Amendment No. 3 to Amended and Restated Master Professional Services Agreement between the Registrant andAscension Health dated as of July 5, 2018

Base Fee for Dependent Services. Effective as of July 1, 2018, Exhibit 4-A to the MPSA is hereby amended as follows:

Sections 1.1 and 1.2 of Exhibit 4-A are hereby deleted in their entirety and replaced with the following:

a single [**] fee with respect to the Steady State Eligible Recipients, which will be calculated in the aggregate (to be invoiced in accordance with Exhibit 4-D) equal to the product of:

the sum of the [**]-Month Rolling Average Cash Collections with respect to such month for all of the Steady State Eligible Recipients in the aggregate,

the result of:

the Blended Ascension Cost to Collect Factor (as defined in Section 1.3(vii))

[**];

with respect to each Additional Book Eligible Recipient that is not a Steady State Eligible Recipient that has commenced receiving Dependent Services from Supplier, a [**] fee (to be invoiced in accordance with Exhibit 4-D) equal to the product of:

the [**]-Month Rolling Average Cash Collections with respect to such month for such Additional Book Eligible Recipient,

the result of:

the Additional Book Cost to Collect Factor (as defined in Section 3.2) applicable to such Additional Book Eligible Recipient,

[**].

Section 1.3(ii) of Exhibit 4-A is hereby deleted in its entirety and replaced with the following:

The following definitions are hereby added to Section 1.3 of Exhibit 4-A:

The first sentence of the third paragraph of Section 2.1 of Exhibit 4-A is hereby deleted in its entirety and replaced with the following:

the applicable Initial Current Book Cost to Collect Factor, and

the aggregated value of all CB Adjustments (as defined in Section 2.2) for the applicable Current Book Eligible Recipient, as approved by the Cost Board in connection with the applicable CB Re-Assessment.

The first sentence of the third paragraph of Section 3.2 of Exhibit 4-A is hereby deleted in its entirety and replaced with the following:

the applicable initial Additional Book Cost to Collect Factor, and

the aggregated value of all AB Adjustments (as defined in Section 3.4) for the applicable Additional Book Eligible Recipient, as approved by the Cost Board in connection with the applicable AB Re-Assessment.”

A new Section 4.3 to Exhibit 4-A is hereby added as follows:

The following is hereby added as Section 6 (Blended Base Fee) of Exhibit 4-A:

Timing of Calculations. The Blended Ascension Cost to Collect Factor for each Ascension Health Fiscal Year will be calculated no later than January 31 of the immediately preceding Ascension Health Fiscal Year and will be fixed for the entirety of the upcoming Ascension Health Fiscal Year; provided that the Parties will re-calculate the Blended Ascension Cost to Collect Factor after it is fixed on a particular January 31 in the event that: (1) the Parties amend the Current Book Cost to Collect Factor, the Additional Book Cost to Collect Factor, the Ascension Wisconsin Cost to Collect Factor, the HIM Cash Collection Factor or the NRIT Cash Collection Factor, as applicable or (2) Ascension Health divests or sells a Steady State Eligible Recipient during such Ascension Health Fiscal Year. For clarity, the allocation of expenses that apply under the Supplement applicable to each Steady State Eligible Recipient or any other agreement between the Parties [**] will continue to apply pursuant to the terms of the particular Supplement or agreement, but will be aggregated for each Steady State Base Fee invoice provided in accordance with Exhibit 4-D.

“If Supplier’s performance for a Service Level does not achieve the Target Level in a Measurement Window, resulting in a Service Level Default for such Service Level, then Supplier shall apply a Service Level Credit for the applicable Eligible Recipient equal to the product of:

The quotient of:

[**] percent ([**]%),

the number of Service Levels with respect to such Eligible Recipient that have commenced their respective Service Level Effective Date and for which this Exhibit contains both a metric (in Article 3) and a target (in Article 4),

(A) with respect to Steady State Eligible Recipients, the portion of the Steady State Base Fee attributable to such Eligible Recipient based on

If more than one Service Level has experienced a Service Level Default for a Measurement Window with respect to an Eligible Recipient, Supplier will apply the sum of the Service Level Credit amounts for each of the Service Levels with respect to such Eligible Recipient that had Service Level Defaults during such Measurement Window in the same manner as described in Section 7.3 above. There shall be, with respect to each Eligible Recipient, up to [**] percent ([**]%) of the portion of the Base Fee attributable to such Eligible Recipient (calculated as set forth in Section 7.3) at risk with respect to such Measurement Window (and Supplier shall in no event be liable for Service Level Credits in excess of such at risk amount).”

Counterparts. This Amendment may be executed in several counterparts, all of which taken together will constitute one single agreement between the Parties.