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AMENDMENT NO. 1 TO SECURITIES PURCHASE AGREEMENT

Purchase and Sale Agreement

AMENDMENT NO. 1 TO SECURITIES PURCHASE AGREEMENT | Document Parties: INTEGRATED HEALTHCARE HOLDINGS INC You are currently viewing:
This Purchase and Sale Agreement involves

INTEGRATED HEALTHCARE HOLDINGS INC

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Title: AMENDMENT NO. 1 TO SECURITIES PURCHASE AGREEMENT
Date: 2/2/2009
Industry: Healthcare Facilities     Law Firm: Rutan Tucker     Sector: Healthcare

AMENDMENT NO. 1 TO SECURITIES PURCHASE AGREEMENT, Parties: integrated healthcare holdings inc
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EXHIBIT 10.1

                AMENDMENT NO. 1 TO SECURITIES PURCHASE AGREEMENT

         This Amendment No. 1 to Securities Purchase Agreement (this "SPA
AMENDMENT") is dated effective as of January 30, 2009, among Integrated
Healthcare Holdings, Inc., a Nevada corporation ("COMPANY"), Kali P. Chaudhuri,
M.D., an individual ("INVESTOR"), and William E. Thomas, an individual
("THOMAS") (for purposes of amendments to Articles IV and VI only). Capitalized
terms used herein and not otherwise defined herein have the meanings set forth
in the SPA (as defined below).

                                 R E C I T A L S

         WHEREAS, on July 18, 2008, the parties entered into the SPA, pursuant
to which, among other things, the Company sold to Investor a purchase right to
purchase shares of the Company's Common Stock ("PREVIOUS PURCHASE RIGHT") and
granted to Investor and Thomas certain pre-emptive rights, releases and waivers,
as more fully described in the SPA.

         WHEREAS, as a condition and inducement to Investor entering into the
SPA and incurring the obligations and taking the actions set forth therein,
concurrently with the execution and delivery of the SPA, the Company, Lenders,
Healthcare Financial and the Subsidiary Borrowers entered into the Payoff
Agreement. In addition, Investor exercised the Exercised Warrants and entered
into the Option and Standstill Agreement concurrent with his entry into the SPA.

         WHEREAS, the Previous Purchase Right expired on January 10, 2009, the
market price of shares of the Company's Common Stock has declined since July 18,
2008, the Company was unable to resolve certain litigation in satisfaction of a
condition to closing of the Previous Purchase Right, and the Company desires to
sell an additional 33,333,333 shares of Common Stock ("ADDITIONAL SHARES"), at a
purchase price of $0.03 per share and to grant a new purchase right as set forth
herein.

         WHEREAS, Investor desires to purchase the Additional Shares and obtain
a new purchase right on the terms and subject to the conditions of this
Agreement.

                                A G R E E M E N T

         NOW, THEREFORE, IN CONSIDERATION of the mutual covenants contained in
this Amendment and the Agreement, and for other good and valuable consideration,
the receipt and adequacy of which are hereby acknowledged, the Company and
Investor (and Thomas for purposes of Articles IV and VI of the Agreement, as
amended hereby) agree as follows:

         1. DEFINED TERMS.

         (a) The following defined terms contained in Article I of the SPA are
hereby amended and restated as follows:

                  "AGREEMENT" means the SPA, as amended by the SPA Amendment.


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                  "CLOSING" means an Additional Shares Closing or SPR Closing,
         each of which shall take place at the offices of Rutan & Tucker, LLP,
         611 Anton Boulevard, Suite 1400, Costa Mesa, California 92626 or at
         such other location as the parties may agree.

                  "CLOSING DATE" means an Additional Shares Closing Date or an
         SPR Closing Date.

                  "INVESTMENT AMOUNT" means the portion of the Maximum
         Investment Amount elected to be paid by Investor at an SPR Closing.

                  "OPTION AND STANDSTILL AGREEMENT" means the Option and
         Standstill Agreement dated effective as of July 18, 2008, among MPFC I,
         MPFC II, Healthcare Financial and Investor, as amended from time to
         time in a manner satisfactory to Investor in his sole discretion.

                  "OUTSIDE DATE" means 5:00 p.m. California time on January 30,
         2010.

                  "PAYOFF AGREEMENT" means the Early Loan Payoff Agreement dated
         effective as of July 18, 2008, among the Company, the Subsidiary
         Borrowers, Healthcare Financial and Lenders, as amended from time to
         time in a manner satisfactory to Investor in his sole discretion.

                  "SECURITIES" means the Shares, the Warrants, the Warrant
         Shares and the Additional Shares.

                  "TRANSACTION DOCUMENTS" means the SPA, the Payoff Agreement,
         the SPA Amendment and any other documents or agreements executed in
         connection with the transactions contemplated hereunder and thereunder.

         (b) The following defined terms are hereby added to Article I of the
SPA in appropriate alphabetical order:

                  "ADDITIONAL SHARES" has the meaning set forth in the recitals
         to the SPA Amendment.

                  "ADDITIONAL SHARES CLOSING" means the closing of the purchase
         and sale of Additional Shares as contemplated by the SPA Amendment.

                  "ADDITIONAL SHARES CLOSING DATE" means the date of the
         Additional Shares Closing, which shall occur, subject to the terms and
         conditions of this Agreement, on or before the later of (i) January 30,
         2009 and (ii) the tenth Business Day after full execution and delivery
         of the SPA Amendment and the documents referred to in Section 5.1(h) of
         this Agreement.

                  "CAPITAL INCREASE EFFECTIVE TIME" means the date upon which
         the Company's authorized capital is increased to 500,000,000 shares of
         Common Stock as contemplated by Section 4.12 of this Agreement.


                                       2

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                  "MAXIMUM INVESTMENT AMOUNT" means $5,968,268.01, except that
         prior to the Capital Increase Effective Time, only an aggregate of up
         to $4,468,268.00 of this amount may be invested at SPR Closings.

                  "SPA" means the Securities Purchase Agreement dated as of July
         18, 2008, among the Company, Investor and Thomas.

                  "SPA AMENDMENT" means Amendment No. 1 to the SPA, among the
         Company, Investor and Thomas.

                  "SPR CLOSING" means a closing, if any, of the purchase and
         sale of some or all of the SPR Shares.

                  "SPR CLOSING DATE" means the date of any SPR Closing, which
         shall occur, if at all, on or prior to 5:00 p.m. California time on the
         Outside Date.

                  "SPR SHARES" means Shares purchased at the Per Share Purchase
         Price at an SPR Closing pursuant to the Purchase Right.

         (c) The defined term "Company Deliverables" is hereby deleted in its
entirety.

         2. EXECUTION OF SPA AMENDMENT. Section 2.1 of the SPA is hereby amended
by inserting the following new Section 2.1(c) immediately following Section
2.1(b):

                  "(c) Effective January 30, 2009, the Company hereby grants to
         Investor a new Purchase Right on the terms described in the SPA
         Amendment, and Investor shall deliver to the Company on or prior to
         January 30, 2009 the balance, if any, of $30,000.00 being paid by
         Investor in consideration for Investor's receipt of the new Purchase
         Right."

         3. SPR CLOSINGS. Section 2.2 of the SPA is hereby amended and restated
to read in its entirety as follows:

                  "2.2 SPR CLOSINGS AND SPR CLOSING DELIVERIES. Subject to the
         terms and conditions set forth in this Agreement (including, without
         limitation, the conditions set forth in Article V), on each SPR Closing
         Date, the Company shall issue and sell to Investor, and Investor shall
         purchase from the Company, the number of Shares equal to the Investment
         Amount divided by the Per Share Purchase Price, and:

                           (a) The Company shall deliver or cause to be
                  delivered to Investor the following:

                                    (i) irrevocable instructions to the
                           Company's transfer agent to promptly deliver a
                           certificate or certificates in denominations
                           requested by Investor evidencing an aggregate number
                           of Shares equal to the portion of the Investment
                           Amount elected to be paid by Investor at the SPA
                           Closing divided by the Per Share Purchase Price,
                           registered in the name of Investor;


                                       3

<PAGE>

                                    (ii) the legal opinions of Company Counsel
                           addressed to Investor and in such forms as are
                           reasonably requested by Investor; and

                                    (iii) certificates of officers as required
                           under Sections 5.1(b) and 5.1(c) of this Agreement;
                           and

                           (b) Investor shall deliver or cause to be delivered
                  to the Company:

                                    (i) the Investment Amount, in United States
                           dollars and in immediately available funds, by wire
                           transfer to an account designated in writing by the
                           Company for such purpose; and

                                    (ii) A duly executed investor certification
                           required pursuant to Section 3.2(b) of this
                           Agreement."

         4. ADDITIONAL SHARES CLOSING. Article II of the SPA is hereby amended
by inserting the following new Section 2.3 immediately following revised Section
2.2:

                  "2.3 ADDITIONAL SHARES CLOSING AND DELIVERIES. Subject to the
         terms and conditions set forth in this Agreement (including, without
         limitation, the conditions set forth in Article V), on the Additional
         Shares Closing Date:

                  (a) The Company shall deliver or cause to be delivered to
         Investor:

                           (i) irrevocable instructions to the Company's
                  transfer agent to promptly deliver a certificate or
                  certificates in denominations requested by Investor evidencing
                  the Additional Shares, registered in the name of Investor;

                           (ii) a copy of an amendment to the Payoff Agreement,
                  duly executed by the Company, the Subsidiary Borrowers,
                  Healthcare Financial and Lenders, in form and substance
                  satisfactory to Investor;

                           (iii) the legal opinions of Company Counsel addressed
                  to Investor and Thomas and in such forms as are reasonably
                  requested by Investor and Thomas;

                           (iv) certifications acknowledging and agreeing that
                  the execution of the Transaction Documents, the consummation
                  of the transactions contemplated thereby, and/or the exercise
                  of the Exercised Warrants or the Warrants will not give rise
                  to or trigger any severance, termination or other rights or
                  obligations of the Company under any employment, consulting or
                  similar agreements or arrangements to which the Company, any
                  member of the Board of Directors of the Company, Ken
                  Westbrook, Steve Blake, Dan Brothman, Scott Schoeffel or Jerry
                  Kanaly is a party or is otherwise bound, duly executed by each
                  party to such agreements or arrangements;


                                       4

<PAGE>

                           (v) resolutions of the Board of Directors authorizing
                  and approving the SPA Amendment and the transactions
                  contemplated thereby, including without limitation the
                  increase in authorized capital contemplated by Section 4.12,
                  which resolutions are certified by the Secretary of the
                  Company;

                           (vi) resolutions of the Board of Directors or
                  Compensation Committee of the Board of Directors of the
                  Company, as appropriate, ensuring that no awards under the
                  Company's 2006 Stock Incentive Plan are accelerated by the
                  execution of the Transaction Documents, the consummation of
                  the transactions contemplated hereby and thereby, and/or the
                  exercise of the Exercised Warrants or Warrants, which
                  resolutions are certified by the Secretary of the Company; and

                           (vii) certificates of officers as required under
                  Sections 5.1(b) and 5.1(c) of this Agreement.

                  (b) Investor shall deliver or cause to be delivered to the
         Company:

                           (i) $1,000,000 in United States dollars, representing
                  the purchase price of the Additional Shares; and

                           (ii) A duly executed investor certification required
                  pursuant to Section 3.2(b) of this Agreement."

         5. REPRESENTATIONS AND WARRANTIES OF THE COMPANY. Section 3.1 of the
SPA is hereby amended as follows:

                  (a) Section 3.1(g) is hereby amended by amended and restated
         in its entirety as follows:

                           "(g) CAPITALIZATION. The only class of capital stock
                  that the Company is authorized to issue is Common Stock. The
                  total number of shares of Common Stock outstanding is
                  161,973,929, excluding the issuances of Additional Shares
                  being made hereunder. The total number of shares of Common
                  Stock issuable upon full exercise of options outstanding under
                  the Company's option plan (whether or not vested or
                  exercisable) is 9,445,000. Other than rights granted to
                  Investor and Thomas pursuant to Section 4.9 of this Agreement,
                  no securities of the Company are entitled to preemptive or
                  similar rights, and no Person has any right of first refusal,
                  preemptive right, right of participation, or any similar right
                  to participate in the transactions contemplated by the
                  Transaction Documents. Other than the Warrants, the Exercised
                  Warrants, the 9,445,000 options, the $10.7 Million Note and
                  the Purchase Right and right to purchase Additional Shares
                  granted hereunder, there are no outstanding options, warrants,
                  scrip rights to subscribe to, calls or commitments of any
                  character whatsoever relating to, or securities, rights or
                  obligations convertible into or exchangeable for, or giving
                  any Person any right to subscribe for or acquire, any shares


                                       5

<PAGE>

                  of Common Stock, or contracts, commitments, understandings or
                  arrangements by which the Company or any Subsidiary is or may
                  become bound to issue additional shares of Common Stock, or
                  securities or rights convertible or exchangeable into shares
                  of Common Stock. The issue and sale of the Securities will
                  not, immediately or with the passage of time, obligate the
                  Company to issue shares of Common Stock or other securities to
                  any Person (other than Investor) and will not result in a
                  right of any holder of Company securities to adjust the
                  exercise, conversion, exchange or reset price under such
                  securities, except as set forth in the first paragraph of
   


 
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