THIRD AMENDMENT TO AGREEMENT OF SALE AND PURCHASE

Exhibit 10.3

THIRD AMENDMENT TO AGREEMENT OF SALE AND PURCHASE

THIS THIRD AMENDMENT TO AGREEMENT OF SALE AND PURCHASE (this “ Amendment ”) is made and entered into as of this 26th day of August, 2009 by and between Greenville Hospital System , a political subdivision organized under the laws of South Carolina and Board of Trustees of Greenville Hospital System (aka, The Board of Trustees of The Greenville Hospital System) (collectively, “ GHS ”), Greenville Health Corporation, Inc. (“ GHC ”), a South Carolina corporation and GHC Health Resources, Inc. (“ GHR ”), a South Carolina corporation, all having an address at 701 Grove Road, Greenville, SC 29605 (collectively the “ Seller ”), and HTA — Greenville, LLC , a Delaware limited liability company, having an address at 16427 N. Scottsdale Road, Suite 440, Scottsdale, Arizona 85254 (“ Buyer ”). Seller and Buyer are each individually referred to herein as a “ Party ” and collectively as the “ Parties ”.

R E C I T A L S :

A. Seller and Buyer entered into that certain Agreement of Sale and Purchase as of July 15, 2009 (as amended by that certain First Amendment to Agreement of Sale and Purchase, executed by Buyer and Seller as of August 14, 2009 and that certain Second Amendment to Agreement of Sale and Purchase, executed by Buyer and Seller as of August 21, 2009, the “ Agreement of Sale ”).

B. Seller and Buyer desire to amend the Agreement of Sale as described herein.

NOW, THEREFORE , in consideration of the terms, conditions and covenants contained herein, and of other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, Seller and Buyer agree as follows:

1.  Section 2(a) . Section 2(a) of the Agreement of Sale is hereby amended by deleting the amount “One Hundred Sixty-One Million Six Hundred Thirty Thousand Dollars ($161,630,000)” and replacing it with the amount “One Hundred Sixty-One Million Six Hundred Seventy Thousand Dollars ($161,670,000)”.

2.  Section 4(a)(iii) . Section 4(a)(iii) of the Agreement of Sale is hereby amended by (a) deleting the phrase “a space lease between Buyer, as landlord, and Seller and the “ Endowment Fund ” (as hereinafter defined), as tenant” from the first sentence thereof and replacing it with the phrase “a space lease between Buyer, as landlord, and GHS and the “Endowment Fund” (as hereinafter defined), as tenant” and (b) inserting the phrase “ Shared Services Agreement ” (as hereinafter defined) for each Property, as applicable,” prior to the phrase “the “ROFR Agreement” (as hereinafter defined) in the first sentence thereof.

3.  Section 4(f) . The last sentence of Section 4(f) of the Agreement of Sale is hereby amended by deleting the phrase “Section 4(g) and 4(h)” and replacing it with the phrase “Section 4(f) and 4(g)”.

4.  Section 6(m)(vi) . Section 6(m)(vi) of the Agreement of Sale is hereby deleted in its entirety and replaced with the following:

(vi) With respect to each Property, two (2) originals of a valid assignment in the form attached hereto as Exhibit “O” (the “ Assignment of Intangibles ”), together with fully executed consents to the assignment of any Warranties thereunder which require consent for assignment, as set forth in Schedule I to the Assignment of Intangibles;

5.  Section 6(m)(x) . Section 6(m)(x) of the Agreement of Sale is hereby deleted in its entirety and replaced with the following:

(x) To the extent deemed necessary and appropriate by Buyer and Seller, with respect to each Fee Property and Ground Lease Property located on a hospital campus identified on the attached Exhibit “A ,” one (1) original of the Agreement for Grant of Reciprocal Easements and Establishment of Covenants, Conditions and Restrictions in the form agreed upon prior to the expiration of the Due Diligence Period (which includes, among other things, provisions for parking reasonably adequate to Buyer and Seller) (the “ REAs ”) and one (1) original of the Shared Services Agreement in the form agreed upon prior to the expiration of the Due Diligence Period (the “ Shared Services Agreement ”), each duly executed and acknowledged by Seller and the Endowment Fund and (in the case of the REAs) in a proper form for recording, which collectively allocate the responsibilities and costs related to all services and utilities provided to the related hospital campus;

6.  Section 6(m)(xiii) . Section 6(m)(xiii) of the Agreement of Sale is hereby deleted in its entirety and replaced with the following:

(xiii) Two (2) originals of the Future Development Agreement in the form agreed upon prior to the expiration of the Due Diligence Period (the “ Future Development Agreement ”) and two (2) originals of the Right of First Opportunity Agreement in the form agreed upon prior to the expiration of the Due Diligence Period, each duly executed by Seller, which collectively describe the exclusive arrangement between Buyer and Seller with respect to financing certain future development projects;

7.  Section 6(m)(xiv) . Section 6(m)(xiv) of the Agreement of Sale is hereby deleted in its entirety and replaced with the phrase “Intentionally Omitted”.

8.  Section 6(m)(xxiii) . Section 6(m)(xxiii) of the Agreement of Sale is hereby deleted in its entirety and replaced with the phrase “Intentionally Omitted”.

9.  Section 6(m)(xxviii) . Section 6(m)(xxviii) of the Agreement of Sale is hereby deleted in its entirety and replaced with the following:

(xxviii) Seller shall deliver fully executed lease amendments reasonably acceptable to Buyer with respect to the Leases described on Exhibit “T” attached hereto.

10.  Section 6(m)(xxix) . A new Section 6(m)(xxix) is hereby added to the Agreement of Sale which reads in its entirety as follows:

(xxix) With respect to each Property, Seller shall provide a “final” certificate of occupancy for the Improvements thereon or, in the absence of a certificate of occupancy for any such Property, Seller shall provide evidence reasonably satisfactory to Buyer that a certificate of occupancy has been issued for such Property or evidence reasonably satisfactory to Buyer that all requirements for the issuance of a “final” certificate of occupancy have been satisfied.

11.  Section 6(m)(xxx) . A new Section 6(m)(xxx) is hereby added to the Agreement of Sale which reads in its entirety as follows:

(xxx) With respect to the recently completed tenant improvements at the Travelers Rest property: (1) a final certificate of occupancy; (2) lien waivers or evidence of payment from the general contractor, subcontractors and architect or other documentation sufficient to allow the title company to issue title coverage against all liens; (3) an assignment of all warranties, indemnities and recourse rights under the construction, architect and subcontract agreements in favor of Buyer, together with any consents to assignment to the extent required; and (4) a “closeout manual” that includes (a) a list of all subcontractors by trade, (b) warranty documents by subcontractor or equipment, as applicable, (c) spec sheets for equipment (if applicable), (d) manuals for all equipment (if applicable) and (e) “as built” drawings of the improvements; provided, however, that to the extent the “closeout manual” is unavailable at Settlement, Seller may provide it to Buyer after Settlement (and promptly upon the availability thereof), and Seller shall use commercially reasonable efforts to make it available to Buyer as soon as reasonably practicable. Notwithstanding the foregoing, delivery of the closeout manual after Settlement shall not relieve Seller of any obligation to deliver the items in clauses (1) through (3) above prior to Settlement.

12.  Section 6(m)(xxxi) . A new Section 6(m)(xxxi) is hereby added to the Agreement of Sale which reads in its entirety as follows:

(xxxi) With respect to the current improvement projects listed on Exhibit “R” attached hereto, Seller shall provide final lien waivers evidencing that all contractors and subcontractors have been paid and no lien rights exist against the applicable Property. Upon completion of such work, Seller shall provide Buyer with final certificates of occupancy (if required by the relevant municipality), “as built” drawings (if requested by Buyer and reasonably available), and any available warranties (together with assignments thereof).

13.  Exhibit “B” . Exhibit “B” attached to the Agreement of Sale is hereby deleted in its entirety and is hereby replaced with Exhibit “B” attached hereto.

14.  Exhibit “C” . Exhibit “C” attached to the Agreement of Sale is hereby deleted in its entirety and is hereby replaced with Exhibit “C” attached hereto.

15.  Exhibit “D” . Exhibit “D” attached to the Agreement of Sale is hereby amended by (i) deleting the $1,585,000 allocated to Travelers Rest and replacing it with $1,625,000 and by (ii) deleting the total purchase price of $161,630,000 and replacing it with $161,670,000.

16.  Exhibit “F” . Exhibit “F” attached to the Agreement of Sale is hereby amended by (a) deleting the word “Inc.” after the phrase “the Endowment Fund of the Greenville Hospital System” and (b) deleting the table at the end of such exhibit in its entirety and replacing the same with the following:

17.  Exhibit “H” . Exhibit “H” attached to the Agreement of Sale is hereby deleted in its entirety and is hereby replaced with Exhibit “H” attached hereto.

18.  Exhibit “I” . Exhibit “I” attached to the Agreement of Sale is hereby deleted in its entirety and is hereby replaced with Exhibit “I” attached hereto.

19. “ Exhibit “L ”. Exhibit “L” attached to the Agreement of Sale is hereby amended by deleting the phrase “claiming the same or any part thereof” in the last paragraph thereof and replacing it with the phrase “and against all persons claiming through or under the Grantor but not otherwise”

20.  Exhibit “O” . Exhibit “O” attached to the Agreement of Sale is hereby deleted in its entirety and is hereby replaced with Exhibit “O” attached hereto.

21.  Exhibit “R” . Exhibit “R” attached to the Agreement of Sale is hereby deleted in its entirety and is hereby replaced with Exhibit “R” attached hereto.

22.  Exhibit “T” . A new Exhibit “T” is attached hereto and is hereby incorporated by reference into the Agreement of Sale.

23.  Reaffirmation . Except as modified by this Amendment, Seller and Buyer hereby reaffirm all terms, covenants and conditions contained in the Agreement of Sale. The Parties agree that except as modified herein, all other terms of the Agreement of Sale shall remain in full force and effect. In the event of any conflict between the provisions of this Amendment and the provisions of the Agreement of Sale, the provisions of this Amendment shall control. Whether or not specifically amended by this Amendment, all of the terms and provisions of the Agreement of Sale are hereby amended to the extent necessary to give effect to the purpose and intent of this Agreement.

24.  Counterparts . This Amendment may be executed in any number of identical counterparts, any or all of which may contain the signatures of fewer than all of the Parties but all of which shall be taken together as a single instrument.

25.  Distribution . Counterparts to this Amendment may be executed and delivered by facsimile or other electronic transmission, and for purposes of this Amendment, signatures so transmitted shall be deemed to be original signatures.

[SIGNATURE PAGE FOLLOWS]

1

IN WITNESS WHEREOF, the Parties have executed this Second Amendment as of the day, month and year first written above.

SELLER:

GREENVILLE HOSPITAL SYSTEM ,
a political subdivision organized under the laws of South Carolina

By: /s/ Susan J. Bichel
Name: Susan J. Bichel
Title: Vice President and CFO

BOARD OF TRUSTEES OF GREENVILLE HOSPITAL SYSTEM (aka THE BOARD OF TRUSTEES OF THE GREENVILLE HOSPITAL SYSTEM)

By: /s/ Susan J. Bichel
Name: Susan J. Bichel
Title: Vice and President and CFO

GREENVILLE HEALTH CORPORATION

a South Carolina corporation

By: /s/ Susan J. Bichel
Name: Susan J. Bichel
Title: Vice President and CFO

GHC HEALTH RESOURCES, INC. ,

a South Carolina corporation

By: /s/ Susan J. Bichel
Name: Susan J. Bichel
Title: Secretary/Treasurer

BUYER:

HTA – GREENVILLE , LLC ,

a Delaware limited liability company

By: /s/ Kellie S. Pruitt
Name: Kellie S. Pruitt
Title: Chief Accounting Officer

Exhibit “B”

EXCLUDED PERSONAL PROPERTY