Common use of Per Procedure Payments Clause in Contracts

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to this Agreement, Hospital shall pay to GKF the applicable per procedure payments set forth in Exhibit "B" attached to this Amendment Three (the “Lease Payment”) for each and every "Procedure" that is completed by Hospital, its representatives, affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure is performed using the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related treatment planning and delivery, imaging and other ancillary services. As used herein, the term “Procedure” means any treatment that involves stereotactic, external, single or up to and including five (5) fractions(s), conformal radiation, commonly called radiosurgery, that may include one or more isocenters during the patient treatment session, delivered to any site(s) superior to the foramen magnum. “If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment devices, Hospital shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an invoice to Hospital on the fifteenth (15th) and last day of each calendar month (or portion thereof) for the actual number of Procedures performed during the first and second half of the calendar month, respectively. The Hospital shall pay invoices received within thirty (30) days after submission by GKF to Hospital. All or any portion of an invoice which is not paid in full within forty five (45) days after submission shall bear interest at the rate of the lesser of one percent (1.0%) per month (or the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid in full. If GKF shall at any time accept a Lease Payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreement. “Within ten (10) days after Hospital’s receipt of written request by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable books and records during normal business hours to verify the number of Procedures performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devices, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; provided that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA.”

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to Except as set forth in this AgreementPxxxxxxxx 0, Hospital XXX shall pay to GKF the applicable a per procedure payments set forth in Exhibit "B" attached to this Amendment Three payment of Nine Thousand Five Hundred Dollars (the “Lease Payment”$9,500) for each and every "Procedure" that is completed by Hospital, its representatives, affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective use of whether the Procedure is performed using the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related . A procedure shall be defined as a single patient treatment planning and delivery, imaging and other ancillary services. As used herein, the term “Procedure” means any treatment that involves stereotactic, external, single or up to and including five (5) fractions(s), conformal radiation, commonly called radiosurgery, session that may include one or more isocenters during the patient treatment that session, delivered to any site(s) superior to the foramen magnum. “If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment devices, Hospital JFK shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an invoice to Hospital billed on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures procedures performed during the first and second half of the calendar month, respectively. The Hospital JFK shall pay invoices received the procedures invoiced within thirty (30) days after submission by GKF to Hospital. All or any portion of an invoice which is not paid in full within forty forty- five (45) days after submission being invoiced by GKF. Interest shall bear interest begin to accrue at the rate of the lesser of one percent (1.0%) 1-1/2% per month on all invoices remaining unpaid after sixty (or the maximum monthly interest 60) days. JFK acknowledges that its current Medicare reimbursement rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon for DRG 1 is paid in fullFourteen Thousand Three Hundred Nineteen Dollars ($14,319). If GKF shall at any time accept the Medicare reimbursement rate paid to JFK for DRG 1 shall be less than Eleven Thousand Five Hundred Dollars ($11,500), JFK and GKF shall renegotiate the per procedure payment rate set forth hereinabove to reflect JFK's reduced Medicare reimbursement rate for DRG I. As consideration for GKF's renegotiation of the per procedure payment rate, at that time, JFK and GKF shall review and adjust the technical fee amounts then being charged or billed by JFK for all Gamma Knife procedures (i.e., procedures performed for Medicare patients and non-Medicare patients). As a Lease Payment from Hospital after it means to permit JFK to perform charity care for persons who require Gamma Knife procedures, who are not covered by Medicare, Medicaid or private insurance programs (whether indemnity, preferred provider, health maintenance organization, etc.) and who do not have the means to pay for such procedures based upon state adopted standards of indigency, GKF shall become due, such acceptance waive the per procedure payment described in this Paragraph 7 for one (1) Gamma Knife procedure for each twenty-five (25) Gamma Knife procedures performed under this Agreement by JFK for which a per procedure payment is made to GKF in the manner described herein. JFK shall be solely responsible (and GKF shall not constitute in any manner be or be construed become responsible) to determine (a) whether any person described herein requires a Gamma Knife procedure, (b) who shall receive a Gamma Knife procedure hereunder if more than one (1) person described herein requires a Gamma Knife procedure, and (c) whether any person meets the standards of indigency. JFK shall provide reasonable written documentation evidencing satisfaction of the conditions set forth herein to GKF at or prior to the time of payment in order for GKF to waive the per procedure payment for charity care purposes. Except as a waiver of any or all of GKF’s rights under this Agreementset forth herein, including JFK shall pay to GKF the rights of GKF per procedure payment set forth in Section 20 this Paragraph 7 for each Gamma Knife procedure regardless of the Agreement. “Within ten (10) days after Hospital’s receipt ability of written request the patient to pay for such services or the amount of reimbursement or payment received by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable books and records during normal business hours to verify the number of Procedures performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devices, and Hospital shall provide GKF (or cause GKF to be provided) with access to JFK for such applicable books and records; provided that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAAprocedure.”

Per Procedure Payments. As rent for the lease Medical Center shall schedule use of the Equipment at its sole discretion and shall be obligated to Hospital pursuant to this Agreement, Hospital no minimum number of procedures. Medical Center shall pay to GKF the applicable a per procedure payments set forth payment of $8,750 (Eight thousand seven hundred fifty dollars) for procedures 1-100 performed in Exhibit "B" attached each year of the Agreement for the use of the Equipment and $8,000 (Eight Thousand Dollars) per procedure for procedures 101 and above during each year of the Agreement for the use of the Equipment. For purposes of per procedure calculation, procedure counts are not cumulative and the procedure count reverts to this Amendment Three (zero on the “Lease Payment”Reset Date” which is one (1) for year after the Commencement Date and each and every "Procedure" that is completed by Hospital, its representatives, affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” anniversary date thereafter. (A procedure shall be defined as used in the Medicare billing context), and irrespective of whether the Procedure is performed using the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related a single patient treatment planning and delivery, imaging and other ancillary services. As used herein, the term “Procedure” means any treatment that involves stereotactic, external, single or up to and including five (5) fractions(s), conformal radiation, commonly called radiosurgery, session that may include one or more isocenters during the patient treatment that session, delivered to any site(s) superior to the foramen magnum. “If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment devices, Hospital Medical Center shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an invoice to Hospital billed on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures procedures performed during the first and second half of the calendar month, respectively. The Hospital Medical Center shall pay invoices received the procedures invoiced within thirty (30) days after submission by GKF being invoiced. Interest shall begin to Hospital. All or any portion of an invoice which is not paid in full within forty five (45) days after submission shall bear interest accrue at the rate of 1-1/2% per month on all invoices remaining unpaid after 45 days. (a) If the lesser of one “Reimbursement Rate” in effect on any “Reset Date” is twenty-five percent (1.025%) per month greater or less than the “Base Rate,” Medical Center shall inform GKF in writing within sixty (60) days of such increase or decrease and shall provide GKF with the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid information used in fullcalculating such Reimbursement Rate. If GKF shall at any time accept a Lease Payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreement. “Within ten thirty (1030) days after Hospital’s GKF's receipt of written request such notice, the parties shall meet to renegotiate in good faith the per procedure payments payable by Medical Center for patients treated under this Agreement with Medicare as their primary insurer. (b) In determining the renegotiated per procedure payment any reduction or increase, only for those patients treated who have Medicare as their primary insurer, thereto may or may not be in proportion to the reduction or increase to the Reimbursement Rate. Furthermore, any reduction to the per procedure payment will be calculated to provide Medical Center with Operating Income estimated at a break even level as a result of such reduction; provided that no revised per procedure payment shall be imposed if it would result in negative Operating Income to GKF in accordance with subsection (c) below. Medical Center shall permit GKF to inspect Medical Center's books and records pertaining to the Equipment in order to verify such Operating Income. (c) If the per procedure payment for patients treated who have Medicare as their primary insurer proposed by Medical Center would result in negative “Operating Income” (as defined below) to GKF, at its sole cost and expensethen, GKF shall have the right no recourse to audit Hospital’s applicable books and records during normal business hours to verify the number of Procedures performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devices, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; arbitration as provided that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA.”this Section

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to this Agreement, Hospital shall pay to GKF the applicable per procedure payments sum as set forth in Exhibit "B" attached to 8 of this Amendment Three Agreement. (the “Lease Payment”) ). Hospital shall pay the Lease Payment for each and every "“Procedure" ” that is completed by Hospitalthe Hospital or its representatives or affiliates at the Site, its representativesas defined in Section 5.1, affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure is performed using on the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related treatment planning and delivery, imaging and other ancillary servicesdevices. As used herein, the term a “Procedure” means any treatment that involves stereotactic, using external, single or up to and including five (5) fractions(s)fraction, conformal radiation, commonly called stereotactic radiosurgery, that may include one or more isocenters during the patient treatment session, delivered to any site(s) superior to the foramen magnum. “Hospital’s obligation to make Lease Payments pursuant to this Section shall be expressly limited by Section 8.2, 8.3 and 8.4 hereof. If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment devicesdevices at the Hospital, Hospital shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an invoice to Hospital on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures performed during the first and second half of the calendar month, respectively. The Hospital shall pay invoices received during the initial three (3) months following the First Procedure Date within sixty (60) days after receipt of such invoices by the Hospital. For invoices received by the Hospital following the initial three (3) months following the First Procedure Date, the Hospital shall pay invoices within thirty (30) days after submission by GKF to Hospital. All or any portion of an invoice which is not paid in full within forty forty-five (45) days after submission (with respect to invoices provided after the initial three (3) months following the First Procedure Date) or seventy (75) days after submission (with respect to invoices provided during the initial three (3) months following the First Procedure Date) shall bear interest at the rate of the lesser of one percent (1.0%) per month (or the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid in full. If GKF shall at any time accept a Lease Payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreementhereof. “Within ten (10) days after Hospital’s receipt of written request by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable books and records during normal business hours (including, without limitation, the books and records pertaining to any other radiosurgery equipment or devices) relating solely to the Hospital’s provision of Procedures to verify the number of Procedures that have been performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devicesHospital, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; records; provided that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure.”

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to this Agreement, Hospital shall pay to GKF the applicable per procedure payments set forth in Exhibit "B" attached to sum of * for each Gamma Knife procedure. Hospital shall pay GKF this Amendment Three amount (the “"Lease Payment”") for each and every "Procedure" that is completed performed by Hospital, Hospital or its representatives, representatives or affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure is performed using on the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related treatment planning and delivery, imaging and other ancillary servicesdevices. As used herein, the term “a "Procedure” " means any treatment that involves stereotactic, external, single or up to and including five (5) fractions(s)fraction, conformal radiation, commonly called radiosurgery, that may include one or more isocenters during the patient treatment session, delivered to any site(s) superior to the foramen magnum. “If no Procedures Gamma Knife procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment devicesEquipment, no rent payments shall be owing by Hospital shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an a rent invoice to Hospital on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures Gamma Knife procedures performed during the first and second half of the calendar month, respectively. The Hospital shall pay invoices received the rent invoice within thirty (30) days after submission by GKF to Hospital. All or any portion of an a rent invoice which is not paid in full within forty forty-five (45) days after submission shall bear interest at the rate of the lesser of one and one-half percent (1.01.50%) per month (or the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid in full. If GKF shall at any time accept a Lease Payment rent payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s 's rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreementhereof. “Within ten (10) days after Hospital’s 's receipt of written request by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable 's books and records during normal business hours (including, without limitation, the books and records pertaining to any other radiosurgery equipment or devices) to verify the number of Procedures that have been performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devicesHospital, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; provided PROVIDED that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA.”

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to this AgreementAgreement and in consideration for GKF's reimbursement of the amounts set forth in Section 7 above, Hospital shall pay to GKF the applicable per procedure payments set forth in Exhibit "B" attached to this Amendment Three sum of Eight Thousand Two Hundred Fifty Dollars (the “Lease Payment”$8,250) for each and every "Procedure" that is completed performed by Hospital, Hospital or its representatives, representatives or affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure is performed using on the Equipment or using any other equipment or devices in lieu of, or as an alternative to, (the Equipment, and includes, without limitation, any and all related treatment planning and delivery, imaging and other ancillary services"Lease Payment"). As used herein, the term “a "Procedure” " means any treatment that involves stereotactic, external, single or up to and including five (5) fractions(s)fraction, conformal radiation, commonly called radiosurgery, that may include one or more isocenters during the patient treatment session, delivered to any site(s) superior to the foramen magnum. “If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment devices, Hospital shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an a rent invoice to Hospital on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures Gamma Knife procedures performed during the first and second half of the calendar month, respectively. The Hospital shall pay invoices received the rent invoice within thirty (30) days after submission by GKF to Hospital. All or any portion of an a rent invoice which is not paid in full within forty forty-five (45) days after submission shall bear interest at the rate of the lesser of one and one-half percent (1.01.50%) per month (or the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid in full. If GKF shall at any time accept a Lease Payment rent payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s 's rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreementhereof. “Within ten (10) days after Hospital’s 's receipt of written request by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable 's books and records during normal business hours (including, without limitation, the books and records pertaining to any other radiosurgery equipment or devices) to verify the number of Procedures that have been performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devicesHospital, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; provided PROVIDED that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA.”

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to this Agreement, Hospital shall pay to GKF the applicable per procedure payments set forth in Exhibit "B" attached to this Amendment Three sum of Eight Thousand Five Hundred Dollars (the “Lease Payment”$8,500.00) for each and every "“Procedure" ” that is completed performed by Hospital, Hospital or its representatives, representatives or affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure is performed using on the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related treatment planning and delivery, imaging and other ancillary servicesdevices. As used herein, the term a “Procedure” means any treatment that involves stereotactic, external, single or up to and including five (5) fractions(s)fraction, conformal radiation, commonly called radiosurgery, that may include one or more isocenters during the patient treatment session, delivered to any site(s) superior to the foramen magnum. “The parties acknowledge that the foregoing rent payment constitutes a fair market value rental rate. Within ten (10) days following the end of each month (or portion thereof) during the term of this Agreement, Hospital shall inform GKF in writing as to the number of Procedures performed during that month utilizing the Equipment and any other equipment or devices. If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment or devices, no rent payments shall be owing by Hospital shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an a rent invoice to Hospital on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures performed utilizing the Equipment and any other equipment or devices during the first and second half of the calendar month, respectively. The Hospital shall pay invoices received the rent invoice within thirty (30) days after submission by GKF to Hospital. All or any portion of an a rent invoice which is not paid in full within forty forty-five (45) days after submission shall bear interest at the rate of the lesser of one and one-half percent (1.01.50%) per month (or the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid in full. If Subject to Section 20.1.1 below, if GKF shall at any time accept a Lease Payment rent payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreementhereof. “Within ten (10) days after Hospital’s receipt of written request by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable books and records during normal business hours to verify the number of Procedures that have been performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devicesHospital, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; provided that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA.”

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to this Agreement, Hospital shall pay to GKF the applicable per procedure payments sum as set forth in Exhibit "B" attached to 8 of this Amendment Three Agreement. (the “Lease Payment”) ). Hospital shall pay the Lease Payment for each and every "“Procedure" ” that is completed by Hospitalthe Hospital or its representatives or affiliates at the Site, its representativesas defined in Section 5.1, affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure is performed using on the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related treatment planning and delivery, imaging and other ancillary servicesdevices. As used herein, the term a “Procedure” means any treatment that involves stereotactic, using external, single or up to and including five (5) fractions(s)fraction, conformal radiation, commonly called stereotactic radiosurgery, that may include one or more isocenters during the patient treatment session, delivered to any site(s) superior to the foramen magnum. “Hospital’s obligation to make Lease Payments pursuant to this Section shall be expressly limited by Section 8.2, 8.3 and 8.4 hereof. * Confidential material has been omitted in accordance with rule 24b-2. If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment devicesdevices at the Hospital, Hospital shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an invoice to Hospital on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures performed during the first and second half of the calendar month, respectively. The Hospital shall pay invoices received during the initial three (3) months following the First Procedure Date within sixty (60) days after receipt of such invoices by the Hospital. For invoices received by the Hospital following the initial three (3) months following the First Procedure Date, the Hospital shall pay invoices within thirty (30) days after submission by GKF to Hospital. All or any portion of an invoice which is not paid in full within forty forty-five (45) days after submission (with respect to invoices provided after the intial three (3) months following the First Procedure Date) or seventy (75) days after submission (with respect to invoices provided during the initial three (3) months following the First Procedure Date) shall bear interest at the rate of the lesser of one percent (1.0%) per month (or the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid in full. If GKF shall at any time accept a Lease Payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreementhereof. “Within ten (10) days after Hospital’s receipt of written request by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable books and records during normal business hours (including, without limitation, the books and records pertaining to any other radiosurgery equipment or devices) relating solely to the Hospital’s provision of Procedures to verify the number of Procedures that have been performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devicesHospital, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; provided that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any ““ Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure.”

Per Procedure Payments. As rent for the lease of the Equipment to Hospital pursuant to this Agreement, Hospital shall pay to GKF the applicable per procedure payments set forth in Exhibit "B" attached to this Amendment Three (the “Lease Payment”) sum of * for each and every "Procedure" that is completed performed by Hospital, Hospital or its representatives, representatives or affiliates, joint ventures and/or partnerships, on an inpatient or outpatient basis, or “under arrangement” (as used in the Medicare billing context), and irrespective of whether the Procedure is performed using on the Equipment or using any other equipment or devices in lieu of, or as an alternative to, the Equipment, and includes, without limitation, any and all related treatment planning and delivery, imaging and other ancillary servicesdevices. As used herein, the term “a "Procedure” " means any treatment that involves stereotactic, external, single or up to and including five (5) fractions(s)fraction, conformal radiation, commonly called radiosurgery, that may include one or more isocenters during the patient treatment session, delivered to any site(s) superior to the foramen magnum. “The parties acknowledge that the foregoing rent payment constitutes a fair market value rental rate. Within ten (10) days following the end of each month (or portion thereof) during the term of this Agreement, Hospital shall inform GKF in writing as to the number of Procedures performed during that month utilizing the Equipment and any other equipment or devices. If no Procedures are performed by Hospital or any other person utilizing the Equipment or any other equipment or devices, no rent payments shall be owing by Hospital shall not owe any Lease Payment to GKF. In the event a Procedure is not completed due to a technical problem with the Equipment, the Hospital will not be charged a Lease Payment for such Procedure. GKF shall submit an a rent invoice to Hospital on the fifteenth (15th) and the last day of each calendar month (or portion thereof) for the actual number of Procedures performed utilizing the Equipment and any other equipment or devices during the first and second half of the calendar month, respectively. The Hospital shall pay invoices received the rent invoice within thirty (30) days after submission by GKF to Hospital. All or any portion of an a rent invoice which is not paid in full within forty forty-five (45) days after submission shall bear interest at the rate of the lesser of one and one-half percent (1.01.50%) per month (or the maximum monthly interest rate permitted to be charged by law between an unrelated, commercial borrower and lender, if less) until the unpaid rent invoice together with all accrued interest thereon is paid in full. If Subject to Section 20.1.1 below, if GKF shall at any time accept a Lease Payment rent payment from Hospital after it shall become due, such acceptance shall not constitute or be construed as a waiver of any or all of GKF’s 's rights under this Agreement, including the rights of GKF set forth in Section 20 of the Agreementhereof. “Within ten (10) days after Hospital’s 's receipt of written request by GKF, at its sole cost and expense, GKF shall have the right to audit Hospital’s applicable 's books and records during normal business hours to verify the number of Procedures that have been performed by Hospital or its agents, representatives, affiliates, joint ventures and/or partnerships utilizing the Equipment and/or any other equipment or devicesHospital, and Hospital shall provide GKF (or cause GKF to be provided) with access to such applicable books and records; provided that any patient names or identifiers shall not be disclosed. Such audit shall take place no more than one time in a twelve month period and at a date and time mutually agreed upon between Hospital and GFK. GKF shall not have access to nor shall it directly or indirectly access any “Patient Health Information” as such terms are defined by HIPAA. GKF agrees that it shall execute such documents and agreements as may be reasonably required by Hospital to assure compliance with HIPAA.”