FORM OF INCOME TAX RECEIVABLE AGREEMENT Dated as of [ ], 2015Income Tax Receivable Agreement • August 3rd, 2015 • Surgery Partners, Inc. • Services-general medical & surgical hospitals, nec • New York
This INCOME TAX RECEIVABLE AGREEMENT (as amended from time to time, this “Agreement”), dated as of [ ], 2015, is hereby entered into by and among Surgery Partners, Inc., a Delaware corporation (the “Corporation”), H.I.G. Surgery Centers LLC, a Delaware limited liability company (the “Stockholders Representative,” in its capacity as such), the persons listed on Annex A hereto (each a “Stockholder” and collectively the “Stockholders”) and each of the permitted successors and assigns thereto.
