SECOND AMENDMENT TO MANAGEMENT AND INVESTMENT ADVISORY SERVICES AGREEMENT

Exhibit 10.4

SECOND AMENDMENT TO

MANAGEMENT AND INVESTMENT ADVISORY SERVICES AGREEMENT

This SECOND AMENDMENT TO MANAGEMENT AND INVESTMENT ADVISORY SERVICES AGREEMENT (the “Second Amendment”), is made and entered into this 3rd day of November, 2014 (the “Effective Date”), by and among Surgery Center Holdings, Inc., a Delaware corporation (“Parent”), each of Parent’s direct or indirect subsidiaries listed as signatories hereto (such entities together with Parent, collectively being, the “Company”), and Bayside Capital, Inc., a Florida corporation (“Bayside”). The Company and Bayside are referred to herein individually as a “Party” and, collectively as, the “Parties.”

RECITALS:

WHEREAS, each of the Parties entered into that certain Management and Investment Advisory Services Agreement, dated as of December 24, 2009, and later entered into that certain First Amendment to Management and Investment Advisory Services Agreement, dated as of May 4, 2011 (collectively, the “Agreement”);

WHEREAS, pursuant to and in accordance with Section 16 of the Agreement, each of the Parties desires to amend the Agreement in certain respects upon the terms and conditions set forth herein; and

WHEREAS, all capitalized terms used herein and not otherwise defined herein shall have the meanings ascribed to such terms in the Agreement.

NOW, THEREFORE, in consideration of the promises contained herein, and for other good and valuable consideration, the receipt and sufficiency of which are hereby conclusively acknowledged, the parties hereto, intending to become legally bound, hereby agree as follows:

TERMS AND CONDITIONS:

(a) Amendment to Header of Agreement. The Legend set forth at the top of the Agreement in all capital letters beginning with the phrase “THE PAYMENT OF AMOUNTS PAYABLE . . .” and ending with the phrase “CERTAIN SECURITIES PURCHASE AGREEMENT DATED AS OF THE DATE HEREOF.” is hereby deleted from the Agreement.

(b) Amendment to Section 1. The last sentence of Section 1 of the Agreement is hereby amended by deleting it in its entirety and replacing it with the following:

If requested by Bayside, the Company shall cause any subsidiaries which become directly or indirectly wholly owned by Parent to execute a joinder to this Agreement to be included as a Company hereunder.

(c) Amendment to Section 6.1.1. Section 6.1.1 of the Agreement is hereby amended by deleting it in its entirety and replacing it with the following:

(d) Amendment to Section 6.2. The following sentence shall be added at the end of Section 6.2 of the Agreement:

“The parties hereto agree that the Transaction Fee for the Transaction pursuant to that certain Agreement and Plan of Merger, dated as of June 13, 2014, by and among Surgery Center Holdings, Inc., SCH Acquisition Corp., Symbion Holdings Corporation and Crestview Symbion Holdings, L.L.C. shall be $15,800,000, which shall consist of an Investment Banking Fee of $7,900,000 and a Supplemental Management Fee of $7,900,000.”

(a) Effect of Amendment. Except as otherwise expressly provided in this Second Amendment, nothing herein shall be deemed to amend or modify any provision of the Agreement, which shall remain unchanged and in full force and effect and is hereby ratified and reaffirmed in all respects.

(b) Headings. The headings, captions, and arrangements used in this Second Amendment are for convenience only and shall not affect the interpretation of this Second Amendment.

(c) Compliance. This Second Amendment is made pursuant to and in the accordance with Section 16 of the Agreement.

(d) Counterparts. This Second Amendment may be executed by the parties hereto in separate counterparts, each of which when so executed and delivered shall be an original, but all such counterparts shall together constitute one and the same instrument. Each counterpart may consist of a number of copies hereof each signed by less than all, but together signed by all of the parties. The parties hereto agree that facsimile and electronically transmitted portable document format (pdf) signatures shall be deemed originals.

(e) Severability. Any provision of this Second Amendment held by a court of competent jurisdiction to be invalid or unenforceable shall not impair or invalidate the remainder of this Second Amendment and the effect thereof shall be confined to the provision so held to be invalid or unenforceable.

(f) Entire Agreement. This Second Amendment and the Agreement represent the final agreement between the parties and may not be contradicted by evidence of prior, contemporaneous, or subsequent oral agreements of the parties. There are no unwritten oral agreements between the parties.

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(g) Applicable Law. This Second Amendment shall be governed by the laws of the State of Florida as to all matters, including, but not limited to, matters of validity, construction, effect and performance.

[SIGNATURES APPEAR ON THE FOLLOWING PAGE]

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IN WITNESS WHEREOF, this First Amendment has been duly executed as of the date first written above.

BAYSIDE:
BAYSIDE CAPITAL, INC.
By:
Name:		Richard Siegel
Its:		Vice President and General Counsel
THE COMPANY:
SURGERY CENTER HOLDINGS, INC.
By:
Name:		Chris Laitala
Its:		President
APS OF BRADENTON, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
APS OF MERRITT ISLAND, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF CORAL GABLES, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

SURGERY PARTNERS OF LAKE MARY, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF LAKE WORTH, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF MERRITT ISLAND, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF MILLENIA, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF NEW TAMPA, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF PARK PLACE, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

SURGERY PARTNERS OF SARASOTA, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF WESTCHASE, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS OF WEST KENDALL, L.L.C.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
ANESTHESIA MANAGEMENT SERVICES, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
ANESTHESIOLOGY PROFESSIONAL SERVICES, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
BUSINESS IT SOLUTIONS OF TAMPA, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

MEDICAL BILLING SOLUTIONS, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
SURGERY PARTNERS, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
TAMPA PAIN RELIEF CENTER, INC. D/B/A ORLANDO PAIN RELIEF CENTER
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
ARMENIA AMBULATORY SURGERY CENTER, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
BLUE RIDGE NOVAMED, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
MDN ACQUISITION COMPANY, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

MIDWEST UNCUTS, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NMGK, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NMI, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NMLO, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED ACQUISITION COMPANY, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

NOVAMED ALLIANCE, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED EYE SURGERY AND LASER CENTER OF ST. JOSEPH, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED EYE SURGERY CENTER OF CINCINNATI, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED EYE SURGERY CENTER OF NORTH COUNTY, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED EYE SURGERY CENTER (PLAZA), L.L.C.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED EYECARE RESEARCH, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

NOVAMED MANAGEMENT OF KANSAS CITY, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED MANAGEMENT SERVICES, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED OF BETHLEHEM, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED OF DALLAS, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED OF LAREDO, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED OF LEBANON, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

NOVAMED OF LOUISVILLE, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED OF SAN ANTONIO, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED OF TEXAS, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED OF WISCONSIN, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
NOVAMED SURGERY CENTER OF LAREDO, LP
By:
Name:		Michael Doyle
Its:		Chief Executive Officer
PATIENT EDUCATION CONCEPTS, INC.
By:
Name:		Michael Doyle
Its:		Chief Executive Officer

SURGERY PARTNERS OF SUNCOAST, LLC
By:
Name:		Michael Doyle
Its:		Chief Executive Officer