Common use of COUNTERSIGNATURE Clause in Contracts

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICIS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: Title: Vice President FOURTH LOAN MODIFICATION AGREEMENT This Fourth Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT') is entered into as of June 29, 2006, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICIS, INC. By: /s/ R. ROBERT SCOTT LENTZ ------------------------------------- Name: R. ScotR▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇le▇▇ Title: SecretaryTreasurer, CFO PICIS US, INC., FORMERLY KNOWN ▇▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. ROBERT SCOTT LENTZ ------------------------------------- Name: R. ScotR▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇le▇▇ Title: SecretaryTreasurer, Treasurer CFO PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT ▇▇▇▇▇ ▇▇OTT LENTZ ------------------------------------- Name: R. ScotR▇▇▇▇▇ ▇▇▇▇▇ ▇▇▇le▇▇ Title: Vice PresidentTreasurer, SecretaryCFO IBEX HEALTHDATA SYSTEMS, Treasurer IBEX HEAL▇▇▇. ▇▇: /▇/ ▇▇▇ERT SCOTT LENTZ ------------------------------------- Name: R▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇leTitle: Secretary Treasurer, CFO BANK: SILICON VALLEY BANK, d/b/a SIBA▇▇, ▇/▇/▇ ▇▇▇▇▇Y ▇▇ VALLEY EAST By: /s/ [illegible signature] DAVID G. RODRIGUEZ ------------------------------------- Name: D▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇▇ Title: Vice President FOURTH THIRD LOAN MODIFICATION AGREEMENT This Fourth Third Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENTLoan Modification Agreement') is entered into as of June 29December __, 20062005, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 0188001580, and PICIS (US, ▇▇▇., ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇, ▇▇▇., a Massachusetts corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, PICIS (WIS▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 ▇ ▇▇0 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an01880, and IBEX H▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇., ▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇ices at 5600 North River Road, Rosemont, Illinois 60018 (jointly and several▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICIS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- --------------------------- Name: R. ScotScott Lentz Title: ▇▇▇▇▇▇▇▇▇ PICIS US, INC., FORMERLY KNOWN AS M▇▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS EMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- --------------------------- Name: R. Scot▇ Scott Lentz Title: ▇▇▇▇▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇By: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: /s/ R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS▇ --------------------------- Name: R. Scott Lentz Title: ▇▇▇▇▇▇▇▇▇ IBEX HEALTHDATA SYSTEMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ /▇/ ▇. ▇▇▇▇▇ LENTZ --------------------------- Name: R. Scott Lentz Title: ▇▇▇le: Secretary ▇▇▇▇▇▇ BANK: SILICON VALLEY BANK, d/b/a SI▇SIL▇▇▇▇ ▇▇▇▇▇Y ▇ EAST By: /s/ [illegible signature] ------------------------------------- DAVID G. RODRIGUEZ --------------------------- Name: TitleDavid G. Rodrig▇▇▇ ▇▇▇▇▇: Vice President FOURTH ▇▇▇▇ ▇▇esident SECOND LOAN MODIFICATION AGREEMENT This Fourth Second Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENTLoan Modification Agreement') is entered into as of June 29__, 20062005, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (US, ▇▇▇., ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇, ▇▇▇., a Massachusetts corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, PICIS (WIS▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 ▇ ▇▇0 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an01880, and IBEX H▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇▇., ▇ ▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇ices at 5600 North River Road, Rosemont, Illinois 60018 (jointly and several▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [remainder of page intentionally left blank] This Fifth Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICIS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Scott Lentz ------------------------------------ Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN S. Len▇▇ ▇▇▇▇▇: ▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer hief Financial Officer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- R. Scott Lentz ------------------------------------ Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇S. Len▇▇ ▇▇▇▇EMS, INC. By▇: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary hief Financial Officer BANK: SILICON VALLEY BANKB▇▇▇, d▇/b▇/a SI▇▇ SILICON VALLEY EAST By: /s/ Jay T. Tracy ------------------------------------ Name: Jay T. T▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: Title: Vice President FOURTH SIXTH LOAN MODIFICATION AGREEMENT This Fourth Sixth Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT') is entered into as of June September 29, 2006, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: PHASE FORWARD INCORPORATED SILICON VALLEY BANK, INC. doing business as SILICON VALLEY EAST By: /s/ R. SCOTT LENTZ ------------------------------------- William G. Porter By: /s/ Jack Gaziano -------------------------- ---------------------------------------- Name: R. Scot▇ William G. Porter Name: Jack Gaziano Title: Vice Presiden▇, ▇▇▇▇▇▇▇ ▇itle: SVP Ph▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. Incorporated SILICON VALLEY BANK By: /s/ R. SCOTT LENTZ ------------------------------------- Maggie Garcia ---------------------------------------- Name: R. Scot▇ Maggie Garcia Title: AVP (Signed in Santa Clara County, California) The undersigned, PHASE FORWARD SECUR▇▇▇▇▇ ▇▇▇le: SecretaryCORPORATION, Treasurer PICIS ratifies, confirms and reaffirms, all and singular, the terms and conditions of a certain Unlimited Guaranty dated May 3, 1999 (WISCONSIN)the "Guaranty") and acknowledges, INCconfirms and agrees that the Guaranty shall remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or delivered in connection herewith. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. PHASE FORWARD SECURITIES CORPORATION By: /s/ R. SCOTT LENTZ ------------------------------------- John J. Schickling ---------------------------------------- Name: R. Scot▇ ▇▇▇John J. Schickling Title: Treasur▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: Title: Vice President FOURTH THIRD LOAN MODIFICATION AGREEMENT This Fourth Third Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENTLoan Modification Agreement') is entered into as of June 29March 31, 20062003, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇prod▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark▇rk, Suite 200, 2221 200,2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ under ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC.▇ASE FORWARD INCORPORATED, a Delaware corporation with offices its principal place of business at 100 Quannapowitt Parkway1440 Main Street, WakefieldWaltham, Massachusetts 01880, and PICIS 02451 (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇Borrower").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: CRITICAL THERAPEUTICS, INC. SILICON VALLEY BANK, doing business as SILICON VALLEY EAST By: /s/ Edith Estabrook By: /s/ R. SCOTT LENTZ ------------------------------------- Bryan Jadot ------------------------------- ---------------------------------- Name: Edith Estabrook Name: R. Scot▇ Bryan Jadot Title: D▇▇▇▇▇ ▇▇▇le, ▇▇▇▇▇▇ions Title: Secretary, CFO PICIS US, INC., FORMERLY KNOWN Vice ▇▇ ▇▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. SILICON VALLEY BANK By: /s/ R. SCOTT LENTZ ------------------------------------- Maggie Garcia ---------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: Maggie Garcia Title: Vice President FOURTH AV▇ (signed in Santa Clara County, Californi▇) THIRD LOAN MODIFICATION AGREEMENT This Fourth Third Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT'Loan Modification Agreement") is entered into as of June 2930, 20062004, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇prod▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark▇rk, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇u▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS▇ITICAL THERAPEUTICS, INC., a Delaware corporation with offices its chief executive office located at 100 Quannapowitt Parkway675 Massachusetts Avenue, Wakefield14th Floor, Cambridge, Massachusetts 01880, and PICIS 02139 (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: CENTRA SOFTWARE, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y doing business as SILICON VALLEY EAST By: /s/ [illegible signature] ------------------------------------- Name: Title: Vice President FOURTH LOAN MODIFICATION AGREEMENT This Fourth Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT') is entered into as of June 29, 2006, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ By: /s/▇▇▇▇▇▇ Tsho ---------------------------------- --------------------------------- Name: ▇▇▇▇▇▇▇ ▇▇ . ▇▇▇ ▇▇▇▇▇▇ Name: ▇▇▇▇▇▇ TSHO -------------------------------- ------------------------------- Title: DIRECTOR OF FINANCE AND ADMIN. Title: VICE PRESIDENT ------------------------------- ------------------------------ SILICON VALLEY BANK By: /s/▇▇▇▇▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business . ▇▇▇▇▇▇▇▇ --------------------------------- Name: ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇▇ ------------------------------- Title: ASST. VICE PRESIDENT ------------------------------ (Signed at Santa ▇▇▇▇" ("▇▇▇▇"▇ County, CA) ▇▇▇ ▇ICISFIRST LOAN MODIFICATION AGREEMENT This First Loan Modification Agreement is entered into as of December 30, 1998, by and between CENTRA SOFTWARE, INC., a Delaware corporation with offices its principal place of business at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ("Borrower") and SILICON VALLEY BANK a California-chartered bank ("Bank"), with its principal place of business at ▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇▇ ▇▇▇▇▇, ▇▇ ▇▇▇▇▇ and with a loan production office located at Wellesley Office Park, ▇▇ ▇▇▇▇▇▇▇, "▇ ▇▇▇▇▇▇▇▇▇ Suite 350, Wellesley, MA 02481, doing business under the name ")Silicon Valley East".

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [The remainder of this page is intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: ROVING SOFTWARE INCORPORATED SILICON VALLEY BANK, INC. doing business as SILICON VALLEY EAST By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- --------------------------------- ------------------------------------ Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- ▇▇ Name: Title: Vice President FOURTH CEO ---------------------------------- Title: --------------------------------- SILICON VALLEY BANK By: ------------------------------------ Name: ---------------------------------- Title: --------------------------------- (signed in Santa ▇▇▇▇▇ County, California) SECOND LOAN MODIFICATION AGREEMENT This Fourth Second Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT'Loan Modification Agreement") is entered into as of June 29February 10, 20062004, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇, ▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇ and with a loan production office located at One Newton Executive Park, Suite 200, ▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇, doing business under the name "Silicon Valley East" ("Bank") and ROVING SOFTWARE INCORPORATED, a Delaware corporation with its chief executive office located at ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway▇▇▇, Wakefield, Massachusetts 01880 (jointly an▇▇▇▇▇ ▇▇▇, ▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, ▇ ("▇▇▇▇▇▇▇▇Borrower").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [The remainder of this page is intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: PHASE FORWARD INCORPORATED SILICON VALLEY BANK, INC. doing business as SILICON VALLEY EAST By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. Ari Buchler By: /s/ R. SCOTT LENTZ ------------------------------------- Michael J Tromack -------------------------- ---------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Ari Buchler Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇leMichael J Tromack Title: Vice President, Secretary, Treasurer IBEX HEALPr▇▇▇▇▇▇▇ ▇▇▇ General Title: Vice Pr▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: Counsel Phase Forward Incorporated SILICON VALLEY BANK, d/b/a SI▇BANK By: /s/ MICHELLE D. GIANNINI ---------------------------------------- Name: MICHELLE D. GIANNINI Title: ASST. ▇▇▇▇ ▇▇▇▇. (signed in Santa Clara County, California) The undersigned, PHASE FORWARD SECUR▇Y EAST ▇▇▇▇ CORPORATION, ratifies, confirms and reaffirms, all and singular, the terms and conditions of a certain Unlimited Guaranty dated May 3, 1999 (the "Guaranty") and acknowledges, confirms and agrees that the Guaranty shall remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or delivered in connection herewith. PHASE FORWARD SECURITIES CORPORATION By: /s/ [illegible signature] ------------------------------------- John J. Schickling ---------------------------------------- Name: John J. Schickling Title: Vice President FOURTH Treasur▇▇ SECOND LOAN MODIFICATION AGREEMENT This Fourth Second Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENTLoan Modification Agreement') is entered into as us of June 29February 28, 20062003, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇prod▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark▇rk, Suite 200, 2221 Washington Street, Newton, Massachusetts Mas▇▇▇▇▇▇etts 02462, doing business ▇u▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC.▇ASE FORWARD INCORPORATED, a Delaware corporation with offices its principal place of business at 100 Quannapowitt Parkway1440 Main Street, WakefieldWaltham, Massachusetts 01880, and PICIS 02451 (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇Borrower").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [remainder of page intentionally left blank] This Fifth Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICIS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Scott Lentz ---------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN Scott Len▇▇ ▇▇▇▇▇: ▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer hief Financial Officer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Scott Lentz ---------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇Scott Len▇▇ ▇▇▇▇EMS, INC. By▇: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary reasurer BANK: SILICON VALLEY BANK, dD/bB/a A SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Michael J. Tramack ---------------------------------- Name: TitleMicha▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇▇e: Senior Vice President FOURTH SEVENTH LOAN MODIFICATION AGREEMENT This Fourth Seventh Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT'") is entered into as of June 29December 26, 2006, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [The remainder of this page is intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICIS, INCBANK: ARCHEMIX CORP. SILICON VALLEY BANK By: /s/ R. SCOTT LENTZ ------------------------------------- ▇▇▇▇▇ ▇▇▇▇▇▇ By: --------------------------------- ------------------------------------ Name: R. Scot▇▇▇▇▇ ▇▇▇▇▇▇ Name: ------------------------------- ---------------------------------- Title: CFO, VP, Secretary Title: ------------------------------ --------------------------------- This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: BANK: ARCHEMIX CORP. SILICON VALLEY BANK By: By: /s/ ▇▇▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ --------------------------------- ------------------------------------ Name: Name: ▇▇▇▇▇▇▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ------------------------------- ---------------------------------- Title: Title: VP ------------------------------ --------------------------------- SCHEDULE 1 The location of Borrower's chief executive office and the Borrower's mailing address is ▇▇▇ ▇▇▇▇▇ ▇▇▇le: Secretary▇▇▇, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT▇▇▇, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC▇. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: Title: Vice President FOURTH SECOND LOAN MODIFICATION AGREEMENT This Fourth Second Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT'Loan Modification Agreement") is entered into as of June 29December 22, 2006, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇, ▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., and with a Delaware corporation with offices loan production office located at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (One ▇▇▇▇▇▇▇▇▇)▇ Executive Park, Suite 200, ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇▇ ("Bank") and ARCHEMIX CORP., a Delaware corporation ("▇▇▇▇▇▇▇▇Borrower").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [The remainder of this page is intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: ONESOURCE INFORMATION SERVICES, INC. SILICON VALLEY BANK, doing business as SILICON VALLEY EAST By: /s/ R. SCOTT LENTZ ------------------------------------- Roy D. Landon By: /s/ Michael Tramack ---------------------------------- ------------------------------ Name: R. Scot▇ Roy D. Landon Name: Michael Tramack ---------------------------- Title: Senior Vice President and CFO Title: Vice President --------------------------- SILICON VALLEY BANK By: /s/ Maggie Garcia ------------------------------ Name: Maggie Garcie ---------------------------- Title: AVP --------------------------- (signed in Santa Clara County, Califor▇▇▇) SCHEDULE 6 TO FIRST LOAN MODIFICATION AGREEMENT BETWEEN SILICON VALLEY BANK AND ONESOURCE INFORMATION SERVICES The Perfection Certificate of OneSource Information Services, Inc. dated as of December 20, 2002, shall be amended as follows: 1. Delete the following addresses appearing in Section 2(d) thereof: 10 Presidents Landing Medford MA 400 Holger ▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: Title: Vice President FOURTH LOAN MODIFICATION AGREEMENT This Fourth Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT') is entered into as of June 29, 2006, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇t in lieu thereof th▇ ▇▇▇▇▇▇▇▇▇: ▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business inter Street Waltham MA 2. Delete the following ▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ng in Section 2(e) thereof: Exodus 10 Presidents Landing Medford MA Exodus ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇ ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (Jose CA Both are ▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ site. And insert in lieu thereof the following: Cable & Wireless 580 Winter Street Waltham MA Hosting fa▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇. ▇. ▇▇▇▇▇, "t the following location at the end of Section 3 (b): Cable & Wireless 580 Winter Street Waltham MA 4. Delete the followin▇ ▇▇▇▇ ▇▇▇▇▇▇▇▇")▇ ▇▇ ▇▇▇▇▇▇▇ ▇(▇) ▇▇▇▇▇▇f: Both are computer hosting facilities for our website. And insert in lieu thereof the following: Computer hosting facilities for our website. 5. Delete the following copyrights and registrations appearing in Section 6(a) thereof: CorpTech EXPLORE Database Pending CorpTech EXPLORE Database GOLD TX-5-338-499 And insert in lieu thereof the following: CorpTech EXPLORE Database TX-5-776-592 CorpTech EXPLORE Database GOLD TX-5-776-591 6. Delete the following list of software appearing in Section 6(b) thereof: NONE And insert in lieu thereof the following: AppLink Catalyst Module for Siebel Catalyst Module for Microsoft Word Catalyst Module for Microsoft Excel 7. Delete the following registered trademark appearing in Section 6(e) thereof:

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISEXCHANGE APPLICATIONS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SISILICON VALLEY EAST By______________________________ By___________________________ President or Vice President Title________________________ By______________________________ Secretary or Ass't Secretary EXSTATIC SOFTWARE, INC., formerly known as GINO BORLAND, INC. By______________________________ President ▇▇ ▇▇▇▇ ▇▇▇▇▇Y EAST ident By: /s/ [illegible signature] ------------------------------------- ______________________________ Secretary or Ass't Secretary The undersigned each ratify confirm and reaffirm, all and singular, the terms and conditions of certain Unconditional Guaranties each dated April 24, 2001 (collectively, the "Guaranty") and a certain Security Agreement dated April 24, 2001 (the "Security Agreement") and acknowledge, confirm and agree that the Guaranty and the Security Agreement remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or delivered in connection herewith. Further, the undersigned each hereby grant to Bank, and reaffirm the grant to Bank of, a continuing security interest in and to the property listed on Exhibit A to the Security Agreement to secure the Obligations. ACTION SYSTEMS, INC. By:___________________________ Name: Title: Vice President FOURTH LOAN MODIFICATION AGREEMENT CUSTOMER ANALYTICS HOLDINGS, INC. By:___________________________ Name: Title: CUSTOMER ANALYTICS, INC. By:___________________________ Name: Title: EXCHANGE APPLICATIONS SECURITIES CORPORATION By:___________________________ Name: Title: KNOWLEDGE STREAM PARTNERS, INC. By:___________________________ Name: Title: This Fourth First Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENTLoan Modification Agreement') is entered into as of June 29_______________, 20062001, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICISXCHANGE APPLICATIONS, INC.. d/b/a Xchange, a Delaware corporation with offices at 100 Quannapowitt ParkwayInc., WakefieldOne Lincoln Plaza, 89 South Street, Boston, Massachusetts 01880, 02110 and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇, ▇▇▇., ▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield▇▇▇., Massachusetts 01880 (jointly an▇ ▇4555 Roosevelt Way Seattle, Washington 98105(her▇▇▇▇▇▇▇▇, ▇▇llective▇▇▇▇▇▇▇, ▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [remainder of page intentionally left blankTHE REMAINDER OF THIS PAGE IS INTENTIONALLY LEFT BLANK] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: MOMENTA PHARMACEUTICALS, INC. SILICON VALLEY BANK, doing business as SILICON VALLEY EAST By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC▇. ▇▇▇▇ By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- ▇ ------------------- ------------------ Name: R. Scot▇ ▇▇▇▇▇▇▇ ▇. ▇▇le▇▇ Name: Secretary BANK: SILICON VALLEY BANK, d/b/a SIR. ▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: ▇ --------------- -------------- Title: Vice President FOURTH LOAN MODIFICATION AGREEMENT This Fourth Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT') is entered into as of June 29, 2006, by and between Chief Financial Officer Title: Vice President ------------------------------------------ -------------- SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, BANK By: [illegible] ----------- Name: [illegible] ----------- Title: Loan Ops Supervisor ------------------- (signed in Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇arkCounty, Suite 200California) EXHIBIT A The Collateral consists of all of Borrower's right, 2221 Washington Streettitle and interest in and to the following: 1. Each item of equipment, Newtonor personal property financed with a "Equipment Advance" pursuant to that certain Loan and Security Agreement, Massachusetts 02462dated as of December 27, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ 2002 (the "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" (Loan Agreement"▇▇▇▇") ▇▇▇ ▇ICIS), INC.by and between Borrower and Bank, a Delaware corporation including, without limitation, the property described in ANNEX A hereto, whether now owned or hereafter acquired, together with offices at 100 Quannapowitt Parkwayall substitutions, Wakefieldrenewals or replacements of and additions, Massachusetts 01880improvements, and PICIS (▇▇▇▇▇▇▇▇▇)accessions to any and all of the foregoing, ▇▇▇and all proceeds from sales, renewals, releases or other dispositions thereof. 2. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt ParkwayAll Borrower's books relating to the foregoing and any and all claims, Wakefieldrights and interest in any of the above and all substitutions for, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇additions, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇attachments, "▇▇▇▇▇▇▇▇")accessories, accessions and improvements to and replacements, products, proceeds and insurance proceeds of any or all of the foregoing.

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and Bank. [remainder of page intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: ATHENAHEALTH, INC. SILICON VALLEY BANK, By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, CFO PICIS US, INC., FORMERLY KNOWN ▇▇ ▇▇▇▇▇▇▇ SYSTEMS MANAGEMENT, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. ▇ By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- ▇ --------------------------------- ------------------------------------ Name: ▇▇▇▇▇▇▇▇ ▇▇▇▇ Name: ▇▇▇▇▇ ▇▇▇▇▇ Title: Vice President FOURTH & CEO Title: RM PATENT APPLICATIONS PATENT DOCKET APPLICATION FILING DESCRIPTION NO. COUNTRY NUMBER DATE STATUS ----------- ------ ------- ----------- ------- ------- "Method for Sharing of Medical Information" USA 60/818,181 6/30/06 Pending Automated Installation and Configuration of USA 60/832,073 7/20/06 Pending Medical Practice Management Systems" "Medical Image Annotation" USA 11/514,469 9/1/06 Pending TRADEMARKS (INCLUDING BUT NOT LIMITED TO) TRADEMARK REGISTRATION REG. DESCRIPTION COUNTRY DATE NO. STATUS ----------- ------- ------------- ------- ------ ATHENAHEALTH** USA July 15, 2003 2737212 Active athenaClinicals None Payerview None ** Originally ▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ TRADEMARK APPLICATIONS TRADEMARK DATE SERIAL DESCRIPTION FILED NUMBER ----------- ------- -------- "RUN A PRACTICE NOT AN OBSTACLE COURSE" 6/12/06 78905735 OLIVE BRANCH (DESIGN) 1/30/06 78802459 NINTH LOAN MODIFICATION AGREEMENT This Fourth Ninth Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENT'Loan Modification Agreement") is entered into as of June January 29, 20062007, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇, ▇▇▇▇▇ ▇▇▇▇▇, ▇▇▇▇ ▇ark, Suite 200, 2221 Washington Street, Newton, Massachusetts 02462, doing business ▇▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇ and with a loan production office located at One Newton Executive Park, Suite 200, ▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC., a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇, ▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇ ("Bank") and ATHENAHEALTH, INC., a Delaware corporation with its chief executive office located at ▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway▇▇▇▇▇, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, ▇ ("▇▇▇▇▇▇▇▇Borrower").

COUNTERSIGNATURE. This Loan Modification Agreement shall become effective only when it shall have been executed by Borrower and BankBank (provided, however, in no event shall this Loan Modification Agreement become effective until signed by an officer of Bank in California). [The remainder of this page is intentionally left blank] This Loan Modification Agreement is executed as a sealed instrument under the laws of the Commonwealth of Massachusetts as of the date first written above. BORROWER: PICISBANK: PHASE FORWARD INCORPORATED SILICON VALLEY BANK, INC. doing business as SILICON VALLEY EAST By: /s/ R. SCOTT LENTZ ------------------------------------- John J. Schickling By: /s/ Michael Tramack ________________________________ ___________________________________ Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇leJohn J. Schickling Name: SecretaryMichael Tramack ______________________________ _________________________________ Title: Senior VP & CFO Title: Vice President _____________________________ ________________________________ SILICON VALLEY BANK By:___________________________________ Name:_________________________________ Title:________________________________ (signed in Santa Clara County, CFO PICIS USCalifornia) The undersigned, INC., FORMERLY KNOWN ▇▇ PHASE FORWARD SE▇▇▇▇▇▇▇ SYSTEMS MANAGEMENTIES CORPORATION, INCratifies, confirms and reaffirms, all and singular, the terms and conditions of a certain Unlimited Guaranty dated May 3, 1999 (the "Guaranty") and acknowledges, confirms and agrees that the Guaranty shall remain in full force and effect and shall in no way be limited by the execution of this Loan Modification Agreement, or any other documents, instruments and/or agreements executed and/or delivered in connection herewith. PHASE FORWARD SECURITIES CORPORATION By: /s/ R. SCOTT LENTZ ------------------------------------- John J. Schickling _________________________________________ Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary, Treasurer PICIS (WISCONSIN), INC. ▇▇: /▇/ ▇. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Vice President, Secretary, Treasurer IBEX HEAL▇▇▇▇▇▇ ▇▇▇▇EMS, INC. By: /s/ R. SCOTT LENTZ ------------------------------------- Name: R. Scot▇ ▇▇▇▇▇ ▇▇▇le: Secretary BANK: SILICON VALLEY BANK, d/b/a SI▇▇▇▇▇ ▇▇▇▇▇Y EAST By: /s/ [illegible signature] ------------------------------------- Name: John J. Schickling Title: Vice President Treasurer FOURTH LOAN MODIFICATION AGREEMENT This Fourth Loan Modification Agreement (this "LOAN MODIFICATION AGREEMENTLoan Modification Agreement') is entered into as of June 29February 27, 20062004, by and between SILICON VALLEY BANK, a California-chartered bank, with its principal place of business at 3003 Tasman Drive, Santa Clara, California 95054 and with a loan pro▇prod▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇ ▇▇ ▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇ ▇ark▇rk, Suite 200, 2221 Washington Street, Newton, Massachusetts Mas▇▇▇▇▇▇etts 02462, doing business ▇u▇▇▇▇ ▇▇▇ ▇▇▇▇ "▇▇▇▇▇▇▇ ▇▇▇▇▇▇ ▇▇▇▇" ("▇▇▇▇") ▇▇▇ ▇ICIS, INC.▇ASE FORWARD INCORPORATED, a Delaware corporation with offices at 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880, and PICIS (▇▇▇▇▇▇▇▇▇), ▇▇▇. ▇ ▇▇▇▇▇▇▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇▇ ▇▇▇▇▇▇▇ ▇t 100 Quannapowitt Parkway, Wakefield, Massachusetts 01880 (jointly an▇ ▇▇▇▇▇▇▇▇▇, ▇▇▇▇▇▇▇▇▇▇▇▇ ▇▇▇ ▇▇▇▇▇▇▇▇▇▇▇▇, "▇▇▇▇▇▇▇▇Borrower").