AGREEMENT WITH

Exhibit 10.10

THREE RIVERS PROVIDER NETWORK

AGREEMENT WITH

______________________________

This Agreement is made this 23rd day of October 2008, by and between Three Rivers Provider Network, Inc., a Nevada Corporation (“TRPN”) and American Surgical Assistants a Provider Group of health care services.  TRPN contracts with hospitals, physicians, ancillaries and entities hereinafter referred to as “Provider” rendering medical and health care services at pre-determined rates as follow.

1.  Clients. Covered Services.  Contract Rates: TRPN contracts with insurance companies, third party administrators, health plans, individuals and entities hereinafter referred to as “Clients” that directly or indirectly access TRPN contracted providers for covered services. Covered Services shall include all services that are medically necessary including health, workers’ compensation, automobile and general liability.  The rate used in conjunction with this Agreement will be a * discount off of Provider’s usual charge for covered services, less any applicable co-payments, co-insurance or deductibles.  Clients are obligated to make payment directly to provider only at the contracted rate as payment in full.  Provider shall not balance xxxx the patient upon receipt of payment in full at the contracted rate.  TRPN has no responsibility to make payments on behalf of Clients.  Payments shall be made within thirty (30) calendar days of receipt of clean claim.  Where a state mandated fee schedule exists, provider agrees to accept a * discount below the state schedule.  Payments made and cashed by the provider shall be accepted as payment in full and fulfillment of all terms of the agreement, providing the total payment including the member’s portion is not less than the contracted rate.

2.  Licenses, Standards of Care:  Provider agrees to deliver health care services that meet all legal standards of care complying with applicable Federal, State and Local laws and maintains the standards of NCQA and/or JCAHO.  The provider is delegated by TRPN to carry out and/or assign credentialing responsibilities.  Evidence of such licenses, certificates and standards shall be made available to TRPN upon request.

3.  Term and Termination:  This Agreement shall continue in effect for a period of one (1) years with automatic successive one (1) year terms.  This Agreement may be terminated by either party without cause with a ninety (90) day prior written notice to the other party at the mailing addresses listed under the signatures.  This Agreement may be immediately terminated with cause by TRPN should Provider lose applicable licenses, malpractice coverage, fail to honor the applicable contracted rates pursuant to this Agreement, or if any information provided in Attachment A is illegible, incomplete, or invalid.

4.  Dispute Resolution:  This Agreement shall be construed and interpreted in accordance with the laws of the State of Nevada.  Provider agrees to meet and confer in good faith to resolve any disputes that may arise under this Agreement. If a dispute between TRPN and Provider arises out of this Agreement and is not resolved, either party may submit the dispute to arbitration which shall be commenced and conducted in accordance with the Rules of Practice and Procedures of the Judicial Arbitration and Mediation Services, Inc. (“JAMS”) as in effect at the time (“JAMS Rules”).

5.  Attachment A:  All information provided in Attachment A of this Agreement is complete and accurate to the best of Provider’s knowledge and Provider shall immediately notify TRPN of any changes thereto.  Provider agrees to xxxx “N/A” next to any blank that is not applicable to Provider’s business.

6.  Faxed Signatures:  The parties agree that facsimile signatures of authorized representatives of the parties shall legally bind the parties to the terms and conditions of this Agreement as if the signatures were original and shall be considered evidence of a fully executed Agreement.

_______________

* Portions of this document omitted pursuant to an application for an order for confidential treatment pursuant to Rule 24b-2 under the Exchange Act.  Confidential portions of this document have been filed separately with the Securities and Exchange Commission.

Page 1

IN WITNESS WHEREOF, the authorized parties hereto have executed this Agreement and intend to be bound thereby.

PROVIDER GROUP NAME (Please Print): American Surgical Assistants			ATTENTION: XXXX XXXXXXXX TRPN CONTRACTING COORDINATOR
			THREE RIVERS PROVIDER NETWORK
Signature:	/s/ Xxxxx Xxxx		Signature:
Title:	COO
Date:	11/5/08
				NAME:  Xxxx Xxxxxxx, C.O.O. Mailing Address:  0000 Xxxxx Xxxxxx Xxxxx 000 Xxx Xxxxx, XX 00000    Phone:  (000) 000-0000
			Date:

ATTACHMENT A: PROVIDER INFORMATION

(Please attach a roster of all the provider’s full names, titles, NPI#s, and all locations under the group’s Tax Id#, use Addendum A)

Tax ID:  00-0000000	Practice Name:  American Surgical Assistants
National Provider Identifier (NPI): 0000000000 (If there is more than one NPI Number, please attach a listing.)	Group / IPA Affiliation:___________
Degree:  LSA, CSA ,SA-C, RUFA Specialty :  Surgical Assistants                      First Assist	Office Hours:  8-4:30 PM Primary Address:  00000 Xxxxxxxxx X-000 Xxxxxxx, XX  00000 County:  Xxxxxx Phone:  000-000-0000  Fax:  000-000-0000 Email:  Xxxxxxxxx@xx.xxx Other Practice and/or Billing Address:  Yes □  No □ If “yes”, attach page with additional information Hospital Affiliations (list name, date and type):
	Attached

Provider agrees to xxxx “N/A” next to any blank that is not applicable to Provider’s business.

Page 2

ADDENDUM A:

MEDICAL STAFF LISTING & FACILITY LOCAITONS

_______________________________

i.  The attached roster of providers and or locations will be participating under thisAgreement between American Surgical Assistants and Three Rivers Provider Network and shall include Tax Identification Numbers, NPI Numbers, Address(s), Phone and Fax Numbers.

Page 3

Provider List

10/23/2008

Code Last Name	Name	National Provider Identifier	Credentials	License Number
XX    XXXXXX	XXXXXX, XXXXXXX	0000000000	LSA	SA00024
SA    XXXX	XXXX, SAYED	0000000000	LSA	SA00289
XX    XXXXXXX	XXXXXXX, XXXX	0000000000	LSA	SA00283
OA    AKUPUE	AKUPUE, OKECHUKWU	0000000000	LSA	SA00307
MA    ALALAM	ALALAM, MOHD	0000000000	LSA	SA00309
XX    XXXXXX	XXXXXX, RECTO	0000000000	SA-C	A01143
AA ARREOZOLA	XXXXXXXXX, XXXXXXXXX	0000000000	LSA	SA00299
XX    XXXXXX	XXXXXX, XXXXX	0000000000	LSA	A03119
MA01    XXXXXX	XXXXXX, XXXX	0000000000	LSA	SA00029
IA    XXXX	XXXX, ILIA	0000000000	CSA	CSA04209
QB    BABURI	BABURI, QASIM	0000000000	LSA	SA00160
VB01    BARCES	XXXXXX, XXXXXXX	0000000000	LSA	SA00161
XX    XXXXXX`	XXXXXX, XXXXXXXXX	0000000000	LSA	SA00290
XX    XXXXXXX	XXXXXXX, XXXXXX	0000000000	LSA	SA00163
XX    XXXXX	XXXXX, XXXXXXX	0000000000	CST/CFA	109540

1

Provider List

10/23/2008

Code Last Name	Name	National Provider Identifier	Credentials	License Number
DGB    XXXXXX	XXXXXX, XXXXX G	0000000000	LSA	SA00291
XX    XXXXXXXXX	XXXXXXXXX, XXXXXX	0000000000	XXX	XX00000
JC01    CANSECO	XXXXXXX, XXXX	0000000000	LSA	SA00110
JC002 XXXXXXX	XXXXXXX, XXXX	0000000000	XX-X	00000
XX    XXXXXX	XXXXXX, XXXXX	0000000000	CSA
XX      XXXXXXXXXXX	XXXXXXXXXXX, XXXXX	0000000000	LSA	SA00237
XX    XXXXX	XXXXX, XXXX	0000000000	LSA	SA00255
XX    XXXXXXXX	XXXXXXXX,XXXXXXXX	0000000000	LSA	SA00277
MC01    XXXXXXX	XXXXXXX, XXXX	0000000000	SA-C	07272
XX    XXXX	XXXX, VIRGINIA	0000000000	CSA	A05223
AD    DARWISHS-SALAMA	DARWISHS-XXXXXX, XXXXXXX	0000000000	XXX	XX0000
ND    XXXXX	XXXXX, XXXXXX	0000000000	CSA	ABSA 001163
BE    XXXXX	XXXXX, XXXXX	0000000000	CRNFA	061022
XX XXXXXXX	ELGAMAL, ZAK	0000000000	LSA	SA00011
XX XXXXX	XXXXX, XXXXXXX	0000000000	LSA	SA00038

2

Provider List

10/23/2008

Code Last Name	Name	National Provider Identifier	Credentials	License Number
XX    XXXXXX	XXXXXX, XXXXX	0000000000	LSA	SA00069
XX    XXXXXX	XXXXXX, XXXXXXX	0000000000	CNOR	CNOR030775
XX    XXXXX	XXXXX, XXXX	0000000000	LSA	SA00170
XX    XXXXXX	XXXXXX, XXXX	0000000000	LSA	SA00073
XX    XXXXXX-XXXXXXX	XXXXXX-XXXXXXX, XXXXXX	0000000000	XXX	XX0000
EG    XXXXXX	XXXXXX, XXXXXXX	0000000000	LSA	SA00270
XX XXXXXXXX	XXXXXXXX, XXXX	0000000000	CSA	A06115
XX    XXXXXXXX	XXXXXXXX, XXXX	0000000000	SA-C	07336
XX    XXXXXXXXX	XXXXXXXXX, XXXX	0000000000	CSA	SA25282
XX    XXXXXX	XXXXXX, XXXXXX	0000000000	CSA	CSA2667
XX    XXXX	KHAN, SOSUN	0000000000	LSA	SA00272
XX XXXX	XXXX, XXXXXXX	0000000000	SA-C	A03118
XX    XXXXX	XXXXX, XXXXX	0000000000	CSA	A05224
JM0-1    XXXXXXX	XXXXXXX, XXXXXXX	0000000000	CSA	CSA3044
XX    XXXXXXX	XXXXXXX, XXXX	0000000000	LSA	SA00129

3

Provider List

10/23/2008

Code Last Name	Name	National Provider Identifier	Credentials	License Number
XX    XXXXXXX	XXXXXXX, XXXXXX	0000000000	LSA	SA00263
XX    XXXXXXXX	XXXXXXXX, OMAR	0000000000	LSA	SA00286
MM    MAYOR	MAYOR, MASOUDA	0000000000	LSA	SA00296
XX    XXXXXX	XXXXXX, XXXXXX	0000000000	SAC	03132
XX    XXXXX	XXXXX, XXXX	1154440673	CSA	A06119
XX    XXXXXXXXX	XXXXXXXXX, XXXXXXXX	0000000000	LSA	SA00084
NN    XXXXXX	XXXXXX, NAYEF	0000000000	LSA	SA00135
XX    XXXXX	NESIC, J-XXXXXX	0000000000	LSA	SA00312
CN    NNA-WOSU	NNA-WOSU, CHI	0000000000	LSA	SA00085
XXX    XXXX	XXXX, XXXXX X	0000000000	XXX	XX00000
HP    XXXXXXXX	XXXXXXXX, XXXXX	0000000000	CSA	A05207
XX    XXXXXX	XXXXXX, XXXXXXX	0000000000	LSA	SA00020
KP01    XXXXX	XXXXX, XXXXX	0000000000	SA-C	A05217
LP01    XXXXXXX	XXXXXXX, XXXXX	0000000000	LSA	SA00138
XX    XXXXXXX	XXXXXXX, XXXXXXXX	0000000000	SA-C	A96160

4

Provider List

10/23/2008

Code Last Name	Name	National Provider Identifier	Credentials	License Number
XX    XXXXX	XXXXX, XXXXXXX	0000000000	CSA	CSA2617
XX    XXXX	PITA, KLEBER	0000000000	LSA	SA00274
CP    PITTY	PITTY, XXXXXXXX	0000000000	XXX	XX00000
XX    XXXXXXX	XXXXXXX, XXXXX	0000000000	LSA	SA00303
XX    XXX	XXX, XXXXXX	0000000000	LSA	SA00276
SR    XXXXX	XXXXX, XXXXX	0000000000	LSA	SA00090
XX    XXXXXX	XXXXXX, XXXXXX	0000000000	CSA	A07252
XX    XXXXXXXXX	XXXXXXXXX, XXXXXXX	0000000000	LSA	SA00091
JR    XXXXXXX	XXXXXXX, XXXXX	0000000000	XXX/XXX	XXX00000
XX    XXXXXXX	XXXXXXX, XXXXXXXX	0000000000	LSA	SA TEMPORARY
XX    XXXXXXXXX	XXXXXXXXX, XXXXX	0000000000	LSA	SA00269
XX    XXXXXXXX	XXXXXXXX, XXXXX	0000000000	CST/CFA	109194
PS    SLAVCHEV	XXXXXXXX, XXXXXX	0000000000	LSA	SA00316
AS    SOLOMAY	SOLOMAY, XXXX	0000000000	SA-C	A99216
PT01    XXXXXXX	XXXXXXX, XXXXX	0000000000	SA-C	08120

5

Provider List

10/23/2008

Code Last Name	Name	National Provider Identifier	Credentials	License Number
PT    XXXXXXXX	XXXXXXXX, XXXXXXXX	0000000000	LSA	SA00156
IV    XXXXX-XXXX	XXXXX-XXXX, XXXXXXXX	0000000000	LSA	SA00191
XX    XXXXXXXXXX	XXXXXXXXXX, XXXXXXX	0000000000	LSA	SA00249
XX    XXXXXX	XXXXXX, XXXX	0000000000	CSA	ABSA 08138
XX    XX	XX, XXXXX	0000000000	CSA	CSA2958
XX    XXXXXXXX	XXXXXXXX, XXXXX	0000000000	LSA	SA00056
BZ    XXXXX	XXXXX, XXXX XXXX	0000000000	LSA	SA00158

6

Provider List

10/23/2008

Code Last Name	Name	National Provider Identifier	Credentials	License Number
XX    XXXXX	XXXXX, XXXXXXX	0000000000	CST/CFA	109540
XX    XXXXXX	XXXXXX, XXXXXXX	0000000000	CNOR	030775
XX    XXXXXX	XXXXXX, XXXX	0000000000	LSA	SA00073
JR01    XXXX	XXXX, XXXXX	0000000000	SA-C	A05263
SR    XXXXX	XXXXX, XXXXX	0000000000	LSA	SA00090
JR    XXXXXXX	XXXXXXX, XXXXX	0000000000	XXX/XXX	XXX00000
XX    XXXXXXXX	XXXXXXXX, XXXXX	0000000000	CST/CFA	109194
PT01    XXXXXXX	XXXXXXX, XXXXX	0000000000	SA-C	08120
PT    XXXXXXXX	XXXXXXXX, XXXXXXXX	0000000000	LSA	SA00156

7

Christus Xxxxx Health System

000 Xxxxxxxxx Xxxxxx

Xxxxxx Xxxxxxx XX 00000

Corpus Christi Medical Center

0000 Xxxxx Xxxxxxxx

Xxxxxx Xxxxxxx XX 00000

Bayshore Medical Center

0000 Xxxxxxx Xxxxxxx

Xxxxxxxx XX 00000

Christus St. Catherine’s

000 Xxxxx Xxx Xxxx

Xxxx XX 00000

Christus St. Xxxx Hospital

00000 Xx. Xxxx Xx.

Xxxxxx Xxx, XX 00000

Clear Lake Medical Center

000 Xxxxxx Xxxxxx Xxxx.

Xxxxxxx XX 00000

Cypress Fairbanks Medical Center

00000 Xxxxxxxxxx Xxxxx

Xxxxxxx, XX 00000

Doctors Surgical Center

0000 Xxxxxxxxx Xxxxxxx

Xxxxxxx XX 00000

East Houston Regional Medical Center

00000 Xxxx Xxxxxxx

Xxxxxxx XX 00000

East Side Surgery Center

00000 Xxxx Xxxxxxx

Xxxxxxx XX 00000

First Street Hospital

0000 Xxxxxxxxx

Xxxxxxxx XX 00000

First Surgical Memorial Village

00000 Xxxxxxxx Xxxx #000

Xxxxxxx XX 00000

First Surgical Partners LLC

000 Xxxxx Xxxxxx

Xxxxxxxx XX 00000

Foundations Surgery Center

0000 Xxxx Xxxx Xxxxx

Xxxxxxxx XX 00000

Houston NW Medical Center

000 XX 0000 Xxxx

Xxxxxxx, XX 00000

Katy St. Catherine’s Surgery Center

000 Xxxxx Xxx Xxxx #000

Xxxx XX 00000

Palladium Surgery Center

0000 Xxxxxxxxx Xxxxxxx #000

Xxxxxxx XX 00000

Park Plaza Hospital

0000 Xxxxxxx Xxxxx

Xxxxxxx XX 00000

Special Surgery Centre

0000 Xxxx Xxxxxxx Xxxxx 000

Xxxxxxx XX 00000

Spring Branch Medical Center

0000 Xxxx Xxxxx

Xxxxxxx XX 00000

St. Xxxxxx Medical Center

0000 Xx. Xxxxxx Xxxxxxx

Xxxxxxx, XX 00000

St. Luke’s Episcopal Hospital Sugar Land

0000 Xxxx Xxxxx Xxxxxxx

Xxxxx Xxxx XX 00000

St. Luke’s Episcopal Hospital

0000 Xxxxxxx Xxxxxx

Xxxxxxx XX 00000

Sugar Land Surgical Hospital

0000 Xxxxxxx 0 Xxxxx 00

Xxxxx Xxxx XX 00000

The Woman’s Hospital

0000 Xxxxxx

Xxxxxxx XX 00000

West Houston Medical Center

00000 Xxxxxxxx Xxxxxx

Xxxxxxx XX 00000

West Houston Surgicare

000 Xxxxxxxx Xxxx

Xxxxxxx XX 00000

Kingwood Medical Center

00000 XX Xxxxxxx 00

Xxxxxxxx XX 00000

Memorial Hermann

0000 Xxxxxx

Xxxxxxx, XX 00000

Memorial Hermann Memorial City

000 Xxxxxxx Xxxx

Xxxxxxx XX 00000

Memorial Hermann Northwest

0000 Xxxxx Xxxx Xxxx

Xxxxxxx XX 00000

Memorial Hermann Southeast

00000 Xxxxxxx Xxxx

Xxxxxxx XX 00000

Memorial Hermann Southwest

0000 Xxxxxxxx

Xxxxxxx XX 00000

Memorial Hermann Surgery Center Northwest

0000 Xxxxx Xxxx Xxxx #000

Xxxxxxx XX 00000

Memorial Hermann Surgery Center Southwest

0000 Xxxxxxxxx Xxxxxxx #000

Xxxxxxx XX 00000

Memorial Hermann The Woodlands

0000 Xxxxxxxxx

Xxx Xxxxxxxxx XX 00000

Methodist Sugar Land

00000 Xxxxxxxxx Xxxxxxx

Xxxxx Xxxx XX 00000

Methodist Willowbrook

00000 Xxxxxxx Xxxxxxx

Xxxxxxx XX 00000

North Cypress Medical Center

00000 Xxxxxxxxx Xxxxxxx

Xxxxxxx XX 00000

Northeast Medical Center

00000 Xxxxxxxx Xxxxx

Xxxxxx XX 00000

OakBend Medical Center

0000 Xxxxxxx Xxxxxx

Xxxxxxxx XX 00000

AMENDMENT TO

AGREEMENT

BETWEEN

THREE RIVERS PROVIDER NETWORK

AND

AMERICAN SURGICAL ASSISTANTS, INC.

This AMENDMENT to the Agreement between THREE RIVERS PROVIDER NETWORK (“TRPN”) AND (Tax  Id# 00-0000000), dated 10-23-08 (“Agreement”), is entered into and made effective as of   05-07-2010.

FOR VALUABLE CONSIDERATION, the receipt and sufficiency of which is hereby acknowledged, and in consideration of the mutual promises and mutual covenants of the parties, the parties agree that the Agreement is hereby amended as follows:

1.           This Agreement is being amended due to renegotiations of the reimbursement rate in Section 1. and will now reflect the following change in rate:

a) The rate used in conjunction with this Agreement will be * discount off of Provider’s usual charge for covered services, less any applicable co-payments, co-insurance or deductibles.

2.           The remaining terms and conditions of the Agreement shall remain in full force and effect unless so amended pursuant to the terms of the Agreement.

IN WITNESS WHEREOF, the parties have executed this Amendment to the Provider Service Agreement to be effective as of the Effective Date.

		THREE RIVERS PROVIDER NETWORK
By /s/ Xxxxx X. Xxxx		By /s/ Xxxx Xxxxxxx
Signature		Signature
Name: /s/ Xxxxx X. Xxxx		Name Xxxx Xxxxxxx
Title:  COO		Title Chief Operating Officer
Date   5/7/2010		Date    5/7/2010

* Portions of this document omitted pursuant to an application for an order for confidential treatment pursuant to Rule 24b-2 under the Exchange Act.  Confidential portions of this document have been filed separately with the Securities and Exchange Commission.