Medical Provider Financial Corporation III
June 20, 2008
VIA U.S. MAIL AND EMAIL
Integrated Healthcare Holdings, Inc.
1301 North Tustin Avenue
Santa Ana, California 92705
Attn: Bruce Mogel, President/CEO
Re: Amendment No. 2 to $50 Million Revolving Credit Agreement dated October 9, 2007
Borrowers: Integrated Healthcare Holdings, Inc.
Chapman Medical Center, Inc.
Coastal Communities Hospital, Inc.
Credit Parties: Pacific Coast Holdings Investment, LLC
Reference is made to the $50 Million Revolving Credit Agreement dated October 9, 2007, as first amended on
June 10, 2008 (together, the "Credit Agreement") by and between Borrowers and Lender. Capitalized terms not
otherwise defined herein shall have the same meaning as set forth in the Credit Agreement.
In connection with the preparation of Borrower's annual reports management requested a clarification concerning
that the effect the definition of Material Adverse Effect in the Credit Agreement constitutes a subjective
acceleration provision which could require the accountants to treat the Revolving Facility as a short-term
obligation rather than a long-term obligation, Borrowers have requested that Lender revise the definition of
Material Adverse Effect. Lender has considered Borrower's request and is prepared to amend the Credit
Agreement as follows:
1. The definition of Material Adverse Effect, set forth in Annex B to the Credit Agreement, is hereby deleted in its
entirety and replaced with the following new definition of Material Adverse Effect:
"MATERIAL ADVERSE EFFECT" means any result, occurrence, fact, change, event or effect (whether or not
constituting a breach of a representation, warranty or covenant set forth in this Agreement), that, individually or in
the aggregate with any such other results, occurrences, facts, changes, events or effects, is or would reasonably
be expected to be adverse to any Borrower's or any Credit Party's or an