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201901174 CONSTRUCTION LEASEHOLD DEED OF TRUST AND SECURITY AGREEMENT WITH ASSIGNMENT OF RENTS This Construction Leasehold Deed of Trust and Security Agreement with Assignment of Rents (the "Deed of Trust") dated as of February 28, 2019 from GI HOSPITAL BUILDING, LLC, a Nebraska limited liability company, with its principal place of business and mailing address at 3533 Prairieview, Grand Island, NE 68803 (hereinafter referred to as "Grantor"), to U.S. BANK NATIONAL ASSOCIATION, as Trustee with a mailing address of 400 City Center, Oshkosh, WI 54901 (said Trustee together with any successors in trust being hereinafter referred to as "Trustee"), in trust for the benefit of U.S. BANK NATIONAL ASSOCIATION, a national banking association with its principal place of business at 400 City Center, Oshkosh, WI 54901 (hereinafter referred to as "Beneficiary"); WITNESSETH THAT: WHEREAS, GI HOSPITAL REAL ESTATE, LLC, a Nebraska limited liability company ("Real Estate"), GI HOSPITAL EQUIPMENT, LLC, a Nebraska limited liability company ("Equipment") and Grantor (together with Building and Equipment, the "Borrowers" and each individually, a "Borrower"), GRAND ISLAND HOSPITAL HOLDINGS, LLC, a Nebraska limited liability company ("Holdings ") as a guarantor, and Beneficiary have entered into that certain Credit Agreement dated as of February 28, 2019 (such Credit Agreement, as the same may from time to time be amended, modified or restated, being hereinafter referred to as the "Credit Agreement"), pursuant to which Beneficiary has agreed, subject to certain terms and conditions, to make available to the Borrower (i) a term credit facility (the "Building Term Credit") in a maximum principal amount of $34,900,000 with advances under the Building Term Credit to be evidenced by a Building Term Note of the Borrower payable to the order of Beneficiary and maturing in no event later than February 28, 2024 (the "Facility Termination Date ") and bearing interest thereon at the rates and payable at the times provided in the Credit Agreement (such Building Term Note and any and all promissory notes issued in renewal thereof or in substitution or replacement therefor being hereinafter referred to as the "Building Term Note"), (ii) a term credit facility (the "Equipment Term Credit") in a maximum principal amount of $20,000,000 with advances under the Equipment Term Credit to be evidenced by an Equipment Term Note of the Borrower payable to the order of Beneficiary and maturing in no event later than the Facility Termination Date and bearing interest thereon at the rates and payable at the times provided in the Credit Agreement (such Equipment Term Note and any and all promissory notes issued in renewal thereof or in substitution or replacement therefor being hereinafter referred to as the "Equipment Term Note ") and (iii) a term credit facility (the "TIF Term Credit" and the Building Term Credit and the Equipment Term Credit being hereinafter referred to collectively as the "Credits" and individually as a "Credit") in a maximum principal amount of $11,600,000 with advances under the TIF Term Credit to be evidenced by a TIF Term Note of the Borrower payable to the order of Beneficiary and maturing in no event later than the Facility Termination Date and bearing interest thereon at the rates and payable at the times provided in the Credit Agreement (such TIF Term Note and any and all promissory notes issued in renewal thereof or in deed of trust (Leasehold) 4819-6984-3593 v2.doc 4268520