The World Bank 1818 H Street N.W. (202) 473-6048 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT Washington, D.C. 20433 Cable Address: INTBAFRAD INTERNATIONAL DEVELOPMENT ASSOCIATION U.S.A. Cable Address: INDEVAS CONFORMED COPY December 15, 2011 His Excellency Gheorghe Ialomitianu Minister Ministry of Public Finance Bucharest, Romania Dear Mr. Minister: Health Sector Reform Project – Phase II (Loan No. 4760- RO) Fifth Amendment to the Loan Agreement We refer to the Loan Agreement between Romania (the Borrower) and the International Bank for Reconstruction and Development (the Bank), for the above- referenced Project, dated January 28, 2005 (the Loan Agreement), as amended and your letters dated September 23, 2010 and November 19, 2010, requesting certain amendments to the above mentioned Loan Agreement. We concur with your request and hereby agree to amend the Loan Agreement as follows (the modifications are shown in italics): 1. Article II, Section 2.03 of the Loan Agreement is amended as follows (modifications are shown in italics): “Section 2.03. The Closing Date shall be December 15, 2012, or such later date as the Bank shall establish. The Bank shall promptly notify the Borrower of such later date.� 2. A new table to Schedule 1 of the Loan Agreement is introduced as set out in Annex 1 to this letter. 3. Schedule 2 of the Loan Agreement is amended as follows: 3.1. In Part E a new sub-paragraph 3 is modified to read as follows: “3. Provision of technical assistance to assist the MOH in the preparation and implementation of (i) the National Strategy for Hospital and Sanitary System Rationalization of the Borrower and (ii) the action plan related to the law No. 220 of November 28, 2011 modifying Law 95/2006 on health reform.� Phone (202) 473-6048 Fax (202) 522-2566 H.E. Gheorghe Ialomitianu -2- December 15, 2011 The revised Supplemental Letter is provided separately. All other terms and conditions of the Agreement, except as amended herein, remain unchanged. Please confirm your agreement with the foregoing, on behalf of Romania, by signing, dating and returning to us the enclosed copy of this letter. This amendment will become effective upon the date of your countersigning of this letter. Sincerely, /s/ Peter Harrold Director Central Europe and the Baltic Countries Europe and Central Asia Region AGREED: ROMANIA By /s/ Bogdan Dragoi Authorized Representative Title Secretary of State Date December 15, 2011 cc: H.E. Attila Cseke Minister of Health Ministry of Health Bucharest, Romania Mr. Raed Arafat Undersecretary of State Ministry of Health Bucharest, Romania Mr. Bogdan Dragoi Secretary of State Ministry of Public Finance H.E. Gheorghe Ialomitianu -3- December 15, 2011 Bucharest, Romania Mrs. Angela Carabas Director General Ministry of Public Finance Bucharest, Romania Mr. Ruud Treffers Executive Director World Bank H.E. Gheorghe Ialomitianu -4- December 15, 2011 Annex 1 SCHEDULE 1 Withdrawal of the Proceeds of the Loan 1. The table below sets forth the Categories of items to be financed out of the proceeds of the Loan, the allocation of the amounts of the Loan to each Category and the percentage of expenditures for items so to be financed in each Category: Amount of the Loan % of Allocated Expenditures Category (Expressed in Euro) to be Financed (1) Dispatch equipment 2,850,059 100% of foreign expenditures, 100% of local expenditures (ex- factory) and 80% of local costs for other items procured locally (2) Goods (other than 30,412,960 100% of foreign dispatch equipment) expenditures, 100% of local expenditures (ex- factory) and 80% of local costs for other items procured locally (3) Consultant’s services 999,742 75% of expenditures (including audit) incurred by local consultants; and 85% of expenditures incurred by foreign consultants (4) Training 80,218 100% of foreign expenditures and 75% of local expenditures H.E. Gheorghe Ialomitianu -5- December 15, 2011 Amount of the Loan % of Allocated Expenditures Category (Expressed in Euro) to be Financed (5) Sub-loans under Part C.2 0 100% of the Project (6) Works 338,865 80% (7) Operating costs 414,764 45% (8) Unallocated 0 (9) Goods, dispatch equipment, Consultant services (including audit), training, works and operating costs as of November 26, 2008 30,003,392 74% TOTAL 65,100,000