0000754009-04-000086 Sample Contracts

FORM OF CONTINGENT PURCHASE PRICE NOTE AGREEMENT
Contingent Purchase Price Note Agreement • March 5th, 2004 • Sierra Health Services Inc • Hospital & medical service plans • New York

THIS CONTINGENT PURCHASE PRICE NOTE AGREEMENT is dated as of ________ __, 2004 (this "Agreement") among Folksamerica Holding Company, Inc. a New York corporation (the "Purchaser"), Sierra Health Services, Inc., a Nevada corporation ("Sierra"), CII Financial, Inc., a California corporation and a wholly owned subsidiary of Sierra (the "Seller"), and, with respect to Article 5 only, Folksamerica Reinsurance Company, a New York insurance company and a wholly owned subsidiary of the Purchaser ("FRC").

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FIRST AMENDMENT TO CREDIT AGREEMENT
Credit Agreement • March 5th, 2004 • Sierra Health Services Inc • Hospital & medical service plans • New York

THIS FIRST AMENDMENT TO CREDIT AGREEMENT (this "Amendment") is entered into as of September 5, 2003 among (i) SIERRA HEALTH SERVICES, INC., a Nevada corporation (the "Borrower"), (ii) the subsidiaries of the Borrower identified as Guarantors on the signature pages hereto, (iii) the Lenders identified on the signature pages hereto and (iv) BANK OF AMERICA, N.A., as Administrative Agent (the "Administrative Agent"). All capitalized terms used herein and not otherwise defined shall have the meanings ascribed to such terms in the Credit Agreement referred to below.

SECOND AMENDMENT TO CREDIT AGREEMENT
Credit Agreement • March 5th, 2004 • Sierra Health Services Inc • Hospital & medical service plans • New York

THIS SECOND AMENDMENT TO CREDIT AGREEMENT (this "Amendment") is entered into as of January 26, 2004 among (i) SIERRA HEALTH SERVICES, INC., a Nevada corporation (the "Borrower"), (ii) the subsidiaries of the Borrower identified as Guarantors on the signature pages hereto, (iii) the Lenders identified on the signature pages hereto and (iv) BANK OF AMERICA, N.A., as Administrative Agent (the "Administrative Agent"). All capitalized terms used herein and not otherwise defined shall have the meanings ascribed to such terms in the Credit Agreement referred to below.

STOCK PURCHASE AGREEMENT among SIERRA HEALTH SERVICES, INC., and FOLKSAMERICA HOLDING COMPANY, INC. Dated as of November 25, 2003
Stock Purchase Agreement • March 5th, 2004 • Sierra Health Services Inc • Hospital & medical service plans • New York

STOCK PURCHASE AGREEMENT, dated as of November 25, 2003, among Sierra Health Services, Inc., a Nevada corporation ("Sierra"), CII Financial, Inc., a California corporation and a wholly owned subsidiary of Sierra (the "Seller") and Folksamerica Holding Company, Inc., a New York corporation (the "Purchaser").

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