis.

(iii)At any time that the administrator of the then-current Benchmark has

permanently or indefinitely ceased to provide such Benchmark or such Benchmark has been

announced by the regulatory supervisor for the administrator of such Benchmark pursuant to

public statement or publication of information to be no longer representative of the underlying

market and economic reality that such Benchmark is intended to measure and that

representativeness will not be restored, the Borrower may revoke any request for a borrowing of,

conversion to or continuation of Loans to be made, converted or continued that would bear

interest by reference to such Benchmark until the Borrower’s receipt of notice from the

Administrative Agent that a Benchmark Replacement has replaced such Benchmark, and, failing

that, the Borrower will be deemed to have converted any such request into a request for a

borrowing of or conversion to Base Rate Loans. During the period referenced in the foregoing

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sentence, the component of Base Rate based upon the Benchmark will not be used in any

determination of Base Rate.

(iv)In connection with the implementation and administration of a Benchmark

Replacement, the Administrative Agent will have the right to make Benchmark Replacement

Conforming Changes from time to time and, notwithstanding anything to the contrary herein or in

any other Loan Document, any amendments implementing such Benchmark Replacement

Conforming Changes will become effective without any further action or consent of any other

party to this Agreement.

(v)The Administrative Agent will promptly notify the Borrower and the Lenders of

(A) the implementation of any Benchmark Replacement and (B) the effectiveness of any

Benchmark Replacement Conforming Changes. Any determination, decision or election that may

be made by the Administrative Agent pursuant to this Section 3.03(c), including any

determination with respect to a tenor, rate or adjustment or of the occurrence or non-occurrence

of an event, circumstance or date and any decision to take or refrain from taking any action, will

be conclusive and binding absent manifest error and may be made in its sole discretion and

without consent from any other party hereto, except, in each case, as expressly required pursuant

to this Section 3.03(c).

(vi)At any time (including in connection with the implementation of a Benchmark

Replacement), (A) if the then-current Benchmark is a term rate (including Term SOFR), then the

Administrative Agent may remove any tenor of such Benchmark that is unavailable or non-

representative for Benchmark (including Benchmark Replacement) settings and (B) the

Administrative Agent may reinstate any such previously removed tenor for Benchmark (including

Benchmark Replacement) settings.

3.04Increased Cost and Reduced Return; Capital Adequacy

(a)If any Lender determines that as a result of the introduction of or any change in or in the

interpretation of any Law, or such Lender’s compliance therewith, there shall be any increase in the cost

to such Lender of agreeing to make or making, funding or maintaining Term SOFR Loans, or a reduction

in the amount received or receivable by such Lender in connection with any of the foregoing (excluding

for purposes of this Section 3.04(a) any such increased costs or reduction in amount resulting from (i)

Indemnified Taxes or Other Taxes indemnifiable under Section 3.01 or any Excluded Taxes and (ii)

reserve requirements utilized, as to Term SOFR Loans, in the determination of Term SOFR), then from

time to time upon demand of such Lender (with a copy of such demand to the Administrative Agent), the

Borrower shall pay to such Lender such additional amounts as will compensate such Lender for such

increased cost or reduction; provided that, notwithstanding anything herein to the contrary, (x) the Dodd-

Frank Wall Street Reform and Consumer Protection Act and all requests, rules, guidelines or directives

thereunder or issued in connection therewith and (y) all requests, rules, guidelines or directives

promulgated by the Bank for International Settlements, the Basel Committee on Banking Supervision (or

any successor or similar authority) or the United States or foreign regulatory authorities, in each case in

this clause (y) pursuant to Basel III, shall in each case in this proviso be deemed to be a change in or in

the interpretation of Law, regardless of the date enacted, adopted or issued.

(b)If any Lender determines that the introduction of any Law regarding capital adequacy or

liquidity or any change therein or in the interpretation thereof, or compliance by such Lender (or its

Lending Office) therewith, has the effect of reducing the rate of return on the capital of such Lender or

any corporation controlling such Lender as a consequence of such Lender’s obligations hereunder (taking

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into consideration its policies with respect to capital adequacy or liquidity and such Lender’s desired

return on capital), then from time to time upon demand of such Lender (with a copy of such demand to

the Administrative Agent), the Borrower shall pay to such Lender such additional amounts as will

compensate such Lender for such reduction; provided that, notwithstanding anything herein to the

contrary, (x) the Dodd-Frank Wall Street Reform and Consumer Protection Act and all requests, rules,

guidelines or directives thereunder or issued in connection therewith and (y) all requests, rules, guidelines

or directives promulgated by the Bank for International Settlements, the Basel Committee on Banking

Supervision (or any successor or similar authority) or the United States or foreign regulatory authorities,

in each case in this clause (y) pursuant to Basel III, shall in each case in this proviso be deemed to be such

a change in or in the interpretation of Law, regardless of the date enacted, adopted or issued.

3.05Funding Losses

Promptly upon demand of any Lender (with a copy to the Administrative Agent) from time to

time, the Borrower shall promptly compensate such Lender for and hold such Lender harmless from any

loss, cost or expense incurred by it as a result of:

(a)any continuation, conversion, payment or prepayment of any Loan other than a

Base Rate Loan on a day other than the last day of the Interest Period for such Loan (whether

voluntary, mandatory, automatic, by reason of acceleration, or otherwise);

(b)any failure by the Borrower (for a reason other than the failure of such Lender to

make a Loan) to prepay, borrow, continue or convert any Loan other than a Base Rate Loan on

the date or in the amount notified by the Borrower; or

(c)an assignment of a Term SOFR Loan on a day other than the last day of the

Interest Period therefor as a result of a request by the Borrower pursuant to Section 11.16;

including any foreign exchange losses and any loss or expense arising from the liquidation or

reemployment of funds obtained by it to maintain such Loan (excluding any loss of anticipated profits) or

from fees payable to terminate the deposits from which such funds were obtained. The Borrower shall

also pay any customary administrative fees charged by such Lender in connection with the foregoing.

For purposes of calculating amounts payable by the Borrower to the Lenders under this Section

3.05, each Lender shall be deemed to have funded each Term SOFR Loan made by it at Term SOFR used

in determining Term SOFR for such Loan by a matching deposit or other borrowing in the applicable

offshore interbank market for a comparable amount and for a comparable period, whether or not such

Term SOFR Loan was in fact so funded.

3.06Matters Applicable to All Requests for Compensation

(a)A certificate of the Administrative Agent or any Lender claiming compensation under this

Article III and setting forth in reasonable detail the additional amount or amounts to be paid to it

hereunder shall be conclusive in the absence of manifest error. In determining such amount, the

Administrative Agent or such Lender may use any reasonable averaging and attribution methods.

Notwithstanding anything in this Agreement to the contrary, to the extent any notice required under this

Article III is given by the Administrative Agent or any Lender more than 90 days after the Administrative

Agent or such Lender has knowledge (or should have had knowledge) of the occurrence of the event

giving rise to the additional cost, reduction in amounts, loss, or other additional amounts described in this

Article III, the Administrative Agent or such Lender shall not be entitled to compensation under this

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Article III for any such amounts incurred or accruing prior to the 91st day prior to the giving of such

notice to the Borrower.

(b)Upon any Lender’s making a claim for compensation under Section 3.01 or 3.04, the

Borrower may replace such Lender in accordance with Section 11.16.

3.07Survival

All of the Borrower’s obligations under this Article III shall survive termination of the

Commitments and repayment of all other Obligations hereunder.

ARTICLE IV

GUARANTY

4.01The Guaranty

Subject to Section 4.08, each of the Guarantors hereby jointly and severally guarantees to each

Lender and the Administrative Agent as hereinafter provided, as primary obligor and not as surety, the

prompt payment of the Obligations in full when due (whether at stated maturity, as a mandatory

prepayment, by acceleration, as a mandatory cash collateralization or otherwise) strictly in accordance

with the terms thereof. Subject to Section 4.08, the Guarantors hereby further agree that if any of the

Obligations are not paid in full when due (whether at stated maturity, as a mandatory prepayment, by

acceleration, as a mandatory cash collateralization or otherwise), the Guarantors will, jointly and

severally, promptly pay the same, without any demand or notice whatsoever, and that in the case of any

extension of time of payment or renewal of any of the Obligations, the same will be promptly paid in full

when due (whether at extended maturity, as a mandatory prepayment, by acceleration, as a mandatory

cash collateralization or otherwise) in accordance with the terms of such extension or renewal.

Subject to Section 4.08, notwithstanding any provision to the contrary contained herein or in any

other of the Loan Documents, the obligations of each Guarantor under this Agreement and the other Loan

Documents shall be limited to an aggregate amount equal to the largest amount that would not render

such obligations subject to avoidance under the Debtor Relief Laws or any comparable provisions of any

applicable state law.

4.02Obligations Unconditional

The obligations of the Guarantors under Section 4.01 are joint and several, absolute and

unconditional, irrespective of the value, genuineness, validity, regularity or enforceability of any of the

Loan Documents, or any other agreement or instrument referred to therein, or any substitution, release,

impairment or exchange of any other guarantee of or security for any of the Obligations, and, to the

fullest extent permitted by applicable law, irrespective of any other circumstance whatsoever which might

otherwise constitute a legal or equitable discharge or defense (other than a defense of payment) of a

surety or guarantor, it being the intent of this Section 4.02 that the obligations of the Guarantors

hereunder shall be absolute and unconditional under any and all circumstances. Each Guarantor agrees

that such Guarantor shall not exercise any right of subrogation, indemnity, reimbursement or contribution

against the Borrower or any other Guarantor for amounts paid under this Article IV until such time as the

Obligations have been paid in full and the Commitment have expired or terminated. Without limiting the

generality of the foregoing, it is agreed that, to the fullest extent permitted by applicable law, the

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occurrence of any one or more of the following shall not alter or impair the liability of any Guarantor

hereunder, which shall remain absolute and unconditional as described above:

(a)at any time or from time to time, without notice to any Guarantor, the time for

any performance of or compliance with any of the Obligations shall be extended, or such

performance or compliance shall be waived;

(b)any of the acts mentioned in any of the provisions of any of the Loan Documents

or any other agreement or instrument referred to in the Loan Documents shall be done or omitted;

(c)the maturity of any of the Obligations shall be accelerated, or any of the

Obligations shall be modified, supplemented or amended in any respect, or any right under any of

the Loan Documents or any other agreement or instrument referred to in the Loan Documents

shall be waived or any other guarantee of any of the Obligations or any security therefor shall be

released, impaired or exchanged in whole or in part or otherwise dealt with;

(d)any Lien granted to, or in favor of, the Administrative Agent or any Lender or

Lenders as security for any of the Obligations shall fail to attach or be perfected;

(e)any of the Obligations shall be determined to be void or voidable (including,

without limitation, for the benefit of any creditor of any Guarantor) or shall be subordinated to

the claims of any Person (including, without limitation, any creditor of any Guarantor);

(f)any change in the corporate existence, structure or ownership of the Borrower, or

any insolvency, bankruptcy, reorganization or other similar proceeding affecting the Borrower or

its assets or any resulting release or discharge of any obligation of the Borrower contained in this

Agreement or any other Loan Document;

(g)the existence of any claim, setoff or other rights which any Guarantor may have

at any time against the Borrower, the Lenders, the Administrative Agent or any other Person,

whether in connection herewith or any unrelated transactions; or

(h)any invalidity or unenforceability relating to or against any Guarantor for any

reason of any Loan Document, or any provision of applicable law, regulation or order purporting

to prohibit the payment by any Guarantor of the principal of or interest on any Term Note or any

other amount payable by any Guarantor under any Loan Document.

With respect to its obligations hereunder, to the extent permitted under applicable law, each

Guarantor hereby expressly waives diligence, presentment, demand of payment, protest and all notices

whatsoever, and any requirement that the Administrative Agent or any Lender exhaust any right, power or

remedy or proceed against any Person under any of the Loan Documents or any other agreement or

instrument referred to in the Loan Documents or against any other Person under any other guarantee of,

or security for, any of the Obligations.

4.03Reinstatement

The obligations of the Guarantors under this Article IV shall be automatically reinstated if and to

the extent that for any reason any payment by or on behalf of any Person in respect of the Obligations is

rescinded or must be otherwise restored by any holder of any of the Obligations, whether as a result of

any proceedings in bankruptcy or reorganization or otherwise, and each Guarantor agrees that it will

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indemnify the Administrative Agent and each Lender on demand for all reasonable and documented out-

of-pocket costs and expenses (including, without limitation, Attorney Costs) incurred by the

Administrative Agent or such Lender in connection with such rescission or restoration, including any

such reasonable and documented out-of-pocket costs and expenses incurred in defending against any

claim alleging that such payment constituted a preference, fraudulent transfer or similar payment under

any bankruptcy, insolvency or similar law.

4.04Certain Additional Waivers

Without limiting the generality of the provisions of this Article IV, each Guarantor hereby agrees

that such Guarantor shall have no right of recourse to security for the Obligations, except through the

exercise of rights of subrogation pursuant to Section 4.02 and through the exercise of rights of

contribution pursuant to Section 4.06.

4.05Remedies

The Guarantors agree that, to the fullest extent permitted by applicable law, as between the

Guarantors, on the one hand, and the Administrative Agent and the Lenders, on the other hand, the

Obligations may be declared to be forthwith due and payable as provided in Section 9.02 (and shall be

deemed to have become automatically due and payable in the circumstances provided in said Section

9.02) for purposes of Section 4.01 notwithstanding any stay, injunction or other prohibition preventing

such declaration (or preventing the Obligations from becoming automatically due and payable) as against

any other Person and that, in the event of such declaration (or the Obligations being deemed to have

become automatically due and payable), the Obligations (whether or not due and payable by any other

Person) shall forthwith become due and payable by the Guarantors for purposes of Section 4.01. The

Guarantors acknowledge and agree that their obligations hereunder are secured in accordance with the

terms of the Collateral Documents and that the Lenders may exercise their remedies thereunder in

accordance with the terms thereof.

4.06Rights of Contribution

Subject to Section 4.08, the Guarantors hereby agree as among themselves that, if any Guarantor

shall make an Excess Payment (as defined below), such Guarantor shall have a right of contribution from

each other Guarantor in an amount equal to such other Guarantor’s Contribution Share (as defined below)

of such Excess Payment. The payment obligations of any Guarantor under this Section 4.06 shall be

subordinate and subject in right of payment to the Obligations until such time as the Obligations have

been paid in full and the Commitments have expired or terminated, and none of the Guarantors shall

exercise any right or remedy under this Section 4.06 against any other Guarantor until such Obligations

have been paid in full and the Commitments have expired or terminated. For purposes of this Section

4.06, (a) “Excess Payment” shall mean the amount paid by any Guarantor in excess of its Ratable Share

of any Guaranteed Obligations; (b) “Ratable Share” shall mean, for any Guarantor in respect of any

payment of Obligations, the ratio (expressed as a percentage) as of the date of such payment of

Guaranteed Obligations of (i) the amount by which the aggregate present fair salable value of all of its

assets and properties exceeds the amount of all debts and liabilities of such Guarantor (including

contingent, subordinated, unmatured, and unliquidated liabilities, but excluding the obligations of such

Guarantor hereunder) to (ii) the amount by which the aggregate present fair salable value of all assets and

other properties of all of the Loan Parties exceeds the amount of all of the debts and liabilities (including

contingent, subordinated, unmatured, and unliquidated liabilities, but excluding the obligations of the

Loan Parties hereunder) of the Loan Parties; provided, however, that, for purposes of calculating the

Ratable Shares of the Guarantors in respect of any payment of Obligations, any Guarantor that became a

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Guarantor subsequent to the date of any such payment shall be deemed to have been a Guarantor on the

date of such payment and the financial information for such Guarantor as of the date such Guarantor

became a Guarantor shall be utilized for such Guarantor in connection with such payment; (c)

“Contribution Share” shall mean, for any Guarantor in respect of any Excess Payment made by any other

Guarantor, the ratio (expressed as a percentage) as of the date of such Excess Payment of (i) the amount

by which the aggregate present fair salable value of all of its assets and properties exceeds the amount of

all debts and liabilities of such Guarantor (including contingent, subordinated, unmatured, and

unliquidated liabilities, but excluding the obligations of such Guarantor hereunder) to (ii) the amount by

which the aggregate present fair salable value of all assets and other properties of the Loan Parties other

than the maker of such Excess Payment exceeds the amount of all of the debts and liabilities (including

contingent, subordinated, unmatured, and unliquidated liabilities, but excluding the obligations of the

Loan Parties) of the Loan Parties other than the maker of such Excess Payment; provided, however, that,

for purposes of calculating the Contribution Shares of the Guarantors in respect of any Excess Payment,

any Guarantor that became a Guarantor subsequent to the date of any such Excess Payment shall be

deemed to have been a Guarantor on the date of such Excess Payment and the financial information for

such Guarantor as of the date such Guarantor became a Guarantor shall be utilized for such Guarantor in

connection with such Excess Payment; and (d) “Guaranteed Obligations” shall mean the Obligations

guaranteed by the Guarantors pursuant to this Article IV. This Section 4.06 shall not be deemed to affect

any right of subrogation, indemnity, reimbursement or contribution that any Guarantor may have under

Law against the Borrower in respect of any payment of Guaranteed Obligations. Notwithstanding the

foregoing, all rights of contribution against any Guarantor shall terminate from and after such time, if

ever, that such Guarantor shall be relieved of its obligations in accordance with Section 10.11.

4.07Guarantee of Payment; Continuing Guarantee

The guarantee in this Article IV is a guaranty of payment and not of collection, is a continuing

guarantee, and shall apply to all Obligations whenever arising.

4.08Limited Guarantee by Tenant Subsidiaries.

So long as the Relative Rights Agreement is in effect, (i) the principal amount of Indebtedness

guaranteed in this Article IV provided by the Tenant Subsidiaries in the aggregate, together with the

principal amount of all other Indebtedness subject to the Relative Rights Agreement guaranteed by the

Tenant Subsidiaries, shall not exceed $375,000,000 and any guarantee by the Tenant Subsidiaries in

excess of such amount shall be null and void and (ii) each Lender hereby acknowledges and agrees to the

automatic assignment (the “Tenant Subsidiary Guarantee Assignment”) of the guarantees provided by the

Tenant Subsidiaries under this Agreement of the Term Loans to the Ventas Assignee in respect of the

Ventas Purchase Option Term Loans upon the consummation of the Ventas Purchase Option and

assignment of the Ventas Purchase Option Term Loans pursuant to Section 2.18. It is further

acknowledged and agreed that after giving effect to the Tenant Subsidiary Guarantee Assignment, the

Non-Ventas Purchase Option Term Loans shall no longer receive the benefit of guarantees from the

Tenant Subsidiaries.

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ARTICLE V

CONDITIONS PRECEDENT

5.01Conditions to Effective Date

The effectiveness of this Agreement is subject to satisfaction or waiver of the following

conditions precedent:

(a)Loan Documents. The Administrative Agent shall have received (A) duly

executed counterparts of the Amendment and Restatement Agreement from Parent, the Borrower,

the Guarantors, each Initial Term Lender, the Administrative Agent and the Resigning

Administrative Agent and (B) duly executed copies of (i) the Successor Agency Agreement and

(ii) the Other Appointment and Resignation Documentation.

(b)Opinions of Counsel. Receipt by the Administrative Agent of a favorable opinion

of each of (i) Sidley Austin LLP, special New York counsel to the Loan Parties, (ii) Bass, Berry

& Sims PLC, special Tennessee counsel to the Loan Parties, (iii) Rodey Law Firm, special New

Mexico counsel to the Loan Parties and (iv) Fox Rothschild LLP, special New Jersey counsel to

the Loan Parties, in each case, addressed to the Administrative Agent and each Lender, dated as

of the Effective Date and in form and substance reasonably satisfactory to the Administrative

Agent.

(c)Organization Documents, Resolutions, Etc. Receipt by the Administrative Agent

of the following:

(i)copies of the Organization Documents of each Loan Party certified to be

true and complete as of a recent date by the appropriate Governmental Authority of the

state or other jurisdiction of its incorporation or organization, where applicable, and

certified by a secretary or assistant secretary of such Loan Party to be true and correct in

all material respects as of the Effective Date (or, in the alternative, a certification by a

Responsible Officer that no modifications to the Organization Documents delivered on

the Original Closing Date have occurred since the Original Closing Date);

(ii)copies of such certificates of resolutions or other action, incumbency

certificates and/or other certificates of Responsible Officers of each Loan Party as the

Administrative Agent may reasonably request prior to the Effective Date evidencing the

identity, authority and capacity of each Responsible Officer thereof authorized to act as a

Responsible Officer in connection with the Amendment and Restatement Agreement and

the other Loan Documents to which such Loan Party is a party; and

(iii)copies of such documents and certifications as the Administrative Agent

may reasonably request prior to the Effective Date to evidence that each Loan Party is

duly organized or formed, and is validly existing, in good standing and qualified to

engage in business in its state of organization or formation.

(d)Lien Searches. The Administrative Agent shall have received:

(i)searches of Uniform Commercial Code filings, tax and judgment liens in

the jurisdiction of formation of each Loan Party, the jurisdiction of the chief executive

office of each Loan Party where a filing would need to be made in order to perfect the

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Administrative Agent’s security interest in the Collateral, copies of the financing

statements or other liens on file in such jurisdictions and evidence that no Liens exist

other than Permitted Liens and Liens to be released substantially concurrently with the

consummation of the Amendment and Restatement Transactions; and

(ii)searches of ownership of, and Liens on, intellectual property of each

Loan Party (to the extent requested by the Administrative Agent) in the appropriate

governmental offices;

(e)Solvency. The Administrative Agent shall have received a certificate executed

by a Responsible Officer of the Borrower as of the Effective Date, substantially in the form of

Exhibit Q, regarding the Solvency of Parent and its Subsidiaries on a consolidated basis and

immediately after giving effect to the consummation of the Amendment and Restatement

Transactions on the Effective Date.

(f)Fees and Expenses. Payment by the Loan Parties of all reasonable fees and

documented and reasonable out-of-pocket expenses due to the Resigning Administrative Agent,

the Administrative Agent and the Joint Book Runners, including, to the extent invoiced at least

two (2) Business Days prior to the Effective Date, reimbursement or payment of all reasonable,

documented out-of-pocket expenses (including the reasonable, documented legal fees and

expenses of Cahill Gordon & Reindel LLP, counsel to the Resigning Administrative Agent, the

Administrative Agent and the Joint Book Runners).

(g)Refinancing. The Borrower shall have, immediately after the making of Initial

Term Loans hereunder, (i) prepaid all Term B-1 Loans outstanding immediately prior to the

Effective Date and (ii) paid to all Term B-1 Lenders all accrued and unpaid interest, fees or other

outstanding amounts on their Term B-1 Loans outstanding immediately prior to the Effective

Date to, but not including, the Effective Date;

(h)Representations and Warranties. The representations and warranties of the Loan

Parties set forth in this Agreement and Section 5 of the Amendment and Restatement Agreement

shall be true and correct in all material respects (or in all respects if qualified by materiality or

material adverse effect) on and as of the Effective Date (it being understood and agreed that any

representation or warranty which by its terms is made as of a specified date shall be required to be

true and correct in all material respects (or in all respects if qualified by materiality or material

adverse effect) only as of such specified date).

(i)Know Your Customer. The Administrative Agent and the Lenders shall have

received, at least three (3) Business Days prior to the Effective Date, (i) all documentation and

other information required by bank regulatory authorities under applicable “know your customer”

and anti-money laundering rules and regulations, including the USA PATRIOT Act and (ii) to the

extent the Borrower qualifies as a “legal entity customer” under the Beneficial Ownership

Regulation, a Beneficial Ownership Certification in relation to the Borrower, in each case of

clauses (i) and (ii), to the extent reasonably requested by such Person in writing at least ten (10)

Business Days prior to the Effective Date.

(j)Borrower’s Certificate. The Administrative Agent shall have received a

certificate from a Responsible Officer of the Borrower certifying that the conditions specified in

Section 5.01(h) have been satisfied.

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(k)Loan Notice. The Administrative Agent shall have received a Loan Notice in

accordance with the requirements hereof.

(l)Mortgaged Property. The Administrative Agent shall have received for each

Mortgaged Property currently subject to a Mortgage Instrument (except those Mortgaged

Properties listed on Schedule 1.10) (i) a completed “life-of-loan” Federal Emergency

Management Agency standard flood hazard determination and (ii) to the extent any such

Mortgaged Property is located in an area identified by the Federal Emergency Management

Agency (or any successor agency) as a special flood hazard area with respect to which flood

insurance has been made available under the Flood Insurance Laws, a notice about special flood

hazard area status and flood disaster assistance duly executed by the Borrower and the applicable

Loan Party relating thereto together with a copy of, or a certificate as to coverage under, and a

declaration page relating to, the insurance policies to the extent required by Section 7.07(b) of

this Agreement.

ARTICLE VI

REPRESENTATIONS AND WARRANTIES

The Loan Parties represent and warrant to the Administrative Agent and the Lenders that:

6.01Existence, Qualification and Power

Each Loan Party (a) is a corporation, partnership or limited liability company duly organized or

formed, validly existing and in good standing under the Laws of the jurisdiction of its incorporation or

organization, (b) has all requisite power and authority and all requisite governmental licenses,

authorizations, consents and approvals to (i) own its assets and carry on its business and (ii) execute,

deliver and perform its obligations under the Loan Documents to which it is a party, and (c) is duly

qualified and is licensed and in good standing under the Laws of each jurisdiction where its ownership,

lease or operation of properties or the conduct of its business requires such qualification or license; except

in each case referred to in clause (b)(i) or (c), to the extent that failure to do so could not reasonably be

expected to have a Material Adverse Effect.

6.02Authorization; No Contravention

The execution, delivery and performance by each Loan Party of each Loan Document to which

such Person is party have been duly authorized by all necessary corporate or other organizational action,

and do not (a) contravene the terms of any of such Person’s Organization Documents; (b) conflict with or

result in any breach or contravention of, or the creation of any Lien under (i) any material Contractual

Obligation to which such Person is a party or (ii) any order, injunction, writ or decree of any

Governmental Authority or any arbitral award to which such Person or its property is subject; (c) violate

any Law (including, without limitation, Regulation U or Regulation X issued by the FRB); (d) result in a

limitation on any licenses, permits or other approvals applicable to the business, operations or properties

of any Loan Party; or (e) materially and adversely affect the ability of any Loan Party to participate in any

Medical Reimbursement Programs (except, in the cases of clauses (b)(i), (c) and (d), as could not

reasonably be expected to have a Material Adverse Effect).

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6.03Governmental Authorization; Other Consents

No approval, consent, exemption, authorization, or other action by, or notice to, or filing with,

any Governmental Authority or any other Person with respect to any material Contractual Obligation is

necessary or required in connection with the execution, delivery or performance by, or enforcement

against, any Loan Party of this Agreement or any other Loan Document to which such Person is party,

other than (i) those that have already been obtained and are in full force and effect, (ii) filings to perfect

the Liens created by the Collateral Documents, (iii) filings which customarily are required in connection

with the exercise of remedies in respect of the Collateral and (iv) those in respect of which the failure to

obtain could not reasonably be expected to have a Material Adverse Effect.

6.04Binding Effect

This Agreement and each other Loan Document has been duly executed and delivered by each

Loan Party that is party thereto. This Agreement and each other Loan Document constitutes a legal, valid

and binding obligation of each Loan Party that is party thereto, enforceable against each such Loan Party

in accordance with its terms except as enforceability may be limited by applicable Debtor Relief Laws or

by equitable principles relating to enforceability.

6.05Financial Statements; No Material Adverse Effect

(a)(i) The Audited Financial Statements (A) were prepared in accordance with GAAP

consistently applied throughout the period covered thereby, except as otherwise expressly noted therein;

and (B) fairly present in all material respects the financial condition of Parent and its Subsidiaries as of

the date thereof and their results of operations for the period covered thereby in accordance with GAAP

consistently applied throughout the period covered thereby, except as otherwise expressly noted therein;

and (C) show, in accordance with GAAP, all material indebtedness and other liabilities, direct or

contingent, of Parent and its Subsidiaries as of the date thereof, including liabilities for taxes,

commitments and Indebtedness and (ii) the Unaudited Financial Statements have been prepared in

accordance with GAAP consistently applied by the Parent, except as otherwise noted therein, subject to

normal year-end audit adjustments (none of which individually or in the aggregate would be material) and

the absence of footnotes.

(b)The financial statements delivered pursuant to Sections 7.01(a) and (b) have been

prepared in accordance with GAAP (except as may otherwise be permitted under Sections 7.01(a) and

(b)) and present fairly (on the basis disclosed in the footnotes to such financial statements) the

consolidated financial condition, results of operations and cash flows of the Parent and its Subsidiaries as

of such date and for such periods.

(c)Since December 31, 2020, there has been no event or circumstance that has had or could

reasonably be expected to have a Material Adverse Effect.

6.06Litigation

There are no actions, suits, investigations, criminal prosecutions, civil investigative demands,

impositions of criminal or civil fines and penalties, proceedings, claims or disputes pending or, to the

knowledge of the Loan Parties after due and diligent investigation, threatened in writing, at law, in equity,

in arbitration or before any Governmental Authority, by or against the Borrower or any of its Subsidiaries

or against any of their properties or revenues that (a) purport to affect the legality, enforceability, validity

of this Agreement or any other Loan Document or the priority of an Lien arising under this Agreement or

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any other Loan Agreement or (b) individually or in the aggregate could reasonably be expected to have a

Material Adverse Effect.

6.07Contractual Obligations

Neither the Borrower nor any Restricted Subsidiary (excluding the ETMC JV) is in default under

or with respect to any Contractual Obligation that could reasonably be expected to have a Material

Adverse Effect.

6.08Ownership of Property; Liens

The Borrower and its Restricted Subsidiaries have good record and marketable title in fee simple

to, or valid leasehold interests or other rights of use in, all Real Property necessary or used in the ordinary

conduct of its business, except for such defects in title as could not, individually or in the aggregate,

reasonably be expected to have a Material Adverse Effect. The property of the Borrower and its

Restricted Subsidiaries (excluding the ETMC JV) is subject to no Liens, other than Permitted Liens. No

Mortgage Instrument encumbers improved Real Property that is located in an area that has been identified

by the Secretary of Housing and Urban Development as an area having special flood hazards within the

meaning of the Flood Insurance Laws unless flood insurance available under such Flood Insurance Laws

have been obtained in accordance with Section 7.07.

6.09Environmental Compliance

Except as could not reasonably be expected to have a Material Adverse Effect:

(a)Each of the Facilities and all operations at the Facilities are in compliance with

all applicable Environmental Laws, and there is no violation of any Environmental Law with

respect to the Facilities or the Businesses, and there are no conditions relating to the Facilities or

the Businesses that would be reasonably likely to give rise to any Environmental Liability.

(b)None of the Facilities contains, or has previously contained, any Hazardous

Materials at, on or under the Facilities in amounts or concentrations that constitute or constituted

a violation of, or would be reasonably likely to give rise to any Environmental Liability.

(c)Neither the Borrower nor any Restricted Subsidiary (excluding the ETMC JV)

has received any written or verbal notice of, or inquiry from any Governmental Authority that is

outstanding or unresolved regarding any violation, alleged violation, non-compliance, liability or

potential liability regarding environmental matters or compliance with Environmental Laws with

regard to any of the Facilities or the Businesses, nor does any Responsible Officer of any Loan

Party have knowledge or reason to believe that any such notice will be received or is being

threatened.

(d)Hazardous Materials have not been transported or disposed of from the Facilities,

or generated, treated, stored or disposed of at, on or under any of the Facilities or any other

location, in each case by or on behalf the Borrower or any Restricted Subsidiary (excluding the

ETMC JV) in violation of, or in a manner that would be reasonably likely to give rise to any

Environmental Liability.

(e)No judicial proceeding or governmental or administrative action is pending or, to

the knowledge of the Responsible Officers of the Loan Parties, threatened, under any

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Environmental Law to which the Borrower or any Restricted Subsidiary (excluding the ETMC

JV) is or will be named as a party, nor are there any consent decrees or other decrees, consent

orders, administrative orders or other orders, or other administrative or judicial requirements

outstanding under any Environmental Law with respect to the Borrower, any Restricted

Subsidiary (excluding the ETMC JV), the Facilities or the Businesses.

(f)There has been no release or threat of release of Hazardous Materials at or from

the Facilities, or arising from or related to the operations (including, without limitation, disposal)

of the Borrower or any Restricted Subsidiary (excluding the ETMC JV) in connection with the

Facilities or otherwise in connection with the Businesses, in violation of or in amounts or in a

manner that would be reasonably likely to give rise to any Environmental Liability.

6.10Insurance

The properties of the Borrower and its Restricted Subsidiaries (excluding the ETMC JV) are

insured with financially sound and reputable insurance companies not Affiliates of the Borrower or any of

its Restricted Subsidiaries (excluding the ETMC JV), in such amounts, with such deductibles and

covering such risks as are customarily carried by companies engaged in similar businesses and owning

similar properties in localities where the Borrower or the applicable Restricted Subsidiary (excluding the

ETMC JV) operates; provided, however, that such insurance shall not be required to the extent provided

by the Captive Insurance Subsidiary. The insurance coverage of the Loan Parties as in effect on the

Effective Date is outlined as to carrier, policy number, expiration date, type, amount and deductibles on

Schedule 6.10.

6.11Taxes

The Borrower and each of its Restricted Subsidiaries has filed or has caused to be filed all federal,

state and other material Tax returns and reports required to be filed, and has paid or caused to be paid all

federal, state and other material Taxes (including in its capacity as a withholding agent) levied or imposed

upon it or its properties, income or assets or otherwise due and payable, except those which are being

contested in good faith by appropriate proceedings diligently conducted and for which adequate reserves

have been provided in accordance with GAAP. To the Loan Parties’ knowledge, there is no proposed

Tax assessment against the Borrower or any Subsidiary that would, if made, reasonably be expected,

individually or in aggregate, to have a Material Adverse Effect.

6.12ERISA Compliance

(a)Each Plan is in compliance in all material respects with the applicable provisions of

ERISA, the Internal Revenue Code and other federal or state Laws. Each Plan that is intended to qualify

under Section 401(a) of the Internal Revenue Code has received a favorable determination letter from the

IRS or is entitled to rely on an IRS opinion letter on the form of the Plan and, to the knowledge of the

Loan Parties, nothing has occurred which would prevent, or cause the loss of, such qualification. The

Borrower has and, to the knowledge of the Loan Parties, each ERISA Affiliate has made all required

contributions to each Plan subject to Section 412 of the Internal Revenue Code, and no application for a

funding waiver or an extension of any amortization period pursuant to Section 412 of the Internal

Revenue Code has been made with respect to any Plan.

(b)There are no pending or, to the knowledge of the Loan Parties, threatened claims, actions

or lawsuits, or action by any Governmental Authority, with respect to any Plan that could be reasonably

be expected to have a Material Adverse Effect. There has been no prohibited transaction or violation of

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the fiduciary responsibility rules with respect to any Plan that has resulted or could reasonably be

expected to result in a Material Adverse Effect.

(c)(i) No ERISA Event has occurred or is reasonably expected to occur; (ii) no Pension Plan

has any Unfunded Pension Liability; (iii) neither the Borrower nor any ERISA Affiliate has incurred, or

reasonably expects to incur, any liability under Title IV of ERISA with respect to any Pension Plan (other

than premiums due and not delinquent under Section 4007 of ERISA); (iv) neither the Borrower nor any

ERISA Affiliate has incurred, or reasonably expects to incur, any liability (and no event has occurred

which, with the giving of notice under Section 4219 of ERISA, would result in such liability) under

Section 4201 or 4204 of ERISA with respect to a Multiemployer Plan; and (v) neither the Borrower nor

any ERISA Affiliate has engaged in a transaction that could be subject to Section 4069 or 4212(c) of

ERISA, except for an event described in the foregoing clauses (i) through (v) that, individually or in the

aggregate with all such events, does not cause the Borrower or any ERISA Affiliate to incur liability that

could reasonably be expected to result in a Material Adverse Effect.

6.13Subsidiaries

Set forth on Schedule 6.13 is a complete and accurate list as of the Effective Date of each

Subsidiary of the Borrower, together with (i) jurisdiction of formation, (ii) number of shares of each class

of Capital Stock outstanding, (iii) number and percentage of outstanding shares of each class owned

(directly or indirectly) by the Borrower or any Subsidiary, (iv) number and effect, if exercised, of all

outstanding options, warrants, rights of conversion or purchase and all other similar rights with respect

thereto and (v) a statement as to whether such Subsidiary is an Unrestricted Subsidiary. The outstanding

Capital Stock of each Subsidiary is validly issued, fully paid and non-assessable.

6.14Margin Regulations; Investment Company Act

(a)Neither the Borrower nor any Subsidiary is engaged principally or as one of its important

activities, in the business of purchasing or carrying margin stock (within the meaning of Regulation U

issued by the FRB), or extending credit for the purpose of purchasing or carrying margin stock.

Following the application of the proceeds of each Borrowing, not more than 25% of the value of the

assets (either of the Borrower only or of the Borrower and its Subsidiaries on a consolidated basis) subject

to the provisions of Section 8.01 or Section 8.05 or subject to any restriction contained in any agreement

or instrument between the Borrower and any Lender or any Affiliate of any Lender relating to

Indebtedness and within the scope of Section 9.01(e) will be margin stock.

(b)Neither the Borrower nor any Guarantor is required to be registered as an “investment

company” under the Investment Company Act of 1940.

6.15Disclosure

(a)No report, financial statement, certificate or other written information (other than any

projections and information of a general economic or industry-specific nature) furnished by or to the

knowledge of any Loan Party on behalf of such Loan Party to the Administrative Agent or any Lender in

connection with the transactions contemplated hereby and the negotiation of this Agreement or delivered

hereunder (as modified or supplemented by other written information so furnished and taken together

with the information disclosed in the Borrower’s or its direct or indirect parent entity’s public filings with

the SEC) when furnished and taken as a whole contains any material misstatement of fact or omits to state

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any material fact necessary to make the statements therein, in the light of the circumstances under which

they were made, not misleading in any material respect.

(b)Any projected financial information made available by any Loan Party or on behalf of any

Loan Party has been prepared in good faith based upon assumptions believed to be reasonable at the time

such information was provided (it being recognized that (i) such projections are not to be viewed as facts

or a guarantee of performance and are subject to significant uncertainties and contingencies many of

which are beyond the control of the Loan Parties and (ii) no assurance can be given that any particular

projections will be realized, and that actual results during the period or periods covered by any such

projections may differ from the projected results, and such differences may be material).

(c)As of the Effective Date, the information included in the Beneficial Ownership

Certification provided to any Lender on or prior to the Effective Date is true and correct in all respects.

6.16Compliance with Laws

The Borrower and its Subsidiaries are in compliance with the requirements of all Laws

(including, without limitation, Medicare Regulations, Medicaid Regulations, HIPAA, the federal Anti-

Kickback Statute (42 U.S.C. §1320a-7b), the federal Physician Self-Referral Law, commonly known as

the “Stark Law” (42 U.S.C. §§ 1395nn and 1396b(s)) and all orders, writs, injunctions, decrees, licenses

and permits applicable to it or to its properties, except in such instances in which (a) such requirement of

Law or order, writ, injunction or decree is being contested in good faith by appropriate proceedings

diligently conducted or (b) the failure to comply therewith could not reasonably be expected to have a

Material Adverse Effect. Without limiting the generality of the foregoing, to the knowledge of the

Borrower or any Subsidiary:

(i)neither the Borrower nor any Subsidiary, nor any individual employed by the

Borrower or any Subsidiary, would reasonably be expected to have criminal culpability or to be

excluded from participation in any Medical Reimbursement Program for corporate or individual

actions or failures to act known to the Borrower or any Subsidiary where such culpability or

exclusion has resulted or could reasonably be expected to result in an Exclusion Event or a

Material Adverse Effect;

(ii)no officer or other member of management continues to be employed by the

Borrower or any Subsidiary who may reasonably be expected to have individual culpability for

matters under investigation by the OIG or other Governmental Authority unless such officer or

other member of management has been, within a reasonable period of time after discovery of

such actual or potential culpability, either suspended or removed from positions of responsibility

related to those activities under challenge by the OIG or other Governmental Authority;

(iii)current billing policies, arrangements, protocols and instructions of the Borrower

and its Subsidiaries comply with all requirements of Medical Reimbursement Programs and are

administered by properly trained personnel, except where any such failure to comply would not

reasonably be expected to result in an Exclusion Event or a Material Adverse Effect; and

(iv)current medical director compensation arrangements of the Borrower and its

Subsidiaries comply with state and federal anti-kickback, and self-referral laws, including without

limitation the federal Anti-Kickback Statute (42 U.S.C. § 1320a-7b) and the Stark Law (42

U.S.C. Section 1395nn and 1396b(s)), and all regulations promulgated under such laws, except

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where any such failure to comply would not reasonably be expected to result in an Exclusion

Event or a Material Adverse Effect.

6.17Intellectual Property; Licenses, Etc.

The Borrower and its Restricted Subsidiaries (excluding the ETMC JV) own, possess or

otherwise have the legal right to use all of the trademarks, service-marks, trade names, copyrights and

patents (collectively, “IP Rights”) that are used in or reasonably necessary for the operation of their

respective businesses, except as the failure to own, possess or otherwise have the right to use such IP

Rights would not, individually or in the aggregate, reasonably be expected to have a Material Adverse

Effect. Set forth on Schedule 6.17 is a list of all IP Rights registered or pending registration with the

United States Copyright Office or the United States Patent and Trademark Office, as applicable, and

owned by each Loan Party as of the Effective Date. Except for such claims and infringements that could

not reasonably be expected to have a Material Adverse Effect, no claim has been asserted and is pending

by any Person challenging the Borrower’s and its Restricted Subsidiaries’ (excluding the ETMC JV)

rights to use any IP Rights, nor does any Loan Party know of any such claim, and, to the knowledge of

the Responsible Officers of the Loan Parties, the use of any IP Rights by the Borrower or any Restricted

Subsidiary (excluding the ETMC JV) or the granting of a right or a license in respect of any IP Rights

from the Borrower or any Restricted Subsidiary (excluding the ETMC JV) does not infringe on the rights

of any Person. As of the Effective Date, none of the IP Rights owned by any of the Loan Parties is

subject to any material or exclusive licensing agreement or similar arrangement except as set forth on

Schedule 6.17.

6.18Solvency

Parent and its Subsidiaries, on a consolidated basis, are Solvent.

6.19Perfection of Security Interests in the Collateral

The Collateral Documents create in favor of the Administrative Agent, for its benefit and the

benefit of the Secured Parties (as defined in the applicable Security Agreement), valid security interests

in, and Liens on, the Collateral purported to be covered thereby, which security interests and Liens are

currently legal, valid and enforceable security interests and Liens.

(i)In the case of the Pledged Collateral (as defined in the Pledge Agreement)

constituting “securities” under Article 8 of the Uniform Commercial Code, when stock

certificates representing such Pledged Collateral are delivered to the Administrative Agent, and in

the case of the other Collateral described in each Security Agreement (other than Patents,

Copyrights and Trademarks, in each case as defined therein), when financing statements and

other filings are filed in the proper filing office, the Collateral Documents shall create in favor of

the Administrative Agent, for its benefit and the benefit of the Secured Parties (as defined in the

applicable Security Agreement), a perfected security interest in, and Lien on, such Collateral to

the extent perfection can be obtained by filing Uniform Commercial Code Financing Statements,

or in the case of Pledged Collateral, by possession or control, in each case, prior to all other Liens

other than Permitted Liens.

(ii)When each Security Agreement or a summary thereof is properly filed in the

United States Patent and Trademark Office and the United States Copyright Office, and, with

respect to Collateral in which a security interest cannot be perfected by such filings, upon the

proper filing of the financing statements referred to in clause (i) above, the Collateral Documents

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shall create in favor of the Administrative Agent, for its benefit and the benefit of the Lenders, a

perfected security interest in, and Lien on, such Collateral, prior to all Liens other than Permitted

Liens (it being understood that subsequent recordings in the United States Patent and Trademark

Office and the United States Copyright Office may be necessary to perfect a Lien on registered

trademarks and patents, trademark and patent applications and registered copyrights acquired by

the Loan Parties after the Effective Date).

(iii)When the Mortgage Instruments are properly filed in the proper real estate filing

offices, such Mortgage Instruments are effective to create in favor of the Administrative Agent,

for its benefit and the benefit of the Secured Parties (as defined in the applicable Security

Agreement), legal, valid and enforceable first priority Liens on, and security interests in, all of the

Loan Parties’ right, title and interest in the Mortgaged Properties and proceeds thereof, subject

only to Permitted Liens. In the case of any Mortgage Instrument executed and delivered after the

date hereof in accordance with the provisions of Section 7.14, the office specified in the opinion

of local counsel delivered in connection therewith as required by such Section) the Mortgage

Instruments shall constitute fully perfected Liens, and security interests in, all of the Loan Parties’

right, title and interest in the Mortgaged Properties and proceeds thereof, in each case prior to and

superior in right to any other Person, other than Permitted Liens.

6.20[Reserved]

6.21Brokers’ Fees

Neither the Borrower nor any Restricted Subsidiary (excluding the ETMC JV) has any obligation

to any Person in respect of any finder’s, broker’s, investment banking or other similar fee in connection

with the Amendment and Restatement Transactions.

6.22Labor Matters

As of the Effective Date, (a) other than as set forth in Schedule 6.22, there are no collective

bargaining agreements or Multiemployer Plans covering the employees of the Borrower or any Restricted

Subsidiary (excluding the ETMC JV) and (b) neither the Borrower nor any Restricted Subsidiary

(excluding the ETMC JV) has suffered any strikes, walkouts, work stoppages or other material labor

difficulty since the earlier of (i) the date five years prior to the Effective Date and (ii) the date upon which

such Restricted Subsidiary (excluding the ETMC JV) was created or acquired.

6.23Fraud and Abuse

To the knowledge of the Responsible Officers of the Loan Parties, neither the Borrower nor any

Subsidiary or any of their respective officers or directors has engaged in any activities that are prohibited

under Medicare Regulations or Medicaid Regulations that could reasonably be expected to have a

Material Adverse Effect.

6.24Licensing and Accreditation

Except to the extent it would not reasonably be expected to have a Material Adverse Effect, each

of the Borrower and its Subsidiaries has, to the extent applicable: (i) obtained (or been duly assigned) all

required certificates of need or determinations of need as required by the relevant state Governmental

Authority for the acquisition, construction, expansion of, investment in or operation of its businesses as

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currently operated; (ii) obtained and maintains in good standing all required licenses, permits,

authorizations and approvals of each Governmental Authority necessary to the conduct of its business;

(iii) except as set forth on Schedule 6.24, obtained and maintains accreditation by The Joint Commission,

Det Norske Veritas Healthcare or the Accreditation Association for Ambulatory Health Care for each of

the hospitals or freestanding surgery centers operated by them; (iv) entered into and maintains in good

standing its Medicare Provider Agreements and Medicaid Provider Agreements; and (v) ensured that all

such required licenses are in full force and effect on the Effective Date and have not been revoked or

suspended or otherwise limited.

6.25Anti-Terrorism Laws; Anti-Corruption

(a)No Loan Party, none of its Subsidiaries and, to the knowledge of each Loan Party, none

of its Affiliates and, none of the respective officers, directors and, to the knowledge of each Loan Party,

none of the brokers or agents of such Loan Party, such Subsidiary or, to the knowledge of any Loan

Party, Affiliate has violated or is in violation of Anti-Terrorism Laws.

(b)No Loan Party, none of its Subsidiaries and, to the knowledge of each Loan Party, none

of its Affiliates and none of the respective officers, directors, and to the knowledge of each Loan Party,

none of the brokers or agents of such Loan Party, such Subsidiary or, to the knowledge of any Loan

Party, such Affiliate that is acting or benefiting in any capacity in connection with the Loans is an

Embargoed Person.

(c)No Loan Party, none of its Subsidiaries and, to the knowledge of each Loan Party, none of

its Affiliates and none of the respective officers, directors, and to the knowledge of each Loan Party, none

of the brokers or agents of such Loan Party, such Subsidiary or, to the knowledge of any Loan Party,

such Affiliate acting or benefiting in any capacity in connection with the Loans (i) conducts any business

or engages in making or receiving any contribution of funds, goods or services to or for the benefit of any

Embargoed Person, (ii) deals in, or otherwise engages in any transaction related to, any property or

interests in property blocked pursuant to any Anti-Terrorism Law or (iii) engages in or conspires to

engage in any transaction that evades or avoids, or has the purpose of evading or avoiding, or attempts to

violate, any of the prohibitions set forth in any Anti-Terrorism Law.

(d)The Loan Parties and their Subsidiaries and, to the knowledge of each Loan Party, its

Affiliates and the respective officers, directors, and to the knowledge of each Loan Party, none of the

brokers or agents of such Loan Party, such Subsidiary or, to the knowledge of such Loan Party, Affiliate,

have for the previous five years conducted their businesses in compliance with the United States Foreign

Corrupt Practices Act of 1977, and other similar anti-corruption legislation in other applicable

jurisdictions and have instituted and maintained policies and procedures designed to promote and achieve

compliance with such laws.

6.26Affected Financial Institutions

None of the Loan Parties is an Affected Financial Institution.

6.27HMO Entities

None of the Loan Parties, nor any of their respective Subsidiaries, is an HMO Entity.

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ARTICLE VII

AFFIRMATIVE COVENANTS

So long as any Lender shall have any Commitment hereunder, any Loan or other Obligation

hereunder shall remain unpaid or unsatisfied, the Loan Parties shall and shall cause each of their

Restricted Subsidiaries (excluding the ETMC JV) to:

7.01Financial Statements

Deliver to the Administrative Agent:

(a)Annual Financial Statements.

As soon as available, but in any event within 120 days after the end of each fiscal year

thereafter of the Parent, a consolidated balance sheet of the Parent and its Subsidiaries as at the

end of such fiscal year, and the related consolidated statements of income or operations,

shareholders’ equity and cash flows for such fiscal year, setting forth in each case in comparative

form the figures for the previous fiscal year, all in reasonable detail and prepared in accordance

with GAAP, audited and accompanied by a report and opinion of Ernst & Young LLP or another

independent certified public accountant of nationally recognized standing reasonably acceptable

to the Administrative Agent, which report and opinion shall be prepared in accordance with

generally accepted auditing standards and shall not be subject to any “going concern” or like

qualification, assumption or exception or any qualification or exception as to the scope of such

audit (other than as a result of a current maturity of the Term Loans, the ABL Facility or the 2029

Notes); provided that if the Parent switches from one independent certified public accounting

firm to another, the audit report of any such new accounting firm may contain a qualification or

exception as to the scope of such consolidated financial statements that relates to any fiscal year

prior to its retention which, for the avoidance of doubt, shall have been the subject of an audit

report of the previous accounting firm meeting the criteria set forth above; provided further that,

if the Parent shall own material assets other than any Capital Stock of the Borrower or have

material operations or other liabilities, the Borrower shall provide a consolidated balance sheet of

the Borrower and its Subsidiaries as at the end of such fiscal year, and the related consolidated

statements of income or operations, shareholders’ equity and cash flows for such fiscal year,

setting forth in each case in comparative form the figures for the previous fiscal year, all in

reasonable detail and prepared in accordance with GAAP, audited and accompanied by a report

and opinion of Ernst & Young LLP or another independent certified public accountant of

nationally recognized standing reasonably acceptable to the Administrative Agent, which report

and opinion shall be prepared in accordance with generally accepted auditing standards and shall

not be subject to any “going concern” or like qualification, assumption or exception or any

qualification or exception as to the scope of such audit (other than as a result of a current maturity

of the Term Loans and the ABL Facility); provided further that if the Borrower switches from one

independent certified public accounting firm to another, the audit report of any such new

accounting firm may contain a qualification or exception as to the scope of such consolidated

financial statements that relates to any fiscal year prior to its retention which, for the avoidance of

doubt, shall have been the subject of an audit report of the previous accounting firm meeting the

criteria set forth above.

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(b)Quarterly Financial Statements.

As soon as available, but in any event within 45 days after the end of each of the first

three fiscal quarters of each fiscal year ending thereafter of the Parent, a consolidated balance

sheet of the Parent and its Subsidiaries as at the end of such fiscal quarter, and the related

consolidated statements of income or operations and cash flows for such fiscal quarter, setting

forth in each case in comparative form the figures for the corresponding fiscal quarter of the

previous fiscal year and the corresponding portion of the previous fiscal year all in reasonable

detail and certified by a Responsible Officer of the Borrower as fairly presenting in all material

respects the financial condition, results of operations and cash flows of the Parent and its

Subsidiaries in accordance with GAAP, subject only to normal year-end audit adjustments and

the absence of footnotes; provided that, if the Parent shall own material assets other than any

Capital Stock of the Borrower or have material operations or other liabilities, the Borrower shall

provide a consolidated balance sheet of the Borrower and its Subsidiaries as at the end of such

fiscal quarter, and the related consolidated statements of income or operations and cash flows for

such fiscal quarter, setting forth in each case in comparative form the figures for the previous

fiscal quarter of the previous fiscal year and the corresponding portion of the previous fiscal year,

all in reasonable detail certified by a Responsible Officer of the Borrower as fairly presenting in

all material respects the financial condition, results of operations and cash flows of the Borrower

and its Subsidiaries in accordance with GAAP, subject only to normal year-end audit adjustments

and the absence of footnotes.

7.02Certificates; Other Information

Deliver to the Administrative Agent:

(a)[Reserved];

(b)(i) concurrently with the delivery of the financial statements referred to in

Sections 7.01(a), a duly completed Excess Cash Certificate (including data supporting financial

ratio calculation and pro forma adjustments) signed by a Responsible Officer of the Borrower

which Excess Cash Certificate shall include a calculation of the Borrower’s Portion of Excess

Cash Flow as at the last day of the applicable fiscal period, (ii) as soon as available, but in any

event within 120 days after the end of each fiscal year and within 45 days after the end of each of

the first three fiscal quarters thereafter of the Parent or Borrower, as applicable, a narrative report

and/or management’s discussion and analysis prepared with respect to the period covered by such

financial statements as compared to the corresponding period in the prior fiscal year (or the prior

fiscal year in the case of financial statements delivered pursuant to Section 7.01(a)) (which

Excess Cash Certificate may be delivered, unless the Administrative Agent or a Lender requests

executed originals, by electronic communication, including fax or email, which shall be deemed

to be an original authentic counterpart thereof for all purposes) and (iii) if the Borrower has

designated any of its Subsidiaries as an Unrestricted Subsidiary and all such Unrestricted

Subsidiaries, either individually or collectively, would otherwise constitute a Significant

Subsidiary, then the quarterly and annual reports required by the preceding paragraphs will

include a reasonably detailed presentation of the financial condition and results of operations of

the Borrower and its Restricted Subsidiaries separate from the financial condition and results of

operations of the Unrestricted Subsidiaries of the Borrower;

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(c)within 45 days after the first day of each fiscal year of the Borrower, an annual

business plan and budget of the Borrower and its Subsidiaries for the next fiscal year containing,

among other things, pro forma financial statements for each quarter of the next fiscal year;

(d)[reserved];

(e)promptly after any written request by the Administrative Agent, copies of any

detailed audit reports, management letters or material recommendations submitted to the board of

directors (or the audit committee of the board of directors) of the Borrower by independent

accountants in connection with the accounts or books of the Borrower or any Subsidiary, or any

audit of any of them;

(f)promptly after the same are publicly available, copies of all annual, regular,

periodic and special reports and registration statements which the Parent may file or be required

to file with the SEC under Section 13 or 15(d) of the Securities Exchange Act of 1934, as

amended or with any Governmental Authority that may be substituted therefor (other than

amendments to any registration statement (to the extent such registration statement, in the form it

became effective, is delivered)), exhibits to any registration statement and, if applicable, any

registration statement on Form S-8) and in any case not otherwise required to be delivered to the

Administrative Agent pursuant to any other clause of this Section 7.02;

(g)promptly, notice of any exercise by LeaseCo or its Affiliates of the Ventas Asset

Purchase or the Ventas Purchase Option;

(h)promptly, (i) such other information regarding the business, financial condition,

operations, liabilities (actual or contingent) or properties of the Borrower or any Subsidiary, or

compliance with the terms of the Loan Documents or (ii) information and documentation for

purposes of compliance with applicable “know your customer” requirements under the PATRIOT

Act or other applicable anti-money laundering laws, in each case, as the Administrative Agent or

any Lender may from time to time reasonably request;

(i)concurrently with the delivery of the financial statements referred to in Section

7.01(a), a certificate of a Responsible Officer of the Borrower (i) listing (A) all United States

applications, if any, for Copyrights, Patents or Trademarks (each such term as defined in the

applicable Security Agreement) made since the date of the prior certificate (or, in the case of the

first such certificate, the Effective Date), (B) all United States issuances of registrations or letters

on existing United States applications for Copyrights, Patents and Trademarks (each such term as

defined in the applicable Security Agreement) received since the date of the prior certificate (or,

in the case of the first such certificate, the Effective Date), and (C) all material Trademark

Licenses, Copyright Licenses and Patent Licenses (each such term as defined in the applicable

Security Agreement) entered into since the date of the prior certificate (or, in the case of the first

such certificate, the Effective Date), and (ii) attaching the insurance binder or other evidence of

insurance for any insurance coverage of the Borrower or any Restricted Subsidiary (excluding the

ETMC JV) that was renewed, replaced or modified during the period covered by such financial

statements;

(j)(i) promptly upon filing with the applicable Governmental Authority, copies of

any request for an extension to the time period within which financial statements prepared in

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accordance with SAP must be filed with such Governmental Authority and (ii) promptly copies

of any extensions or rejections to extensions provided by any Governmental Authority; and

(k)promptly after any written request by the Administrative Agent, copies of all cost

reports filed by any Loan Party with Medicare, Medicaid or any other third party payor;

Documents required to be delivered pursuant to Sections 7.01(a) or (b) or Section 7.02(f) (to the

extent any such documents are included in materials otherwise filed with the SEC) may be delivered

electronically and if so delivered, shall be deemed to have been delivered on the date (i) on which the

Borrower posts such documents, or provides a link thereto on the Borrower’s website on the Internet at

the website address listed on Schedule 11.02; or (ii) on which such documents are posted on the

Borrower’s behalf on an Internet or intranet website, if any, to which each Lender and the Administrative

Agent have access (whether a commercial, third-party website or whether sponsored by the

Administrative Agent); provided that: (A) upon the written request of the Administrative Agent or any

Lender, the Borrower shall deliver paper copies of such documents to the Administrative Agent or any

Lender that requests the Borrower to deliver such paper copies until a written request to cease delivering

paper copies is given by the Administrative Agent or such Lender and (B) the Borrower shall notify the

Administrative Agent and each Lender (by telecopier or electronic mail) of the posting of any such

documents and provide to the Administrative Agent by electronic mail electronic versions (i.e., soft

copies) of such documents. Thethat Borrower or any direct or indirect parent entity of Borrower has filed

such reports with the SEC via the EDGAR filing system or any successor filing system and such reports

are publicly available; provided, that the Administrative Agent shall have no obligation to request the

delivery of or to maintain paper copies of the documents referred to above, and in any event shall have no

responsibility to monitor compliance by the Borrower with any such request by a Lender for delivery, and

each Lender shall be solely responsible for requesting delivery to it or maintaining its copies of such

documents.responsibility whatsoever to determine if such filing has occurred.

The Borrower hereby agrees that it will use commercially reasonable efforts to provide to the

Administrative Agent all information, documents and other materials that it is obligated to furnish to the

Administrative Agent pursuant to the Loan Documents, including, without limitation, all notices,

requests, financial statements, financial and other reports, certificates and other information materials, but

excluding any such communication that (i) relates to a request for a new, or a conversion of an existing,

borrowing or other extension of credit (including any election of an interest rate or interest period relating

thereto), (ii) relates to the payment of any principal or other amount due under this Agreement prior to the

scheduled date therefor, (iii) provides notice of any Default or Event of Default under this Agreement or

(iv) is required to be delivered to satisfy any condition precedent to the effectiveness of this Agreement

and/or any borrowing or other extension of credit thereunder (all such non-excluded communications

being referred to herein collectively as “Communications”), by transmitting the Communications in an

electronic/soft medium in a format mutually acceptable to the Administrative Agent and the Borrower to

the Platform (as defined below).

The Borrower hereby acknowledges that (a) the Administrative Agent and/or the Joint Book

Runners will make available to the Lenders materials and/or information provided by or on behalf of the

Borrower hereunder (collectively, “Borrower Materials”) by posting the Borrower Materials on

IntraLinks or another similar confidential and secure electronic system (the “Platform”) and (b) certain of

the Lenders (each, a “Public Lender”) may have personnel who do not wish to receive material non-

public information with respect to the Borrower or its Affiliates, or the respective securities of any of the

foregoing, and who may be engaged in investment and other market-related activities with respect to such

Persons’ securities. The Borrower hereby agrees that it will use commercially reasonable efforts to

identify that portion of the Borrower Materials that may be distributed to the Public Lenders and that (w)

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all such Borrower Materials shall be clearly and conspicuously marked “PUBLIC” which, at a minimum,

shall mean that the word “PUBLIC” shall appear prominently on the first page thereof; (x) by marking

Borrower Materials “PUBLIC,” the Borrower shall be deemed to have authorized the Administrative

Agent, the Joint Book Runners and the Lenders to treat such Borrower Materials as not containing any

material non-public information (although it may be sensitive and proprietary) with respect to the

Borrower or its securities for purposes of United States Federal and state securities laws (provided,

however, that to the extent such Borrower Materials constitute Information, it shall be treated as set forth

in Section 11.08); (y) all Borrower Materials marked “PUBLIC” are permitted to be made available

through a portion of the Platform designated “Public Side Information;” and (z) the Administrative Agent

and the Joint Book Runners shall treat any Borrower Materials that are not marked “PUBLIC” as being

suitable only for posting on a portion of the Platform not designated “Public Side Information.”

Notwithstanding the foregoing, the Borrower shall be under no obligation to mark any Borrower

Materials “PUBLIC”.

THE PLATFORM IS PROVIDED “AS IS” AND “AS AVAILABLE.” THE AGENT PARTIES

(AS DEFINED BELOW) DO NOT WARRANT THE ACCURACY OR COMPLETENESS OF THE

BORROWER MATERIALS OR THE ADEQUACY OF THE PLATFORM, AND EXPRESSLY

DISCLAIM LIABILITY FOR ERRORS IN OR OMISSIONS FROM THE BORROWER MATERIALS.

NO WARRANTY OF ANY KIND, EXPRESS, IMPLIED OR STATUTORY, INCLUDING ANY

WARRANTY OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-

INFRINGEMENT OF THIRD PARTY RIGHTS OR FREEDOM FROM VIRUSES OR OTHER CODE

DEFECTS, IS MADE BY ANY AGENT PARTY IN CONNECTION WITH THE BORROWER

MATERIALS OR THE PLATFORM. In no event shall the Administrative Agent or any of its Affiliates

or its or their respective officers, directors, employees, agents and attorneys-in-fact (collectively, the

“Agent Parties”) have any liability to Parent, the Borrower, any Lender or any other Person for losses,

claims, damages, liabilities or expenses of any kind (whether in tort, contract or otherwise) arising out of

the Borrower’s or the Administrative Agent’s transmission of Borrower Materials through the Internet,

except to the extent that such losses, claims, damages, liabilities or expenses are determined by a court of

competent jurisdiction by a final and nonappealable judgment to have resulted from the gross negligence,

bad faith or willful misconduct of such Agent Party; provided, however, that in no event shall any Agent

Party have any liability to Parent, the Borrower, any Lender or any other Person for indirect, special,

incidental, consequential or punitive damages (as opposed to direct or actual damages).

The Administrative Agent agrees that the receipt of the Communications by the Administrative

Agent at its e-mail address set forth above shall constitute effective delivery of the Communications to the

Administrative Agent for purposes of the Loan Documents. Each Lender agrees that notice to it (as

provided in the next sentence) specifying that the Communications have been posted to the Platform shall

constitute effective delivery of the Communications to such Lender for purposes of the Loan Documents.

Each Lender agrees to notify the Administrative Agent in writing (including by electronic

communication) from time to time (i) of such Lender’s e-mail address to which the foregoing notice may

be sent by electronic transmission and (ii) that the foregoing notice may be sent to such e-mail address.

Nothing herein shall prejudice the right of the Administrative Agent or any Lender to give any

notice or other communication pursuant to any Loan Document in any other manner specified in such

Loan Document.

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7.03Notices

(a)Promptly upon knowledge thereof, notify the Administrative Agent of the occurrence of

any Default.

(b)Promptly upon knowledge thereof, notify the Administrative Agent of any matter that has

resulted or could reasonably be expected to result in a Material Adverse Effect.

(c)Promptly upon knowledge thereof, notify the Administrative Agent of the occurrence of

any ERISA Event that, alone or together with any other ERISA Events that have occurred, could

reasonably be expected to result in liability of the Borrower and its Subsidiaries in an aggregate amount

exceeding the Threshold Amount.

(d)Promptly notify the Administrative Agent of any material change in accounting policies

or financial reporting practices by the Borrower or any Subsidiary.

(e)Promptly upon knowledge thereof, notify the Administrative Agent of (i) the institution of

any investigation, review or proceeding against the Borrower or any Subsidiary to suspend, revoke or

terminate (or that may result in the termination of) any Medicaid Provider Agreement or Medicare

Provider Agreement, or any such investigation or proceeding that would reasonably be expected to result

in an Exclusion Event, (ii) a copy of any notice of intent to exclude, any notice of proposal to exclude

issued by the OIG or any other Exclusion Event, or (iii) all notices of loss of accreditation, loss of

participation under any Medical Reimbursement Program or loss of applicable health care license, and all

other material deficiency notices, compliance orders or adverse reports issued by any Governmental

Authority or private insurance company pursuant to a provider agreement that, if not promptly complied

with or cured, would reasonably be expected to result in the suspension or forfeiture of any license,

certification, or accreditation.

(f)[Reserved].

(g)[Reserved].

(h)Promptly upon knowledge thereof, notify the Administrative Agent of the occurrence of

any Event of Default (as defined in the Master Lease) under the Master Lease, and so long as such Event

of Default (as defined in the Master Lease) is continuing, provide copies of any written notices provided

by LeaseCo under the Master Lease.

(i)Promptly upon knowledge thereof, notify the Administrative Agent of any change in the

information provided in the Beneficial Ownership Certification that would result in a change to the list of

beneficial owners identified in parts (c) or (d) of such certification.

(j)Promptly (x) upon knowledge thereof, notify the Administrative Agent of any event of

default under any Joint Venture Agreement and (y) provide the Administrative Agent with copies of any

material notices received from any Joint Venture or from any other member in any Joint Venture.

Each notice pursuant to Sections 7.03(a) through (e) (other than (d)) and (h) shall be accompanied

by a statement of a Responsible Officer of the Borrower setting forth details of the occurrence referred to

therein and stating what action the Borrower has taken and proposes to take with respect thereto. Each

notice pursuant to Section 7.03(a) shall describe with particularity any and all provisions of this

Agreement and any other Loan Document that have been breached.

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7.04Payment of Taxes

Pay and discharge as the same shall become due and payable, all material Taxes imposed or

levied upon it or its properties or assets, unless the same are being contested in good faith by appropriate

proceedings diligently conducted and adequate reserves in accordance with GAAP are being maintained

by such Loan Party.

7.05Preservation of Existence, Etc.

(a)Preserve, renew and maintain in full force and effect its legal existence under the Laws of

the jurisdiction of its organization except in a transaction permitted by Section 8.04 or 8.05.

(b)Preserve, renew and maintain in full force and effect its good standing under the Laws of

the jurisdiction of its organization except in a transaction permitted by Section 8.04 or 8.05.

(c)Take all reasonable action to maintain all rights, privileges, permits, licenses and

franchises necessary or desirable in the normal conduct of its business, except to the extent that the failure

to do so could not reasonably be expected to have a Material Adverse Effect.

(d)Preserve or renew all of its material registered patents, trademarks, trade names, service

marks, copyrights and other registered intellectual property, the non-preservation of which could

reasonably be expected to have a Material Adverse Effect. Notwithstanding the foregoing, nothing in this

Section 7.05(d) shall prohibit any of the transactions permitted in Sections 8.04 and 8.05 or otherwise

prevent the Borrower and its Restricted Subsidiaries from abandoning or discontinuing the preservation or

renewal of any registered patents, trademarks, trade names, service marks and copyrights if such

abandonment or discontinuance is desirable in the conduct of its business.

7.06Maintenance of Properties

(a)Maintain, preserve and protect all of its material tangible properties and equipment

necessary in the operation of its business in good working order and condition, ordinary wear and tear

excepted.

(b)Make all necessary repairs thereto and renewals and replacements thereof, except where

the failure to do so could not reasonably be expected to have a Material Adverse Effect.

(c)Use the standard of care typical in the industry in the operation and maintenance of its

Facilities.

Notwithstanding the foregoing, nothing in this Section 7.06 shall prohibit any of the transactions

permitted in Sections 8.04 and 8.05 or otherwise prevent the Borrower and its Restricted Subsidiaries

from discontinuing the operation or maintenance of any of its assets or properties if such discontinuance

is, in the judgment of its board of directors or similar body, desirable in the conduct of its business.

7.07Maintenance of Insurance

(a)Maintain in full force and effect insurance (including worker’s compensation insurance,

liability insurance, casualty insurance and business interruption insurance) with financially sound and

reputable insurance companies not Affiliates of the Borrower or any Subsidiary, in such amounts, with

such deductibles and covering such risks as are customarily carried by companies engaged in similar

businesses and owning similar properties in localities where the Borrower or the applicable Restricted

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Subsidiary operates; provided that the Borrower and its Restricted Subsidiaries may reduce the amount of

insurance required to be maintained above to the extent the Borrower and its Restricted Subsidiaries

establish a self-insurance program providing insurance coverage in lieu of such insurance. The

Administrative Agent shall be named as loss payee or mortgagee, as its interest may appear, and/or

additional insured with respect to any such insurance providing coverage in respect of any Collateral, and

each provider of any such insurance shall agree, by endorsement upon the policy or policies issued by it

or by independent instruments furnished to the Administrative Agent, that it will give the Administrative

Agent (i) ten (10) days (in the case of any insurance policy provided by Steadfast Insurance Corporation

or American Guarantee and Liability Insurance Company or any Affiliate thereof) or (ii) in the case of

any other insurance policy thirty (30) days (or ten (10) days in case of cancellation because of non-

payment) prior written notice before any such policy or policies shall be altered (to the extent the relevant

insurance carrier, as a matter of policy, provides notices of alterations in its policies to such loss payees or

mortgagees, as the case may be) or canceled.

(b)With respect to each Mortgaged Property, obtain flood insurance in such total amount as

the Administrative Agent may from time to time reasonably require, if at any time the area in which any

improvements located on any Mortgaged Property is designated a “flood hazard area” in any Flood

Insurance Rate Map published by the Federal Emergency Management Agency (or any successor

agency), and otherwise comply with the Flood Insurance Laws.

7.08Compliance with Laws

Except to the extent the failure to do so would not have or would not reasonably be expected to

have a Material Adverse Effect, the Borrower will, and will cause each of its Restricted Subsidiaries to,

(a) comply with all requirements of Law, and all applicable restrictions imposed by all Governmental

Authorities, applicable to it and its Property (including, without limitation, Environmental Laws and

ERISA); (b) conform with and duly observe in all material respects all applicable laws, rules and

regulations and all other valid requirements of any regulatory authority with respect to the conduct of its

business, including without limitation Titles XVIII and XIX of the Social Security Act, Medicare

Regulations, Medicaid Regulations, and all laws, rules and regulations of Governmental Authorities,

pertaining to the business of the Borrower and its Restricted Subsidiaries ; (c) obtain and maintain all

licenses, permits, certifications and approvals of all applicable Governmental Authorities as are required

for the conduct of its business as currently conducted and herein contemplated, including without

limitation professional licenses, CLIA certifications, Medicare Provider Agreements and Medicaid

Provider Agreements; (d) ensure that (i) billing policies, arrangements, protocols and instructions will

materially comply with reimbursement requirements under Medicare, Medicaid and other Medical

Reimbursement Programs and will be administered by properly trained personnel; and (ii) medical

director compensation arrangements and other arrangements with referring physicians will comply with

applicable state and federal self-referral and anti-kickback laws, including without limitation the federal

Anti-Kickback Statute (42 U.S.C. §1320a-7b(b)) and the federal Physician Self-Referral Law, commonly

known as the “Stark Law” (42 U.S.C. §§ 1395nn and 1396b(s)); and (e) implement policies that are

consistent with (i) the Standards for the Privacy of Individually Identifiable Health Information at 45

C.F.R. Parts 160 and 164, Subparts A and E (the “Privacy Standards”); (ii) the Security Standards for the

Protection of Electronic Protected Health Information at 45 C.F.R. Parts 160 and 164, Subparts A and C

(the “Security Standards”); and (iii) the Standards for Notification in the Case of Breach of Unsecured

Protected Health Information at 45 C.F.R. Part 164, Subpart D (the “Breach Notification Standards” and

together with the Privacy and Security Standards, the “HIPAA Standards”) implementing the privacy and

security requirements of the Administrative Simplification subtitle of the Health Insurance Portability and

Accountability Act of 1996 (HIPAA) set forth at 45 CFR Parts 160 and 164 on or before the date that

such HIPAA Standards become applicable to the Borrower and its Restricted Subsidiaries. Further, the

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Borrower has in place a compliance program for the Borrower and its Restricted Subsidiaries which is

reasonably designed to provide effective internal controls that promote adherence to, prevent and detect

material violations of, any Laws applicable to the Borrower and its Restricted Subsidiaries, and which

includes the implementation of internal audits and monitoring on a regular basis to monitor compliance

with the compliance program and with Laws.

7.09Books and Records

(a)Maintain proper books of record and account, in which full, true and correct entries in

conformity in all material respects with GAAP consistently applied shall be made of all financial

transactions and matters involving the assets and business of the Borrower or such Restricted Subsidiary,

as the case may be.

(b)Maintain such books of record and account in material conformity with all applicable

requirements of any Governmental Authority having regulatory jurisdiction over the Borrower or such

Restricted Subsidiary, as the case may be.

7.10Inspection Rights

(a)Permit representatives and independent contractors of the Administrative Agent and if any

Event of Default shall have occurred and be continuing, any Lender (concurrently with the

Administrative Agent’s exercise of its rights under this Section 7.10) to visit and inspect any of its

properties, to examine its corporate, financial and operating records, and make copies thereof or abstracts

therefrom, and to discuss its affairs, finances and accounts with its directors, senior officers, and

independent public accountants (provided that, so long as no Event of Default exists, the Borrower will be

provided an opportunity to attend such meetings), all at the reasonable expense of the Borrower and at

such reasonable times during normal business hours and as often as may be reasonably desired, upon

reasonable advance notice to the Borrower; provided, however, that (i) absent the existence of an Event of

Default (x) only the Administrative Agent on behalf of the Lenders may exercise the rights under this

Section 7.10 and (y) the Administrative Agent may make only one (1) such visit during any fiscal year,

which such visit shall be at the Borrower’s expense and (ii) when an Event of Default has occurred and is

continuing the Administrative Agent (or any of its representatives or independent contractors) may do any

of the foregoing at the expense of the Borrower at any time during normal business hours and without

advance notice.

(b)At a date designated by the Borrower no later than 30 days following each delivery of

financial statements pursuant to Section 7.01(a) or (b) during normal business hours, the Borrower will

participate, and will cause key management personnel of the Borrower to participate, in one (1)

telephonic conference call with the Lenders during any fiscal quarter.

7.11Use of Proceeds

(i)On the Effective Date, the proceeds of the Term Loans shall be used to finance the

Amendment and Restatement Transactions and (ii) on the Effective Date and thereafter, the proceeds of

the Term Loans shall be used for working capital or general corporate purposes; provided that, in each

case, in no event shall proceeds of the Loans be used in contravention of any Law (including the FCPA

and any sanctions administered or enforced by OFAC) or any Loan Document. The Borrower shall use

the proceeds of the 2024 Term B Loans made on the Amendment No. 2 Effective Date solely for the

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repayment of the Initial Term Loans. For the avoidance of doubt, the Initial Term Loans may be

converted into the 2024 Term B Loans as contemplated by Amendment No. 2.

7.12Additional Subsidiaries; Additional Guarantors

(a)Within thirty (30) days (or such longer period as the Administrative Agent shall

reasonably determine) after the acquisition or formation of any direct or indirect Restricted Subsidiary (or

after any non-Wholly Owned Subsidiary (including any Joint Venture) becomes a Wholly Owned

Subsidiary) of the Borrower (with any Subsidiary Redesignation resulting in an Unrestricted Subsidiary

becoming a Restricted Subsidiary being deemed to constitute the acquisition of a Restricted Subsidiary)

or any Subsidiary of the Borrower ceasing to be an Excluded Subsidiary:

(i)notify the Administrative Agent thereof in writing, together with (A) jurisdiction

of formation, (B) number of shares of each class of Capital Stock outstanding, (C) number and

percentage of outstanding shares of each class owned (directly or indirectly) by the Borrower or

any Restricted Subsidiary, and (D) number and effect, if exercised, of all outstanding options,

warrants, rights of conversion or purchase and all other similar rights with respect thereto; and

(ii)if such Restricted Subsidiary is a Material Domestic Subsidiary other than an

Excluded Subsidiary , cause such Person to (1) become a Guarantor by executing and delivering

to the Administrative Agent a Non-Tenant Joinder Agreement or Tenant Joinder Agreement, as

applicable, or such other documents as the Administrative Agent shall reasonably deem

appropriate for such purpose, (2) deliver to the Administrative Agent documents of the types

referred to in Section 5.01(c) and favorable opinions of counsel to such Person (which shall

cover, among other things, the legality, validity, binding effect and enforceability of the

documentation referred to in clause (1)), all in form, content and scope reasonably satisfactory to

the Administrative Agent and (3) take all actions required by the Collateral Documents or

reasonably requested by the Administrative Agent to perfect the security interests granted by such

Guarantor under the Collateral Documents as more fully set forth in Section 7.14 and subject to

the deadlines and grace periods set forth therein.

(b)If at any time any Subsidiary that is not a Guarantor provides a guarantee of the

Borrower’s obligations in respect of the ABL Facility or the 2029 Notes, then promptly (and in any event

within ten (10) Business Days (or such longer period as the Administrative Agent shall reasonably

determine)) cause such Subsidiary to become a Guarantor by executing and delivering to the

Administrative Agent a Non-Tenant Joinder Agreement or Tenant Joinder Agreement, as applicable, or

such other documents as the Administrative Agent shall reasonably deem appropriate for such purpose,

and (ii) deliver to the Administrative Agent documents of the types referred to in Section 5.01(c) and

favorable opinions of counsel to such Person (which shall cover, among other things, the legality,

validity, binding effect and enforceability of the documentation referred to in clause (i)), all in form,

content and scope reasonably satisfactory to the Administrative Agent.

7.13ERISA Compliance

Do, and cause each of its ERISA Affiliates to do, each of the following: (a) maintain each Plan in

compliance in all material respects with the applicable provisions of ERISA, the Internal Revenue Code

and other federal or state law; (b) cause each Plan that is qualified under Section 401(a) of the Internal

Revenue Code to maintain such qualification; and (c) make all required contributions to any Plan subject

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to Section 412 of the Internal Revenue Code, in any case except, where the failure to do so would not

individually or in the aggregate reasonably be expected to result in a Material Adverse Effect.

7.14Pledged Assets

Subject to Section 7.17 and Section 12 of the Amendment and Restatement Agreement, each

Loan Party will (a) (i) cause all of its owned Real Property and personal Property (including, without

limitation, its rights in each Intercompany Note and the Intercompany Security Documents) consisting of

Collateral, other than Excluded Property, to be subject at all times from and after Effective Date to first

priority (subject to the terms of the Intercreditor Agreement), perfected Liens (subject to Permitted Liens)

in favor of the Administrative Agent for its benefit and the benefit of the Secured Parties (as defined in

the applicable Security Agreement) to secure the Obligations pursuant to the terms and conditions of the

Collateral Documents, (ii) with respect to any such Property, other than Excluded Property, acquired

subsequent to the Effective Date, within 90 days of acquisition (or such later date as may be agreed to by

the Administrative Agent), cause such Property to be subject to first priority (subject to the terms of the

Intercreditor Agreement), perfected Liens in favor of the Administrative Agent for its benefit and the

benefit of the Secured Parties (as defined in the applicable Security Agreement) to secure the Obligations

pursuant to the terms and conditions of the Collateral Documents, subject in any case to Permitted Liens,

(iii) register, file or record, or cause to be registered, filed or recorded, in an appropriate governmental

office, any document or instrument supplemental to or confirmatory of the Collateral Documents or

otherwise deemed by the Administrative Agent reasonably necessary for the continued validity,

perfection and priority of the Liens on the Collateral covered thereby subject to no other Liens other than

Permitted Liens, (iv) deliver or cause to be delivered to the Administrative Agent from time to time such

other documentation, consents, authorizations, approvals and orders in form and substance reasonably

satisfactory to the Administrative Agent as the Administrative Agent shall reasonably deem necessary to

perfect or maintain the Liens (subject to Permitted Liens) on the Collateral pursuant to the Collateral

Documents, (v) during the continuance of an Event of Default, upon the exercise by the Administrative

Agent of any power, right, privilege or remedy pursuant to any Loan Document which requires any

consent, approval, registration, qualification or authorization of any Governmental Authority, execute and

deliver all applications, certifications, instruments and other documents and papers that the

Administrative Agent may require in connection with such exercise and (vi) if the Administrative Agent

or the Required Lenders determine that they are required by Law to have appraisals prepared in respect of

the owned Real Property of any Loan Party constituting Collateral and having a fair market value in

excess of $5,000,000, provide to the Administrative Agent appraisals that satisfy the applicable

requirements of the Real Estate Appraisal Reform Amendments of FIRREA or such other applicable

Laws; provided, however, that the Loan Parties shall not be responsible for the cost of obtaining more

than one (1) appraisal per calendar year for any individual owned Real Property site and (b) deliver such

other documentation as the Administrative Agent may reasonably request in connection with the

foregoing, including, without limitation, appropriate Mortgage Instruments, UCC-1 financing statements,

real estate title insurance policies, surveys, environmental reports (limited to Phase Is), a completed “Life-

of-Loan” Federal Emergency Management Agency standard flood hazard determination with respect to

each owned Real Property constituting Collateral and having a fair market value in excess of $5,000,000

(together with a notice about special flood hazard area status and flood disaster assistance duly executed

by the Borrower and each applicable Loan Party relating thereto) and if such owned Real Property is

located in a flood hazard area, evidence of insurance required pursuant to Section 7.07, certified

resolutions and other organizational and authorizing documents of such Person, favorable opinions of

counsel to such Person (which shall cover, among other things, the legality, validity, binding effect and

enforceability of the documentation referred to above and the perfection of the Administrative Agent’s

Liens thereunder) and other items of the types required to be delivered pursuant to Section 5.01(f) all in

form, content and scope (and prepared by vendors selected by the Borrower) reasonably satisfactory to

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the Administrative Agent. Without limiting the generality of the above, so long as it is not otherwise

Excluded Property, the Loan Parties will cause (i) 100% of the issued and outstanding Capital Stock of

(x) each Material Domestic Subsidiary, (y) each Joint Venture (solely with respect to any Joint Venture

that would otherwise qualify as a Material Domestic Subsidiary if such Joint Venture were a Wholly

Owned Subsidiary) and (z) the ETMC JV, in each case owned by the Borrower or any Guarantor, (ii)

65% (or such greater percentage that, due to a change in an applicable Law after the Effective Date, (A)

could not reasonably be expected to cause the undistributed earnings of such Foreign Subsidiary as

determined for U.S. federal income tax purposes to be treated as a deemed dividend to such Foreign

Subsidiary’s United States parent and (B) could not reasonably be expected to cause any material adverse

tax consequences) of the issued and outstanding Capital Stock entitled to vote (within the meaning of

Treas. Reg. Section 1.956-2(c)(2)) and 100% of the issued and outstanding Capital Stock not entitled to

vote (within the meaning of Treas. Reg. Section 1.956-2(c)(2)) in each Foreign Subsidiary directly owned

by the Borrower or any Guarantor to be subject at all times from and after ninety days after the Effective

Date or later date of a Loan Party’s acquisition thereof (or such other date as may be agreed to by the

Administrative Agent) to a first priority (subject to the terms of the Intercreditor Agreement), perfected

Lien (subject to Permitted Liens) in favor of the Administrative Agent pursuant to the terms and

conditions of the Collateral Documents, (iii) (A) all intercompany loans permitted by Sections 8.02(g)

and (ee) to be evidenced by Intercompany Notes (and in the case of intercompany loans permitted by

Section 8.02(g), secured by Intercompany Security Documents) and (B) its rights in all such

Intercompany Notes (and in the case of intercompany loans permitted by Section 8.02(g), Intercompany

Security Documents) to be pledged to the Administrative Agent pursuant to the Collateral Assignment

Documents and such other security documents as the Administrative Agent may reasonably request and

(iv) the applicable Loan Parties to execute and deliver an account control agreement in form and

substance reasonably satisfactory to the Administrative Agent (or an assignment or amendment of an

existing deposit account control agreement to reflect the Agency Transfer) with respect to each deposit

account (other than Excluded Deposit Accounts (as defined in the ABL Credit Agreement) and Excluded

ETMC Accounts (as defined in the ABL Credit Agreement)) within ninety (90) days after the Effective

Date (with time periods to be extended with the consent of the Administrative Agent).

Notwithstanding the foregoing, the parties hereto agree the Loan Parties shall not be required to comply

with the terms of this Section 7.14 with respect to Subsidiaries created subsequent to the Effective Date

until the documentation described in Section 7.12(a) is delivered or required to be delivered with respect

to such Subsidiary.

7.15Annual Appraisals

Deliver to the Administrative Agent as and when required under Section 2.3(a)(ii) of the Relative

Rights Agreement, an appraisal of the Option Assets (as defined in the Relative Rights Agreement)

conducted by an MAI Appraiser (as defined in the Master Lease) mutually acceptable to the

Administrative Agent and LeaseCo.

7.16Change in Nature of Business

Not enter into any business, either directly or through any Restricted Subsidiary, except for those

businesses of the same general type as those in which the Borrower and its Restricted Subsidiaries are

engaged on the Effective Date (after giving effect to the Amendment and Restatement Transactions) or

which are reasonably related, supplemental or ancillary thereto and any business related, supplement or

ancillary thereto.

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7.17Post-Closing Matters

The applicable Loan Parties shall obtain and deliver to the Administrative Agent the items set

forth on Schedule 7.17, within the time periods set forth on such Schedule (unless waived or extended by

the Administrative Agent in its discretion).

7.18Compliance with Terms of Master Lease

Make all payments and otherwise perform all obligations in respect of the Master Lease, keep

such Master Lease in full force and effect and not allow such Master Lease to lapse or be terminated or

any rights to renew such Master Lease to be forfeited or cancelled, except, in any case, where the failure

to do so, either individually or in the aggregate, could not be reasonably likely to have a Material Adverse

Effect.

ARTICLE VIII

NEGATIVE COVENANTS

So long as any Lender shall have any Commitment hereunder, or any Loan or other Obligation

hereunder shall remain unpaid or unsatisfied, no Loan Party shall, nor shall it permit any of its Restricted

Subsidiaries (excluding the ETMC JV other than with respect to Section 8.16) to, directly or indirectly:

8.01Liens

Create, incur, assume or suffer to exist any Lien upon any of its property, assets or revenues,

whether now owned or hereafter acquired, other than the following:

(a)Liens pursuant to any Loan Document (including, without limitation, pursuant to

any Loan Document with respect to the Ventas Purchase Option Term Loans); provided the

Ventas Purchase Option Term Loans shall not be secured by Liens on any assets or property of

Parent, the Borrower or any Restricted Subsidiary other than on the equity interests of the Tenant

Subsidiaries;

(b)Liens existing on the Effective Date and listed on Schedule 8.01 and any

renewals or extensions thereof not any less favorable (taken as a whole) to the Lenders; provided

that the property covered thereby is not increased (other than as a result of the appreciation in

value of such property) and any renewal or extension of the obligations secured or benefited

thereby is permitted by Section 8.03(b);

(c)Liens (other than Liens imposed under ERISA) for Taxes, assessments or

governmental charges or levies not overdue for more than 60 days or which are being contested

in good faith and by appropriate proceedings diligently conducted, if adequate reserves with

respect thereto are maintained on the books of the applicable Person in accordance with GAAP;

(d)statutory Liens of landlords and Liens of carriers, warehousemen, mechanics,

materialmen and suppliers and other Liens imposed by law or pursuant to customary reservations

or retentions of title arising in the ordinary course of business; provided that such Liens secure

only amounts not overdue for more than 60 days or, if overdue for more than 60 days, are unfiled

and no other action has been taken to enforce the same or are being contested in good faith by

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appropriate proceedings for which adequate reserves determined in accordance with GAAP have

been established;

(e)pledges or deposits in the ordinary course of business (i) in connection with

workers’ compensation, unemployment insurance and other social security legislation, other than

any Lien imposed by ERISA and (ii) securing liability for reimbursement or indemnification

obligations of (including obligations in respect of letters of credit or bank guarantees for the

benefit of) insurance carriers providing property, casualty or liability insurance to Parent or any

Restricted Subsidiary;

(f)deposits to secure the performance of bids, trade contracts and leases (other than

Indebtedness or the Master Lease), the Master Lease, statutory obligations, surety bonds (other

than bonds related to judgments or litigation), performance bonds and other obligations of a like

nature incurred in the ordinary course of business;

(g)easements, rights-of-way, restrictions and other similar encumbrances affecting

Real Property which do not materially detract from the value of the Real Property subject thereto

or materially interfere with the ordinary conduct of the business of the applicable Person;

(h)Liens securing judgments for the payment of money (or appeal or other surety

bonds relating to such judgments) not in excess of the Threshold Amount (except to the extent

covered by independent third-party insurance as to which the insurer has acknowledged in

writing its obligation to cover), unless any such judgment remains undischarged for a period of

more than sixty consecutive days during which execution is not effectively stayed;

(i)Liens securing Indebtedness permitted under Section 8.03(e); provided that (i)

such Liens do not at any time encumber any Property other than the Property financed by such

Indebtedness, (ii) the Indebtedness secured thereby does not exceed the cost or fair market value,

whichever is lower, of the Property being acquired on the date of acquisition and (iii) such Liens

attach to such Property concurrently with or within 90 days after the acquisition thereof;

(j)leases, subleases, licenses or sublicenses granted to others not interfering in any

material respect with the business of the Borrower or any Restricted Subsidiary;

(k)any interest or title of a lessor, sublessor, licensor or licensee under, and Liens

arising from UCC financing statements (or equivalent filings, registrations or agreements in

foreign jurisdictions) relating to, leases or licensing agreements permitted by this Agreement;

(l)Liens deemed to exist in connection with Investments in repurchase agreements

permitted under Section 8.02;

(m)normal and customary rights of setoff upon deposits of cash in favor of banks or

other depository institutions;

(n)Liens of a collection bank arising under Section 4-210 of the Uniform

Commercial Code on items in the course of collection;

(o)Liens created or deemed to exist by the establishment of trusts for the purpose of

satisfying (A) Governmental Reimbursement Program Costs and (B) other actions or claims

pertaining to the same or related matters or other Medical Reimbursement Programs; provided

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that the Borrower, in each case, shall have established adequate reserves for such claims or

actions;

(p)Liens of sellers of goods to the Borrower and any of its Restricted Subsidiaries

arising under Article 2 of the Uniform Commercial Code or similar provisions of applicable law

in the ordinary course of business, covering only the goods sold and securing only the unpaid

purchase price for such goods and related expenses;

(q)Liens in favor of the Borrower or any Loan Party on the assets of each Non-

Guarantor Restricted Subsidiary in accordance with the terms hereof to secure the applicable

Intercompany Note of such Non-Guarantor Restricted Subsidiary;

(r)Liens on the assets of the Captive Insurance Subsidiary created or deemed to

exist in connection with the self-insurance program of the Captive Insurance Subsidiary;

(s)Liens in favor of the Administrative Agent pursuant to Collateral Assignment

Documents;

(t)zoning, building codes and other land use Laws regulating the use or occupancy

of the Real Property or the activities conducted thereon which are imposed by any governmental

authority having jurisdiction over the Real Property which are not violated by the current use or

occupancy of the Real Property or the ordinary conduct of the business of the applicable Person,

or any violation which would not have a Material Adverse Effect;

(u)Liens securing obligations incurred in connection with Permitted IRB

Transactions;

(v)Liens related to industrial revenue bonds and similar securities to the extent such

Liens attach to Property that is not Collateral, so long as the Borrower and its Restricted

Subsidiaries hold all the securities, bonds, notes or other evidence of Indebtedness issued in

respect thereof;

(w)Liens existing on Property or any asset at the time of acquisition thereof by the

Borrower or any Restricted Subsidiary or existing on any Property or asset of any Person that

becomes a Restricted Subsidiary after the Original Closing Date prior to the time such Person

becomes a Restricted Subsidiary; provided that (i) such Lien is not created in contemplation of or

in connection with such acquisition or such Person becoming a Restricted Subsidiary, as the case

may be, (ii) such Lien shall not apply to any other Property or assets of the Borrower or any

Restricted Subsidiary (other than proceeds) and (iii) such Lien shall secure only those obligations

which it secured on the date of such acquisition or the date such Person becomes a Restricted

Subsidiary, as the case may be, and extensions, renewals, refinancings and replacements thereof

that do not increase the outstanding principal amount thereof (other than by an amount not in

excess of fees and expenses, including premium and defeasance costs associated therewith) or

result in a decreased average weighted life thereof;

(x)(a) Liens securing obligations in respect of Indebtedness permitted under Section

8.03(p)(a), that are either (1) subject to the Intercreditor Agreement or (2) with respect to any

cash flow revolving facility that refinances the ABL Credit Agreement, with respect to

Indebtedness that is secured by Collateral on a pari passu or junior Lien basis and is subject to an

Acceptable Intercreditor Agreement and (b) Liens securing obligations in respect of the Ventas

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Purchase Option ABL Loans permitted under Section 8.03(p)(b); provided that the Ventas

Purchase Option ABL Loans shall not be secured by Liens on any assets or property of Parent,

the Borrower or any Restricted Subsidiary other than on the equity interests of the Tenant

Subsidiaries;

(y)other Liens securing obligations in an amount not to exceed the greater of (A)

$215,000,000 and (B) 45% of Consolidated EBITDA in the aggregate at any time outstanding;

(z)Liens securing obligations in respect of Indebtedness permitted under

Section 8.03(r) so long as such Liens attach only to Property or assets of the BSA Entities;

(aa)(i) any rights of LeaseCo pursuant to the Relative Rights Agreement and (ii)

Liens on security deposits and similar deposits pursuant to Section 4.3 of the Master Lease;

(bb)Liens in favor of providers of (i) Cash Management Services (as defined in the

ABL Credit Agreement); (ii) products under agreements relating to any swap, cap, floor, collar,

option, forward, cross right or obligation, or combination thereof or similar transaction, with

respect to interest rate, foreign exchange, currency, commodity, credit or equity risk; (iii)

commercial credit card and merchant card services; or (iv) other banking products or services as

may be requested by any Loan Party or Restricted Subsidiary, other than Letters of Credit (as

defined in the ABL Credit Agreement), (x) securing Obligations incurred in connection with

credit card and merchant card processing servicing arrangements, or (y) subject to a subordination

agreement executed by such provider and the Administrative Agent, which provides that such

Liens are subordinated to the Liens securing the Obligations;

(cc)Liens securing obligations in respect of Indebtedness permitted under

Section 8.03 (f), (u), (v), (w) and (y) (including, with respect to clause (y), first priority tax liens);

and

(dd)Liens on sums payable by Loan Parties or their Restricted Subsidiaries under

insurance policies securing Indebtedness incurred in the ordinary course of business under

financing arrangements related to the payment of premiums and deductibles under insurance

policies.

Notwithstanding the foregoing, in no event shall the Borrower or any of its Restricted

Subsidiaries (excluding the ETMC JV) create, incur, assume or permit to exist any Lien (i) on the

leasehold interest in the Master Lease securing any Indebtedness unless the Administrative Agent, for the

benefit of the Secured Parties (as defined in the applicable Security Agreement), shall have been granted a

Lien on such property that ranks senior to the Lien on such property granted to secure such other

Indebtedness, (ii) on the Collateral (as defined in the applicable Security Agreement) in violation of the

Relative Rights Agreement and/or the Master Lease, as applicable, or (iii) on any Excluded ETMC

Account (other than Liens permitted by Section 8.01(a) (so long as a Lien is granted for the benefit of all

Lenders), (c), (d), (e), (f), (m), (n), (s) (so long as a Lien is granted for the benefit of all Lenders) and

(bb)) unless a Lien is also granted for the benefit of the Lenders on a senior priority basis .

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8.02Investments

Make any Investments, except:

(a)Investments held by the Borrower or such Restricted Subsidiary in the form of

cash or Cash Equivalents;

(b)Investments existing as of the Effective Date and set forth in Schedule 8.02 and

any renewals, refinancings and extensions thereof on terms and conditions not materially less

favorable (taken as a whole) to the Lenders;

(c)(d) Investments in any Person that is a Loan Party (other than an ETMC Loan

Party), (i) Investments by any Loan Party in any newly formed Restricted Subsidiary that

becomes a Loan Party (other than an ETMC Loan Party), (ii) Investments by any ETMC Loan

Party in any Loan Party or any other ETMC Loan Party, (iii) [reserved], (iv) Investments by any

Non-Guarantor Restricted Subsidiary in any Loan Party, any other Non-Guarantor Restricted

Subsidiary or any ETMC Loan Party, and (v) Investments by any ETMC Loan Party in any

newly formed Subsidiary that becomes an ETMC Loan Party;

(e)Investments consisting of extensions of credit in the nature of accounts

receivable or notes receivable arising from the grant of trade credit in the ordinary course of

business, and Investments received in satisfaction or partial satisfaction thereof from financially

troubled account debtors to the extent reasonably necessary in order to prevent or limit loss;

(f)Guarantees permitted by Section 8.03;

(g)Investments subsequent to the Original Closing Date in the form of equity or

capital contributions in Non-Guarantor Restricted Subsidiaries or Joint Ventures using cash

invested in the Parent by the Sponsor Group and/or Ventas and immediately passed through by

the Parent to the applicable Non-Guarantor Restricted Subsidiary or Joint Venture;

(h)[Reserved];

(i)so long as immediately before and immediately after giving effect to such

Investment, no Event of Default has occurred and is continuing, Investments in a Joint Venture,

together with all other Investments made by the Borrower or any Restricted Subsidiary pursuant

to this Section 8.02(h) in an aggregate amount at the time of such Investment not to exceed the

greater of (A) $190,000,000 and (B) 40% of Consolidated EBITDA in the aggregate outstanding

at any one time; provided that if such Investment is in the form of a loan, (x) each such

intercompany loan is evidenced by an Intercompany Note, (y) the Loan Parties shall take

commercially reasonable efforts to have such Intercompany Note secured by the assets of the

applicable Non-Guarantor Restricted Subsidiary or Joint Venture pursuant to the Intercompany

Security Documents and such other documentation reasonably satisfactory to the Administrative

Agent and (y) the rights of the applicable lender under each such Intercompany Note and, if

applicable, Intercompany Security Document have been pledged to the Administrative Agent

pursuant to documentation reasonably satisfactory to the Administrative Agent;

(i)Investments subsequent to the Effective Date in Non-Guarantor Restricted

Subsidiaries or any ETMC Subsidiary, together with all other Investments made by the Borrower

or any Restricted Subsidiary pursuant to this Section 8.02(i) and all other Investments in Non-

Guarantor Restricted Subsidiaries and ETMC Subsidiaries made pursuant to Section 8.02(j) not to

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exceed the greater of (A) $140,000,000 and (B) 30% of Consolidated EBITDA in the aggregate

outstanding at any one time; provided that if such Investment is in the form of a loan (x) each

such intercompany loan is evidenced by an Intercompany Note and the Loan Parties shall take

commercially reasonable efforts to have such Intercompany Note secured by the assets of the

applicable Non-Guarantor Restricted Subsidiary or ETMC Subsidiary pursuant to the

Intercompany Security Documents and such other documentation reasonably satisfactory to the

Administrative Agent and (y) the rights of the applicable lender under each such Intercompany

Note and Intercompany Security Document (if applicable) have been pledged to the

Administrative Agent pursuant to documentation reasonably satisfactory to the Administrative

Agent;

(j)Permitted Acquisitions;

(k)Investments in the Captive Insurance Subsidiary in an amount not to exceed 150%

of the minimum amount of capital required under the laws of the jurisdiction in which the

Captive Insurance Subsidiary is formed and other Investments in the Captive Insurance

Subsidiary to cover reasonable general corporate and overhead expenses of the Captive Insurance

Subsidiary;

(l)loans and advances in the ordinary course of business to employees of the

Borrower or any of its Restricted Subsidiaries so long as the aggregate principal amount of such

advances outstanding at any time shall not exceed $10,000,000;

(m)Investments consisting of non-cash consideration received in connection with a

sale of assets permitted under Section 8.05;

(n)Investments arising from endorsements for collection or deposit in the ordinary

course of business;

(o)so long as immediately before and immediately after giving effect to such

Investment, no Event of Default has occurred and is continuing, Investments in a Similar

Business having an aggregate fair market value, taken together with all other Investments made

pursuant to this Section 8.02(o) that are at that time outstanding, not to exceed the greater of (x)

$140,000,000 and (y) 30% of Consolidated EBITDA in the aggregate outstanding at any one time

(in each case, determined on the date such Investment is made, with the fair market value of each

Investment being measured at the time made and without giving effect to subsequent changes in

value);

(p)so long as immediately before and immediately after giving effect to such

Investment, no Event of Default has occurred and is continuing, other Investments in an amount

not to exceed the greater of (A) $190,000,000 and (B) 40% of Consolidated EBITDA in the

aggregate at any time outstanding;

(q)[reserved];

(r)Investments consisting of extensions of credit in the nature of accounts

receivable or notes receivable arising from the grant of trade credit in the ordinary course of

business and Investments received in satisfaction or partial satisfaction thereof from financially

troubled account debtors and other credits to suppliers in the ordinary course of business;

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(s)Investments (including debt obligations and Capital Stock) received in

connection with the bankruptcy or reorganization of suppliers and customers or in settlement of

delinquent obligations of, or other disputes with, customers and suppliers arising in the ordinary

course of business or upon the foreclosure with respect to any secured Investment or other

transfer of title with respect to any secured Investment;

(t)licenses or sublicenses in the ordinary course of business that do not materially

detract from the value of the Property subject thereto or materially interfere with the ordinary

conduct of the business of the Borrower or any Material Domestic Subsidiary;

(u)so long as immediately before and after giving effect to such Investment, no

Event of Default has occurred and is continuing, other Investments in an amount not to exceed

the Borrower’s Portion of Excess Cash Flow immediately prior to the time of the making of any

Investment; provided that after giving pro forma effect thereto, the Fixed Charge Coverage Ratio

(calculated on a pro forma basis) is not less than 2.00:1.00;

(v)additional Investments to the extent that payment for such Investments is made

solely with net proceeds of any Equity Issuance of Qualified Capital Stock of the Borrower (or

Parent, to the extent such cash proceeds are contributed to the Borrower) after the Effective Date

that are not used for any other purpose;

(w)Investments made in connection with Permitted IRB Transactions;

(x)Investments consisting of Physician Support Obligations made by the Borrower

or any Restricted Subsidiary in the ordinary course of business;

(y)the purchase of up to 15% of the outstanding Capital Stock of Physicians

Surgical Hospitals, LLC and Physicians Surgical Real Estate, LLC;

(z)Investments made by any Non-Guarantor Restricted Subsidiary into any other

Non-Guarantor Restricted Subsidiary (including intercompany Indebtedness);

(aa)Investments consisting of extensions of credit or other Indebtedness owing by

any BSA Entity permitted by Section 8.03(r);

(bb)the purchase of any equity interest of any BSA Entity pursuant to a put or call

option in respect of such BSA Entity’s equity interests set forth in the Organization Documents of

such BSA Entity so long as such BSA Entity becomes a Wholly Owned Subsidiary after giving

effect to such purchase;

(cc)cash management transactions between any Loan Party and the BSA Entities;

(dd)Investments in the form of unsecured Guarantees by a Loan Party or any of its

Restricted Subsidiaries that manages any hospital of such hospital’s obligation to repurchase Self-

Pay Accounts that have been disposed of pursuant to clause (x)(B) of the definition of

“Disposition”;

(ee)Investments consisting of (i) the intercompany loan evidenced by the Required

Payment Intercompany Note in an aggregate principal amount not to exceed $205,000,000

(excluding any interest paid in kind) at any time outstanding; (ii) intercompany loans

(collectively, the “Working Capital Intercompany Loans”) from a Loan Party to AHS East Texas

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in an aggregate principal amount not to exceed $46,000,000 (excluding any interest paid in kind)

at any time outstanding and any Investments from an ETMC Loan Party to any ETMC Subsidiary

which Investments are made solely with the proceeds of the Working Capital Intercompany

Loans; and (iii) an intercompany loan from AHS East Texas to AHS Legacy Operations, LLC in

an aggregate principal amount not to exceed $25,000,000 (excluding any interest paid in kind) at

any time outstanding; provided (x) each such intercompany loan is evidenced by an

Intercompany Note and such other documentation reasonably requested by the Administrative

Agent and (y) the rights of the applicable Loan Party under each such Intercompany Note have

been pledged to the Administrative Agent pursuant to documentation reasonably satisfactory to

the Administrative Agent;

(ff)subject to Section 8.16, the ETMC Subsidiaries may make Investments in the

ETMC JV with cash generated from the operations of such ETMC Subsidiaries to the extent

required by the ETMC JV Agreement;

(gg)so long as immediately before and after giving effect to such Investment, no

Event of Default has occurred and is continuing, additional Investments; provided that after

giving pro forma effect thereto, the Consolidated Net Leverage Ratio (calculated on a pro forma

basis) is not greater than 3.25:1.00;

(hh)Investments to the extent constituting Approved Hospital Swaps;

(ii)Investments pursuant to any customary buy/sell arrangements in favor of investors

or joint venture parties in connection with syndications of healthcare facilities, including, without

limitation, Hospitals, ambulatory surgery centers, outpatient diagnostic centers or imaging

centers;

(jj)  distributions or payments in connection with a Securitization Transaction in an

aggregate amount not to exceed, together with all Investments pursuant to Section 8.02(kk) and

Dispositions pursuant to clause (xviii) of the definition of “Dispositions”, the greater of (A)

$100,000,000 and (B) 25.0% of Consolidated EBITDA, provided that no distributions of ABL

Priority Collateral shall be permitted by this clause (jj);

(kk)any Investment in a Receivable Subsidiary or other Person, pursuant to the terms

and conditions of a Securitization Transaction and any right to receive distributions or payments

of fees related to a Securitization Transaction and any right to purchase assets of a Receivables

Subsidiary in connection with a Securitization Transaction in an aggregate amount not to exceed,

together with all Investments pursuant to Section 8.02(jj) and Dispositions pursuant to clause

(xviii) of the definition of “Dispositions”, the greater of (A) $100,000,000 and (B) 25.0% of

Consolidated EBITDA, provided that no distributions of ABL Priority Collateral shall be

permitted by this clause (kk);

(ll)after (or concurrently with) the consummation of the Ventas Purchase Option,

Investments in the Tenant Subsidiaries in an amount not to exceed the amount of Investments in

such Tenant Subsidiaries immediately prior to the consummation of the Ventas Purchase Option;

and

(mm) Investments in Unrestricted Subsidiaries having an aggregate fair market value,

taken together with all other Investments made pursuant to this clause (mm) that are at the time

outstanding, without giving effect to the sale of an Unrestricted Subsidiary to the extent the

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proceeds of such sale do not consist of cash or marketable securities received by Parent, the

Borrower or a Restricted Subsidiary, not to exceed the greater of (x) $70.0 million and (y) 15% of

Consolidated EBITDA at the time of such Investment (with the fair market value of each

Investment being measured at the time made and without giving effect to subsequent changes in

value).

8.03Indebtedness

Create, incur, assume or suffer to exist any Indebtedness, except:

(a)Indebtedness under the Loan Documents (including, without limitation, in

connection with the Ventas Purchase Option Term Loans in an amount not to exceed the Ventas

Purchase Option Term Loan Amount);

(b)Indebtedness of the Borrower and its Restricted Subsidiaries set forth in Schedule

8.03 (and renewals, refinancings and extensions thereof (not exceeding the principal amount of

the Indebtedness so renewed, refinanced or extended) on terms and conditions not materially less

favorable (taken as a whole) to the applicable debtor(s) or to the Lenders);

(c)intercompany Indebtedness permitted under Section 8.02;

(d)obligations (contingent or otherwise) of the Borrower or any Restricted

Subsidiary existing or arising under any Swap Contract entered into in the ordinary course of

business and not for speculative purposes;

(e)purchase money Indebtedness (including obligations in respect of Capital Leases

or Synthetic Leases) hereafter incurred by the Borrower or any of its Restricted Subsidiaries to

finance the purchase of fixed assets, and renewals, refinancings and extensions thereof; provided

that (i) the total of all such Indebtedness for all such Persons taken together shall not exceed an

aggregate principal amount of the greater of (A) $190,000,000 and (B) 40% of Consolidated

EBITDA at any one time outstanding; (ii) such Indebtedness when incurred shall not exceed the

purchase price of the asset(s) financed; and (iii) no such Indebtedness shall be refinanced for a

principal amount in excess of the principal balance outstanding thereon at the time of such

refinancing (other than for interest, premiums, penalties and fees);

(f)Securitization Transactions (solely in respect of Collateral of a type that would

not constitute ABL Priority Collateral) in an aggregate principal amount at any one time

outstanding not to exceed the greater of (A) $100,000,000 and (B) 25% of Consolidated

EBITDA;

(g)intercompany Indebtedness incurred under the LHP Cash Management Transfer

System;

(h)Indebtedness under performance bonds, surety bonds, letter of credit obligations

to provide security for workers’ compensation claims and bank overdrafts, in each case in the

ordinary course of business;

(i)Indebtedness in the form of trade payables and accrued expenses incurred in the

ordinary course of business;

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(j)other Indebtedness in an aggregate principal amount not to exceed the greater of

(A)$215,000,000 and (B) 45% of Consolidated EBITDA at any one time outstanding;

(k)Indebtedness of the Borrower or any other Loan Party in the form of loans from

the Captive Insurance Subsidiary in an aggregate principal amount at any time outstanding not to

exceed twenty percent (20%) of the total assets of the Captive Insurance Subsidiary, as shown on

the most recent balance sheet of the Captive Insurance Subsidiary in accordance with GAAP;

(l)Earn-Out Obligations not to exceed $10,000,000 in the aggregate at any one time

outstanding;

(m)Guarantees by the Borrower or its Restricted Subsidiaries of Indebtedness

permitted to be incurred by such Borrower or Restricted Subsidiary in accordance with the

provisions of this Agreement; provided that in the event such Indebtedness that is being

Guaranteed is Subordinated Indebtedness, then any related Guarantee of the Borrower or a Loan

Party shall be subordinated in right of payment to the Term Loans;

(n)Indebtedness of the Loan Parties incurred in the ordinary course of business

under financing arrangements related to the prepayment of premiums and deductibles under the

Loan Parties’ insurance policies;

(o)Indebtedness of Non-Guarantor Restricted Subsidiaries, together with any

Indebtedness incurred by Non-Guarantor Restricted Subsidiaries pursuant to Section 8.03(u) and

to Section 8.03(v) below not to exceed the greater of (A) $190,000,000 and (B) 40% of

Consolidated EBITDA at any one time outstanding;

(p)(a) Indebtedness incurred pursuant to the ABL Facility by the Borrower or any

Loan Party in an aggregate principal amount of commitments, loans or letters of credit thereunder

(without any duplication thereof) not to exceed (A) the greater of (x) $225,000,000 (plus any

incremental facilities permitted thereunder as in effect on the Effective Date in an amount not to

exceed $100,000,000) less the aggregate principal amount of commitments in respect of the

Ardent ABL Facility Silo terminated in connection with the Ventas Purchase Option and (y) the

Borrowing Base (as defined in the ABL Facility as in effect on the Effective Date; provided that

after giving effect to the Ventas Purchase Option, this clause (y) shall no longer include the

Borrowing Base in respect of the Ardent ABL Facility Silo); provided that such Indebtedness is

either (1) subject to the terms of the Intercreditor Agreement in the capacity of “ABL

Obligations” or (2) with respect to any cash flow revolving facility that refinances the ABL

Credit Agreement, such Indebtedness is secured by Collateral on a pari passu or junior Lien basis

and is subject to an Acceptable Intercreditor Agreement and (b) after consummation of the Ventas

Purchase Option, Indebtedness assigned to the Ventas Assignees under the ABL Facility in an

amount equal to the Ventas Purchase Option ABL Amount (the “Ventas Purchase Option ABL

Loans”) (provided that the guarantees in respect of such Indebtedness by Parent, Borrower and

Loan Parties thereunder shall be subordinated to the Non-Ventas Purchase Option Term Loans);

(q)Indebtedness incurred in connection with Permitted IRB Transactions;

(r)Indebtedness of the BSA Entities in an amount not to exceed at any one time

outstanding $30,000,000; provided that such Indebtedness shall not be guaranteed in any respect

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by Parent, the Borrower or any Guarantor (other than any BSA Entity) except to the extent

permitted by Section 8.02;

(s)[reserved];

(t)Unsecured Indebtedness incurred pursuant to the 2029 Notes Indenture by the

Borrower or any Loan Party in an aggregate principal amount thereunder not to exceed

$300,000,000 and refinancings and replacements thereof so long as (i) such unsecured

refinancing or replacement Indebtedness shall mature no earlier than the maturity date of the 2029

Notes, (ii) such unsecured refinancing or replacement Indebtedness shall not contain any

amortization or mandatory prepayment provisions (other than customary offer to purchase

provisions consistent with the offer to purchase provisions contained in the 2029 Notes Indenture)

and (iii) the other terms and provisions of such unsecured refinancing or replacement

Indebtedness shall not be more restrictive to the Borrower and its Restricted Subsidiaries, taken

as a whole, than the 2029 Notes Indenture as in effect on the Effective Date;

(u)(i) Indebtedness secured by Liens that are pari passu with or junior to the Liens

securing the Term Loans so long as immediately after giving effect to the incurrence of such

Indebtedness and the use of proceeds thereof, the Senior Secured Net Leverage Ratio on a Pro

Forma Basis is not greater than 3.75:1.00; provided that for purposes of this clause (i), net cash

proceeds of Indebtedness incurred at such time shall not be netted against the applicable amount

of Consolidated Indebtedness for purposes of such calculation of the Senior Secured Net

Leverage Ratio and (ii) unsecured Indebtedness so long as immediately after giving effect to the

incurrence of such Indebtedness and the use of proceeds thereof, either (A) the Consolidated Net

Leverage Ratio on a Pro Forma Basis is not greater than 5.25:1.00 or (B) the Fixed Charge

Coverage Ratio is not less than 2.00:1.00 (provided that for purposes of this clause (ii), net cash

proceeds of Indebtedness incurred at such time shall not be netted against the applicable amount

of Consolidated Indebtedness for purposes of such calculation of the Consolidated Net Leverage

Ratio); provided, that the aggregate principal amount of such Indebtedness incurred by Non-

Guarantor Restricted Subsidiaries, together with any Indebtedness incurred by Non-Guarantor

Restricted Subsidiaries pursuant to Section 8.03(o) and Section 8.03(v) shall not exceed at any

time outstanding, the greater of (A) $190,000,000 or (B) 40% of Consolidated EBITDA;

provided, further, that (I) such Indebtedness shall be subject to the Maturity and Weighted

Average Life to Maturity Limitations, (II) if secured, such Indebtedness shall be secured only by

Collateral either on a pari passu or junior Lien on the Collateral, (III) in the case of term loans

secured on a pari passu basis with the Liens securing the Term Loans, such Indebtedness shall be

subject to the MFN Provisions and (IV) such Indebtedness shall be on terms and pursuant to

documentation (including an Acceptable Intercreditor Agreement if applicable) reasonably

satisfactory to the Borrower and the lenders proving such Indebtedness (provided that to the

extent such terms and documentation are not consistent with this Agreement (except as they relate

to maturity, Weighted Average Life to Maturity or interest rates), they shall not be more

favorable, taken as a whole (as reasonably determined by the Borrower), to the lenders providing

such Indebtedness than the terms of the Term Loans (other than with respect to terms and

conditions applicable after the maturity of the Term Loans) unless such more favorable terms are

added for the benefit of the Term Loans, which shall not require the consent of the Lenders and

any such Indebtedness may contain any financial maintenance covenants, so long as such

covenants are also added for the benefit of the Lenders, which shall not require consent of the

Lenders);

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(v)assumed Indebtedness of a Restricted Subsidiary acquired after the Original

Closing Date or a person merged or consolidated with the Borrower or any Restricted Subsidiary

after the Original Closing Date and Indebtedness otherwise incurred by the Borrower or any

Restricted Subsidiary in connection with the acquisition of assets or equity interests (including a

Permitted Acquisition), where such acquisition, merger or consolidation is not prohibited by this

Agreement; provided that in the case of assumed Indebtedness, such Indebtedness is not incurred

in contemplation of such acquisition or merger; provided, further, that, (x) such Indebtedness is

secured by Liens that are pari passu with or junior to the Liens securing the Term Loans and

immediately after giving effect to such acquisition, merger or consolidation, the incurrence or

assumption of such Indebtedness and the use of proceeds thereof, the Senior Secured Net

Leverage Ratio on a Pro Forma Basis is either (A) not greater than 3.75:1.00 or (B) no greater

than the Senior Secured Net Leverage Ratio in effect immediately prior thereto (provided that for

purposes of this clause (x), net cash proceeds of Indebtedness incurred at such time shall not be

netted against the applicable amount of Consolidated Indebtedness for purposes of such

calculation of the Senior Secured Net Leverage Ratio) or (y) such Indebtedness is unsecured and

immediately after giving effect to such acquisition, merger or consolidation, the incurrence or

assumption of such Indebtedness and the use of proceeds thereof, either (i) the Consolidated Net

Leverage Ratio on a Pro Forma Basis is either (A) not greater than 5.25:1.00 or (B) no greater

than the Consolidated Net Leverage Ratio in effect immediately prior thereto (provided that for

purposes of this clause (y), net cash proceeds of Indebtedness incurred at such time shall not be

netted against the applicable amount of Consolidated Indebtedness for purposes of such

calculation of the Consolidated Net Leverage Ratio) or (ii) the Fixed Charge Coverage Ratio is

either (A) not less than 2.00:1.00 or (B) not less than Fixed Charge Coverage Ratio in effect

immediate prior thereto; provided, further, that the aggregate amount of such Indebtedness

incurred by Non-Guarantor Restricted Subsidiaries, together with any Indebtedness incurred by

Non-Guarantor Restricted Subsidiaries pursuant to Section 8.03(o) and Section 8.03(u) shall not

exceed at any time outstanding, the greater of (A) $190,000,000 or (B) 40% of Consolidated

EBITDA; provided, further, that (I) such incurred Indebtedness shall be subject to the Maturity

and Weighted Average Life to Maturity Limitations, (II) if secured, such Indebtedness shall be

secured only by either a pari passu or junior Lien on the Collateral, (III) in the case of term loans

secured on a pari passu basis with the Liens securing the Term Loans, such Indebtedness shall be

subject to the MFN Provisions and (IV) such incurred Indebtedness shall be on terms and

pursuant to documentation (including an Applicable Intercreditor Agreement if applicable)

reasonably satisfactory to the Borrower and the lenders proving such Indebtedness (provided that

to the extent such terms and documentation are not consistent with this Agreement (except as

they relate to maturity, Weighted Average Life to Maturity or interest rates), they shall not be

more favorable, taken as a whole (as reasonably determined by the Borrower), to the lenders

providing such Indebtedness than the terms of the Term Loans (other than with respect to terms

and conditions applicable after the maturity of the Term Loans) unless such more favorable terms

are added for the benefit of the Term Loans, which shall not require the consent of the Lenders

and any such Indebtedness may contain any financial maintenance covenants, so long as such

covenants are also added for the benefit of the Lenders, which shall not require consent of the

Lenders);

(w)Attributable Indebtedness of the Borrower or any Restricted Subsidiary arising

from a Permitted Sale Leaseback;

(x)Indebtedness incurred on behalf of or representing Guarantees of Indebtedness of

Joint Ventures of the Borrower or any Restricted Subsidiary not in excess of the greater of (A)

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$190,000,000 and (B) 40% of Consolidated EBITDA at any one time outstanding; and

(y)Indebtedness in connection with property assessed clean energy financing or

similar financing in connection with energy efficiency, renewable energy and other eligible

improvements, including, without limitation, PACE Financings.

Notwithstanding the foregoing, in no event shall the Borrower or any of its Restricted

Subsidiaries (excluding the ETMC JV) create, incur, assume or suffer to exist any Indebtedness or any

Guarantee in violation of the Relative Rights Agreement and/or the Master Lease, as applicable.

Notwithstanding the foregoing, any Indebtedness incurred pursuant to this Section 8.03 that is

subordinated in right of payment to the Term Loans shall comply with the definition of “Subordinated

Indebtedness”.

8.04Fundamental Changes

Merge, dissolve, liquidate, consolidate with or into another Person, or Dispose of (whether in one

transaction or in a series of related transactions) all or substantially all of its assets (whether now owned

or hereafter acquired) to or in favor of any Person; provided that, notwithstanding the foregoing

provisions of this Section 8.04 but subject to the terms of Sections 7.12 and 7.14, (a) any Loan Party

(other than any ETMC Loan Party) may merge, dissolve into or consolidate with any other Loan Party

(other than any ETMC Loan Party); provided that if the Borrower is a party thereto, the Borrower shall be

the continuing or surviving corporation, (b) any Foreign Subsidiary may be merged, dissolved into or

consolidated with or into any Loan Party; provided that such Loan Party shall be the continuing or

surviving corporation, (c) any Foreign Subsidiary may be merged, dissolved into or consolidated with or

into any other Foreign Subsidiary, (d) any non-Loan Party or ETMC Loan Party may be merged,

dissolved into or consolidated with or into any Loan Party; provided that such Loan Party shall be the

continuing or surviving corporation, (e) any non-Loan Party may be merged, dissolved into or

consolidated with or into any other non-Loan Party, (f) any Restricted Subsidiary may merge with any

Person that is not a Loan Party in connection with an Acquisition permitted hereunder; provided that any

Loan Party shall be the continuing or surviving corporation, (g) any ETMC Loan Party may be merged,

dissolved into or consolidated with or into any other ETMC Loan Party, (h) any Restricted Subsidiary of

the Borrower may dissolve, liquidate or wind up its affairs at any time; provided that such dissolution,

liquidation or winding-up, as applicable, could not reasonably be expected to have a Material Adverse

Effect or otherwise result in a Default or Event of Default hereunder and (i) nothing in this Section 8.04

shall prohibit any transaction of the type excluded from the definition of “Disposition” by virtue of

clauses (i) through (xvii) of the definition of “Disposition” or any Disposition otherwise permitted under

Section 8.05. Notwithstanding anything to the contrary set forth herein or in any other Loan Document,

(x) the Parent may convert into a “C” corporation” and/or (y) so long as no Event of Default exists or

would result therefrom, the Borrower may merge (the “Permitted Merger”) with and into the Parent in

connection with an initial public offering of the common stock or common equity interests of the

Borrower or any direct or indirect parent entity of the Borrower; provided that (A) the Parent shall

continue to be an entity organized or existing under the laws of the United States, any state thereof, the

District of Columbia or any territory thereof, (B) the Parent shall expressly assume all the obligations of

the Borrower under this Agreement and the other Loan Documents to which the Borrower is a party

pursuant to a supplement hereto or thereto in form reasonably satisfactory to the Administrative Agent,

(C) each Guarantor, unless it is the other party to such merger or consolidation, shall have by a

supplement to this Agreement confirmed that its Guarantee shall apply to the Parent’s obligations under

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this Agreement, (D) each Loan Party, unless it is the other party to such merger or consolidation, shall

have by a supplement to each Security Agreement, as applicable, confirmed that its obligations thereunder

shall apply to the Parent’s obligations under this Agreement, (E) each mortgagor of a Mortgaged

Property, unless it is the other party to such merger or consolidation, shall have by an amendment to or

restatement of the applicable Mortgage Instrument (or other instrument or agreement reasonably

satisfactory to the Administrative Agent) confirmed that its obligations thereunder shall apply to the

Parent’s obligations under this Agreement, and (F) the Borrower shall have delivered to the

Administrative Agent (x) an officer’s certificate stating that such merger or consolidation and such

supplement to this Agreement or any other Loan Document comply with this Agreement and (y) and an

opinion of counsel stating that this Agreement and certain other Loan Documents reasonably requested by

the Administrative Agent, as modified by the applicable supplements set forth above, are enforceable

against the Borrower and the other applicable Loan Parties, in each case after giving effect to the

Permitted Merger ; provided, further, that if the foregoing are satisfied, the Parent will succeed to, and be

substituted for, the Borrower under this Agreement and the other Loan Documents; provided, further, that

such Borrower agrees to provide any documentation and other information about the Parent as shall have

been reasonably requested in writing by any Lender through an Administrative Agent that such Lender

shall have reasonably determined is required by regulatory authorities under applicable “know your

customer” and anti-money laundering rules and regulations, including Title III of the USA Patriot Act;

8.05Dispositions

Make any Disposition (other than any Approved Hospital Swap) unless (i) (a) at least 75% of the

total consideration received by the Borrower or such Restricted Subsidiary in connection therewith shall

be cash or Cash Equivalents paid contemporaneous with consummation of the transaction and the total

consideration paid shall be in an amount not less than the fair market value of the Property disposed of,

(b) such transaction does not involve a sale or other disposition of receivables other than receivables

owned by or attributable to other Property concurrently being disposed of in a transaction otherwise

permitted under this Section 8.05, (c) the aggregate net book value of all of the assets (excluding assets

subject to a Permitted Sale Leaseback) sold or otherwise Disposed of by the Borrower and its Restricted

Subsidiaries (excluding any Dispositions of any ETMC Subsidiaries that are Excluded Subsidiaries) in all

such transactions in any fiscal year of the Borrower shall not exceed $100,000,000 and (d) in the case of

any Disposition (excluding any Dispositions of any ETMC Subsidiaries that are Excluded Subsidiaries)

where the aggregate net book value of all of the assets sold or otherwise disposed of exceeds

$20,000,000, no later than five (5) Business Days prior to such Disposition, the Borrower shall have

delivered to the Administrative Agent a certificate of a Responsible Officer of the Borrower specifying

the anticipated date of such Disposition, briefly describing the assets to be sold or otherwise disposed of

and setting forth the net book value of such assets, the aggregate consideration and the Net Cash Proceeds

to be received for such assets in connection with such Disposition, (ii) such Disposition is pursuant to the

Relative Rights Agreement or (iii) such Disposition is of one or more medical office buildings and related

Real Property (whether or not arising from Sale and Leaseback Transactions) (any such Disposition, a

“MOB Disposition”); provided that no Default or Event of Default shall have occurred or be continuing

or would result therefrom.

8.06Restricted Payments

Declare or make, directly or indirectly, any Restricted Payment, or incur any obligation

(contingent or otherwise) to do so, except that:

(a)(i) (A) each Restricted Subsidiary may make Restricted Payments (directly or

indirectly) to any Loan Party (other than an ETMC Loan Party) and (B) each ETMC Subsidiary

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may make Restricted Payments (directly or indirectly) to any Loan Party; (ii) any non-Loan Party

may make cash dividends on a pro rata basis to the holders of its Capital Stock, (iii) any BSA

Entity may make Restricted Payments on a pro rata basis to the holders of any equity interests

therein and (iv) subject to Section 8.16, each ETMC Subsidiary may make Restricted Payments

(directly or indirectly) using cash generated from its operations to the ETMC JV to the extent

required by the ETMC JV Agreement;

(b)Parent and each of its Restricted Subsidiaries may declare and make dividend

payments or other distributions payable solely in the Capital Stock (other than Disqualified

Capital Stock) of such Person;

(c)the Borrower or any Restricted Subsidiary may make Restricted Payments to the

Parent (or any parent entity thereof that controls the Borrower) so that the Parent (or any parent

entity thereof that controls the Borrower) may consummate the repurchase of Capital Stock held

by employees, former employees, directors, former directors, officers, former officers,

consultants or former consultants of the Parent or any of its Subsidiaries in an amount not to

exceed $15,000,000 in the aggregate during any fiscal year of the Borrower (which will increase

to $30,000,000 following the consummation of an initial Public Equity Offering by the Borrower

or any direct or indirect parent entity of the Borrower) (with unused amounts in any fiscal year

being carried over to the next succeeding fiscal years), subject to a maximum payment in any

fiscal year of $30,000,000 (which will increase to $60,000,000 following the consummation of an

initial Public Equity Offering by the Borrower or any direct or indirect parent entity of the

Borrower); provided, however, that no Event of Default shall have occurred and be continuing at

the time of any such distribution or payment or result therefrom;

(d)with respect to any taxable period for which the Borrower and/or any of its

Subsidiaries is a member of a consolidated, combined or similar income tax group (a “Tax

Group”) of which any parent entity of the Borrower is the common parent, the portion of any

federal, state and/or local income taxes, as applicable, of such Tax Group that is attributable to

the taxable income of Borrower and its applicable Subsidiaries (reduced by any dividends or

distributions made by the Borrower prior to the Effective Date with respect to such Taxes for

such taxable period); provided that the amount of such payments made in respect of any taxable

period in the aggregate shall not exceed the amount that the Borrower and/or its applicable

Subsidiaries would have been required to pay if the Borrower and such Subsidiaries had been a

stand-alone Tax Group for all relevant taxable periods; provided, further, that the amount of such

payments attributable to the taxable income of any Unrestricted Subsidiary shall be limited to the

amount actually paid by such Unrestricted Subsidiary to the Borrower or any other Loan Party for

the purposes of paying such consolidated, combined or similar taxes;

(e)the Borrower or any Restricted Subsidiary may make distributions to the Parent

(or any parent entity thereof that controls the Borrower) in any fiscal year so that the Parent (or

any parent entity thereof that controls the Borrower) may pay (A)(i) any Sponsor Fees in an

amount not to exceed $5,000,000 in any fiscal year and (ii) any customary transaction fees;

provided, however, that no Default or Event of Default shall have occurred and be continuing at

the time of any such distribution or payment or result therefrom; provided further that, if at any

time any such Sponsor Fees and transaction fees are not permitted to be paid as a result of the

failure to satisfy the foregoing proviso or otherwise elected to be deferred, then (1) such amounts

shall continue to accrue, and (2) any such amounts that have accrued but which were not

permitted to, or were elected not to, be paid may be paid in any subsequent period so long as the

conditions set forth in the foregoing proviso are satisfied at the time of the making of such

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payments, (B) reasonable out-of-pocket expenses of the Sponsor and (C) indemnity payments to

the Sponsor;

(f)so long as no Event of Default shall have occurred and be continuing or would

result therefrom, Borrower and any Restricted Subsidiary may make additional Restricted

Payments to the Parent (or any parent entity thereof that controls the Borrower) the proceeds of

which may be utilized by the Parent (or any parent entity thereof that controls the Borrower) to

make additional Restricted Payments in an amount not to exceed the Borrower’s Portion of

Excess Cash Flow, calculated immediately prior to the making of such Restricted Payment;

provided that after giving pro forma effect thereto, the Fixed Charge Coverage Ratio (calculated

on a pro forma basis) is not less than 2.00:1.00;

(g)additional Restricted Payments to the extent made solely with the net proceeds of

any substantially concurrent Equity Issuance of Qualified Capital Stock of the Borrower (or

Parent, to the extent such cash proceeds are contributed to the Borrower) after the Effective Date

that are not used for any other purpose;

(h)the declaration and payment by the Borrower of dividends on the common stock

or common equity interests of the Borrower or any direct or indirect parent entity of the Borrower

following the consummation of an initial Public Equity Offering of such common stock or

common equity interests, in an amount not to exceed 6% of the proceeds received by or

contributed to the Borrower or any direct or indirect parent entity of the Borrower in or from any

public offering in any fiscal year, other than public offerings with respect to the Borrower’s or

such parent’s common stock registered on Form S-4 or Form S-8 and other than any public sale

the proceeds of which were used to finance a Restricted Payment pursuant to Section 8.06(g) or

Investments pursuant to Section 8.02(v).

(i)the Borrower and any Restricted Subsidiary may make distributions to (A) the

Parent (or any parent entity thereof that controls the Borrower) in connection with expenses

required to maintain the Parent’s or such parent entity’s corporate existence and provided that no

Event of Default has occurred and is continuing, reasonable general corporate overhead expenses

to the extent such expenses are attributable to the ownership or operation of the Parent and its

Subsidiaries, which such expenses in the aggregate do not exceed $2,000,000 in any fiscal year

and (B) the Parent (or any parent entity thereof that controls the Borrower) for the payment of

insurance premiums, costs, expenses and deductibles as part of a common arrangement for

purchasing insurance by Parent (or such other parent entity) for the benefit of itself and its

Restricted Subsidiaries to the extent the proceeds thereof are promptly used by Parent (or such

other parent entity) to promptly pay premiums, costs, expenses and deductibles of insurance

obtained by Parent (or such other parent entity) for the benefit of the Borrower and its Restricted

Subsidiaries; provided that such Restricted Payments shall not exceed the aggregate amount of

premiums, costs, expenses and deductibles that are attributable solely to the Borrower and its

Restricted Subsidiaries; provided, further, that such Restricted Payments shall not in any event

exceed the aggregate amount that the Borrower and its Restricted Subsidiaries would have been

required to pay as a stand-alone insured entity;

(j)any Loan Party and any Restricted Subsidiary may make cashless repurchases of

Capital Stock deemed to occur upon the exercise of stock options or warrants if such Capital

Stock represents a portion of the exercise price of such options or warrants;

(k)so long as immediately before and after giving effect to such Restricted

Payments, no Event of Default has occurred and is continuing, make additional Restricted

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Payments; provided that after giving pro forma effect thereto, the Consolidated Net Leverage

Ratio (calculated on a Pro Forma Basis) is not greater than 2.50:1.00;

(l)payments made to cash-out Class C Units of Parent pursuant to their terms in

connection with an initial public offering of common stock or other common equity interests of

the Borrower or any direct or indirect parent entity thereof;

(m)(i) following a public offering of the common stock or common equity interests of

the Borrower or any direct or indirect parent entity of the Borrower, make Restricted Payment to

pay listing fees and other costs and expenses attributable to being a public company, of any

direct or indirect parent entity of the Borrower, and (ii) fees and expenses, other than to Affiliates

of Parent or the Borrower, related to any unsuccessful public offering of the common Stock or

common equity interests of the Borrower or any direct or indirect parent entity of the Borrower;

(n)other Restricted Payments in an aggregate amount, which, when taken together

with all other Restricted Payments made pursuant to this Section 8.06(n) shall not exceed

$75,000,000; provided, however, that no Event of Default shall have occurred and be continuing

at the time of any such distribution or payment or result therefrom; and

(o)so long as no Default or Event of Default shall have occurred and be continuing

or would result therefrom, other Restricted Payments made using solely proceeds of any

Disposition permitted pursuant to Section 8.05(iii) in an aggregate amount, when taken together

with all other Restricted Payments made pursuant to this Section 8.06(o), not to exceed the

greater of (A) $240,000,000 and (B) 50% of Consolidated EBITDA.

8.07[Reserved]

8.08Transactions with Affiliates

Enter into or permit to exist any transaction or series of transactions with any Affiliate of such

Person other than (a) advances of working capital to any Loan Party, (b) transfers of cash and assets to

any Loan Party, (c) transactions expressly permitted by Section 7.07, 8.01, 8.02, 8.03, 8.04, 8.05, 8.06,

8.13, 8.16 and 8.17, (d) normal and reasonable compensation, reimbursement of expenses and

indemnification of officers, directors, employees and consultants, (e) any Equity Issuance, (f) except as

otherwise specifically limited in this Agreement, other transactions which are entered into in the ordinary

course of such Person’s business on terms and conditions substantially as favorable (taken as a whole) to

such Person as would be obtainable by it in a comparable arms-length transaction with a Person other

than an Affiliate, (g) Equity Issuances of the Capital Stock of the Parent to a member of the Sponsor

Group or Ventas pursuant to Sections 8.02(v), and 8.06(g), (h) the consummation of the Amendment and

Restatement Transactions, (i) performance under any employment contracts, collective bargaining

agreements, stock option plans, employee benefit plans, related trust agreements or similar arrangement

of the Loan Parties and the Restricted Subsidiaries in the ordinary course of business, (j) any transaction

solely among Loan Parties and their Restricted Subsidiaries expressly permitted hereunder; (k) any

assignment of the Loans to any Non-Debt Fund Affiliate or Purchasing Borrower Party; (l)

reimbursement of expenses and indemnification of the Sponsor Group; (m) cash management transactions

between any Loan Party and the BSA Entities; (n) management agreements (including, without limitation,

with respect to the ETMC Subsidiaries and AHS Management Company, Inc., the JV Management

Agreement, JV Clinical Management Agreement and the JV Sub-Management Agreement to be entered

into among any Affiliate of Parent and officers and employees of the Borrower or any Restricted

Subsidiary; provided that such management agreements shall (i) include compensation to be paid by such

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Affiliate to the Borrower or its Restricted Subsidiaries for services received on arms-length terms, (ii)

relate only to any provision of services by officers and employees of the Borrower and its Restricted

Subsidiaries to such Affiliate, (iii) not in the good faith judgment of the Borrower interfere in any

material respect with the management, business or operations of the Borrower and its Restricted

Subsidiaries and (iv) not permit the allocation of more than 25% of the time of any officers and

employees in the aggregate to all such Affiliates, (o) pursuant to the Master Lease (and any guaranty

thereof) and the Relative Rights Agreement including the exercise of the Ventas Purchase Option, and (p)

with respect to the ETMC Subsidiaries and AHS Management Company, Inc., pursuant to the ETMC JV

Agreement.

8.09Burdensome Agreements

(a)Enter into, or permit to exist, any Contractual Obligation that encumbers or restricts the

ability of any such Person to (i) pay dividends or make any other distributions to any Loan Party on its

Capital Stock or with respect to any other interest or participation in, or measured by, its profits, (ii) pay

any Indebtedness or other obligation owed to any Loan Party, (iii) make loans or advances to any Loan

Party, (iv) sell, lease or transfer any of its Property to any Loan Party, (v) pledge its Property pursuant to

the Loan Documents or any renewals, refinancings, exchanges, refundings or extension thereof or (vi) act

as a Loan Party pursuant to the Loan Documents or any renewals, refinancings, exchanges, refundings or

extension thereof, except (in respect of any of the matters referred to in clauses (i)-(v) above) for (1) this

Agreement, the other Loan Documents and the Ventas Purchase Option Amendment (only as it applies to

Tenant Subsidiaries), (2) the ABL Credit Agreement, the Loan Documents (as defined in the ABL Credit

Agreement) and the Ventas Purchase Option Amendment (as defined in the ABL Credit Agreement)

(only as it applies to Tenant Subsidiaries), (3) the Subordinated Indebtedness Documents, the 2029 Notes

Indenture (and/or any other Indebtedness incurred pursuant to Section 8.03(t)) and the ETMC JV

Agreement (provided the terms of Section 8.16(b) are complied with), (4) any document or instrument

governing Indebtedness incurred pursuant to Section 8.03(e), (u) and (v); provided that any such

restriction contained therein relates only to the asset or assets constructed or acquired in connection

therewith, (5) any Permitted Lien or any document or instrument governing any Permitted Lien; provided

that any such restriction contained therein relates only to the asset or assets subject to such Permitted

Lien, (6) customary restrictions and conditions contained in any agreement relating to the sale of any

Property permitted under Section 8.05 pending the consummation of such sale, (7) Contractual

Obligations of any Person that becomes a Restricted Subsidiary after the Original Closing Date; provided

that such Contractual Obligations existed at the time such Person becomes a Restricted Subsidiary and

was not created in contemplation of or in connection with such Person becoming a Restricted Subsidiary,

(8) with respect to any non-Wholly Owned Subsidiary, customary supermajority voting provisions and

customary provisions with respect to the disposition or distribution of assets or property, in each case

contained in Joint Venture Agreements, (9) any document or instrument governing Indebtedness

permitted to be incurred pursuant to Section 8.03(r) or 8.03(j), so long as, for purposes of this clause (9),

neither the Parent, the Borrower nor any other Loan Party has obligations in respect of such Indebtedness,

or (10) pursuant to the Master Lease (and any guaranty thereof) and the Relative Rights Agreement. The

foregoing shall not apply to customary restrictions and conditions contained in agreements relating to a

Securitization Transaction.

(b)Enter into, or permit to exist, any Contractual Obligation that prohibits or otherwise

restricts the existence of any Lien upon any of its Property in favor of the Administrative Agent (for the

benefit of the holders of the Obligations) for the purpose of securing the Obligations, whether now owned

or hereafter acquired, or requiring the grant of any security for any obligation if such Property is given as

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security for the Obligations, except (i) any document or instrument governing Indebtedness incurred

pursuant to Section 8.03(e); provided that any such restriction contained therein relates only to the asset

or assets constructed or acquired in connection therewith, (ii) in connection with any Permitted Lien or

any document or instrument governing any Permitted Lien; provided that any such restriction contained

therein relates only to the asset or assets subject to such Permitted Lien, (iii) pursuant to customary

restrictions and conditions contained in any agreement relating to the sale of any Property permitted under

Section 8.05, pending the consummation of such sale, (iv) Contractual Obligations of any Person that

becomes a Restricted Subsidiary after the Original Closing Date; provided that such Contractual

Obligations existed at the time such Person becomes a Restricted Subsidiary and was not created in

contemplation of or in connection with such Person becoming a Restricted Subsidiary, (v) with respect to

any non-Wholly Owned Subsidiary, customary supermajority voting provisions and customary provisions

with respect to the pledge, disposition or distribution of assets or property, in each case contained in Joint

Venture Agreements, (vi) any document or instrument governing Indebtedness permitted to be incurred

pursuant to Section 8.03(r) or 8.03(j), so long as, for purposes of this clause (vi), neither the Parent, the

Borrower nor any other Loan Party has obligations in respect of such Indebtedness and (vii) any

agreement with LeaseCo, including the Relative Rights Agreement, or the Ventas Assignee. The

foregoing shall not apply to customary restrictions and conditions contained in agreements relating to a

Securitization Transaction.

8.10[Reserved]

8.11[Reserved]

8.12[Reserved]

8.13Prepayment of Subordinated Indebtedness, Etc.

(a)(i) Amend or modify any of the terms of any Subordinated Indebtedness in a manner

materially adverse to the Lenders without the consent of the Administrative Agent, or (ii) amend or

modify any terms of the ABL Facility, except in accordance with the terms of the Intercreditor Agreement

or if the ABL Facility is refinanced with a cash flow revolver the Acceptable Intercreditor Agreement

entered into in connection therewith.

(b)Make any payments with respect to any Subordinated Indebtedness other than (i)

regularly scheduled principal and interest payments and so long as no Event of Default shall have

occurred and be continuing or would result therefrom, the Borrower and its Restricted Subsidiaries may

make additional payments (including prepayments) with respect to Subordinated Indebtedness in an

amount not to exceed the Borrower’s Portion of Excess Cash Flow, calculated immediately prior to the

making of such payment; provided that after giving pro forma effect thereto, the Fixed Charge Coverage

Ratio (calculated on a pro forma basis) is not less than 2.00:1.00, (ii) other payments with respect to

Subordinated Indebtedness in an aggregate amount, which, when taken together with all other payments

of Subordinated Indebtedness pursuant to this Section 8.13(b)(ii), shall not to exceed the greater of (x)

$140,000,000 and (y) 30% of Consolidated EBITDA; provided that that no Default or Event of Default

shall have occurred and be continuing at the time of any such payment or result therefrom and (iii)

additional payments with respect to Subordinated Indebtedness so long as immediately after giving effect

to such Restricted Payments, (A) no Event of Default has occurred and is continuing and (B) the

Consolidated Net Leverage Ratio (calculated on a Pro Forma Basis) is not greater than 2.95:1.00.

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(c)Notwithstanding the foregoing, neither the Borrower nor any of its Restricted

Subsidiaries shall make any payment (other than any payment-in-kind) in respect of any Subordinated

Indebtedness while any Event of Default has occurred and is continuing.

8.14Organization Documents; Fiscal Year; Amendments to Master Lease

(a)Amend, modify or change its Organization Documents in a manner materially adverse to

the Lenders, without the prior written consent of the Administrative Agent.

(b)Change its fiscal year without the prior written consent of the Administrative Agent (such

consent not to be unreasonably withheld, delayed or conditioned).

(c)Amend, modify or change the Master Lease in a manner that would require consent of the

Administrative Agent pursuant to Section 3.1(b) of the Relative Rights Agreement without the prior

written consent of the Administrative Agent or the Required Lenders.

8.15Limitations on Parent

Notwithstanding any other provisions of this Agreement or any other Loan Document to the

contrary, Parent agrees not to engage in any material business activities other than (i) owning any Capital

Stock of (x) the Borrower and (y) its other Subsidiaries that are not Subsidiaries of the Borrower and, in

each case, activities incidental or related thereto, (ii) granting Liens on all of the Capital Stock of the

Borrower owned by Parent to the Administrative Agent, for the benefit of the Lenders, pursuant to the

Collateral Documents and pursuant to the ABL Documents and secured Indebtedness permitted pursuant

to Section 8.03(u) and (v), (iii) in connection with any public offering of its common stock or any other

issuance of its Capital Stock not otherwise prohibited by this Article VIII, (iv) incurring liabilities under

the Loan Documents, the ABL Documents, 2029 Notes Indenture, the Master Lease, Indebtedness

permitted under Section 8.03(t), (u) and (v), and the Subordinated Indebtedness Documents and

performing its obligations thereunder (including with respect to any indemnity obligations), (v) paying

taxes in the ordinary course of business, (vi) paying corporate, administrative and operating expenses in

the ordinary course of business, (vii) making Restricted Payments permitted hereunder, (viii) taking

actions required by applicable law or otherwise necessary or advisable to maintain its corporate existence

and perform its obligations under its Capital Stock and Organization Documents, (ix) owning any deposit

accounts in connection with any of the foregoing, (x) any activities incidental to any of the foregoing, (xi)

guaranteeing the Indebtedness or obligations of its Subsidiaries pursuant to transactions otherwise

permitted under this Agreement (other than with respect to Indebtedness for borrowed money); provided

that the Parent shall use commercially reasonable efforts to have such guarantee provided by a Subsidiary

in lieu of the Parent providing such guarantee, (xii) making an Equity Issuance and (xiii) the

consummation of an initial Public Equity Offering. Notwithstanding the foregoing or anything the

contrary set forth in in any Loan Document, in the event that the Borrower merges with and into the

Parent pursuant to the Permitted Merger, this Section 8.15 and any other similar provision in any Loan

Document that restricts the actions of the Parent solely with respect to it being a holding company shall

automatically have no force and effect immediately after giving effect to such merger.

8.16Limitations on the ETMC JV

Notwithstanding any other provisions of this Agreement or any other Loan Document to the

contrary, the Loan Parties agree:

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(a)to cause the ETMC JV not to engage in any business activities (including, without limitation,

having any operations, making Investments, incurring Indebtedness or Liens, entering into

agreements, making Dispositions or making any Restricted Payments) other than (i) receiving

cash distributions from its equity holders the proceeds of which (less amounts permitted to make

payments pursuant to clauses (ii) and (iii) hereof) are promptly used to make distributions to its

equity holders in accordance with this Section 8.16; (ii) paying taxes in the ordinary course of

business and paying corporate, administrative and operating expenses in the ordinary course of

business; (iii) taking actions required by applicable law or otherwise necessary or advisable to

maintain its corporate existence and perform its obligations under the ETMC JV Agreement in

respect of managing and governing the business of the ETMC Subsidiaries and the UT Tyler

Properties (and not for the avoidance of doubt, any of its own independent business or operations)

(including, without limitation, entering into and performing its obligations under each of (x) the

contracts, documents, transactions and agreements expressly contemplated under the ETMC JV

Agreement as in effect on the Original Closing Date which are necessary for the ETMC JV to

maintain its existence and to manage and govern the business of the ETMC Subsidiaries and UT

Tyler Properties, and (y) any other contracts, documents, transactions or agreements between or

among the ETMC JV and (A) any Loan Party, Subsidiary and/or Affiliate thereof, (B) UT Tyler

and/or any Affiliate thereof or (C) any Governmental Authority, in each case, which are

necessary for the ETMC JV to maintain its existence and to manage and govern the business of

the ETMC Subsidiaries and UT Tyler Properties); and (iv) owning any deposit accounts in

connection with any of the foregoing;

(b)not to (i) amend, supplement or modify the ETMC JV Agreement in a manner that is materially

adverse to the Lenders, or (ii) cause the Loan Parties and their Subsidiaries to consent to any

action or otherwise cause or require the ETMC JV to take any action (or refrain from taking any

action) that is materially adverse to the Lenders, in each case of clauses (i) and (ii), without the

consent of the Required Lenders;

(c)to cause the ETMC JV (i) to distribute all cash and other property held by or owned by the

ETMC JV to its equity holders on a quarterly basis (other than cash or property to be used by the

ETMC JV for a purpose permitted by clause (ii) or (iii) of Section 8.16(a)), (ii) to distribute all

cash or other property (other than cash or property to be used by the ETMC JV for a purpose

permitted by clause (ii) or (iii) of Section 8.16(a)) received from the Borrower or any of its

Subsidiaries within 5 business days of the receipt of such cash to its equity holders, and (iii) to

make the cash distributions required by clauses (i) and (ii) above in accordance with the terms of

the ETMC JV Agreement;

(d)that the sole manager of the ETMC JV shall at all times be a Loan Party;

(e)to cause the ETMC JV to pay and discharge as the same shall become due and payable, all

material Taxes imposed or levied upon it or its properties or assets, unless the same are being

contested in good faith by appropriate proceedings diligently conducted and adequate reserves in

accordance with GAAP are being maintained by the ETMC JV;

(f)to cause the ETMC JV to (i) preserve, renew and maintain in full force and effect its legal

existence under the Laws of the jurisdiction of its organization except in a transaction permitted

by Section 8.04 or 8.05; (ii) preserve, renew and maintain in full force and effect its good

standing under the Laws of the jurisdiction of its organization except in a transaction permitted by

Section 8.04 or 8.05; and (iii) take all reasonable action to maintain all rights, privileges, permits,

licenses and franchises necessary or desirable in the normal conduct of its business, except to the

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extent that the failure to do so could not reasonably be expected to have a Material Adverse

Effect; and

(g)to cause AHS East Texas and its successors and assigns (and/or any other Subsidiary (other than

the ETMC JV) that directly owns any equity interests of or directly receives any distributions

from the ETMC JV) to maintain a separate account which holds all cash or other property

received from the ETMC JV (a “Pledged ETMC Distribution Account”) free of any Liens (other

than Liens permitted by Section 8.01 (a), (c), (d), (e), (f), (m), (n), (s) and (bb));

(h)to prohibit (notwithstanding anything to the contrary set forth herein) each ETMC Subsidiary

from making any Investment, Disposition, dividend or other distribution to the ETMC JV other

than Investments, Dispositions, dividends or other distributions from the Adjusted Earnings for

the Ardent Facilities; and

(i)except to the extent the failure to do so would not have or would not reasonably be expected to

have a Material Adverse Effect, to (a) comply with all requirements of Law, and all applicable

restrictions imposed by all Governmental Authorities, applicable to it and its Property; (b)

conform with and duly observe in all material respects all applicable laws, rules and regulations

and all other valid requirements of any regulatory authority with respect to the conduct of its

business; (c) obtain and maintain all licenses, permits, certifications and approvals of all

applicable Governmental Authorities as are required for the conduct of its business as currently

contemplated.

8.17Required Payment Intercompany Note

The Loan Parties further agree not to cancel, or forgive or reduce any required payment of

interest or principal under, the Required Payment Intercompany Note or to otherwise amend, refinance or

replace the Required Payment Intercompany Note in a manner materially adverse to the Lenders without

the consent of the Required Lenders.

8.18HMO Entities

None of the Loan Parties, nor any of their respective Subsidiaries, shall at any time be an HMO

Entity.

ARTICLE IX

EVENTS OF DEFAULT AND REMEDIES

9.01Events of Default

Any of the following shall constitute an “Event of Default”:

(a)Non-Payment. The Borrower or any other Loan Party fails to pay (i) when and as

required to be paid herein, any amount of principal of any Loan, or (ii) within three (3) Business

Days after the same becomes due, any interest on any Loan or fee due hereunder, or (iii) within

five (5) Business Days after the same becomes due, any other amount payable hereunder or under

any other Loan Document; or

(b)Specific Covenants. (i) The Borrower fails to perform or observe any term,

covenant or agreement contained in any of Sections 7.03(a), 7.05(a), 7.11, or Article VIII (or

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Parent fails to perform or observe Section 8.15) or (ii) the Borrower fails to perform or observe

any term, covenant or agreement contained in Section 7.01, 7.02(b), 7.02(c), 7.03(b), 7.03(c) or

7.10 and, in the case of this clause (ii), such default shall continue for five (5) or more Business

Days; or

(c)Other Defaults. Any Loan Party fails to perform or observe any other covenant or

agreement (not specified in subsection (a) or (b) above) contained in any Loan Document on its

part to be performed or observed and such failure continues for thirty days after the earlier of a

Responsible Officer of a Loan Party becoming aware of such default or notice thereof by the

Administrative Agent; or

(d)Representations and Warranties. Any representation, warranty, certification or

statement of fact made or deemed made by or on behalf of the Borrower or any other Loan Party

herein or in any other Loan Document shall be incorrect or misleading in any material respect

when made; or

(e)Cross-Default. (i) The Borrower or any Restricted Subsidiary (other than the

ETMC JV) (A) fails to make any payment when due (whether at scheduled maturity, required

prepayment, acceleration, demand, or otherwise) in respect of any Indebtedness or Guarantee

(other than Indebtedness hereunder and Indebtedness under Swap Contracts) having an aggregate

principal amount (including undrawn committed or available amounts and including amounts

owing to all creditors under any combined or syndicated credit arrangement) of more than the

Threshold Amount, or (B) fails to observe or perform any other agreement or condition relating

to any such Indebtedness or Guarantee (other than any Guarantee of the Master Lease, which

shall be subject to clause (l) below) or contained in any instrument or agreement evidencing,

securing or relating thereto, or any other event occurs, the effect of which default or other event is

to cause, or to permit the holder or holders of such Indebtedness or the beneficiary or

beneficiaries of such Guarantee (or a trustee or agent on behalf of such holder or holders or

beneficiary or beneficiaries) to cause, with the giving of notice if required, such Indebtedness to

be demanded or to become due or to be repurchased, prepaid, defeased or redeemed

(automatically or otherwise), or an offer to repurchase, prepay, defease or redeem such

Indebtedness to be made, prior to its stated maturity, or such Guarantee to become payable or

cash collateral in respect thereof to be demanded; provided that an event of default under the

ABL Credit Agreement (and after giving effect to the consummation of the Ventas Purchase

Option, this proviso shall only apply to the LHP/ETMC ABL Facility Silo) shall not constitute an

Event of Default unless and until earlier of (i) 45 days after such event of default (during which

period the event of default is not waived or cured) and (ii) the date on which the lenders under the

ABL Credit Agreement have actually declared all such obligations under the ABL Credit

Agreement to be immediately due and payable in accordance with the terms of the ABL Credit

Agreement and such declaration has not been rescinded by the lenders under the ABL Credit

Agreement on or before such date); or (ii) there occurs under any Swap Contract an Early

Termination Date (as defined in such Swap Contract) resulting from (A) any event of default

under such Swap Contract as to which the Borrower or any Restricted Subsidiary (other than the

ETMC JV) is the Defaulting Party (as defined in such Swap Contract) or (B) any Termination

Event (as so defined) under such Swap Contract as to which the Borrower or any Restricted

Subsidiary (other than the ETMC JV) is an Affected Party (as so defined) and, in either event, the

Swap Termination Value owed by the Borrower or such Restricted Subsidiary (other than the

ETMC JV) as a result thereof is greater than the Threshold Amount; or

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(f)Insolvency Proceedings, Etc. Any Loan Party or any of its Restricted

Subsidiaries institutes or consents to the institution of any proceeding under any Debtor Relief

Law, or makes an assignment for the benefit of creditors; or applies for or consents to the

appointment of any receiver, trustee, custodian, conservator, liquidator, rehabilitator or similar

officer for it or for all or any material part of its property; or any receiver, trustee, custodian,

conservator, liquidator, rehabilitator or similar officer is appointed without the application or

consent of such Person and the appointment continues undischarged or unstayed for sixty (60)

calendar days; or any proceeding under any Debtor Relief Law relating to any such Person or to

all or any material part of its property is instituted without the consent of such Person and

continues undismissed or unstayed for sixty calendar days, or an order for relief is entered in any

such proceeding or a Loan Party takes any action indicating its consent to, approval of or

acquiescence in any of the foregoing; or

(g)Inability to Pay Debts; Attachment. The Borrower or any Subsidiary (i) becomes

unable or admits in writing its inability or fails generally to pay its debts as they become due, or

(ii) any writ or warrant of attachment or execution or similar process is issued or levied against all

or any material part of the property of any such Person and is not released, vacated or fully

bonded within thirty days after its issue or levy; or

(h)Judgments. There is entered against the Borrower or any Subsidiary (i) one or

more final judgments or orders for the payment of money in an aggregate amount exceeding the

Threshold Amount (to the extent not covered by independent third-party insurance as to which

the insurer does not dispute coverage), or (ii) any one or more non-monetary final judgments that

have, or could reasonably be expected to have, individually or in the aggregate, a Material

Adverse Effect and, in either case, (A) enforcement proceedings are commenced by any creditor

upon such judgment or order, or (B) there is a period of ten consecutive days during which a stay

of enforcement of such judgment, by reason of a pending appeal or otherwise, is not in effect; or

(i)ERISA. (i) An ERISA Event occurs with respect to a Pension Plan or

Multiemployer Plan which has resulted or could reasonably be expected to result in liability of

the Borrower under Title IV of ERISA to the Pension Plan, Multiemployer Plan or the PBGC in

an aggregate amount in excess of the Threshold Amount, or (ii) the Borrower or any ERISA

Affiliate fails to pay when due, after the expiration of any applicable grace period, any

installment payment with respect to its withdrawal liability under Section 4201 of ERISA under a

Multiemployer Plan which has resulted or could reasonably be expected to result in liability of

the Borrower in an aggregate amount in excess of the Threshold Amount; or

(j)Invalidity of Loan Documents. Any Loan Document, at any time after its

execution and delivery and for any reason other than as expressly permitted hereunder or

satisfaction in full of all the Obligations, ceases to be in full force and effect; or any Loan Party or

any Governmental Authority contests in any manner the validity or enforceability of any Loan

Document; or any Loan Party denies that it has any or further liability or obligation under any

Loan Document, or purports to revoke, terminate or rescind any Loan Document; or

(k)Change of Control. There occurs any Change of Control; or

(l)Master Lease. (i) There shall occur an “Event of Default” (or any comparable

term) under, and as defined in the Master Lease the effect of which is to cause, or permit the

parties thereto, to cause the Master Lease to be terminated and a party to the Master Lease has

declared a termination of the Master Lease prior to its scheduled term or (ii) LeaseCo shall

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exercise its right to dispossess any Tenant Subsidiary from any portion of the Premises (as

defined in the Master Lease as in effect on the Original Closing Date) pursuant to the Master

Lease and such dispossession is in respect of a Premises or a group of Premises that have (x)

assets that constitute 25% or more of all consolidated assets of the Borrower and its Restricted

Subsidiaries as of the last day of the most recently ended four fiscal quarters for which financial

statements have been delivered to the Administrative Agent pursuant to Section 7.01(b), (y)

generate 25% or more of the Consolidated EBITDA of the Borrower and its Restricted

Subsidiaries for the most recently ended four fiscal quarters for which financial statements have

been delivered to the Administrative Agent pursuant to Section 7.01(b) or (z) generate 25% or

more of the gross revenue of the Borrower and its Restricted Subsidiaries for the most recently

ended four fiscal quarters for which financial statements have been delivered to the

Administrative Agent pursuant to Section 7.01(b); or

(m)[Reserved]

(n)Exclusion Event. There shall occur an Exclusion Event that would result in a

Material Adverse Effect; or

(o)Collateral Documents. Any Collateral Document or financing statement after

delivery thereof pursuant to Sections 5.01, 7.12, 7.14 or 7.17 of the Existing Credit Agreement or

Section 7.12, Section 7.14 or Section 7.17 shall for any reason (other than (x) pursuant to the

terms thereof or (y) resulting from any action or inaction by the Administrative Agent within its

control, including the failure to file Uniform Commercial Code continuation statements) cease to

create a valid and perfected first priority lien on and security interest in, subject only to Permitted

Liens, any Collateral with a fair market value in excess of $20,000,000 or any such Loan Party

shall so state in writing; or

(p)Licensure. Any Governmental Authority shall have revoked any license, permit,

certificate or qualification that is necessary under applicable law for each Loan Party and its

Restricted Subsidiaries to own their respective properties and to conduct their respective business,

regardless of whether such license, permit, certificate or qualification was held by or originally

issued for the benefit of a Loan Party, a tenant or any other Person and such revocation has, or

could reasonably be expected to have, a Material Adverse Effect; or

(q)Triggering Event. A Triggering Event shall have occurred; or

(r)Ventas Purchase Option Term Loans and Ventas Purchase Option ABL Loans.

Parent or any of its Subsidiaries (A) fails to make any payment when due (whether at scheduled

maturity, required prepayment, acceleration, demand, or otherwise) in respect of the Ventas

Purchase Option Term Loans or the Ventas Purchase Option ABL Loans, in each case, after the

expiration of any applicable grace period, or (B) fails to observe or perform any other agreement

or condition relating to the Ventas Purchase Option Term Loans or the Ventas Purchase Option

ABL Loans or contained in any instrument or agreement evidencing, securing or relating thereto,

or any other event occurs, in each case, after the expiration of any applicable grace period, the

effect of which default or other event is to cause, or to permit the holder or holders of the Ventas

Purchase Option Term Loans or the Ventas Purchase Option ABL Loans to cause, with the giving

of notice if required, the Ventas Purchase Option Term Loans or the Ventas Purchase Option

ABL Loans, as applicable, to be demanded or to become due or to be repurchased, prepaid,

defeased or redeemed (automatically or otherwise), or an offer to repurchase, prepay, defease or

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redeem the Ventas Purchase Option Term Loans or the Ventas Purchase Option ABL Loans, as

applicable, to be made, prior to its stated maturity.

9.02Remedies upon Event of Default

If any Event of Default occurs and is continuing, the Administrative Agent shall, at the request of,

or may, with the consent of, the Required Lenders, take any or all of the following actions and will

provide written notice thereof to the Borrower:

(a)declare the commitment of each Lender to make Loans to be terminated,

whereupon such commitments shall be terminated;

(b)declare the unpaid principal amount of all outstanding Loans, all interest accrued

and unpaid thereon, and all other amounts owing or payable hereunder or under any other Loan

Document to be immediately due and payable, without presentment, demand, protest or other

notice of any kind, all of which are hereby expressly waived by the Borrower; and

(c)exercise on behalf of itself and the Lenders all rights and remedies available to it

and the Lenders under the Loan Documents or applicable law;

provided, however, that upon the occurrence of an actual or deemed entry of an order for relief with

respect to the Borrower under the Bankruptcy Code of the United States, the obligation of each Lender to

make Loans shall automatically terminate, and the unpaid principal amount of all outstanding Loans and

all interest and other amounts as aforesaid shall automatically become due and payable, without further

act of the Administrative Agent or any Lender.

9.03Application of Funds

After the exercise of remedies provided for in Section 9.02 (or after the Loans have automatically

become immediately due and payable as set forth in the proviso to Section 9.02), any amounts received

on account of the Obligations shall be applied by the Administrative Agent in the following order:

First, to payment of that portion of the Obligations constituting fees, indemnities,

expenses and other amounts (including Attorney Costs and amounts payable under Article III)

payable to the Administrative Agent in its capacity as such;

Second, to payment of that portion of the Obligations constituting fees, indemnities and

other amounts (other than principal and interest) payable to the Lenders (including Attorney

Costs and amounts payable under Article III), ratably among them in proportion to the amounts

described in this clause Second payable to them;

Third, to payment of that portion of the Obligations constituting accrued and unpaid

interest on the other Loans and fees, premiums and scheduled periodic payments, and any interest

accrued thereon, ratably among the Lenders in proportion to the respective amounts described in

this clause Third held by them;

Fourth, to payment of that portion of the Obligations constituting unpaid principal of the

Loans and breakage, termination or other payment and any interest accrued thereon, ratably

among the Lenders and Bank of America in proportion to the respective amounts described in this

clause Fourth held by them; and

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Last, the balance, if any, after all of the Obligations have been paid in full, to the

Borrower or as otherwise required by Law.

ARTICLE X

ADMINISTRATIVE AGENT

10.01Appointment and Authorization of Administrative Agent

Each Lender hereby irrevocably appoints, designates and authorizes Bank of America to act as

the Administrative Agent and authorizes the Administrative Agent to take such action on its behalf under

the provisions of this Agreement and each other Loan Document and to exercise such actions and powers

and perform such duties as are expressly delegated to it by the terms of this Agreement or any other Loan

Document, together with such powers as are reasonably incidental thereto. Notwithstanding any

provision to the contrary contained elsewhere herein or in any other Loan Document, the Administrative

Agent shall not have any duties or responsibilities, except those expressly set forth herein, nor shall the

Administrative Agent have or be deemed to have any fiduciary relationship with any Lender or

participant, and no implied covenants, functions, responsibilities, duties, obligations or liabilities shall be

read into this Agreement or any other Loan Document or otherwise exist against the Administrative

Agent. Without limiting the generality of the foregoing sentence, the use of the term “agent” herein and

in the other Loan Documents with reference to the Administrative Agent is not intended to connote any

fiduciary or other implied (or express) obligations arising under agency doctrine of any applicable Law.

Instead, such term is used merely as a matter of market custom, and is intended to create or reflect only an

administrative relationship between independent contracting parties. The provisions of this Article X are

solely for the benefit of the Administrative Agent and the Lenders and neither the Borrower nor any Loan

Party shall have rights as a third party beneficiary of any such provisions.

10.02Delegation of Duties

The Administrative Agent may perform any and all of its duties and exercise its rights and powers

under this Agreement or any other Loan Document by or through agents, sub-agents, employees or

attorneys-in-fact, in each case appointed by the Administrative Agent and shall be entitled to advice of

counsel and other consultants or experts concerning all matters pertaining to such duties. The

Administrative Agent and any such agent, sub-agent, employee or attorney-in-fact may perform any and

all of its duties and exercise its rights and powers by or through their respective Agent-Related Persons.

The exculpatory provisions of this Article X shall apply to any such agent, sub-agent, employee or

attorney-in-fact and to the Agent-Related Persons of the Administrative Agent and any such agent, sub-

agent, employee or attorney-in-fact and shall apply to their respective activities in connection with the

syndication of the credit facilities provided for herein as well as activities as Administrative Agent. The

Administrative Agent shall not be responsible for the negligence or misconduct of any agent, sub-agent,

employee or attorney-in-fact, except to the extent that a court of competent jurisdiction determines in a

final and nonappealable judgment that the Administrative Agent acted with gross negligence or willful

misconduct in the selection of such agent, sub-agent, employee or attorney-in-fact.

10.03Liability of Administrative Agent

No Agent-Related Person shall (a) be liable for any action taken or omitted to be taken by any of

them under or in connection with this Agreement or any other Loan Document or the transactions

contemplated hereby (except for its own gross negligence or willful misconduct in connection with its

duties expressly set forth herein), or (b) be responsible in any manner to any Lender or participant for any

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recital, statement, representation or warranty made by any Loan Party or any officer thereof, contained

herein or in any other Loan Document, or in any certificate, report, statement or other document referred

to or provided for in, or received by the Administrative Agent under or in connection with, this

Agreement or any other Loan Document, or the validity, effectiveness, genuineness, enforceability or

sufficiency of this Agreement or any other Loan Document, or for any failure of any Loan Party or any

other party to any Loan Document to perform its obligations hereunder or thereunder. No Agent-Related

Person shall be under any obligation to any Lender or participant to ascertain or to inquire as to the

observance or performance of any of the agreements contained in, or conditions of, this Agreement or any

other Loan Document, or to inspect the properties, books or records of any Loan Party or any Affiliate

thereof.

10.04Reliance by Administrative Agent

The Administrative Agent shall be entitled to rely, and shall not incur any liability for relying,

upon any writing, communication, signature, resolution, representation, notice, consent, certificate,

affidavit, letter, telegram, facsimile, electronic mail message, statement or other document or conversation

believed by it to be genuine and correct and to have been signed, sent or made by the proper Person or

Persons, and upon advice and statements of legal counsel (including counsel to any Loan Party),

independent accountants and other experts selected by the Administrative Agent. The Administrative

Agent also shall be entitled to rely upon any statement made to it orally or by telephone and believed by it

to be genuine and correct and to have been signed, sent or made by the proper Person or Persons, and

upon advice and statements of legal counsel (including counsel to any Loan Party), independent

accountants and other experts selected by the Administrative Agent, and shall not incur any liability for

relying thereon. The Administrative Agent shall be fully justified in failing or refusing to take any action

under any Loan Document unless it shall first receive such advice or concurrence of the Required Lenders

as it deems appropriate and, if it so requests, it shall first be indemnified to its satisfaction by the Lenders

against any and all liability and expense which may be incurred by it by reason of taking or continuing to

take any such action. The Administrative Agent shall in all cases be fully protected in acting, or in

refraining from acting, under this Agreement or any other Loan Document in accordance with a request or

consent of the Required Lenders (or such greater number of Lenders as may be expressly required hereby

in any instance) and such request and any action taken or failure to act pursuant thereto shall be binding

upon all the Lenders. In determining compliance with any condition hereunder to the making of a Loan

that by its terms must be fulfilled to the satisfaction of a Lender, the Administrative Agent may presume

that such condition is satisfactory to such Lender unless the Administrative Agent shall have received

notice to the contrary from such Lender prior to the making of such Loan.

10.05Notice of Default

The Administrative Agent shall not be deemed to have knowledge or notice of the occurrence of

any Default, except with respect to defaults in the payment of principal, interest and fees required to be

paid to the Administrative Agent for the account of the Lenders, unless the Administrative Agent shall

have received written notice from a Lender or the Borrower referring to this Agreement, describing such

Default and stating that such notice is a “notice of default.” The Administrative Agent will notify the

Lenders of its receipt of any such notice. The Administrative Agent shall take such action with respect to

such Default as may be directed by the Required Lenders in accordance with Article IX; provided,

however, that unless and until the Administrative Agent has received any such direction, the

Administrative Agent may (but shall not be obligated to) take such action, or refrain from taking such

action, with respect to such Default as it shall deem advisable or in the best interest of the Lenders.

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10.06Credit Decision; Disclosure of Information by Administrative Agent

Each Lender acknowledges that no Agent-Related Person has made any representation or

warranty to it, and that no act by the Administrative Agent or the Joint Book Runners hereafter taken,

including any consent to and acceptance of any assignment or review of the affairs of any Loan Party or

any Affiliate thereof, shall be deemed to constitute any representation or warranty by any Agent-Related

Person to any Lender as to any matter, including whether Agent-Related Persons have disclosed material

information in their possession. Each Lender represents to the Administrative Agent and the Joint Book

Runners that it has, independently and without reliance upon any Agent-Related Person and based on

such documents and information as it has deemed appropriate, made its own credit analysis of, appraisal

of, and an investigation into the business, prospects, operations, property, financial and other condition

and creditworthiness of the Loan Parties and their respective Subsidiaries, and all applicable bank or other

regulatory Laws relating to the transactions contemplated hereby, and made its own decision to enter into

this Agreement and to extend credit to the Borrower hereunder. Each Lender also represents that it will,

independently and without reliance upon any Agent-Related Person and based on such documents and

information as it shall deem appropriate at the time, continue to make its own credit analysis, appraisals

and decisions in taking or not taking action under this Agreement and the other Loan Documents, and to

make such investigations as it deems necessary to inform itself as to the business, prospects, operations,

property, financial and other condition and creditworthiness of the Borrower and the other Loan Parties.

Except for notices, reports and other documents expressly required to be furnished to the Lenders by the

Administrative Agent herein, the Administrative Agent shall not have any duty or responsibility to

provide any Lender with any credit or other information concerning the business, prospects, operations,

property, financial and other condition or creditworthiness of any of the Loan Parties or any of their

respective Affiliates which may come into the possession of any Agent-Related Person. Each Lender

represents and warrants that (i) the Loan Documents set forth the terms of a commercial lending facility

and (ii) it is engaged in making, acquiring or holding commercial loans in the ordinary course and is

entering into this Agreement as a Lender for the purpose of making, acquiring or holding commercial

loans and providing other facilities set forth herein as may be applicable to such Lender, and not for the

purpose of purchasing, acquiring or holding any other type of financial instrument, and each Lender

agrees not to assert a claim in contravention of the foregoing. Each Lender represents and warrants that it

is sophisticated with respect to decisions to make, acquire and/or hold commercial loans and to provide

other facilities set forth herein, as may be applicable to such Lender, and either it, or the Person exercising

discretion in making its decision to make, acquire and/or hold such commercial loans or to provide such

other facilities, is experienced in making, acquiring or holding such commercial loans or providing such

other facilities.

10.07Indemnification of Administrative Agent

Whether or not the transactions contemplated hereby are consummated, the Lenders shall

indemnify upon demand each Agent-Related Person (to the extent not reimbursed by or on behalf of any

Loan Party and without limiting the obligation of any Loan Party to do so), pro rata, and hold harmless

each Agent-Related Person from and against any and all Indemnified Liabilities incurred by it; provided,

however, that no Lender shall be liable for the payment to any Agent-Related Person of any portion of

such Indemnified Liabilities to the extent determined in a final, nonappealable judgment by a court of

competent jurisdiction to have resulted from such Agent-Related Person’s own gross negligence or willful

misconduct; provided, however, that no action taken in accordance with the directions of the Required

Lenders shall be deemed to constitute gross negligence or willful misconduct for purposes of this Section.

Without limitation of the foregoing, each Lender shall reimburse the Administrative Agent upon demand

for its ratable share of any costs or out-of-pocket expenses (including Attorney Costs) incurred by the

Administrative Agent in connection with the preparation, execution, delivery, administration,

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modification, amendment or enforcement (whether through negotiations, legal proceedings or otherwise)

of, or legal advice in respect of rights or responsibilities under, this Agreement, any other Loan

Document, or any document contemplated by or referred to herein, to the extent that the Administrative

Agent is not reimbursed for such expenses by or on behalf of the Borrower. The undertaking in this

Section 10.07 shall survive termination of the Commitments, the payment of all other Obligations and the

resignation of the Administrative Agent.

10.08Administrative Agent in Its Individual Capacity

Bank of America and its Affiliates may make loans to, issue letters of credit for the account of,

accept deposits from, acquire equity interests in and generally engage in any kind of banking, trust,

financial advisory, underwriting or other business with each of the Loan Parties and their respective

Affiliates as though Bank of America were not the Administrative Agent hereunder and without notice to

or consent of the Lenders. The Lenders acknowledge that, pursuant to such activities, Bank of America

or its Affiliates may receive information regarding any Loan Party or its Affiliates (including information

that may be subject to confidentiality obligations in favor of such Loan Party or such Affiliate) and

acknowledge that neither the Administrative Agent nor Bank of America shall be under any obligation to

provide such information to them. With respect to its Loans, Bank of America shall have the same rights

and powers under this Agreement as any other Lender and may exercise such rights and powers as though

it were not the Administrative Agent, and the terms “Lender” and “Lenders” include Bank of America in

its individual capacity.

10.09Successor Administrative Agent

The Administrative Agent may resign as Administrative Agent upon thirty days’ notice to the

Lenders and the Borrower. If the Administrative Agent resigns under this Agreement, the Required

Lenders shall appoint from among the Lenders a successor administrative agent for the Lenders, which

successor administrative agent shall be consented to by the Borrower at all times other than during the

existence of an Event of Default (which consent of the Borrower shall not be unreasonably withheld or

delayed). If no successor administrative agent is appointed prior to the effective date of the resignation of

the Administrative Agent, the Administrative Agent may appoint, after consulting with the Lenders and

the Borrower, a successor administrative agent from among the Lenders. Upon the acceptance of its

appointment as successor administrative agent hereunder, the Person acting as such successor

administrative agent shall succeed to all the rights, powers and duties of the retiring Administrative Agent

and the term “Administrative Agent” shall mean such successor administrative agent, and the retiring

Administrative Agent’s appointment, powers and duties as Administrative Agent shall be terminated

without any other or further act or deed. After any retiring Administrative Agent’s resignation hereunder

as Administrative Agent, the provisions of this Article X and Sections 11.04 and 11.05 shall inure to its

benefit as to any actions taken or omitted to be taken by it while it was Administrative Agent under this

Agreement. If no successor administrative agent has accepted appointment as Administrative Agent by

the date thirty days following a retiring Administrative Agent’s notice of resignation, the retiring

Administrative Agent’s resignation shall nevertheless thereupon become effective and the Lenders shall

perform all of the duties of the Administrative Agent hereunder until such time, if any, as the Required

Lenders appoint a successor agent as provided for above.

10.10Administrative Agent May File Proofs of Claim; Credit Bidding

In case of the pendency of any proceeding under any Debtor Relief Law or any other judicial

proceeding relative to any Loan Party, the Administrative Agent (irrespective of whether the principal of

any Loan shall then be due and payable as herein expressed or by declaration or otherwise and

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irrespective of whether the Administrative Agent shall have made any demand on the Borrower) shall be

entitled and empowered, by intervention in such proceeding or otherwise:

(a)to file and prove a claim for the whole amount of the principal and interest owing

and unpaid in respect of the Loans and all other Obligations that are owing and unpaid and to file

such other documents as may be necessary or advisable in order to have the claims of the Lenders

and the Administrative Agent (including any claim for the reasonable compensation, expenses,

disbursements and advances of the Lenders and the Administrative Agent and their respective

agents and counsel and all other amounts due the Lenders and the Administrative Agent under

Sections 2.09 and 11.04) allowed in such judicial proceeding; and

(b)to collect and receive any monies or other property payable or deliverable on any

such claims and to distribute the same;

and any custodian, receiver, assignee, trustee, liquidator, sequestrator or other similar official in any such

judicial proceeding is hereby authorized by each Lender to make such payments to the Administrative

Agent and, in the event that the Administrative Agent shall consent to the making of such payments

directly to the Lenders, to pay to the Administrative Agent any amount due for the reasonable

compensation, expenses, disbursements and advances of the Administrative Agent and its agents and

counsel, and any other amounts due the Administrative Agent under Sections 2.09 and 11.04.

Nothing contained herein shall be deemed to authorize the Administrative Agent to authorize or

consent to or accept or adopt on behalf of any Lender any plan of reorganization, arrangement,

adjustment or composition affecting the Obligations or the rights of any Lender or to authorize the

Administrative Agent to vote in respect of the claim of any Lender in any such proceeding.

The Secured Parties hereby irrevocably authorize the Administrative Agent, at the direction of the

Required Lenders, to credit bid all or any portion of the Obligations (including accepting some or all of

the Collateral in satisfaction of some or all of the Obligations pursuant to a deed in lieu of foreclosure or

otherwise) and in such manner purchase (either directly or through one or more acquisition vehicles) all

or any portion of the Collateral (a) at any sale thereof conducted under the provisions of the Bankruptcy

Code of the United States, including under Sections 363, 1123 or 1129 of the Bankruptcy Code of the

United States, or any similar Laws in any other jurisdictions to which a Loan Party is subject, (b) at any

other sale or foreclosure or acceptance of collateral in lieu of debt conducted by (or with the consent or at

the direction of) the Administrative Agent (whether by judicial action or otherwise) in accordance with

any applicable Law. In connection with any such credit bid and purchase, the Obligations owed to the

Secured Parties shall be entitled to be, and shall be, credit bid on a ratable basis (with Obligations with

respect to contingent or unliquidated claims receiving contingent interests in the acquired assets on a

ratable basis that would vest upon the liquidation of such claims in an amount proportional to the

liquidated portion of the contingent claim amount used in allocating the contingent interests) in the asset

or assets so purchased (or in the Capital Stock or debt instruments of the acquisition vehicle or vehicles

that are used to consummate such purchase). In connection with any such bid (i) the Administrative

Agent shall be authorized to form one or more acquisition vehicles to make a bid, (ii) to adopt documents

providing for the governance of the acquisition vehicle or vehicles (provided that any actions by the

Administrative Agent with respect to such acquisition vehicle or vehicles, including any disposition of the

assets or Capital Stock thereof shall be governed, directly or indirectly, by the vote of the Required

Lenders, irrespective of the termination of this Agreement and without giving effect to the limitations on

actions by the Required Lenders contained in clauses (a) through (h) of Section 11.01 of this Agreement),

and (iii) to the extent that Obligations that are assigned to an acquisition vehicle are not used to acquire

Collateral for any reason (as a result of another bid being higher or better, because the amount of

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Obligations assigned to the acquisition vehicle exceeds the amount of debt credit bid by the acquisition

vehicle or otherwise), such Obligations shall automatically be reassigned to the Lenders pro rata and the

Capital Stock and/or debt instruments issued by any acquisition vehicle on account of the Obligations that

had been assigned to the acquisition vehicle shall automatically be cancelled, without the need for any

Secured Party or any acquisition vehicle to take any further action.

10.11Collateral and Guaranty Matters

The Lenders irrevocably authorize the Administrative Agent, at its option and in its discretion,

(a)to release or subordinate any Lien on any Collateral granted to or held by the

Administrative Agent under any Loan Document (i) upon termination of the Commitments and

payment in full of all Obligations (other than contingent indemnification obligations), (ii) that is

transferred or to be transferred to a Person that is not a Loan Party as part of or in connection with

any Disposition permitted hereunder or under any other Loan Document, any Involuntary

Disposition or any sale, transfer or other disposition described in the definition of “Disposition”,

(iii) pursuant to the Intercreditor Agreement or the Relative Rights Agreement or (iv) as approved

in accordance with Section 11.01;

(b)to subordinate any Lien on any Property granted to or held by the Administrative

Agent under any Loan Document to the holder of any Lien on such Property that is permitted by

Section 8.01;

(c)to release any Guarantor from its obligations under the Guaranty, as permitted

hereunder or if such Person ceases to be a Subsidiary as a result of a transaction permitted

hereunder;

(d)to assign the Liens on (i) the Capital Stock of the Tenant Subsidiaries and (ii) any

assets or property of the Tenant Subsidiaries under Loan Documents to the Ventas Assignee upon

the consummation of the Ventas Purchase Option and the Ventas Purchase Option Assignment;

(e)to assign the guarantees provided by the Tenant Subsidiaries to the Ventas

Assignee upon consummation of the Ventas Purchase Option and the Ventas Purchase Option

Assignment; and

(f)to release the Liens on the assets and properties of the Tenant Subsidiaries

subject to the Ventas Asset Purchase upon consummation of the Ventas Asset Purchase.

Upon request by the Administrative Agent at any time, the Required Lenders will confirm in

writing the Administrative Agent’s authority to release or subordinate its interest in particular types or

items of Property, or to release any Guarantor from its obligations under the Guaranty pursuant to this

Section 10.11.

Notwithstanding anything to the contrary herein, each Lender acknowledges and agrees that upon

the consummation of the Ventas Purchase Option and the Ventas Purchase Option Assignment, the Term

Loans held by such Lenders shall no longer receive the benefit of any guarantees or Collateral from the

Tenant Subsidiaries.

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10.12Other Agents; Joint Book Runners and Managers

None of the Lenders or other Persons identified on the facing page or signature pages of this

Agreement as a “syndication agent,” “documentation agent,” “co-agent,” “co-manager,” “book manager,”

“lead manager,” “arranger,” “joint lead arranger,” “joint book runner,” or “co-arranger” shall have any

right, power, obligation, liability, responsibility or duty under this Agreement other than, in the case of

such Lenders, those applicable to all Lenders as such. Without limiting the foregoing, none of the

Lenders or other Persons so identified shall have or be deemed to have any fiduciary relationship with

any Lender. Each Lender acknowledges that it has not relied, and will not rely, on any of the Lenders or

other Persons so identified in deciding to enter into this Agreement or in taking or not taking action

hereunder.

10.13No Advisory or Fiduciary Responsibility

In connection with all aspects of each transaction contemplated hereby (including in connection

with any amendment, waiver or other modification hereof or of any other Loan Document), the Borrower

and each other Loan Party acknowledges and agrees, and acknowledges its Affiliates’ understanding, that:

(i) (A) the arranging and other services regarding this Agreement provided by the Administrative Agent

and the Joint Book Runners are arm’s-length commercial transactions between the Borrower, each other

Loan Party and their respective Affiliates, on the one hand, and the Administrative Agent and the Joint

Book Runners, on the other hand, (B) the Borrower and the other Loan Parties has consulted its own

legal, accounting, regulatory and tax advisors to the extent it has deemed appropriate, and (C) the

Borrower and each other Loan Party is capable of evaluating, and understands and accepts, the terms,

risks and conditions of the transactions contemplated hereby and by the other Loan Documents; (ii) (A)

the Administrative Agent and each Joint Book Runner is and has been acting solely as a principal and,

except as expressly agreed in writing by the relevant parties, has not been, is not, and will not be acting as

an advisor, agent or fiduciary for the Borrower, any other Loan Party or any of their respective Affiliates,

or any other Person and (B) neither the Administrative Agent nor any Joint Book Runner has any

obligation to the Borrower, any other Loan Party or any of their respective Affiliates with respect to the

transactions contemplated hereby except those obligations expressly set forth herein and in the other Loan

Documents; and (iii) the Administrative Agent and the Joint Book Runners and their respective Affiliates

may be engaged in a broad range of transactions that involve interests that differ from those of the

Borrower, the other Loan Parties and their respective Affiliates, and neither the Administrative Agent nor

any Joint Book Runner has any obligation to disclose any of such interests to the Borrower, any other

Loan Party or any of their respective Affiliates. To the fullest extent permitted by applicable law, the

Borrower and the other Loan Parties hereby waives and releases any claims that it may have against the

Administrative Agent and the Joint Book Runners with respect to any breach or alleged breach of agency

or fiduciary duty in connection with any aspect of any transaction contemplated hereby.

10.14Exculpatory Provisions

The Administrative Agent or the Joint Book Runners, as applicable, shall not have any duties or

obligations except those expressly set forth herein and in the other Loan Documents and their respective

duties hereunder shall be administrative in nature. Without limiting the generality of the foregoing, the

Administrative Agent or the Joint Book Runners, as applicable:

(a)shall not be subject to any fiduciary or other implied duties, regardless of

whether a Default has occurred and is continuing;

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(b)shall not have any duty to take any discretionary action or exercise any

discretionary powers, except discretionary rights and powers expressly contemplated hereby or

by the other Loan Documents that the Administrative Agent is required to exercise as directed in

writing by the Required Lenders (or such other number or percentage of the Lenders as shall be

expressly provided for herein or in the other Loan Documents); provided that the Administrative

Agent shall not be required to take any action that, in its opinion or the opinion of its counsel,

may expose the Administrative Agent to liability or that is contrary to any Loan Document or

applicable law, including for the avoidance of doubt any action that may be in violation of the

automatic stay under any Debtor Relief Law or that may affect a forfeiture, modification or

termination of property of a Defaulting Lender in violation of any Debtor Relief Law; and

(c)shall not, except as expressly set forth herein and in the other Loan Documents,

have any duty or responsibility to disclose, and shall not be liable for the failure to disclose, any

information relating to the Borrower or any of its Affiliates that is communicated to or obtained

by the Person serving as the Administrative Agent or any of its Affiliates in any capacity.

The Administrative Agent shall not be liable for any action taken or not taken by it (i) with the

consent or at the request of the Required Lenders (or such other number or percentage of the Lenders as

shall be necessary, or as the Administrative Agent shall believe in good faith shall be necessary, under the

circumstances as provided in Sections 11.01 and 9.02) or (ii) in the absence of its own gross negligence or

willful misconduct, as determined by a court of competent jurisdiction by a final and nonappealable

judgment. The Administrative Agent shall be deemed not to have knowledge of any Default unless and

until notice describing such Default is given to the Administrative Agent by the Borrower or a Lender.

The Administrative Agent shall not be responsible for or have any duty to ascertain or inquire

into (i) any statement, warranty or representation made in or in connection with this Agreement or any

other Loan Document, (ii) the contents of any certificate, report or other document delivered hereunder or

thereunder or in connection herewith or therewith, (iii) the performance or observance of any of the

covenants, agreements or other terms or conditions set forth herein or therein or the occurrence of any

Default, (iv) the validity, enforceability, effectiveness or genuineness of this Agreement, any other Loan

Document or any other agreement, instrument or document, or the creation, perfection or priority of any

lien purported to be created by the Collateral Documents, (v) the value or the sufficiency of any Collateral

or (vi) the satisfaction of any condition set forth in Article V or elsewhere herein, other than to confirm

receipt of items expressly required to be delivered to the Administrative Agent.

The Administrative Agent shall not be responsible or have any liability for, or have any duty to

ascertain, inquire into, monitor or enforce, compliance with the provisions hereof relating to Disqualified

Institutions. Without limiting the generality of the foregoing, the Administrative Agent shall not (x) be

obligated to ascertain, monitor or inquire as to whether any Lender or Participant or prospective Lender or

Participant is a Disqualified Institution or (y) have any liability with respect to or arising out of any

assignment or participation of Loans, or disclosure of confidential information, to any Disqualified

Institution.

10.15Rights as Lender

The Person serving as the Administrative Agent hereunder shall have the same rights and powers

in its capacity as a Lender as any other Lender and may exercise the same as though it were not the

Administrative Agent and the term “Lender” or “Lenders” shall, unless otherwise expressly indicated or

unless the context otherwise requires, include the Person serving as the Administrative Agent hereunder

in its individual capacity. Such Person and its Affiliates may accept deposits from, lend money to, own

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securities of, act as the financial advisor or in any other advisory capacity for and generally engage in any

kind of business with the Borrower or any Subsidiary or other Affiliate thereof as if such Person were not

the Administrative Agent hereunder and without any duty to account therefor to the Lenders.

10.16Withholding Taxes

To the extent required by any applicable law (as determined in good faith by the Administrative

Agent), the Administrative Agent may deduct or withhold from any payment to any Lender under any

Loan Document an amount equivalent to any applicable withholding Tax. If the Internal Revenue

Service or any authority of the United States or other jurisdiction asserts a claim that the Administrative

Agent did not properly withhold Tax from amounts paid to or for the account of any Lender (because the

appropriate form was not delivered, was not properly executed, or because such Lender failed to notify

the Administrative Agent of a change in circumstances that rendered the exemption from, or reduction of,

withholding tax ineffective, or for any other reason), such Lender shall indemnify and hold harmless the

Administrative Agent (to the extent that the Administrative Agent has not already been reimbursed by the

Borrower pursuant to Sections 3.01 and 3.04 and without limiting the obligation of the Borrower to do so)

fully for all amounts paid, directly or indirectly, by the Administrative Agent as Tax or otherwise,

together with all expenses incurred, including legal expenses, allocated staff costs and any out of pocket

expenses, whether or not such Tax was correctly or legally imposed or asserted by the relevant

Governmental Authority. A certificate as to the amount of such payment or liability delivered to any

Lender by the Administrative Agent shall be conclusive absent manifest error. Each Lender hereby

authorizes the Administrative Agent to set off and apply any and all amounts at any time owing to such

Lender under this Agreement or any other Loan Document against any amount due the Administrative

Agent under this Section 10.16. The agreements in this Section 10.16 shall survive the resignation and/or

replacement of the Administrative Agent, any assignment of rights by, or the replacement of, a Lender,

the termination of the Agreement and the repayment, satisfaction or discharge of all other obligations.

10.17Intercreditor Agreement; Relative Rights Agreement

(a)EACH LENDER AUTHORIZES AND INSTRUCTS THE ADMINISTRATIVE

AGENT TO ENTER INTO THE INTERCREDITOR AGREEMENT AND THE RELATIVE RIGHTS

AGREEMENT ON BEHALF OF SUCH LENDER, AND TO TAKE ALL ACTIONS (AND EXECUTE

ALL DOCUMENTS) REQUIRED (OR DEEMED ADVISABLE) BY IT IN ACCORDANCE WITH

THE TERMS OF THE INTERCREDITOR AGREEMENT AND THE RELATIVE RIGHTS

AGREEMENT.

(b)THE PROVISIONS OF THIS SECTION 10.17 ARE NOT INTENDED TO

SUMMARIZE ALL RELEVANT PROVISIONS OF THE INTERCREDITOR AGREEMENT AND

THE RELATIVE RIGHTS AGREEMENT, THE FORM OF EACH OF WHICH IS ATTACHED AS AN

EXHIBIT TO THIS AGREEMENT. REFERENCE MUST BE MADE TO THE INTERCREDITOR

AGREEMENT AND THE RELATIVE RIGHTS AGREEMENT ITSELF TO UNDERSTAND ALL

TERMS AND CONDITIONS THEREOF. EACH LENDER IS RESPONSIBLE FOR MAKING ITS

OWN ANALYSIS AND REVIEW OF THE INTERCREDITOR AGREEMENT AND THE RELATIVE

RIGHTS AGREEMENT AND THE TERMS AND PROVISIONS THEREOF, AND NEITHER THE

ADMINISTRATIVE AGENT NOR ANY OF ITS AFFILIATES MAKES ANY REPRESENTATION

TO ANY LENDER AS TO THE SUFFICIENCY OR ADVISABILITY OF THE PROVISIONS

CONTAINED IN THE INTERCREDITOR AGREEMENT AND THE RELATIVE RIGHTS

AGREEMENT.

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(c)EACH LENDER ACKNOWLEDGES THAT IT WILL BE AUTOMATICALLY

BOUND BY THE TERMS AND CONDITIONS OF THE RELATIVE RIGHTS AGREEMENT AS A

CONDITION OF BECOMING A HOLDER OF CERTAIN OBLIGATIONS THEREUNDER AND

ACKNOWLEDGES AND AGREES THAT THE RIGHTS AND REMEDIES OF THE

ADMINISTRATIVE AGENT AND LENDERS (AS DESCRIBED IN THE RELATIVE RIGHTS

AGREEMENT) ARE SUBJECT TO THE RELATIVE RIGHTS AGREEMENT AND, WITHOUT

LIMITATION OF THE FOREGOING, EACH LENDER AGREES TO AND CONSENTS TO THE

PURCHASE RIGHT SET FORTH IN SECTION 2.6 THEREOF AND AGREES TO EXECUTE ANY

DOCUMENTS DEEMED APPROPRIATE BY THE ADMINISTRATIVE AGENT IN CONNECTION

THEREWITH.

(d)NOTWITHSTANDING ANYTHING HEREIN TO THE CONTRARY, THE LIENS

AND SECURITY INTERESTS GRANTED TO BANK OF AMERICA, AS ADMINISTRATIVE

AGENT PURSUANT TO THIS AGREEMENT AND THE EXERCISE OF ANY RIGHT OR REMEDY

BY THE ADMINISTRATIVE AGENT HEREUNDER, ARE SUBJECT TO THE PROVISIONS OF

THE INTERCREDITOR AGREEMENT. IN THE EVENT OF ANY CONFLICT BETWEEN THE

TERMS OF THE INTERCREDITOR AGREEMENT AND THE TERMS OF THIS AGREEMENT,

THE TERMS OF THE INTERCREDITOR AGREEMENT SHALL GOVERN AND CONTROL.

10.18Certain ERISA Matters

(a)Each Lender (x) represents and warrants, as of the date such Person became a Lender

party hereto, to, and (y) covenants, from the date such Person became a Lender party hereto to the date

such Person ceases being a Lender party hereto, for the benefit of, the Administrative Agent and the Joint

Book Runners and their respective Affiliates, and not, for the avoidance of doubt, to or for the benefit of

any Borrower or any other Loan Party, that at least one of the following is and will be true:

(i)such Lender is not using “plan assets” (within the meaning of Section 3(42) of

ERISA or otherwise) of one or more Benefit Plans with respect to such Lender’s entrance into,

participation in, administration of and performance of the Loans, the Commitments or this

Agreement,

(ii)the transaction exemption set forth in one or more PTEs, such as PTE 84-14 (a

class exemption for certain transactions determined by independent qualified professional asset

managers), PTE 95-60 (a class exemption for certain transactions involving insurance company

general accounts), PTE 90-1 (a class exemption for certain transactions involving insurance

company pooled separate accounts), PTE 91-38 (a class exemption for certain transactions

involving bank collective investment funds) or PTE 96-23 (a class exemption for certain

transactions determined by in-house asset managers), is applicable with respect to such Lender’s

entrance into, participation in, administration of and performance of the Loans, the Commitments

and this Agreement,

(iii)(A) such Lender is an investment fund managed by a “Qualified Professional

Asset Manager” (within the meaning of Part VI of PTE 84-14), (B) such Qualified Professional

Asset Manager made the investment decision on behalf of such Lender to enter into, participate

in, administer and perform the Loans, the Commitments and this Agreement, (C) the entrance

into, participation in, administration of and performance of the Loans, the Commitments and this

Agreement satisfies the requirements of sub-sections (b) through (g) of Part I of PTE 84-14 and

(D) to the best knowledge of such Lender, the requirements of subsection (a) of Part I of PTE 84-

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14 are satisfied with respect to such Lender’s entrance into, participation in, administration of and

performance of the Loans, the Commitments and this Agreement, or

(iv)such other representation, warranty and covenant as may be agreed in writing

between the Administrative Agent, in its sole discretion, and such Lender.

(b)In addition, unless either (1) sub-clause (i) in the immediately preceding clause (a) is true

with respect to a Lender or (2) a Lender has provided another representation, warranty and covenant in

accordance with sub-clause (iv) in the immediately preceding clause (a), such Lender further (x)

represents and warrants, as of the date such Person became a Lender party hereto, to, and (y) covenants,

from the date such Person became a Lender party hereto to the date such Person ceases being a Lender

party hereto, for the benefit of, the Administrative Agent and not, for the avoidance of doubt, to or for the

benefit of the Borrower or any other Loan Party, that the Administrative Agent is not a fiduciary with

respect to the assets of such Lender involved in such Lender’s entrance into, participation in,

administration of and performance of the Loans, the Commitments and this Agreement (including in

connection with the reservation or exercise of any rights by the Administrative Agent under this

Agreement, any Loan Document or any documents related hereto or thereto).

10.19Recovery of Erroneous Payments

Without limitation of any other provision in this Agreement, if at any time the Administrative

Agent makes a payment hereunder in error to any Lender (the “Credit Party”), whether or not in respect

of an Obligation due and owing by the Borrower at such time, where such payment is a Rescindable

Amount, then in any such event, each Credit Party receiving a Rescindable Amount severally agrees to

repay to the Administrative Agent forthwith on demand the Rescindable Amount received by such Credit

Party in immediately available funds in the currency so received, with interest thereon, for each day from

and including the date such Rescindable Amount is received by it to but excluding the date of payment to

the Administrative Agent, at the greater of the Federal Funds Rate and a rate determined by the

Administrative Agent in accordance with banking industry rules on interbank compensation. Each Credit

Party irrevocably waives any and all defenses, including any “discharge for value” (under which a

creditor might otherwise claim a right to retain funds mistakenly paid by a third party in respect of a debt

owed by another) or similar defense to its obligation to return any Rescindable Amount. The

Administrative Agent shall inform each Credit Party promptly upon determining that any payment made

to such Credit Party comprised, in whole or in part, a Rescindable Amount.

ARTICLE XI

MISCELLANEOUS

11.01Amendments, Etc.

Subject to the terms of the Intercreditor Agreement and Section 2.14,2.16, 2.17 and 2.18, no

amendment or waiver of any provision of this Agreement or any other Loan Document, and no consent to

any departure by the Borrower or any other Loan Party therefrom, shall be effective unless in writing

signed by the Required Lenders and the Borrower or the applicable Loan Party, as the case may be, and

acknowledged by the Administrative Agent, and each such waiver or consent shall be effective only in the

specific instance and for the specific purpose for which given; provided, however, that no such

amendment, waiver or consent shall:

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(a)extend or increase the Commitment of any Lender (or reinstate any Commitment

terminated pursuant to Section 9.02) without the written consent of such Lender (it being

understood and agreed that a waiver of any Default or Event of Default or a mandatory reduction

in Commitments or mandatory prepayments of Term Loans (other than a mandatory prepayment

required by Section 2.05(b)(iv)) is not considered an extension or increase in Commitments of

any Lender);

(b)postpone any date fixed by this Agreement or any other Loan Document for any

payment of principal (excluding mandatory prepayments), interest, fees, premiums or other

amounts due to the Lenders (or any of them) hereunder or under any other Loan Document

without the written consent of each Lender directly and adversely affected thereby;

(c)reduce the principal of, or the rate of interest specified herein on, any Loan or

any fees or other amounts payable hereunder or under any other Loan Document without the

written consent of each Lender directly and adversely affected thereby; provided, however, that

only the consent of the Required Lenders shall be necessary to amend the definition of “Default

Rate” or to waive any obligation of the Borrower to pay interest at the Default Rate;

(d)change Section 2.13 or Section 9.03 in a manner that would alter the pro rata

sharing of payments required thereby without the written consent of each Lender directly and

adversely affected thereby;

(e)change any provision of this Section 11.01 or the definition of “Required

Lenders” or any other provision hereof specifying the number or percentage of Lenders required

to amend, waive or otherwise modify any rights hereunder or make any determination or grant

any consent hereunder without the written consent of each Lender directly and adversely affected

thereby;

(f)except in connection with a Disposition permitted under Section 8.05 or as

required by the Intercreditor Agreement or the Relative Rights Agreement, release or subordinate

all or substantially all of the Collateral without the written consent of each Lender;

(g)release the Borrower or, except in connection with a merger or consolidation

permitted under Section 8.04 or a Disposition permitted under Section 8.05, all or substantially all

of the Guarantors, from its or their obligations under the Loan Documents without the written

consent of each Lender; or

(h)change Section 11.07 in any manner that would impose any additional restriction

on the ability of the Lenders to assign their respective rights and obligations without the written

consent of each Lender directly affected thereby.

provided, further, that (i) no amendment, waiver or consent shall, unless in writing and signed by the

Administrative Agent in addition to the Lenders required above, affect the rights or duties of the

Administrative Agent under this Agreement or any other Loan Document; (ii) the Fee Letter may be

amended, or rights or privileges thereunder waived, in a writing executed only by the parties thereto; and

(iii) no amendment, waiver or consent shall without the consent of the Lenders holding more than 50% of

the outstanding Term Loans, extend the time for, or reduce the amount, or otherwise alter the manner of

application of proceeds in respect of the Term Loans on account of the mandatory prepayment provisions

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of clauses (ii), (iii) and (iv), inclusive, of Section 2.05(b) or the application provisions of Section

2.05(b)(vii).

Notwithstanding anything to the contrary herein, (i) no Defaulting Lender shall have any right to

approve or disapprove any amendment, waiver or consent hereunder (and any amendment, waiver or

consent which by its terms requires the consent of all Lenders or each affected Lender may be effected

with the consent of the applicable Lenders other than Defaulting Lenders), except that (x) the

Commitment of any Defaulting Lender may not be increased or extended without the consent of such

Lender and (y) any waiver, amendment or modification requiring the consent of all Lenders or each

affected Lender that by its terms affects any Defaulting Lender more adversely than other affected

Lenders shall require the consent of such Defaulting Lender and (ii) this Agreement and the other Loan

Documents may be amended to give effect to any Incremental Term Loans without the consent of the

Lenders to the extent set forth in Section 2.14.

For the avoidance of doubt, each Non-Debt Fund Affiliate shall be entitled to approve or

disapprove any amendment, waiver or consent described in the first proviso to this Section 11.01 that

directly affects such Non-Debt Fund Affiliate or requires the approval of all Lenders.

Notwithstanding the fact that the consent of all the Lenders is required in certain circumstances as

set forth above, (x) each Lender is entitled to vote as such Lender sees fit on any bankruptcy

reorganization plan that affects the Loans; provided, however that each Non-Debt Fund Affiliate agrees

that it shall not exercise its voting rights during any bankruptcy or insolvency proceeding except to the

extent necessary to protect its rights from becoming disproportionately disadvantaged during the course

of such bankruptcy or insolvency proceeding, as determined in the reasonable discretion of the applicable

Non-Debt Fund Affiliate, and each Lender acknowledges that the provisions of Section 1126(c) of the

Bankruptcy Code supersedes the unanimous consent provisions set forth herein and (y) the Required

Lenders shall determine whether or not to allow a Loan Party to use cash collateral in the context of a

bankruptcy or insolvency proceeding and such determination shall be binding on all of the Lenders.

Notwithstanding the foregoing, this Agreement and any other Loan Document may be amended

solely with the consent of the Administrative Agent and the Borrower without the need to obtain the

consent of any other Lender if such amendment is delivered in order to correct or cure (x) ambiguities,

errors, omissions, defects, (y) to effect administrative changes of a technical or immaterial nature or (z)

incorrect cross references or similar inaccuracies in this Agreement or the applicable Loan Document.

The Collateral Documents and related documents executed in connection with this Agreement and the

other Loan Documents may be in a form reasonably determined by the Administrative Agent and may be,

together with this Agreement, amended and waived with the consent of the Administrative Agent at the

request of the Borrower without the need to obtain the consent of any other Lender if such amendment or

waiver is delivered in order (i) to comply with local Law or advice of local counsel, (ii) to cure

ambiguities or defects or (iii) to cause such Security Agreement or other document to be consistent with

this Agreement and the other Loan Documents.

Notwithstanding anything to the contrary in this Section 11.01, the Relative Rights Agreement

may be amended in the manner set forth therein.

Notwithstanding anything to the contrary in this Section 11.01, this Agreement and the other

Loan Documents may be amended on the date the Ventas Purchase Option Assignment is consummated

to affect the amendments contemplated by Section 2.18 with the consent of the Borrower, the

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Administrative Agent and the Ventas Assignee; provided that no such amendments may directly affect the

Term Loan Lenders holding Non-Ventas Purchase Option Term Loans.

11.02Notices and Other Communications; Facsimile Copies

(a)General. Unless otherwise expressly provided herein, all notices and other

communications provided for hereunder shall be in writing (including by facsimile transmission). All

such written notices shall be mailed, faxed or delivered to the applicable address, facsimile number or

electronic mail address, and all notices and other communications shall be made to the applicable address,

facsimile number or electronic mail address set forth for the applicable party on Schedule 11.02 or to such

other address, facsimile number or electronic mail address as shall be designated by such party in a notice

to the other parties.

All such notices and other communications shall be deemed to be given or made upon the earlier

to occur of (i) actual receipt by the relevant party hereto and (ii) (A) if delivered by hand or by courier,

when signed for by or on behalf of the relevant party hereto; (B) if delivered by mail, four Business Days

after deposit in the mails, postage prepaid; (C) if delivered by facsimile, when sent and receipt has been

confirmed by telephone; and (D) if delivered by electronic mail, when delivered; provided, however, that

notices and other communications to the Administrative Agent pursuant to Article II shall not be effective

until actually received by such Person. In no event shall a voicemail message be effective as a notice,

communication or confirmation hereunder.

(b)Electronic Execution of Assignments and Certain Other Documents. The words “execute,”

“execution,” “signed,” “signature,” and words of like import in or related to any document to be signed in

connection with this Agreement and the transactions contemplated hereby (including without limitation

Assignment and Assumptions, amendments or other Loan Notices, waivers and consents) shall be deemed

to include electronic signatures, the electronic matching of assignment terms and contract formations on

electronic platforms approved by the Administrative Agent, or the keeping of records in electronic form,

each of which shall be of the same legal effect, validity or enforceability as a manually executed signature

or the use of a paper-based recordkeeping system, as the case may be, to the extent and as provided for in

any applicable law, including the Federal Electronic Signatures in Global and National Commerce Act,

the New York State Electronic Signatures and Records Act, or any other similar state laws based on the

Uniform Electronic Transactions Act; provided that notwithstanding anything contained herein to the

contrary the Administrative Agent is under no obligation to agree to accept electronic signatures in any

form or in any format unless expressly agreed to by the Administrative Agent pursuant to procedures

approved by it.

(c)Reliance by Administrative Agent and Lenders. The Administrative Agent and the

Lenders shall be entitled to rely and act upon any notices purportedly given by or on behalf of the

Borrower even if (i) such notices were not made in a manner specified herein, were incomplete or were

not preceded or followed by any other form of notice specified herein, or (ii) the terms thereof, as

understood by the recipient, varied from any confirmation thereof. The Borrower shall indemnify each

Agent-Related Person and each Lender from all losses, costs, expenses and liabilities resulting from the

reliance by such Person on each notice purportedly given by or on behalf of the Borrower. All telephonic

notices to and other communications with the Administrative Agent may be recorded by the

Administrative Agent, and each of the parties hereto hereby consents to such recording.

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11.13No Waiver; Cumulative Remedies

No failure by any Lender or the Administrative Agent to exercise, and no delay by any such

Person in exercising, any right, remedy, power or privilege hereunder shall operate as a waiver thereof;

nor shall any single or partial exercise of any right, remedy, power or privilege hereunder preclude any

other or further exercise thereof or the exercise of any other right, remedy, power or privilege. The rights,

remedies, powers and privileges herein provided are cumulative and not exclusive of any rights, remedies,

powers and privileges provided by law.

11.04Attorney Costs, Expenses and Taxes

The Borrower agrees to pay or reimburse (a) the Administrative Agent and the Joint Book

Runners for all reasonable and documented out-of-pocket costs and expenses incurred in connection with

the development, preparation, negotiation and execution of this Agreement and the other Loan

Documents and any amendment, waiver, consent or other modification of the provisions hereof and

thereof (whether or not the transactions contemplated hereby or thereby are consummated), and the

consummation and administration of the transactions contemplated hereby and thereby, including all

Attorney Costs and reasonable and documented out-of-pocket costs and expenses in connection with the

use of IntraLinks, Inc. or other similar information transmission systems in connection with this

Agreement and (b) the Administrative Agent, the Joint Book Runners and each Lender for all reasonable

and documented out-of-pocket costs and expenses incurred in connection with the enforcement, attempted

enforcement, or preservation of any rights or remedies under this Agreement or the other Loan

Documents (including all such costs and expenses incurred during any “workout” or restructuring in

respect of the Obligations and during any legal proceeding, including any proceeding under any Debtor

Relief Law), including all Attorney Costs. The foregoing costs and expenses shall include all search,

filing, recording, title insurance and appraisal charges and fees and taxes (other than income or franchise

taxes) related thereto, and other reasonable and out-of-pocket expenses incurred by the Administrative

Agent and the cost of independent public accountants and other outside experts retained by the

Administrative Agent or any Lender. All amounts due under this Section 11.04 shall be payable within

thirty days after written demand therefor with reasonably detailed supporting backup documentation. The

agreements in this Section 11.04 shall survive the termination of the Commitments and repayment of all

other Obligations.

11.05Indemnification by the Borrower

Whether or not the transactions contemplated hereby are consummated, the Borrower agrees to

indemnify and hold harmless each Agent-Related Person, each Lender and their respective Affiliates,

directors, partners, officers, employees, counsel, agents and attorneys-in-fact (collectively the

“Indemnitees”) from and against any and all liabilities, obligations, losses, damages, penalties, claims,

demands, actions, judgments, suits, costs, expenses and disbursements (including Attorney Costs) of any

kind or nature whatsoever which may at any time be imposed on, incurred by or asserted against any such

Indemnitee in any way relating to or arising out of or in connection with (a) the execution, delivery,

enforcement, performance or administration of any Loan Document or any other agreement, letter or

instrument delivered in connection with the transactions contemplated thereby or the consummation of

the transactions contemplated thereby, (b) any Commitment, Loan or the use or proposed use of the

proceeds therefrom, (c) any actual or alleged presence or release of Hazardous Materials on or from any

property currently or formerly owned or operated by any Loan Party or any of its Subsidiaries, or any

Environmental Liability related in any way to any Loan Party or any of its Subsidiaries, or (d) any actual

or prospective claim, litigation, investigation or proceeding relating to any of the foregoing, whether

based on contract, tort or any other theory (including any investigation of, preparation for, or defense of

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any pending or threatened claim, investigation, litigation or proceeding) and regardless of whether any

Indemnitee is a party thereto (all the foregoing, collectively, the “Indemnified Liabilities”), in all cases,

whether or not any such claim, litigation, investigation or proceeding is brought by the Borrower, its

equity holders, its Affiliates, its creditors or any other Person; provided that such indemnity shall not, as

to any Indemnitee, be available to the extent that such liabilities, obligations, losses, damages, penalties,

claims, demands, actions, judgments, suits, costs, expenses or disbursements (a) are determined by a court

of competent jurisdiction by final and nonappealable judgment to have resulted from (i) the gross

negligence, bad faith or willful misconduct of such Indemnitee or (ii) such Indemnitee’s material breach

of its obligations under any Loan Document or any other agreement, letter or instrument delivered in

connection with the transactions contemplated hereby or thereby or (b) arises from any disputes solely

among Indemnitees (other than any claims against an Agent-Related Person in its capacity as the

Administrative Agent or arranger or in a similar role under the Term Loans) not involving any act or

omission of any Loan Party. No Indemnitee shall be liable for any damages arising from the use by

others of any information or other materials obtained through IntraLinks or other similar information

transmission systems in connection with this Agreement, nor shall any Indemnitee or any Loan Party

have any liability for any indirect, special, punitive or consequential damages relating to this Agreement

or any other Loan Document or arising out of its activities in connection herewith or therewith (whether

before or after the Effective Date); provided that the foregoing shall not in any way limit the Borrower’s

indemnification obligations pursuant to the immediately preceding sentence. All amounts due under this

Section 11.05 shall be payable within thirty days after written demand therefor with reasonably detailed

supporting backup documentation; provided, however, that such Indemnitee shall promptly refund such

amount to the extent that there is a final judicial or arbitral determination that such Indemnitee was not

entitled to indemnification or contribution rights with respect to such payment pursuant to the express

terms of this Section 11.05. The agreements in this Section 11.05 shall survive the resignation of the

Administrative Agent, the replacement of any Lender, the termination of the Commitments and the

repayment, satisfaction or discharge of all the other Obligations.

11.06Payments Set Aside

To the extent that any payment by or on behalf of any Loan Party is made to the Administrative

Agent or any Lender, or the Administrative Agent or any Lender exercises its right of setoff, and such

payment or the proceeds of such setoff or any part thereof is subsequently invalidated, declared to be

fraudulent or preferential, set aside or required (including pursuant to any settlement entered into by the

Administrative Agent or such Lender in its discretion) to be repaid to a trustee, receiver or any other

party, in connection with any proceeding under any Debtor Relief Law or otherwise, then (a) to the extent

of such recovery, the obligation or part thereof originally intended to be satisfied shall be revived and

continued in full force and effect as if such payment had not been made or such setoff had not occurred,

and (b) each Lender severally agrees to pay to the Administrative Agent upon demand its applicable share

of any amount so recovered from or repaid by the Administrative Agent, plus interest thereon from the

date of such demand to the date such payment is made at a rate per annum equal to the Federal Funds

Rate from time to time in effect.

11.07Successors and Assigns

(a)The provisions of this Agreement shall be binding upon and inure to the benefit of the

parties hereto and their respective successors and assigns permitted hereby, except that neither the

Borrower nor any other Loan Party may assign or otherwise transfer any of its rights or obligations

hereunder without the prior written consent of the Administrative Agent and each Lender and no Lender

may assign or otherwise transfer any of its rights or obligations hereunder except (i) to an Eligible

Assignee in accordance with the provisions of subsection (b) of this Section 11.07, (ii) by way of

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participation in accordance with the provisions of subsection (d) of this Section 11.07 or (iii) by way of

pledge or assignment of a security interest subject to the restrictions of subsection (f) of this Section 11.07

(and any other attempted assignment or transfer by any party hereto shall be null and void). Nothing in

this Agreement, expressed or implied, shall be construed to confer upon any Person (other than the parties

hereto, their respective successors and assigns permitted hereby, Participants to the extent provided in

subsection (d) of this Section 11.07 and, to the extent expressly contemplated hereby, the Indemnitees)

any legal or equitable right, remedy or claim under or by reason of this Agreement.

(b)Any Lender may at any time assign to one or more Eligible Assignees all or a portion of

its rights and obligations under this Agreement (including all or a portion of its Commitment and the

Loans at the time owing to it); provided that (i) except in the case of an assignment of the entire

remaining amount of the assigning Lender’s Commitment and the Loans at the time owing to it or in the

case of an assignment to a Lender or an Affiliate of a Lender or an Approved Fund (as defined in

subsection (g) of this Section 11.07) with respect to a Lender, the aggregate amount of the Commitment

(which for this purpose includes Loans outstanding thereunder) subject to each such assignment,

determined as of the date the Assignment and Assumption with respect to such assignment is delivered to

the Administrative Agent or, if “Trade Date” is specified in the Assignment and Assumption, as of the

Trade Date, shall not be less than $1,000,000 unless each of the Administrative Agent and, so long as no

Event of Default pursuant to Sections 9.01(a) and (f) has occurred and is continuing, the Borrower

otherwise consents (each such consent not to be unreasonably withheld or delayed and no such consent

being required in the case of an assignment to a Lender, an Affiliate of the Lender or an Approved Fund);

(ii) each partial assignment shall be made as an assignment of a proportionate part of all the assigning

Lender’s rights and obligations under this Agreement with respect to the Term Loans by such assigning

Lender; (iii) [reserved]; and (iv) the parties to each assignment shall execute and deliver to the

Administrative Agent an Assignment and Assumption, together with (except in the case of an assignment

to an Affiliate or an Approved Fund) a processing and recordation fee of $3,500, which fee may be

waived by the Administrative Agent in its sole discretion; provided that notwithstanding the foregoing, no

Assignment and Assumption shall be required in connection with the Ventas Purchase Option

Assignment pursuant to Section 2.18 (provided that the assigning Lenders shall have been deemed to

have made all of the representations and warranties required to be made by an assigning Lender pursuant

to an Assignment and Assumption to the Ventas Assignees in connection with and simultaneously with

such Ventas Purchase Option Assignment pursuant to Section 2.18) and the Ventas Purchase Option

Term Loans shall have been deemed to have been automatically assigned from Term Loan Lenders on a

pro rata basis to the Ventas Assignee; provided further that payment of such processing and recordation

fee shall not be the obligation of the Borrower or any Loan Party. Subject to acceptance and recording

thereof by the Administrative Agent pursuant to subsection (c) of this Section 11.07, from and after the

effective date specified in each Assignment and Assumption, the Eligible Assignee thereunder shall be a

party to this Agreement and, to the extent of the interest assigned by such Assignment and Assumption

(and subject to clause (j) below), have the rights and obligations of a Lender under this Agreement, and

the assigning Lender thereunder shall, to the extent of the interest assigned by such Assignment and

Assumption, be released from its obligations under this Agreement (and, in the case of an Assignment and

Assumption covering all of the assigning Lender’s rights and obligations under this Agreement, such

Lender shall cease to be a party hereto but shall continue to be entitled to the benefits of Sections 3.01,

3.04, 3.05, 11.04 and 11.05 with respect to facts and circumstances occurring prior to the effective date of

such assignment). Upon request, the Borrower (at its expense) shall execute and deliver a Term Note to

the assignee Lender. Any assignment or transfer by a Lender of rights or obligations under this

Agreement that does not comply with this subsection shall be treated for purposes of this Agreement as a

sale by such Lender of a participation in such rights and obligations in accordance with subsection (d) of

this Section 11.07.

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(c)The Administrative Agent, acting solely for this purpose as a non-fiduciary agent of the

Borrower (and such agency being solely for tax purposes), shall maintain at the Administrative Agent’s

Office a copy of each Assignment and Assumption delivered to it and a register for the recordation of the

names and addresses of the Lenders, and the Commitments of, and principal amounts (and related interest

amount) of the Loans owing to, each Lender pursuant to the terms hereof from time to time (the

“Register”). The entries in the Register shall be conclusive absent manifest error, and the Borrower, the

Administrative Agent and the Lenders shall treat each Person whose name is recorded in the Register

pursuant to the terms hereof as a Lender hereunder for all purposes of this Agreement, notwithstanding

notice to the contrary. In addition, the Administrative Agent shall maintain on the Register information

regarding the designation, and revocation of designation, of any Lender as a Defaulting Lender. The

Register shall be available for inspection by the Borrower at any reasonable time and from time to time

upon reasonable prior notice.

(d)Any Lender may at any time, without the consent of, or notice to, the Borrower, or the

Administrative Agent, sell participations to any Person (other than a natural person or the Borrower or

any of the Borrower’s Affiliates or Subsidiaries or a Disqualified Institution to the extent the Borrower

has made the list of Disqualified Institutions available to the Lenders on the Platform or another similar

electronic system) (each, a “Participant”) in all or a portion of such Lender’s rights and/or obligations

under this Agreement (including all or a portion of its Commitment and/or the Loans owing to it);

provided that (i) such Lender’s obligations under this Agreement shall remain unchanged, (ii) such

Lender shall remain solely responsible to the other parties hereto for the performance of such obligations

and (iii) the Borrower, the Administrative Agent and the other Lenders shall continue to deal solely and

directly with such Lender in connection with such Lender’s rights and obligations under this Agreement.

Any agreement or instrument pursuant to which a Lender sells such a participation shall provide that such

Lender shall retain the sole right to enforce this Agreement and to approve any amendment, modification

or waiver of any provision of this Agreement; provided that such agreement or instrument may provide

that such Lender will not, without the consent of the Participant, agree to any amendment, waiver or other

modification described in the first proviso to Section 11.01 that directly affects such Participant. Each

Lender that sells a participation shall, acting solely for this purpose as a non-fiduciary agent of the

Borrower, maintain a register on which it enters the name and address of each participant and the

principal amounts (and related interest amounts) of each participant’s interest in the Loans and/or

Commitment held by it (the “Participant Register”); provided that no Lender shall have any obligation to

disclose all or any portion of the Participant Register (including the identity of any Participant or any

information relating to a Participant’s interest in any Loan, Commitment, or its other obligations under

any Loan Document) to any Person except to the extent that such disclosure is necessary to establish that

such Loan, Commitment, or its other obligations under any Loan Document) to any Person except to the

extent that such disclosure is necessary to establish that such Loan, Commitment, or other obligation is in

registered form under Section 5f.103-1(c) of the U.S. Treasury Regulations. The entries in the Participant

Register shall be conclusive, absent manifest error, and such Lender shall treat each Person whose name

is recorded in the Participant Register as the owner of such Loan or other obligation hereunder as the

owner of such Loan or other obligation hereunder as the owner thereof for all purposes of this Agreement

notwithstanding any notice to the contrary. Subject to subsection (e) of this Section 11.07, the Borrower

agrees that each Participant shall be entitled to the benefits of Sections 3.01, 3.04 and 3.05 (subject to the

requirements and limitations of such Section and Section 11.16, and it being understood that the

documentation required under Section 3.01(e) shall be delivered solely to the participating Lender) to the

same extent as if it were a Lender and had acquired its interest by assignment pursuant to subsection (b)

of this Section 11.07. To the extent permitted by applicable law, each Participant also shall be entitled to

the benefits of Section 11.09 as though it were a Lender, provided such Participant agrees to be subject to

Section 2.11 as though it were a Lender.

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(e)A Participant shall not be entitled to receive any greater payment under Section 3.01 or

3.04 than the applicable Lender would have been entitled to receive with respect to the participation sold

to such Participant, unless the sale of the participation to such Participant is made with the Borrower’s

prior written consent (not to be unreasonably withheld or delayed).

(f)Any Lender may at any time pledge or assign a security interest in all or any portion of

its rights under this Agreement (including under its Term Note, if any) to secure obligations of such

Lender, including any pledge or assignment to secure obligations to a Federal Reserve Bank or other

central bank; provided that no such pledge or assignment shall release such Lender from any of its

obligations hereunder or substitute any such pledgee or assignee for such Lender as a party hereto.

(g)As used herein, the following terms have the following meanings:

“Eligible Assignee” means (a) a Lender; (b) an Affiliate of a Lender; (c) an Approved

Fund; and (d) any other Person (other than a natural person or a Disqualified Institution to the

extent the Borrower has made (or has caused to be made) the list of Disqualified Institutions

available to the Lenders on the Platform or another similar electronic system) approved by the

Administrative Agent and so long as no Event of Default pursuant to Sections 9.01(a) and (f) has

occurred and is continuing, the Borrower.

“Fund” means any Person (other than a natural person) that is (or will be) engaged in

making, purchasing, holding or otherwise investing in commercial loans and similar extensions of

credit in the ordinary course of its business.

“Approved Fund” means any Fund that is administered or managed by (a) a Lender, (b)

an Affiliate of a Lender or (c) an entity or an Affiliate of an entity that administers or manages a

Lender.

Notwithstanding anything to the contrary contained herein, with respect to the

Borrower’s consent that is required in connection with this Section 11.07, the Borrower shall be

deemed to have consented to any assignment of Term Loans pursuant to this Section 11.07 unless

it shall object thereto by written notice to the Administrative Agent within ten (10) Business Days

after the Borrower has received notice thereof.

(h)[Reserved].

(i)(A) Notwithstanding anything else to the contrary contained in this Agreement, any

Lender may assign all or a portion of its Term Loans to any Non-Debt Fund Affiliate or Purchasing

Borrower Party in accordance with Section 11.07(b); provided that:

(i)no Default or Event of Default has occurred or is continuing or would result

therefrom;

(ii)the assigning Lender and Non-Debt Fund Affiliate or Purchasing Borrower Party

purchasing such Lender’s Term Loans, as applicable, shall execute and deliver to the

Administrative Agent an assignment agreement substantially in the form of Exhibit N (a “Lender

Assignment and Assumption”) in lieu of an Assignment and Assumption;

(iii)[reserved];

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(iv)any Term Loans assigned to any Purchasing Borrower Party shall be

automatically and permanently cancelled upon the effectiveness of such assignment and will

thereafter no longer be outstanding for any purpose hereunder;

(v)no Purchasing Borrower Party may use the proceeds from the ABL Facility to

purchase any Term Loans; and

(vi)no Term Loan may be assigned to a Non-Debt Fund Affiliates pursuant to this

Section 11.07(i), if after giving effect to such assignment, Non-Debt Fund Affiliates in the

aggregate would own in excess of 20% of all Term Loans then outstanding.

(B)Notwithstanding anything to the contrary in this Agreement, no Non-Debt Fund Affiliate

shall have any right to (i) attend (including by telephone) any meeting or discussions (or portion thereof)

among the Administrative Agent or any Lender to which representatives of the Loan Parties are not

invited, and (ii) receive any information or material prepared by the Administrative Agent or any Lender

or any communication by or among the Administrative Agent and/or one or more Lenders, except to the

extent such information or materials have been made available to any Loan Party or its representatives

(and in any case, other than the right to receive notices of prepayments and other administrative notices in

respect of its Loans required to be delivered to Lenders), or (iii) make or bring (or participate in, other

than as a passive participant in or recipient of its pro rata benefits of) any claim, in its capacity as a

Lender, against the Administrative Agent or any other Lender with respect to any duties or obligations or

alleged duties or obligations of the Administrative Agent or any other such Lender under the Loan

Documents.

For the avoidance of doubt, the provisions of this Section 11.07(i) shall not apply to (i) any

assignment of the Ventas Purchase Option Term Loans to the Ventas Assignee pursuant to the terms of

Section 2.18 or (ii) any Ventas Assignee in respect of the Ventas Assignee in respect of the Ventas

Purchase Option Term Loans.

(j)Notwithstanding anything in Section 11.01 or the definition of “Required Lenders” to the

contrary, for purposes of determining whether the “Required Lenders” have (i) consented (or not

consented) to any amendment, modification, waiver, consent or other action with respect to any of the

terms of any Loan Document or any departure by any Loan Party therefrom, (ii) otherwise acted on any

matter related to any Loan Document, or (iii) directed or required the Administrative Agent or any Lender

to undertake any action (or refrain from taking any action) with respect to or under any Loan Document:

(i)all Term Loans held by any Non-Debt Fund Affiliate shall be deemed to be not

outstanding for all purposes of calculating whether the Required Lenders have taken any actions;

and

(ii)all Term Loans held by Debt Fund Affiliates may not account for more than 50%

of the Term Loans of consenting Lenders included in determining whether the “Required

Lenders” have consented to any action pursuant to Section 11.01.

Additionally, the Loan Parties and each Non-Debt Fund Affiliate hereby agree that if a case under Title

11 of the United States Code is commenced against any Loan Party, such Loan Party shall seek (and each

Non-Debt Fund Affiliate shall consent) to provide that the vote of any Non-Debt Fund Affiliate (in its

capacity as a Lender) with respect to any plan of reorganization of such Loan Party shall not be counted

except that such Non-Debt Fund Affiliate’s vote (in its capacity as a Lender) may be counted to the extent

any such plan of reorganization proposes to treat the Obligations held by such Non-Debt Fund Affiliate in

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a manner that is less favorable in any material respect to such Non-Debt Fund Affiliate than the proposed

treatment of similar Obligations held by Lenders that are not Affiliates of the Borrower. Each Non-Debt

Fund Affiliate hereby irrevocably appoints the Administrative Agent (such appointment being coupled

with an interest) as such Non-Debt Fund Affiliate’s attorney-in-fact, with full authority in the place and

stead of such Non-Debt Fund Affiliate and in the name of such Non-Debt Fund Affiliate, from time to

time in the Administrative Agent’s discretion to take any action and to execute any instrument that the

Administrative Agent may deem reasonably necessary to carry out the provisions of this paragraph.

For the avoidance of doubt, the provisions of this Section 11.07(j) shall not apply to (i) any

assignment of the Ventas Purchase Option Term Loans to the Ventas Assignee pursuant to the terms of

Section 2.18 or (ii) any Ventas Assignee in respect of the Ventas Assignee in respect of the Ventas

Purchase Option Term Loans.

11.08Confidentiality

Each of the Administrative Agent and the Lenders agrees to maintain the confidentiality of the

Information (as defined below), except that Information may be disclosed (a) to its and its Affiliates’

directors, officers, employees and agents, including accountants, legal counsel and other advisors (it being

understood that the Persons to whom such disclosure is made will be informed of the confidential nature

of such Information and instructed to keep such Information confidential); (b) to the extent requested by

any regulatory or self-regulatory authority; (c) to the extent required by applicable laws or regulations or

by any subpoena or similar legal process (in which case, except in the case of routine regulatory

examinations or audits, the Administrative Agent and the Lenders agree to inform the Borrower promptly

thereof prior to such disclosure to the extent practicable and not prohibited by law or regulation); (d) to

any other party to this Agreement; (e) in connection with the exercise of any remedies hereunder or any

suit, action or proceeding relating to this Agreement or the enforcement of rights hereunder; (f) subject to

an agreement containing provisions substantially the same as those of this Section 11.08, to (i) any

Eligible Assignee of or Participant in, or any prospective Eligible Assignee of or Participant in, or their

respective officers, employees, managers advisors (financial and legal) and investors, any of its rights or

obligations under this Agreement, (ii) any pledgee referred to in Section 11.07(f) or (iii) any direct or

indirect contractual counterparty or prospective counterparty (or such contractual counterparty’s or

prospective counterparty’s professional advisor) to any credit derivative transaction relating to obligations

of the Loan Parties; (g) with the consent of the Borrower; (h) to the extent such Information (i) becomes

publicly available other than as a result of a breach of this Section 11.08 or (ii) becomes available to the

Administrative Agent or any Lender on a nonconfidential basis from a source other than the Loan Parties;

or (i) to the NAIC or any other similar organization or any nationally recognized rating agency that

requires access to information about a Lender’s or its Affiliates’ investment portfolio in connection with

ratings issued with respect to such Lender or its Affiliates. In addition, the Administrative Agent and the

Lenders may disclose the existence of this Agreement and information about this Agreement to market

data collectors, similar service providers to the lending industry, and service providers to the

Administrative Agent and the Lenders in connection with the administration, management and assignment

of this Agreement, the other Loan Documents, the Commitments, and the Borrowings. For the purposes

of this Section 11.08, “Information” means all information received from any Loan Party relating to any

Loan Party or its business, other than any such information that is available to the Administrative Agent

or any Lender on a nonconfidential basis prior to disclosure by any Loan Party. Any Person required to

maintain the confidentiality of Information as provided in this Section 11.08 shall be considered to have

complied with its obligation to do so if such Person has exercised the same degree of care to maintain the

confidentiality of such Information as such Person would accord to its own confidential information.

Notwithstanding the foregoing, nothing in this Section 11.08 shall prohibit the Administrative Agent from

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posting the list of Disqualified Institutions on a SyndTrak, IntraLinks or similar site to which the Lenders

have been granted access.

11.09Setoff

In addition to any rights and remedies of the Lenders provided by law, upon the occurrence and

during the continuance of any Event of Default, each Lender and any Affiliate of any Lender is

authorized at any time and from time to time, without prior notice to the Borrower or any other Loan

Party, any such notice being waived by the Borrower (on its own behalf and on behalf of each Loan

Party) to the fullest extent permitted by applicable law, to set off and apply any and all deposits (general

or special, time or demand, provisional or final) at any time held by, and other indebtedness at any time

owing by, such Lender to or for the credit or the account of the respective Loan Parties against any and all

Obligations owing to such Lender hereunder or under any other Loan Document, now or hereafter

existing, irrespective of whether or not the Administrative Agent or such Lender shall have made demand

under this Agreement or any other Loan Document, irrespective of whether the Loan Parties are otherwise

fully secured and although such Obligations may be contingent or unmatured or denominated in a

currency different from that of the applicable deposit or indebtedness. Each Lender agrees promptly to

notify the Borrower and the Administrative Agent after any such setoff and application made by such

Lender; provided, however, that the failure to give such notice shall not affect the validity of such setoff

and application.

11.10Interest Rate Limitation

Notwithstanding anything to the contrary contained in any Loan Document, the interest paid or

agreed to be paid under the Loan Documents shall not exceed the maximum rate of non-usurious interest

permitted by applicable Law (the “Maximum Rate”). If the Administrative Agent or any Lender shall

receive interest in an amount that exceeds the Maximum Rate, the excess interest shall be applied to the

principal of the Loans or, if it exceeds such unpaid principal, refunded to the Borrower. In determining

whether the interest contracted for, charged, or received by the Administrative Agent or a Lender exceeds

the Maximum Rate, such Person may, to the extent permitted by applicable Law, (a) characterize any

payment that is not principal as an expense, fee, or premium rather than interest, (b) exclude voluntary

prepayments and the effects thereof, and (c) amortize, prorate, allocate, and spread in equal or unequal

parts the total amount of interest throughout the contemplated term of the Obligations hereunder.

11.11Counterparts

This Agreement may be executed in one or more counterparts, each of which shall be deemed an

original, but all of which together shall constitute one and the same instrument. This Agreement, any

Loan Document and each Communication, including Communications required to be in writing, may be

in the form of an Electronic Record (as defined below) and may be executed using Electronic Signatures

(as defined below). Each of the Loan Parties and each of the Secured Parties agrees that any Electronic

Signature on or associated with any Communication shall be valid and binding on such Person to the

same extent as a manual, original signature, and that any Communication entered into by Electronic

Signature will constitute the legal, valid and binding obligation of such Person enforceable against such

Person in accordance with the terms thereof to the same extent as if a manually executed original

signature was delivered. Any Communication may be executed in as many counterparts as necessary or

convenient, including both paper and electronic counterparts, but all such counterparts are one and the

same Communication. For the avoidance of doubt, the authorization under this paragraph may include,

without limitation, use or acceptance of a manually signed paper Communication which has been

converted into electronic form (such as scanned into PDF format), or an electronically signed

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Communication converted into another format, for transmission, delivery and/or retention. The

Administrative Agent and each of the Secured Parties may, at its option, create one or more copies of any

Communication in the form of an imaged Electronic Record (“Electronic Copy”), which shall be deemed

created in the ordinary course of such Person’s business, and destroy the original paper document. All

Communications in the form of an Electronic Record, including an Electronic Copy, shall be considered

an original for all purposes, and shall have the same legal effect, validity and enforceability as a paper

record. Notwithstanding anything contained herein to the contrary, the Administrative Agent is not under

any obligation to accept an Electronic Signature in any form or in any format unless expressly agreed to

by such Person pursuant to procedures approved by it; provided, further, without limiting the foregoing,

(i) to the extent the Administrative Agent has agreed to accept such Electronic Signature, the

Administrative Agent and each of the Secured Parties shall be entitled to rely on any such Electronic

Signature purportedly given by or on behalf of any Loan Party and/or any Secured Party without further

verification and (ii) upon the request of the Administrative Agent or any Secured Party, any Electronic

Signature shall be promptly followed by a manually executed, original counterpart. For purposes hereof,

“Electronic Record” and “Electronic Signature” shall have the meanings assigned to them, respectively,

by 15 USC §7006, as it may be amended from time to time.

11.12Integration

This Agreement, together with the other Loan Documents, comprises the complete and integrated

agreement of the parties on the subject matter hereof and thereof and supersedes all prior agreements,

written or oral, on such subject matter. In the event of any conflict between the provisions of this

Agreement and those of any other Loan Document, the provisions of this Agreement shall control;

provided that the inclusion of supplemental rights or remedies in favor of the Administrative Agent or the

Lenders in any other Loan Document shall not be deemed a conflict with this Agreement. Each Loan

Document was drafted with the joint participation of the respective parties thereto and shall be construed

neither against nor in favor of any party, but rather in accordance with the fair meaning thereof.

11.13Survival of Representations and Warranties

All representations and warranties made hereunder and in any other Loan Document shall survive

the execution and delivery hereof and thereof. Such representations and warranties have been or will be

relied upon by the Administrative Agent and each Lender, regardless of any investigation made by the

Administrative Agent or any Lender or on their behalf and notwithstanding that the Administrative Agent

or any Lender may have had notice or knowledge of any Default at the time of any Borrowing, and shall

continue in full force and effect as long as any Loan or any other Obligation hereunder shall remain

unpaid or unsatisfied.

11.14Severability

If any provision of this Agreement or the other Loan Documents is held to be illegal, invalid or

unenforceable, (a) the legality, validity and enforceability of the remaining provisions of this Agreement

and the other Loan Documents shall not be affected or impaired thereby and (b) the parties shall endeavor

in good faith negotiations to replace the illegal, invalid or unenforceable provisions with valid provisions

the economic effect of which comes as close as possible to that of the illegal, invalid or unenforceable

provisions. The invalidity of a provision in a particular jurisdiction shall not invalidate or render

unenforceable such provision in any other jurisdiction.

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11.15[Reserved]

11.16Replacement of Lenders

Under any circumstances set forth in the second paragraph of this Section 11.16 or elsewhere in

this Agreement providing that the Borrower shall have the right to replace a Lender as a party to this

Agreement, the Borrower may, upon notice to such Lender and the Administrative Agent, replace such

Lender by causing such Lender to assign its Commitment and outstanding Loans (with the assignment fee

to be paid by the Borrower in such instance) pursuant to Section 11.07(b) to one or more other Lenders or

Eligible Assignees procured by the Borrower (each such Lender or Eligible Assignee, a “Replacement

Lender”). The Borrower shall (x) pay in full all principal, interest, fees, premiums and other amounts

owing to such Lender through the date of replacement (including any amounts payable pursuant to

Section 3.05), and (y) release such Lender from its obligations under the Loan Documents. Any Lender

being replaced shall execute and deliver an Assignment and Assumption with respect to such Lender’s

Commitment and outstanding Loans; provided that the failure by such replaced Lender to execute and

deliver an Assignment and Assumption shall not impair the validity of the removal of such replaced

Lender and the mandatory assignment of a replaced Lender’s Commitments and outstanding Loans

pursuant to this Section 11.16 shall nevertheless be effective without the execution by such replaced

Lender of an Assignment and Assumption.

If, in connection with any proposed change, waiver, discharge or termination to any of the

provisions of this Agreement as contemplated by clauses (b) through (g), inclusive, of the first proviso in

Section 11.01, the consent of the Required Lenders is obtained but the consent of one or more of such

other Lenders whose consent is required is not obtained, then the Borrower shall have the right to replace

each such non-consenting Lender or Lenders with one or more Replacement Lenders pursuant to this

Section 11.16 so long as at the time of such replacement, each such Replacement Lender consents to the

proposed change, waiver, discharge or termination.

11.17Governing Law

(a)THIS AGREEMENT SHALL BE GOVERNED BY, AND CONSTRUED IN

ACCORDANCE WITH, THE LAW OF THE STATE OF NEW YORK APPLICABLE TO

AGREEMENTS MADE AND TO BE PERFORMED ENTIRELY WITHIN SUCH STATE;

PROVIDED THAT THE ADMINISTRATIVE AGENT AND EACH LENDER SHALL RETAIN ALL

RIGHTS ARISING UNDER FEDERAL LAW.

(b)ANY LEGAL ACTION OR PROCEEDING WITH RESPECT TO THIS AGREEMENT

OR ANY OTHER LOAN DOCUMENT MAY BE BROUGHT IN THE COURTS OF THE STATE OF

NEW YORK SITTING IN NEW YORK, NEW YORK OR OF THE UNITED STATES FOR THE

SOUTHERN DISTRICT OF SUCH STATE, AND BY EXECUTION AND DELIVERY OF THIS

AGREEMENT, THE BORROWER, THE ADMINISTRATIVE AGENT AND EACH LENDER

CONSENTS, FOR ITSELF AND IN RESPECT OF ITS PROPERTY, TO THE EXCLUSIVE

JURISDICTION OF THOSE COURTS. THE BORROWER, THE ADMINISTRATIVE AGENT AND

EACH 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 ANY LOAN DOCUMENT OR OTHER

DOCUMENT RELATED THERETO. THE BORROWER, THE ADMINISTRATIVE AGENT AND

EACH LENDER WAIVES PERSONAL SERVICE OF ANY SUMMONS, COMPLAINT OR OTHER

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PROCESS, WHICH MAY BE MADE BY ANY OTHER MEANS PERMITTED BY THE LAW OF

SUCH STATE.

11.18Waiver of Right to Trial by Jury

EACH PARTY TO THIS AGREEMENT HEREBY EXPRESSLY WAIVES ANY RIGHT TO

TRIAL BY JURY OF ANY CLAIM, DEMAND, ACTION OR CAUSE OF ACTION ARISING

UNDER ANY LOAN DOCUMENT OR IN ANY WAY CONNECTED WITH OR RELATED OR

INCIDENTAL TO THE DEALINGS OF THE PARTIES HERETO OR ANY OF THEM WITH

RESPECT TO ANY LOAN DOCUMENT, OR THE TRANSACTIONS RELATED THERETO, IN

EACH CASE WHETHER NOW EXISTING OR HEREAFTER ARISING, AND WHETHER

FOUNDED IN CONTRACT OR TORT OR OTHERWISE; AND EACH PARTY HEREBY AGREES

AND CONSENTS THAT ANY SUCH CLAIM, DEMAND, ACTION OR CAUSE OF ACTION

SHALL BE DECIDED BY COURT TRIAL WITHOUT A JURY, AND THAT ANY PARTY TO THIS

AGREEMENT MAY FILE AN ORIGINAL COUNTERPART OR A COPY OF THIS SECTION WITH

ANY COURT AS WRITTEN EVIDENCE OF THE CONSENT OF THE SIGNATORIES HERETO TO

THE WAIVER OF THEIR RIGHT TO TRIAL BY JURY.

11.19[Reserved]

11.20Publicity

The Borrower will not and will not permit its Affiliates to, in the future, issue any press release or

other public disclosure using the name of the Administrative Agent, any Lender or any of their respective

Affiliates or referring to this Agreement or the other Loan Documents without at least two (2) Business

Days prior written notice to the Administrative Agent and each affected Lender and without the prior

written consent of the Administrative Agent and each affected Lender unless (and only to the extent that)

the Borrower or such Affiliate of the Borrower is required to so disclose under law and then, in any event,

the Borrower or such Affiliate will consult with the Administrative Agent and each affected Lender

before issuing such press release or other public disclosure. The Borrower consents to the publication by

the Administrative Agent and each Lender of a tombstone or similar advertising material relating to the

financing transactions contemplated by this Agreement. The Borrower may disclose to third parties that

the Borrower has a borrowing relationship with the Administrative Agent and the Lenders. Nothing

contained in this Agreement is intended to permit or authorize the Borrower to make any contract on

behalf of the Administrative Agent or any Lender.

11.21USA PATRIOT Act Notice

Each Lender that is subject to the Act (as hereinafter defined) and the Administrative Agent (for

itself and not on behalf of any Lender) hereby notifies the Borrower that pursuant to the requirements of

the USA PATRIOT Act (Title III of Pub. L. 107-56 (signed into law October 26, 2001)) (the “Act”), it is

required to obtain, verify and record information that identifies each Loan Party, which information

includes the name and address of each Loan Party and other information that will allow such Lender or

the Administrative Agent, as applicable, to identify each Loan Party in accordance with the Act. The

Borrower shall, promptly following a request by the Administrative Agent or any Lender, provide all

documentation and other information that the Administrative Agent or such Lender reasonably requests in

order to comply with its ongoing obligations under applicable “know your customer” and anti-money

laundering rules and regulations, including the Act.

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11.22Acknowledgement and Consent to Bail-In of Affected Financial Institutions.

Solely to the extent any Lender that is an Affected Financial Institution is a party to this

Agreement and notwithstanding anything to the contrary in any Loan Document or in any other

agreement, arrangement or understanding among any such parties, each party hereto acknowledges that

any liability of any Lender that is an Affected Financial Institution arising under any Loan Document, to

the extent such liability is unsecured, may be subject to the Write-Down and Conversion Powers of the

applicable Resolution Authority and agrees and consents to, and acknowledges and agrees to be bound

by:

(a)the application of any Write-Down and Conversion Powers by the applicable Resolution

Authority to any such liabilities arising hereunder which may be payable to it by any Lender that is an

Affected Financial Institution; and

(b)the effects of any Bail-In Action on any such liability, including, if applicable:

(i)a reduction in full or in part or cancellation of any such liability;

(ii)a conversion of all, or a portion of, such liability into shares or other instruments

of ownership in such Affected Financial Institution, its parent undertaking, or a bridge institution

that may be issued to it or otherwise conferred on it, and that such shares or other instruments of

ownership will be accepted by it in lieu of any rights with respect to any such liability under this

Agreement or any other Loan Document; or

(iii)the variation of the terms of such liability in connection with the exercise of the

Write-Down and Conversion Powers of the applicable Resolution Authority.

11.23Acknowledgement Regarding Any Supported QFCs.

To the extent that the Loan Documents provide support, through a guarantee or otherwise, for any

Swap Agreement or any other agreement or instrument that is a QFC (such support, “QFC Credit

Support”, and each such QFC, a “Supported QFC”), the parties acknowledge and agree as follows with

respect to the resolution power of the Federal Deposit Insurance Corporation under the Federal Deposit

Insurance Act and Title II of the Dodd-Frank Wall Street Reform and Consumer Protection Act (together

with the regulations promulgated thereunder, the “U.S. Special Resolution Regimes”) in respect of such

Supported QFC and QFC Credit Support (with the provisions below applicable notwithstanding that the

Loan Documents and any Supported QFC may in fact be stated to be governed by the laws of the State of

New York and/or of the United States or any other state of the United States):

(a)In the event a Covered Entity that is party to a Supported QFC (each, a “Covered Party”)

becomes subject to a proceeding under a U.S. Special Resolution Regime, the transfer of such Supported

QFC and the benefit of such QFC Credit Support (and any interest and obligation in or under such

Supported QFC and such QFC Credit Support, and any rights in property securing such Supported QFC

or such QFC Credit Support) from such Covered Party will be effective to the same extent as the transfer

would be effective under the U.S. Special Resolution Regime if the Supported QFC and such QFC Credit

Support (and any such interest, obligation and rights in property) were governed by the laws of the United

States or a state of the United States. In the event a Covered Party or a BHC Act Affiliate of a Covered

Party becomes subject to a proceeding under a U.S. Special Resolution Regime, Default Rights under the

Loan Documents that might otherwise apply to such Supported QFC or any QFC Credit Support that may

be exercised against such Covered Party are permitted to be exercised to no greater extent than such

160

Default Rights could be exercised under the U.S. Special Resolution Regime if the Supported QFC and

the Loan Documents were governed by the laws of the United States or a state of the United States.

Without limitation of the foregoing, it is understood and agreed that rights and remedies of the parties

with respect to a Defaulting Lender shall in no event affect the rights of any Covered Party with respect to

a Supported QFC or any QFC Credit Support.

(b)As used in this Section 11.23, the following terms have the following meanings:

“BHC Act Affiliate” of a party means an “affiliate” (as such term is defined under, and

interpreted in accordance with, 12 U.S.C. 1841(k)) of such party.

“Covered Entity” means any of the following: (i) a “covered entity” as that term is

defined in, and interpreted in accordance with, 12 C.F.R. § 252.82(b); (ii) a “covered bank” as

that term is defined in, and interpreted in accordance with, 12 C.F.R. § 47.3(b); or (iii) a “covered

FSI” as that term is defined in, and interpreted in accordance with, 12 C.F.R. § 382.2(b).

“Default Right” has the meaning assigned to that term in, and shall be interpreted in

accordance with, 12 C.F.R. §§ 252.81, 47.2 or 382.1, as applicable.

“QFC” has the meaning assigned to the term “qualified financial contract” in, and shall

be interpreted in accordance with, 12 U.S.C. 5390(c)(8)(D).

[SIGNATURE PAGES INTENTIONALLY OMITTED]

Document

Exhibit 31.1

CERTIFICATION PURSUANT TO

SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Martin J. Bonick, certify that:

1.I have reviewed this Quarterly Report on Form 10-Q of Ardent Health Partners, Inc.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have:

(a)Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b)[Paragraph intentionally omitted pursuant to Exchange Act Rule 13a-14];

(c)Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d)Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and

5.The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):

(a)All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and

(b)Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting.

Date: November 7, 2024
By: /s/ Martin J. Bonick
Name: Martin J. Bonick
Title: President and Chief Executive Officer
(Principal Executive Officer)

Document

Exhibit 31.2

CERTIFICATION PURSUANT TO

SECTION 302 OF THE SARBANES-OXLEY ACT OF 2002

I, Alfred Lumsdaine, certify that:

1.I have reviewed this Quarterly Report on Form 10-Q of Ardent Health Partners, Inc.;

2.Based on my knowledge, this report does not contain any untrue statement of a material fact or omit to state a material fact necessary to make the statements made, in light of the circumstances under which such statements were made, not misleading with respect to the period covered by this report;

3.Based on my knowledge, the financial statements, and other financial information included in this report, fairly present in all material respects the financial condition, results of operations and cash flows of the registrant as of, and for, the periods presented in this report;

4.The registrant's other certifying officer and I are responsible for establishing and maintaining disclosure controls and procedures (as defined in Exchange Act Rules 13a-15(e) and 15d-15(e)) for the registrant and have:

(a)Designed such disclosure controls and procedures, or caused such disclosure controls and procedures to be designed under our supervision, to ensure that material information relating to the registrant, including its consolidated subsidiaries, is made known to us by others within those entities, particularly during the period in which this report is being prepared;

(b)[Paragraph intentionally omitted pursuant to Exchange Act Rule 13a-14];

(c)Evaluated the effectiveness of the registrant's disclosure controls and procedures and presented in this report our conclusions about the effectiveness of the disclosure controls and procedures, as of the end of the period covered by this report based on such evaluation; and

(d)Disclosed in this report any change in the registrant's internal control over financial reporting that occurred during the registrant's most recent fiscal quarter (the registrant's fourth fiscal quarter in the case of an annual report) that has materially affected, or is reasonably likely to materially affect, the registrant's internal control over financial reporting; and

5.The registrant's other certifying officer and I have disclosed, based on our most recent evaluation of internal control over financial reporting, to the registrant's auditors and the audit committee of the registrant's board of directors (or persons performing the equivalent functions):

(a)All significant deficiencies and material weaknesses in the design or operation of internal control over financial reporting which are reasonably likely to adversely affect the registrant's ability to record, process, summarize and report financial information; and

(b)Any fraud, whether or not material, that involves management or other employees who have a significant role in the registrant's internal control over financial reporting.

Date: November 7, 2024
By: /s/ Alfred Lumsdaine
Name: Alfred Lumsdaine
Title: Executive Vice President, Chief Financial Officer
(Principal Financial Officer)

Document

Exhibit 32.1

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Ardent Health Partners, Inc. (the “Company”) on Form 10-Q for the quarterly period ended September 30, 2024, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Martin J. Bonick, President and Chief Executive Officer of the Company, certify, pursuant to 18 U.S.C. §1350, as adopted pursuant to §906 of the Sarbanes-Oxley Act of 2002, that:

1.The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

2.The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Date: November 7, 2024
By: /s/ Martin J. Bonick
Name: Martin J. Bonick
Title: President and Chief Executive Officer
(Principal Executive Officer)

Document

Exhibit 32.2

CERTIFICATION PURSUANT TO

18 U.S.C. SECTION 1350, AS ADOPTED PURSUANT TO

SECTION 906 OF THE SARBANES-OXLEY ACT OF 2002

In connection with the Quarterly Report of Ardent Health Partners, Inc. (the “Company”) on Form 10-Q for the quarterly period ended September 30, 2024, as filed with the Securities and Exchange Commission on the date hereof (the “Report”), I, Alfred Lumsdaine, Executive Vice President, Chief Financial Officer of the Company, certify, pursuant to 18 U.S.C. §1350, as adopted pursuant to §906 of the Sarbanes-Oxley Act of 2002, that:

1.The Report fully complies with the requirements of Section 13(a) or 15(d) of the Securities Exchange Act of 1934; and

2.The information contained in the Report fairly presents, in all material respects, the financial condition and results of operations of the Company.

Date: November 7, 2024
By: /s/ Alfred Lumsdaine
Name: Alfred Lumsdaine
Title: Executive Vice President, Chief Financial Officer
(Principal Financial Officer)