04-Dec-2023
                                                                             Date:_______________

Dr. Felix Holiday
Medical Director
Sint Maarten Medical Center Foundation
Welgelegen Road 30
Cay Hill
Sint Maarten

                Re:     Sint Maarten Hospital Resiliency and Preparedness Project
                        Grant No. TF0A8176
                        Amendment to Grant Agreement

Excellency:

       We refer to the above-referenced Grant Agreement (“Grant Agreement”) between the Sint
Maarten Medical Center Foundation (“Recipient”) and the International Bank for Reconstruction and
Development (“World Bank”), dated August 22, 2018, as amended.

        We also refer to your letter, dated July 18, 2023, requesting the extension of the Closing
Date of the Grant Agreement, and to our discussions.

      In view of the above and our recent discussions, the Bank proposes to amend the Grant
Agreement as follows:

        1.      Section 6.01 is hereby amended to read as follows:

                “6.01. The Recipient’s Representative referred to in Section 7.02 of the Standard
                       Conditions is its Medical Director.”

        2.      Section I.A.1(c) of Schedule 2 is hereby amended to read as follows:

                “(c)    coordination with the relevant ministries and agencies of the Government
                        of Sint Maarten, including, specifically, the Ministry of Public Health,
                        Social Development and Labor (“VSA”), the Sint Maarten Health and
                        Social Insurance Fund (“SZV”), and the National Recovery Program
                        Bureau (“NRPB”), in the implementation of the Project.”

        3.      Section IV.B.2 of Schedule 2 is hereby amended to read as follows:

                “2.     The Closing Date referred to in Section 3.06(c) of the Standard Conditions is
                        May 31, 2025.”

        4.      Paragraph 6 of the Appendix is hereby amended to read as follows:

                “6.     “Co-financiers” means the financial institutions and other lenders set forth in
                        Schedule 1 of the Co-Financing Agreement, namely the following (and any
                        replacement lender appropriately established pursuant to the terms of the Co-
Dr. Felix Holiday                                 -2-                                      04-Dec-2023



                          financing Agreement): (a) Fatum Life N.V.; (b) Stichting Pensioenfonds
                          Fatum; (c) Algemeen Pensioenfonds van Curaçao; (d) Ennia Caribe Leven
                          N.V.; (e) Banco di Caribe N.V.; (f) Foundation Pension Fund Isla Curaçao;
                          (g) Algemeen Pensioenfonds Sint Maarten; (h) The Windward Islands Bank
                          N.V.; and (i) Uitvoeringsorgaan Sociale-en Ziektekosten Verzekeringen.”

          5.      Paragraph 13 of the Appendix is hereby deleted and all remaining paragraphs are
                  renumbered accordingly.

          6.      A new paragraph 29 that reads as follows is hereby added to the Appendix and all
                  remaining paragraphs are renumbered accordingly:

                  “29.    “Training” means the reasonable costs, as shall have been approved by the
                          World Bank, for training conducted under the Project, including tuition,
                          travel and subsistence costs for training participants, costs associated with
                          securing the services of trainers, rental of training facilities, preparation and
                          reproduction of training materials, and other costs directly related to training
                          course preparation and implementation (but excluding goods and consulting
                          services).”

          All other terms and conditions of the Grant Agreement remain in full force and effect.

        Please confirm your agreement with the foregoing amendment, on behalf of the Recipient,
by signing and dating this letter in the spaces provided below. The provisions set forth in this
amendment letter will become effective as of the date of the countersignature, upon receipt by the
Association of one fully executed original of this letter.

        Please also note that the Project Paper dated August 22, 2023 a copy of which is enclosed
herewith, will be disclosed on the World Bank’s external website as per the Bank’s policy on
Access to Information.

                                          Very truly yours,

         INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT



                               By ______________________________
                                         Lilia Burunciuc
                                         Country Director

AGREED:
SINT MAARTEN MEDICAL CENTER FOUNDATION


By:       _________________________
          Authorized Representative
Title:    Medical Director
          _________________________
          05-Dec-2023
Date:     ________________________