Exhibit 10.10

**FIFTH AMENDMENT TO LOAN DOCUMENTS**

 

**THIS FIFTH AMENDMENT TO LOAN DOCUMENTS**(the            “Amendment”) is made and            entered into effective as of December 4, 2007, by and among            [i]**ALMOST FAMILY, INC.**, a Delaware            corporation (“AFI”),            [ii] each of the Subsidiaries of AFI that is a party to this Amendment (and whether a            party pursuant to the execution and delivery of this Amendment by the Subsidiary, or by            AFI as agent for same, all of which are Borrowers for the purposes of the Loan            Agreement and the other Loan Documents as modified by this Amendment), and            [iii] **JPMORGAN CHASE BANK, N.A.,**a national banking association (in its individual capacity,            “Chase”), for itself as            a Lender and as Agent for the Lenders            (“Agent”).

**RECITALS**

A.        AFI, various            Subsidiaries of AFI, and Chase, for itself as the Lender and in its capacity as Agent            for Lenders, are parties to a certain Loan and Security Agreement dated August 3, 1999,            as modified by an Omnibus Amendment to Loan Documents dated as of May 30, 2001            (“2001 Amendment”), a            Second Amendment to Loan and Security Agreement (“Second            Amendment”) effective as of November 5, 2002, a Third            Amendment to Loan Documents effective as of March 22, 2004            (“Third Amendment”), and            a Fourth Amendment to Loan Documents (“Fourth            Amendment”) effective as of July 15, 2005            (collectively, the “Loan            Agreement”; certain capitalized terms used in this            Amendment have the meanings set forth for them in the Loan Agreement unless expressly            otherwise defined herein), pursuant to which Lenders agreed to make the Loans to, and            issue Letters of Credit for the account of, Borrowers subject to and in accordance with            the provisions of the Loan Agreement and the other Loan Documents.

B.        Borrowers and Lenders            have agreed, subject to and in accordance with the provisions of this Amendment and the            Loan Documents as modified pursuant to this Amendment [i] to increase the amount of the            Revolving Loan Commitment from $22,500,000 to $40,000,000, [ii] to extend the            expiration date of the Original Term to November 30, 2010, [iii] to modify the manner            in which the Interest Rate is determined, [iv] to modify the manner in which the            Borrowing Base EBITDA Availability is calculated, [v] to modify certain of the            financial covenants, and [vi] as otherwise set forth herein.

**NOW, THEREFORE,**in consideration of the            premises, and for other valuable consideration, the receipt and sufficiency of which            are hereby acknowledged, and intending to be legally bound, it is hereby agreed as            follows:

**ARTICLE I.**

 

**Amendments to Loan Agreement**

Borrowers, Agent, and Lenders agree that, effective as of November 30,            2007 in each case, the Loan Agreement shall be modified as follows:

| 1.1 | Section 2.1A of the Loan Agreement is amended and                            restated in its entirety as follows: |
|-----|-------------------------------------------------------------------------------------------------------------------|

|   | 2.1 | Loans. |
|--------|-----|--------|

A.        Revolving Loan. Each Lender, severally,            agrees to lend to Borrowers from time to time its Pro Rata Share of each Revolving            Advance. The aggregate amount of all Revolving Loan Commitments shall not exceed at any            time $40,000,000, as reduced pursuant to the Section of this Agreement entitled            “Mandatory Prepayments”. Amounts borrowed under thisSection 2.1Amay be repaid and reborrowed            at any time prior to the earlier of (i) the termination of the Revolving Loan            Commitment pursuant to any acceleration of the Obligations as provided hereinafter or            (ii) the Termination Date. Except as otherwise provided herein, no Lender shall have            any obligation to make a Revolving Advance to the extent such Revolving Advance would            cause the Revolving Loan (after giving effect to any immediate application of the            proceeds thereof) to exceed the Maximum Revolving Loan Amount.

[1]       “            Maximum Revolving Loan Amount”means, as of any date of            determination, the lesser of (a) the Revolving Loan Commitment(s) of all Lenderslessthe Letter of Credit Reserve and (b)            the Borrowing Baselessthe Letter            of Credit Reserve.

[2]       “            Borrowing Base”means, as of any date of determination,            an amount equal to thegreaterof            [i] Asset Availability, or [ii] Borrowing Base EBITDA Availability.

[3]       “            Asset Availability”means the sum of [i] eighty-five            percent (85%) of Eligible Accounts that are unpaid not more than ninety (90) days after            the due date specified in the original invoice, or for more than one hundred twenty            (120) days after invoice date if no due date was specified or if such due date is more            than thirty (30) days beyond the specified invoice date, [ii] sixty percent (60%) of            Eligible Accounts that remain unpaid more than ninety (90) days but not more than one            hundred eighty (180) days after the due date specified in the original invoice (or for            more than one hundred twenty (120) days or two hundred ten (210) days, respectively,            after invoice date if no due date was specified or if such due date is more than thirty            (30) days beyond the specified invoice date), and [iii] fifty percent (50%) of Eligible            Inventory, up to a maximum of $750,000. For purposes of determining Asset Availability            pursuant to clauses [i] and [ii] above, any otherwise Eligible Account not billed            within 30 days after the services giving rise to same were rendered or goods were            shipped nevertheless shall be deemed to have been billed, and the related invoice            dated, as of such thirtieth day.

[4]       “            Borrowing Base EBITDA Availability”means, during the            period from and including September 30, 2007 and at all times thereafter, the EBITDA            Multiple times Borrowing Base EBITDA for the immediately preceding twelve (12)            consecutive calendar

 

|   | 2 |
|--------|---|

months for which the monthly financial statements required by the            Reporting Rider have been delivered.

As used in this Agreement, the term            “EBITDA Multiple”for            purposes of determining Borrowing Base EBITDA Availability under this Section 2.1A[4]            means 3.50.

 

1.2       The**Borrowing Base Exhibit (§11.1)**in the form attached to and made a part of this Amendment is substituted            for the form thereof in effect immediately prior to the execution and delivery of this            Amendment.

1.3       The**Interest Rate Margin Schedule (§2.2)**in the form attached to and made a part of this Agreement is substituted            for the form thereof in effect immediately prior to the execution and delivery of this            Amendment.

1.4       November 30, 2010 is agreed            to be the expiration date of the Original Term referred to in Section 2.5 of the Loan            Agreement.

1.5       The**Financial Covenants Rider****(Article            6)**attached to and made a part of this Amendment is            substituted for the form thereof in effect immediately prior to the execution and            delivery of this Amendment.

| 1.6 | The provisions of Section 10.18, captioned                            "Arbitration", are                            deleted. |
|-----|------------------------------------------------------------------------------------------------------------------------------|

1.7       The**Compliance Certificate            Schedule****(§11.1)**in the            form attached to and made a part of this Amendment is substituted for the form thereof            in effect immediately prior to the execution and delivery of this Amendment.

1.8       The amount of            “$1,000,000” is substituted for both the amount of “$500,000”            in the first line, and the amount of “$500,000” in the second line, of the            definition of “Acquisition Threshold” contained in Section 11.1 of the Loan            Agreement.

**ARTICLE            II.**         

**Conditions to Effectiveness**

2.1       The provisions of Article 1            of this Amendment shall become effective when, and only when, Agent shall have received            this Amendment and each of the documents or instruments set forth below (collectively,            for purposes of this Amendment, the “Additional Loan            Documents”, all of which upon the satisfaction of all            the conditions set forth in this Article 2 shall be deemed part of the “Loan            Documents” referred to in the Loan Agreement), executed by the each of the            parties hereto and the parties thereto where provided, respectively, and in form and            substance satisfactory in all respects to Agent in its sole discretion, and when each            of the other conditions set forth below has been satisfied to the satisfaction of            Agent:

A.        A Joinder Agreement            executed and delivered by each Subsidiary of AFI not already a party to the Loan            Agreement;            

 

|   | 3 |
|--------|---|

B.        A new Note to evidence            the Revolving Loan Commitment in the amount of $40,000,000, which instrument shall be            substituted for, but not a novation of, the Note delivered on the Closing            Date;

C.        Certified Resolutions            of the Board of Directors of Borrowers authorizing the execution and delivery by them            of this Amendment;

D.        An opinion of counsel            to Borrowers as to the due authorization, execution and delivery by them of this            Amendment and the $40,000,000 Note and such other matters as Agent reasonably            requests;

E.        Borrowers shall pay to            Agent for the benefit of Lenders [i] a fee in the amount of $100,000 for entering into            this Amendment; and

F.        Agent shall receive            such other documents, instruments and certificates, if any, as Agent may reasonably            request to insure the binding effect in accordance with the terms hereof of the Loan            Agreement and the other Loan Documents as modified by this Amendment and the other            Additional Loan Documents.

**ARTICLE III.**

**Other Provisions**

3.1       Borrowers agree to pay, at            the time of execution and delivery of this Amendment, a fee in the amount of            $100,000.00 to Chase as consideration for its entering into this Amendment.

3.2       Borrowers hereby restate            and confirm each of the representations, warranties and covenants contained in the Loan            Agreement and the other Loan Documents, as modified by this Amendment. Without            limitation of the preceding sentence, Borrowers represent and warrant that this            Amendment has been executed and delivered by a representative of AFI for itself and on            behalf of each of the Borrowers duly authorized to do so and is valid and binding on            Borrowers.

3.3       Borrowers agree to            reimburse Agent for all expenses incurred by Agent and Lenders in connection with the            preparation, execution, delivery and performance of this Amendment, including, without            limitation, for reasonable fees of legal counsel to Agent.

3.4       Except as expressly            modified by this Amendment, all terms and conditions of the Note(s), the Loan            Agreement, the Mortgages and the other Loan Documents shall remain in full force and            effect as they were immediately prior to the execution and delivery of this Amendment,            and those terms and conditions as modified are incorporated herein by this reference            and shall govern this Amendment in all respects. Upon the effectiveness of this            Amendment, each reference in the Note(s), the Loan Agreement and the other Loan            Documents to the terms “Loan Agreement,” “hereunder,”            “hereof, “herein” or words of like import shall mean and be deemed a            reference to the Loan Agreement as modified by this Amendment.

3.5       This Amendment may not be            modified in any respect except in writing signed by the party charged with such            modification. This Amendment constitutes the final, complete and exclusive agreement            among Agent, Lenders and Borrowers concerning its subject matter and

 

|   | 4 |
|--------|---|

neither the Agent, Lenders nor the Borrowers are relying on any oral            agreements or understandings of any nature whatsoever with respect thereto.

3.6       This Amendment shall be            governed by and construed in accordance with the laws of the Commonwealth of            Kentucky.

**< the balance of this page intentionally left blank            >**

 

|   | 5 |
|--------|---|

**IN TESTIMONY WHEREOF,**witness the            signatures on behalf of Borrowers, Agent and Lenders effective as of the date first            above written.

“Borrowers”

**ALMOST FAMILY, INC.,**a Delaware            corporation, for itself as a Borrower and as agent for each of the other Borrowers            under the Loan Agreement

|   | By   /s/ C.                            Steven Guenthner    |
|--------|---------------------------------------------------------------------------|
|   | C. Steven Guenthner

Senior Vice President & Chief Financial

Officer |

             

             

“Agent” and “Lenders”

             

**JPMORGAN CHASE BANK, N.A.,**as Agent and for            itself as a Lender

             

|   | By   /s/ Robert                            E. Miles         |
|--------|----------------------------------------------------------------------------|
|   | Robert E. Miles

Senior Vice President

                              |

             

Attachments

--            Borrowing Base Certificate Exhibit (§11.1)

--            Interest Rate Margin Schedule (§2.2)

--            Financial Covenants Rider (Article 6)

--            Compliance Certificate Schedule (§11.1)

 

|   | 6 |
|--------|---|

**Attachment to**

**Fifth Amendment to Loan Documents**

 

**Borrowing Base Certificate            Exhibit**(§11.1)

**BORROWING BASE CERTIFICATE**

(Almost Family, Inc. and the other Borrowers)

(All            amounts and calculations are determined on a consolidated basis

for            all Borrowers as of the Certificate Effective Date in each case)

(000s omitted throughout)

| 1. | Revolving Loan Commitment(s)                            Availability |
|----|----------------------------------------------------------------------|

             

|   | A. | Revolving Loan Commitment(s) | $40,000 |
|--------|----|------------------------------|---------|

             

Less

 

|   | B. | The sum of the following Mandatory                            Prepayments, |
|--------|----|----------------------------------------------------------------------------|

|   | ifthe effect of same is to                            reduce the Revolving |
|--------|----------------------------------------------------------------------------|

|   | Credit Commitment |
|--------|-------------------|

 

|   | [1] | Proceeds of Asset Dispositions |
|--------|-----|--------------------------------|

|   | (as described in Section 2.4B[2] of the |
|--------|-----------------------------------------|

|   | Loan Agreement) | $_______________ |
|--------|-----------------|------------------|

 

Less

 

|   | C. | The Letter of Credit Reserve calculated, without                            duplication, as follows: |
|--------|----|------------------------------------------------------------------------------------------------------|

             

|   | [1] | All reimbursement and other liabilities of |
|--------|-----|--------------------------------------------|

|   | Borrowers or any of their Subsidiaries with                            respect |
|--------|--------------------------------------------------------------------------------|

|   | to each Lender Letter of Credit, whether contingent                            or |
|--------|-----------------------------------------------------------------------------------|

|   | otherwise including: |
|--------|----------------------|

 

|   | [a] | Amount available to be drawn or |
|--------|-----|---------------------------------|

|   | which may become available |
|--------|----------------------------|

|   | to be drawn | $_______________ |
|--------|-------------|------------------|

 

|   | [b] | All amounts which have been |
|--------|-----|-----------------------------|

|   | paid or made available by any |
|--------|-------------------------------|

|   | Lender issuing a Lender Letter of |
|--------|-----------------------------------|

|   | Credit to the extent not reimbursed | $_______________ |
|--------|-------------------------------------|------------------|

 

 

|   | [c] | All unpaid interest, fees and |
|--------|-----|-------------------------------|

|   | expenses related thereto | $_______________ |
|--------|--------------------------|------------------|

 

|   | 7 |
|--------|---|

 

|   | [2] | Letter of Credit Liability for Lender |
|--------|-----|---------------------------------------|

|   | Letters of Credit |
|--------|-------------------|

|   | (sum of C[1][a] through C[1][c]) | $_______________ |
|--------|----------------------------------|------------------|

 

|   | D. | Revolving Loan Commitment Availability |
|--------|----|----------------------------------------|

|   | (1A minus 1B minus 1C[2]) | $_______________ |
|--------|---------------------------|------------------|

 

| 2. | Asset Availability |
|----|--------------------|

             

|   | A. | 85% of Eligible Accounts unpaid not more than |
|--------|----|-----------------------------------------------|

|   | 90/120 days (see attached Schedule) | $ _______________ |
|--------|-------------------------------------|-------------------|

 

| Plus |  

                              |
|------|--------------------------------------------|

             

|   | B. | 60% of Eligible Accounts unpaid not more than |
|--------|----|-----------------------------------------------|

|   | 180/210 days | $_______________ |
|--------|--------------|------------------|

 

| Plus |  

                              |
|------|--------------------------------------------|

             

|   | C. | 50% of Eligible Inventory (not to exceed                            $750) | $_______________ |
|--------|----|---------------------------------------------------------------------------|------------------|

 

|   | D. | Asset Availability (2A plus 2B plus 2C) | $_______________ |
|--------|----|-----------------------------------------|------------------|

 

| 3. | Borrowing Base EBITDA Availability |
|----|------------------------------------|

 

|   | A. | 3.50 times EBITDA for preceding 12 months | $______________ |
|--------|----|-------------------------------------------|-----------------|

| 4. | Borrowing Base Availability |
|----|-----------------------------|

 

|   | A. | Borrowing Base                            (greaterof 2D or                            3A) | $_______________ |
|--------|----|-------------------------------------------------------------------------------------------|------------------|

             

Less

 

|   | B. | Letter of Credit Liability for Lender |
|--------|----|---------------------------------------|

|   | Letters of Credit (1C[2]) | _______________ |
|--------|---------------------------|-----------------|

 

|   | C. | Borrowing Base Availability |
|--------|----|-----------------------------|

|   | (2A minus 2B) | _______________ |
|--------|---------------|-----------------|

 

| 5. | Maximum Revolving Loan Amount |
|----|-------------------------------|

             

|   | A. | Lesser of line 1D and line 4C | $ _______________ |
|--------|----|-------------------------------|-------------------|

             

|   | B. | Revolving Loans outstanding as of |
|--------|----|-----------------------------------|

|   | Certificate Effective Date | $ _______________ |
|--------|----------------------------|-------------------|

 

 

|   | 8 |
|--------|---|

| C. | Availability as of Certificate Effective Date |
|----|-----------------------------------------------|

|   | (5A minus 5B) | $ _______________ |
|--------|---------------|-------------------|

 

**SCHEDULE OF ELIGIBLE ACCOUNTS RECEIVABLE**

(All            amounts and calculations are determined on a consolidated basis

for            all Borrowers as of Calculation Effective Date in each case)

|   | A. | Gross Accounts Receivable | $ _______________ |
|--------|----|---------------------------|-------------------|

Minus

|   | B. | Accounts that are not Eligible Accounts (SeeSection |
|--------|----|-----------------------------------------------------|

2.1Bfor complete criteria)

 

|   | [1] | Payable more than 180 days after date of |
|--------|-----|------------------------------------------|

|   | invoice issuance | $ _______________ |
|--------|------------------|-------------------|

 

|   | [2] | Unpaid more than 180 days after due date |
|--------|-----|------------------------------------------|

specified in invoice, or 210 days if no due

|   | date was specified | _______________ |
|--------|--------------------|-----------------|

 

|   | [3] | Credits due from Borrowers to account |
|--------|-----|---------------------------------------|

|   | debtors of Borrowers | _______________ |
|--------|----------------------|-----------------|

 

|   | [4] | Account debtor located outside U.S. | _______________ |
|--------|-----|-------------------------------------|-----------------|

 

|   | [5] | Account debtor that an Agent has identified |
|--------|-----|---------------------------------------------|

|   | as having unsatisfactory credit standing | _______________ |
|--------|------------------------------------------|-----------------|

 

|   | [6] | Account (other than Medicare and Medicaid) |
|--------|-----|--------------------------------------------|

|   | for which debtor is U.S. Government or |
|--------|----------------------------------------|

|   | instrumentality, and no Assignment of |
|--------|---------------------------------------|

|   | Claims compliance | _______________ |
|--------|-------------------|-----------------|

 

|   | [7] | Account debtor is Affiliate of Borrowers |
|--------|-----|------------------------------------------|

|   | or a director, officer, agent, stockholder or |
|--------|-----------------------------------------------|

|   | employee of any Borrower or any of their |
|--------|------------------------------------------|

|   | Affiliates | _______________ |
|--------|------------|-----------------|

|   | [8] | Accounts as to which more than 25% |
|--------|-----|------------------------------------|

of aggregate accounts are unpaid more

than 180 days after due date

|   | (210 if no due date specified) | _______________ |
|--------|--------------------------------|-----------------|

 

|   | [9] | Accounts subject to unresolved |
|--------|-----|--------------------------------|

|   | dispute to extent of the dispute | _______________ |
|--------|----------------------------------|-----------------|

 

|   | [10] | Evidenced by instrument not in |
|--------|------|--------------------------------|

|   | possession of Agent, on behalf of Lenders | _______________ |
|--------|-------------------------------------------|-----------------|

 

 

|   | 9 |
|--------|---|

|   | [11] | Accounts not subject to first priority Lien                            of |
|--------|------|---------------------------------------------------------------------------|

|   | Agent, on behalf of Lenders | _______________ |
|--------|-----------------------------|-----------------|

 

|   | [12] | Accounts subject to Lien of a Person other |
|--------|------|--------------------------------------------|

|   | than Agent not a Permitted Encumbrance | ________________ |
|--------|----------------------------------------|------------------|

 

|   | [13] | Accounts from account debtors subject to |
|--------|------|------------------------------------------|

|   | bankruptcy or insolvency | ________________ |
|--------|--------------------------|------------------|

 

|   | [14] | Accounts from an account debtor in excess of |
|--------|------|----------------------------------------------|

|   | 20% of all Accounts due from that same |
|--------|----------------------------------------|

|   | account debtor at the Certificate Date | ________________ |
|--------|----------------------------------------|------------------|

 

|   | [15] | Accounts for which account debtor’s |
|--------|------|-------------------------------------------|

obligation to pay is conditional

|   | (e.g., bill and hold; consignment) | _______________ |
|--------|------------------------------------|-----------------|

 

|   | [16] | Account for which account debtor is located |
|--------|------|---------------------------------------------|

in New Jersey or other applicable state and

Borrower hasn’t either qualified there or

filed Notice of Business Activities

|   | Report or similar filing | _______________ |
|--------|--------------------------|-----------------|

 

|   | [17] | Accounts for which account debtor is |
|--------|------|--------------------------------------|

creditor of Borrower, to extent of credits

|   | owed by Borrower | _______________ |
|--------|------------------|-----------------|

 

|   | [18] | Subtotal [1 through 17] | $ _______________ |
|--------|------|-------------------------|-------------------|

 

|   | C. | Eligible Accounts [A minus B18] | $ _______________ |
|--------|----|---------------------------------|-------------------|

 

**AGING SUMMARY OF ACCOUNTS RECEIVABLE**

(All            amounts and calculations are determined on a consolidated basis

for            all Borrowers as of Certificate Effective Date in each case)

| Current | $___________________ |
|---------|----------------------|

 

| 1 to 30 days past due | $___________________ |
|-----------------------|----------------------|

 

| 31 to 60 days past due | $___________________ |
|------------------------|----------------------|

 

| 61 to 90 days past due | $___________________ |
|------------------------|----------------------|

 

| 91 to 120 days past due | $___________________ |
|-------------------------|----------------------|

 

| 121 to 150 days past due | $___________________ |
|--------------------------|----------------------|

 

 

|   | 10 |
|--------|----|

| 151 to 180 days past due | $___________________ |
|--------------------------|----------------------|

 

| Over 180 days past due | $___________________ |
|------------------------|----------------------|

 

| Total Accounts Receivable | $___________________ |
|---------------------------|----------------------|

 

(Reconcile to line 1 of calculation of

Eligible Accounts Receivable)

 

**AGING SUMMARY OF ACCOUNTS PAYABLE**

(All            amounts and calculations are determined on a consolidated basis

for            all Borrowers as of Certificate Effective Date in each case)

 

| Current | $___________________ |
|---------|----------------------|

 

| 1 to 30 days past due | $___________________ |
|-----------------------|----------------------|

 

| 31 to 60 days past due | $___________________ |
|------------------------|----------------------|

 

| 61 to 90 days past due | $___________________ |
|------------------------|----------------------|

 

| 91 to 120 days past due | $___________________ |
|-------------------------|----------------------|

 

| Over 120 days past due | $___________________ |
|------------------------|----------------------|

 

| Total Accounts Payable | $___________________ |
|------------------------|----------------------|

 

|   | 11 |
|--------|----|

**Attachment to**

**Fifth Amendment to Loan Documents**

 

**Interest Rate Margin Schedule**(§2.2)

**to**

**Loan and Security Agreement**

As of each Interest Calculation Date commencing December 31, 2007, the            Base Rate Margin and the LIBOR Margin and the Unused Line Fee, respectively, shall be            that percentage increment as set forth below according to the ratio (being the Leverage            Ratio as defined in the**Financial Covenants            Rider**) of Total Funded Debt of Borrowers as of such            Interest Calculation Date divided by EBITDA of Borrowers during the Applicable            Calculation Period ending on such Interest Calculation Date:

 

| LEVEL                                                                                                                                                           | RATIO  | BASE RATE

MARGIN | LIBOR

MARGIN | UNUSED

LINE FEE |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------|--------|-------------------|---------------|------------------|
| 1.           Less                            than or equal to 1.00 to 1.00                               | -1.50  | 1.25              | 0.250         |
| 2. Greater than 1.00 to 1.00 and less than or equal to                            1.00 to 1.50                                                                  | -1.25  | 1.50              | 0.250         |
| 3. Greater than 1.50 to 1.00 and less than or equal to                            2.00 to 1.00                                                                  | -1.00  | 1.75              | 0.250         |
| 4. Greater than 2.00 to 1.00 and less than or equal to                            2.50 to 1.00                                                                  | -0.75  | 2.00              | 0.350         |
| 5.           Greater                            than 2.50 to 1.00 and less than or equal to 3.00 to 1.00 | -0.50  | 2.25              | 0.350         |
| 6.           Greater                            than 3.00 to 1.00                                        | -0.25  | 2.50              | 0.350         |
|                                                                                                                                                            |   |              |          |
|                                                                                                                                                            |   |              |          |

 

From the effective date of this Amendment until December 31, 2007, the            Base Rate Margin and LIBOR Margin and Unused Line Fee shall be assumed to be and            applied in accordance with Level 2 above, regardless of the actual Leverage Ratio            during that period.

 

|   | 12 |
|--------|----|

**Attachment to**

**Fifth Amendment to Loan Documents**

**Financial Covenants Rider**(Article            6)

**to**

**Loan and Security Agreement**

The consolidated financial statements of Borrowers shall, as of the end            of each fiscal quarter of Borrowers after September 30, 2007, reflect compliance with            the following financial covenants, determined in accordance with GAAP:

A.        The Adjusted Fixed            Charge Coverage Ratio for each Applicable Calculation Period shall not be less than            1.75 to 1.00.

B.        The ratio            (“Leverage Ratio”) of            Total Funded Debt as of the date of calculation divided by EBITDA during the Applicable            Calculation Period ending on such date of calculation shall not be greater than 3.50 to            1.00.

C.        Net Worth shall never            be less than the sum of [i] $18,500,000, plus [ii] 80% of net income, without giving            effect to any losses, during each fiscal quarter of Borrowers beginning with the            quarter ending September 30, 2007.

D.        Capital Expenditure Limits. The aggregate            amount of all Capital Expenditures, Capital Leases with respect to fixed assets of            Borrowers and their Subsidiaries (which shall be considered to be expended in full on            the date such Capital Lease is entered into) and other contracts with respect to fixed            assets initially capitalized on Borrowers’ or any Subsidiary’s balance            sheet prepared in accordance with GAAP (which shall be considered to be expended in            full on the date such contract is entered into) (excluding, in each case, expenditures            for trade-ins and replacement of assets to the extent funded with casualty insurance            proceeds) will not exceed the amount of $5,000,000.00 during each Applicable            Calculation Period.

 

|   | 13 |
|--------|----|

**Attachment to**

**Fifth Amendment to Loan Documents**

**Compliance Certificate Schedule**(§11.1)

**to**

**Loan and Security Agreement**

**COMPLIANCE CERTIFICATE**

This Compliance Certificate is being delivered to JPMorgan Chase Bank,            N.A., a national banking association (in its individual capacity            “Chase”), for itself as            a Lender and as Agent for the Lenders, as that term is defined herein, pursuant to            Section 5.6 of that certain Loan and Security Agreement dated as of August 3, 1999, as            amended, among [i] Almost Family, Inc., a Delaware corporation (f/k/a Caretenders            Health Corp.) and each of the other Borrowers that are parties thereto (referred to            hereinafter each individually as a            “Borrower”and            collectively as the            “Borrowers”), [ii] the            financial institution(s) that are parties thereto and their respective successors and            Eligible Assignees (each individually a            “Lender”and            collectively “Lenders”)            and [iii] Chase, for itself as a Lender and as agent            (“Agent”) for the            Lenders (together with all amendments, modifications and supplements thereto and all            restatements thereof, the “Loan            Agreement”). All capitalized terms used herein without            definition shall have the meanings assigned to those terms in the Loan Agreement. The            undersigned Chief Financial Officer of Almost Family, Inc., for itself as a Borrower            and as agent for the other Borrowers, hereby certifies on behalf of each of the            Borrowers that, as of the last day of the most recently ended fiscal quarter,            ____________________ _____, 200__ (the “Compliance            Date”):

| 1. | Ratio                            Requirements. |
|----|------------------------------------------------|

|   | A. | The Adjusted Fixed Charge Coverage Ratio for theApplicable Calculation Periodin effect as of the Compliance Date (being the four                            consecutive complete fiscal quarters of Borrowers ending ____________                            200_), was _____ to 1.00 calculated as follows (all amounts in the                            following calculations are determined for Borrowers and their                            Subsidiaries on a consolidated basis) [Reference Financial Covenants                            Rider to the Loan Agreement and Section 11.1 of the Loan                            Agreement]: |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | [1] | Net income determined in accordance with GAAP | __________ |
|--------|-----|-----------------------------------------------|------------|

plus, to the extent included in the calculation of net

income the sum of

|   | [2] | Income and franchise taxes paid or accrued | __________ |
|--------|-----|--------------------------------------------|------------|

|   | [3] | Interest expense, net of interest income, paid or                            accrued | __________ |
|--------|-----|--------------------------------------------------------------------------------------|------------|

|   | [4] | Amortization and depreciation expense | __________ |
|--------|-----|---------------------------------------|------------|

|   | [5] | Extraordinary or non-recurring “cash”                            losses |
|--------|-----|-------------------------------------------------------------------------------------|

|   | acceptable to Agent | __________ |
|--------|---------------------|------------|

 

|   | 14 |
|--------|----|

|   | [6] | Extraordinary or non-recurring non-cash                            charges |
|--------|-----|----------------------------------------------------------------------------|

|   | acceptable to Agent | __________ |
|--------|---------------------|------------|

less, to the extent included in the calculation of net income the sum            of

|   | [7] | The income of any Person (other than                            wholly-owned |
|--------|-----|------------------------------------------------------------------------------|

Subsidiaries of Borrowers) in which any Borrower or a

wholly owned Subsidiary of a Borrower has an ownership

interest except to the extent such income is received by

Borrowers or such wholly-owned Subsidiary in a cash

|   | distribution during such period | __________ |
|--------|---------------------------------|------------|

             

|   | [8] | Gains from sales or other dispositions of |
|--------|-----|-------------------------------------------|

assets (other than Inventory in the normal

|   | course of business) | __________ |
|--------|---------------------|------------|

|   | [9] | Extraordinary or non-recurring gains | __________ |
|--------|-----|--------------------------------------|------------|

|   | [10] | EBITDA: ([1]+([2]+[3] +[4]+[5]+[6]) |
|--------|------|-------------------------------------|

|   | -([7]+[8]+[9]) | __________ |
|--------|----------------|------------|

|   | [11] | Interest expense | __________ |
|--------|------|------------------|------------|

|   | [12] | Income tax expense | __________ |
|--------|------|--------------------|------------|

|   | [13] | Current maturities of long term debt | __________ |
|--------|------|--------------------------------------|------------|

|   | [14] | Current maturities of payments due under |
|--------|------|------------------------------------------|

|   | Capital Leases | __________ |
|--------|----------------|------------|

|   | [15] | Dividends and distributions | __________ |
|--------|------|-----------------------------|------------|

|   | [16] | Adjusted Fixed Charges: (Total of [11] |
|--------|------|----------------------------------------|

|   | through [15]) | $_________ |
|--------|---------------|------------|

|   | Calculation: [10] divided by [16] | __________ |
|--------|-----------------------------------|------------|

Required: not less than 1.75 to 1.00

|   | B. | The ratio (the                            “LeverageRatio”) of Total Funded Debt divided by EBITDA, for the                            Applicable Calculation Period in effect as of the Compliance Date, was                            _____ to _____ calculated as follows (all amounts in the following                            calculation are determined for Borrowers and their Subsidiaries on a                            consolidated basis) [Reference Financial Covenants Rider to the Loan                            Agreement and Section 11.1 of the Loan Agreement]: |
|--------|----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | [1] | Indebtedness for borrowed money | __________ |
|--------|-----|---------------------------------|------------|

 

|   | 15 |
|--------|----|

|   | [2] | Indebtedness under Capital Leases | __________ |
|--------|-----|-----------------------------------|------------|

|   | [3] | Subordinated Debt | __________ |
|--------|-----|-------------------|------------|

|   | [4] | Mandatorily redeemable preferred stock | __________ |
|--------|-----|----------------------------------------|------------|

|   | [5] | Contingent debt obligations including under |
|--------|-----|---------------------------------------------|

|   | letters of credit | __________ |
|--------|-------------------|------------|

|   | [6] | Total Funded Debt: [1]+[2]+[3]+[4]+[5] | __________ |
|--------|-----|----------------------------------------|------------|

|   | [7] | EBITDA: Section 1A [10] above | __________ |
|--------|-----|-------------------------------|------------|

|   | Calculation: [6] divided by [7] | __________ |
|--------|---------------------------------|------------|

|   | Required: | Not greater than 3.50 to 1.00. |
|--------|-----------|--------------------------------|

 

|   | C. | The Net Worth of the Borrowers as of the Compliance Date                            was _____________ ([3] below) [Reference Financial Covenants Rider to                            Loan Agreement and Section 11.1 of the Loan Agreement]: |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | [1] | Capital stock and additional paid-in capital | __________ |
|--------|-----|----------------------------------------------|------------|

|   | [2] | Retained earnings (or less accumulated                            deficit) |
|--------|-----|----------------------------------------------------------------------------|

|   | calculated in conformity with GAAP | __________ |
|--------|------------------------------------|------------|

             

|   | [3] | Net Worth [1]+[2] | __________ |
|--------|-----|-------------------|------------|

|   | Required: | Not less than the sum of [i] $18,500,000, plus [ii] 80%                            of net income, without giving effect to any losses, during each fiscal                            quarter of Borrowers, commencing with the fiscal quarter of Borrowers                            that ends on September 30, 2007. |
|--------|-----------|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | [i] | $18,500,000 |
|--------|-----|-------------|

             

|   | + | [ii] | ___________ |
|--------|---|------|-------------|

|   | Total: | ___________ |
|--------|--------|-------------|

|   | D. | The aggregate amount of all Capital Expenditures,                            Capital Leases with respect to fixed assets of Borrowers and their                            Subsidiaries (which shall be considered to be expended in full on the                            date such Capital Lease is entered into) and other contracts with                            respect to fixed assets initially capitalized on Borrowers’ or                            any Subsidiary’s balance sheet prepared in accordance with GAAP                            (which shall be considered to be expended in full on the date such                            contract is entered into) (excluding, in each case, expenditures for                            trade-ins and replacement of assets to the extent funded with casualty                            insurance proceeds) during the Applicable Calculation Period ending as                            of the Compliance Date was _____________ |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

             

|   | 16 |
|--------|----|

calculated as follows [Reference Financial Covenants Rider to Loan            Agreement and Section 11.1 of the Loan Agreement]:

|   | [1] | Capital Expenditures | __________ |
|--------|-----|----------------------|------------|

|   | [2] | Capital Leases with respect to fixed assets                            of| |
|--------|-----|----------------------------------------------------------------------------|

Borrowers and their Subsidiaries (which shall be

considered to be expended in full on the date such

|   | Capital Lease is entered into) | __________ |
|--------|--------------------------------|------------|

|   | [3] | Other contracts with respect to fixed assets |
|--------|-----|----------------------------------------------|

initially capitalized on Borrowers’ or any

Subsidiary’s balance sheet prepared in accordance

with GAAP (which shall be considered to be

expended in full on the date such contract is

entered into) (excluding, in each case, expenditures

for trade-ins and replacement of assets to

the extent funded with casualty

|   | insurance proceeds) | __________ |
|--------|---------------------|------------|

|   | Calculation: [1]+[2]+[3] | __________ |
|--------|--------------------------|------------|

             

|   | Required: |
|--------|-----------|

not greater than $5,000,000 during each Applicable Calculation            Period

| 2. | Covenants. |
|----|------------|

Indebtedness and Liabilities. Since the            immediately preceding Compliance Date, no Borrower nor any Subsidiary of any Borrower            has incurred or assumed any new or additional Indebtedness in excess of the limits            proscribed by Section 7.1 of the Loan Agreement, other than [if any such new or            additional prohibited Indebtedness has been incurred or assumed by any Borrower or any            Subsidiary of any Borrower, described the amount and nature of the prohibited            Indebtedness, the assets securing the same, if any, and the holder thereof] [Reference            Section 7.1 of the Loan Agreement].

|   | A. | Guaranties. Since the                            immediately preceding Compliance Date, no Borrower has consummated any                            of the transactions prohibited by Section 7.2 of the Loan Agreement,                            other than [if any Borrower consummated any of the transactions                            prohibited by Section 7.2 of the Loan Agreement, describe such                            transactions in detail] [Reference Section 7.2 of the Loan                            Agreement]. |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | B. | Transfers, Liens and Related                            Matters. Since the immediately preceding                            Compliance Date, no Borrower has consummated any of the transactions                            prohibited by Section 7.3 of the Loan Agreement, other than [if any                            Borrower consummated any of the transactions prohibited by Section 7.3                            of the Loan Agreement, describe such transactions in detail] [Reference                            Section 7.3 of the Loan Agreement]. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

 

|   | 17 |
|--------|----|

|   | C. | Investments and Loans.                            Since theimmediatelypreceding Compliance Date, no Borrower has made or                            permitted to exist any investments in or any loans to any other Person                            prohibited by Section 7.4 of the Loan Agreement, other than [if any                            Borrower made or permitted to exist any investments in or any loans to                            any Person prohibited by Section 7.4 of the Loan Agreement, describe                            such investments and/or loans in detail] [Reference Section 7.4 of the                            Loan Agreement]. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | D. | Restricted Junior Payments.                            Since the immediately preceding Compliance Date, no Borrower has                            directly or indirectly declared, ordered, paid, made or set apart any                            sum for any Restricted Junior Payment prohibited by Section 7.5 of the                            Loan Agreement, other than [if any Borrower declared, ordered, paid,                            made or set apart any sum for any Restricted Junior Payment prohibited                            by Section 7.5 of the Loan Agreement, describe such transactions in                            detail] [Reference Section 7.5 of the Loan Agreement]. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | E. | Restriction on Fundamental                            Changes. Since the immediately preceding                            Compliance Date, no Borrower has consummated any of the transactions                            prohibited by Section 7.6 of the Loan Agreement, other than [if any                            Borrower consummated any of the transactions prohibited by Section 7.6                            of the Loan Agreement, describe such transactions in detail] [Reference                            Section 7.6 of the Loan Agreement]. |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | F. | Changes Relating to Subordinated                            Debt. Since the immediately preceding                            Compliance Date, no Borrower has changed or amended the terms of the                            Subordinated Debt as prohibited by Section 7.7 of the Loan Agreement,                            other than [if any Borrower has changed or amended the terms of the                            Subordinated Debt as prohibited by Section 7.7 of the Loan Agreement,                            describe such changes or amendments in detail] [Reference Section 7.7                            of the Loan Agreement]. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | G. | Transactions with                            Affiliates. Since the immediately preceding                            Compliance Date, no Borrower has consummated any of the transactions                            prohibited by Section 7.8 of the Loan Agreement, other than [if any                            Borrower consummated any of the transactions prohibited by Section 7.8                            of the Loan Agreement, describe such transactions in detail] [Reference                            Section 7.8 of the Loan Agreement]. |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | H. | Conduct of Business. Since                            the immediately preceding Compliance Date, no Borrower has engaged in                            any business other than businesses of the type engaged in by any such                            Borrower on the Closing Date, other than [if any Borrower has engaged                            in any business other than businesses of the type engaged in by any                            such Borrower on the Closing Date describe any such business(es) in                            detail] [Reference Section 7.9 of the Loan Agreement]. |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | I. | Tax Consolidations. Since                            the immediately preceding Compliance Date, no Borrower has filed or                            consented to the filing of any consolidated income tax return with any                            Person other than [if any Borrower has filed or consented to                            the |
|--------|----|---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

             

|   | 18 |
|--------|----|

filing of any consolidated income tax return with any Person describe            such filing in detail] [Reference Section 7.10 of the Loan Agreement].

|   | J. | Subsidiaries. Since the                            immediately preceding Compliance Date, no Borrower has established,                            created or acquired any Subsidiaries other than [if any Borrower has                            established, created or acquired any Subsidiaries describe such                            Subsidiaries in detail] [Reference Section 7.11 of the Loan                            Agreement]. |
|--------|----|-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | K. | Fiscal Year; Tax                            Designation. Since the immediately preceding                            Compliance Date, no Borrower has changed its Fiscal Year or elected to                            be designated as an entity other than a C Corporation as defined in IRC                            other than [if any Borrower has changed its Fiscal Year or elected to                            be designated as an entity other than a C Corporation as defined in IRC                            describe any such change(s) in detail] [Reference Section 7.12 of the                            Loan Agreement]. |
|--------|----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | L. | Press Release; Public Offering                            Materials. Since the immediately preceding                            Compliance Date, no Borrower has disclosed the name of Agent or any                            Lender in any press release or in any prospectus, proxy statement or                            other materials filed with any governmental entity relating to a public                            offering of the capital stock of any Loan Party except as may be                            required by law other than [if any Borrower has disclosed the name of                            Agent or any Lender in any press release or in any prospectus, proxy                            statement or other materials filed with any governmental entity                            relating to a public offering of the capital stock of any Loan Party                            except as may be required by law describe any such disclosure(s) in                            detail] [Reference Section 7.13 of the Loan Agreement]. |
|--------|----|----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | M. | Bank Accounts. Since the                            immediately preceding Compliance Date, no Borrower has established any                            new bank accounts, or attempted to amend or terminate any Blocked                            Account or lockbox agreement without Agents’ prior written                            consent other than [if any Borrower has established any new bank                            accounts, or attempted to amend or terminate any Blocked Account or                            lockbox agreement without Agent’s prior written consent describe                            any such new bank accounts or amendments or terminations to any Blocked                            Account or lockbox agreement in detail] [Reference Section 7.14 of the                            Loan Agreement] |
|--------|----|------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | N. | Operating Leases. Since the                            immediately preceding Compliance Date, no Borrower has entered into any                            lease or rental agreement that is not a Capital Lease except [if                            Borrower has entered into such an agreement, describe in reasonable                            detail] [Reference Section 7.15 of the Loan Agreement]. |
|--------|----|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

|   | O. | Environmental Compliance.                            No Borrower has, since the immediately preceding Compliance Date, [i]                            failed to comply with all Environmental Laws or [ii] as applicable,                            created, permitted to exist, or obtained knowledge of any claims,                            liabilities, Liens, investigations, litigation, administrative                            proceedings, whether pending or threatened, or judgments or orders                            relating to any Hazardous Materials asserted or threatened against any                            Loan Party or relating to any real property currently or formerly                            owned, leased or operated by any Loan Party other than [if |
|--------|----|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|

             

|   | 19 |
|--------|----|

any Borrower has created, permitted to exist or obtained knowledge of            any such matters describe any such matters in detail][Reference Section 5.15 of the            Loan Agreement].

The undersigned Chief Financial Officer of Almost Family, Inc. executing            and delivering this Compliance Certificate on behalf of Almost Family, Inc., for itself            as a Borrower and for the other Borrowers, further certifies that ____________ has            reviewed the Loan Agreement and has no knowledge of any event or condition which            constitutes an Event of Default under the Loan Agreement or the other Loan Documents            other than [if any Event of Default has occurred, describe the same, the period of            existence thereof and what action the any Borrower has taken or proposes to take with            respect thereto].

**IN WITNESS WHEREOF**, Almost Family, Inc.,            for itself as a Borrower and as agent for the other Borrowers, through its duly            authorized Chief Financial Officer, has executed this Compliance Certificate this _____            day of _______________, 200__.

**ALMOST FAMILY, INC.**, a Delaware            corporation, for itself as a Borrower and as agent for the other Borrowers

|   | By: | ______________________________ |
|--------|-----|--------------------------------|

             

|   | Name: | ______________________________ |
|--------|-------|--------------------------------|

             

|   | Title: | ______________________________ |
|--------|--------|--------------------------------|

             

             

 

 

|   | 20 |
|--------|----|

**JOINDER AND AMENDMENT TO LOAN            DOCUMENTS**

             

**THIS JOINDER AND AMENDMENT TO LOAN            DOCUMENTS**(the “Joinder            Agreement”) is made and entered into as of December 4,            2007, by and among [i]**ALMOST FAMILY, INC.,**a Delaware corporation            (“AFI”), and each of the            other Borrowers that are parties to the Loan Agreement described below (referred to in            this Joinder Agreement each as an “Original            Borrower” and collectively as the            “Original Borrowers”),            [ii] each subsidiary of AFI listed onExhibit Ahereto (each, a “New            Entity” and collectively, the            “New Entities”), and            [iii]**JPMORGAN CHASE BANK, N.A.,**a            national banking association (“Chase”) acting in its capacity as agent            (“Agent”) for itself as            aLenderand the otherLendersthat are parties to the Loan            Agreement described below (each a            “Lender” and            collectively the            “Lenders”).

**RECITALS**:

A.    The Original Borrowers, Agent and Lenders are parties to a certain Loan            and Security Agreement, dated as of August 3, 1999 (together with any amendments            thereto, the “Loan            Agreement”; certain capitalized terms used in this            Joinder Agreement have the meanings set forth for them in the Loan Agreement unless            expressly otherwise defined herein), pursuant to which, among other things, the Lenders            established a $40,000,000.00 Revolving Credit Loan in favor of the Original            Borrowers.

B.        AFI or            one of its subsidiaries, has caused the New Entities to be organized (referred to in            this Joinder Agreement as the            “Organization”).

C.        Pursuant            to the Loan Agreement, the Original Borrowers and each New Entity must, as a condition            to the consummation of the Organization, enter into this Joinder Agreement and the            other Joinder Agreement Documents defined below, pursuant to which each New Entity will            become jointly and severally liable for all of the Obligations, grant and pledge a            first and prior security interest in all of its personal property and, if requested by            Agent in accordance with the provisions of the Loan Documents, all or part of its real            property and fixtures, as part of the Collateral for the Obligations, and otherwise be            obligated and bound by the covenants, conditions, representation and warranties and            other provisions of the Loan Documents binding upon the Original Borrowers thereunder            just as though each New Entity originally was a party thereto.

**NOW, THEREFORE,**in            consideration of the premises and the mutual covenants and agreements set forth in this            Joinder Agreement and for other good and valuable consideration, the mutuality, receipt            and sufficiency of which are hereby acknowledged, the Original Borrowers, each New            Entity and the Agent hereby agree as follows:

**ARTICLE 1**

**Joinder to and Amendment of Loan Agreement and            Other Loan Documents**

Subject to, and immediately and automatically upon,            execution and delivery to the Agent of each of the            “Joinder Agreement            Documents” more particularly described in Article 2 of            this Joinder Agreement:

1.1       Each New            Entity is hereby joined as a Borrower to the Loan Agreement and each of the other Loan            Documents.

1.2       Without            limitation of Section 1.1, each New Entity is hereby joined as a Borrower to each of            the Notes and jointly and severally promises and agrees to pay the indebtedness            evidenced thereby in accordance with the provisions thereof.

|   | 1.3 | Each New Entity covenants and agrees to comply                            with: |
|--------|-----|---------------------------------------------------------------------------------|

A.        all of            the covenants contained in the “Affirmative Covenants” Article of the Loan            Agreement from the date of execution of this Joinder Agreement until all Obligations            have been fully paid and any Commitments of the Lenders to the Borrowers have been            terminated;

 

B.        all of            the covenants contained in the “Negative Covenants” Article of the Loan            Agreement from the date of execution of this Joinder Agreement until all Obligations            have been fully paid and any Commitments of the Lenders to the Borrowers have been            terminated; and

C.        all of            the other terms, conditions, covenants, agreements and obligations of each Borrower to            be performed under and pursuant to the Loan Agreement and each of the other Loan            Documents to which Borrowers are a party.

1.4       Each New            Entity makes, as of the date of this Joinder Agreement, all of the representations and            warranties contained in the “Representations and Warranties” Article of the            Loan Agreement, which shall be continuing in nature and remain in full force and effect            until the Obligations are paid in full, and which shall be true and            correct.

1.5       Each New            Entity hereby grants to Agent, for the benefit of the Lenders, all of its Accounts,            Inventory, Equipment and other Collateral, as security for the payment and performance            of the Note and the other Obligations, in accordance with the provisions of the Loan            Agreement.

1.6       Each            Original Borrower(s), as applicable, grant to Agent all of the membership interests of            each New Entity owned by them, respectively, as security for the Obligations, on all of            the terms and conditions of the Stock Pledge Agreement.

1.7       The            Capitalization Schedule and each other Exhibit, Schedule or Rider to the Loan Agreement            referenced in and modified pursuant toExhibit Battached to and made a part of this Agreement are and shall be deemed            modified accordingly.

 

2

**ARTICLE 2**

**Conditions Precedent**

             

2.1       The joinder            of each New Entity to each of the Loan Agreement, the Notes, and the Security Agreement            and the other Loan Documents described in Article 1 of this Joinder Agreement shall            become effective on that date (the “Effective            Date”) on which each of the following documents, in            form and substance satisfactory to Agent (collectively, the            “Joinder Agreement            Documents”) has been executed by each of the parties to            them and delivered to the Agent and when the Agent determines to its satisfaction that            each other condition set forth below has been fulfilled:

A.        This            Joinder Agreement, duly executed by or on behalf of each of the Original Borrowers,            each New Entity, and the Agent;

B.        Certified            Resolutions of the Board of Directors and/or the sole member of each New Entity            authorizing the execution and delivery by it of this Joinder            Agreement;

C.        UCC-1            Financing Statement(s) naming the New Entities as the Debtor and the Agent as the            Secured Party for filing in all offices where necessary or appropriate to perfect the            security interest of Agent in the Collateral;

D.        If            requested by Agent, landlord waiver(s) executed by each landlord of each New Entity,            and Mortgage(s) of all real property owned or leased by each New Entity together with            such surveys, policy of loan title insurance and other related items that Agent            reasonably may request;

E.         If            requested by Agent, an opinion of counsel to each New Entity as to the due            authorization, execution and delivery by each New Entity of each of the Joinder            Documents to which it is a party and such other matters as Agent reasonably            requests;

 

|   | F. | the Pro-forma Organization Information; |
|--------|----|-----------------------------------------|

             

|   | G. | The completion of the Organization. |
|--------|----|-------------------------------------|

H.        Such            other documents and fulfillment of such other conditions as Agent reasonably may            request.

**ARTICLE 3**

**Other Stipulations**

             

3.1       Each New            Entity acknowledges its receipt of a complete copy of the Loan Agreement and each and            every other presently existing Loan Document referred to or referenced in the Loan            Agreement.

3.2       Upon the            Effective Date, the provisions of Article 1 of this Joinder Agreement shall become            effective and modify or supersede and replace the applicable provisions of the Loan            Agreement and the other Loan Documents recited as being modified by them and each            New

 

3

Entity shall be joined as a party to the Loan Agreement,            the Notes, and all of the other Loan Documents to which the Original Borrowers are            parties. From and after the Effective Date each reference to the “Loan            Agreement” and the “Loan Documents” or words of like import shall            mean and be deemed a reference to, as applicable, the Loan Agreement and Loan Documents            as modified by this Joinder Agreement but, except as modified by this Joinder Agreement            and the other Joinder Agreement Documents, the Loan Agreement and the other Loan            Documents shall remain in full force and effect in the same form as existed immediately            prior to the Effective Date.

3.3       If each of            the Joinder Agreement Documents has not been fully executed and delivered to the Agent            on or before December 31, 2007, this Joinder Agreement shall be voidable at any time            prior to the delivery of each of such Joinder Agreement Document upon notice given by            AFI to the Agent or Agent to AFI.

3.4       This Joinder            Agreement and the other Joinder Agreement Documents contain the final, complete and            exclusive agreement of the parties to them with regard to their subject matter, may not            be amended except in writing signed by each of the parties to them, shall be binding            upon and inure to the benefit of the respective successors and assigns of each of the            parties to them (subject to applicable provisions of, as applicable, the Loan Agreement            and the Loan Documents), and shall be construed in accordance with and otherwise            governed in all respects by the laws of the Commonwealth of Kentucky. This Joinder            Agreement may be executed in counterparts, and all counterparts collectively shall            constitute but one original document. Each of the Original Borrowers and each New            Entity hereby agrees to reimburse the Agent for all costs and expenses incurred by the            Agent in connection with the preparation, negotiation, documentation, execution and            delivery of this Joinder Agreement and the other Joinder Agreement Documents, including            but not limited to the reasonable fees of legal counsel to Agent.

3.5          Each            of the Original Borrowers join in this Joinder Agreement for the purpose of consenting            to the provisions of the foregoing Joinder Agreement, and each of the Original            Borrowers confirm and agree that its and their respective obligations under, as            applicable, the Note and the other Loan Documents shall be unimpaired by this Joinder            Agreement and that no Original Borrower has any defenses or set offs against the Agent            or Lenders, or their respective officers, directors, employees, agents or attorneys            with respect to, as applicable, the Note or the other Loan Documents and that all of            the terms, conditions and covenants in the Loan Documents remain unaltered and in full            force and effect and are hereby ratified and confirmed.

 

4

**IN WITNESS WHEREOF**, the            parties hereto have caused this Joinder Agreement to be duly executed as of the day and            year first above written.

**“Agent”**

             

**JPMORGAN CHASE BANK, N.A.**

             

By:/s/ Robert E.            Miles       

|   | Name:Robert E.                            Miles |
|--------|-------------------------------------------------|

|   | Title: | Sr. Vice President |
|--------|--------|--------------------|

**“Original Borrowers”**

             

**ALMOST FAMILY, INC.,**a            Delaware corporation, for itself as a Borrower and as agent and attorney-in-fact for            the other Original Borrowers pursuant to the grant and provision for same under the            Loan Agreement

|   | By   /s/ C.                            Steven Guenthner    |
|--------|---------------------------------------------------------------------------|
|        | C. Steven Guenthner

Senior Vice President & Chief Financial

Officer |

             

**ADULT DAY CARE OF AMERICA, INC.,**

a Delaware corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**ADULT DAY CARE OF LOUISVILLE,            INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**ADULT DAY CLUBS OF AMERICA JOINT VENTURE            LTD.,**a Delaware corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

5

             

**CARETENDERS HOMECARE, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS INFUSION CORP.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS INFUSION OF BIRMINGHAM, INC.,**an Alabama corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF BIRMINGHAM, INC.,**

an Alabama corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF BOSTON, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF CHARLOTTE, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

6

**CARETENDERS OF CINCINNATI, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF CLEVELAND, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF COLUMBUS, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF ELIZABETHTOWN, INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF EVANSVILLE, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF FORT LAUDERDALE, INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF INDIANA, INC.,**

an Indiana corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|

 

 

7

 

|  | C. Steven Guenthner

Secretary and Treasurer |
|--|----------------------------------------------|

             

**CARETENDERS OF INDIANAPOLIS,            INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF LOUISVILLE, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF MARSHALL COUNTY, INC.,**an Alabama corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF NEW JERSEY, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF NORTHERN KENTUCKY, INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF RICHMOND, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

8

             

**CARETENDERS OF SOUTHWEST FLORIDA, INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS OF THE BLUEGRASS, INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS OF WEST PALM BEACH, INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES EMPLOYMENT COMPANY,            INC.,**a

Kentucky corporation formerly known as Caretenders HME of            Florida, Inc.

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF CENTRAL INDIANA,            INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF CINCINNATI,            INC.,**a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

9

**CARETENDERS VISITING SERVICES**

**OF SOUTHEAST FLORIDA, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS VISITING SERVICES**

**OF SOUTHWEST FLORIDA, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**FREELIFE MEDICAL EQUIPMENT,            INC.,**

an Alabama corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**HOME HEALTH OF JEFFERSON COUNTY, INC.,**a Georgia corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**HOUSECALLS OF AMERICA, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**HOUSECALLS, INC.,**a Delaware            corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

10

**METRO HOME CARE, INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**NATIONAL HEALTH INDUSTRIES,            INC.**,

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**NATIONAL ORTHOPEDIC & REHABILITATION SERVICES,            INC.,**

an Alabama corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**PRO-CARE HOME HEALTH OF BROWARD, INC.,**a Florida corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**RELIABLE HOME HEALTH CARE, INC.,**

an Ohio corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**SPECIAL HEALTHCARE SERVICES,            INC.,**

a Kentucky corporation

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

11

**“New Entities”**

             

**ALMOST FAMILY PC OF FT. LAUDERDALE            LLC**    

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **ALMOST FAMILY PC OF                            KENTUCKY, LLC** |
|--------|------------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**ALMOST FAMILY PC OF SW FLORIDA,            LLC** 

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **ALMOST FAMILY PC OF                            WEST PALM, LLC** |
|--------|-------------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS MOBILE MEDICAL SERVICES,            LLC**        

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **CARETENDERS OF                            JACKSONVILLE, LLC** |
|--------|-----------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

12

**CARETENDERS VISITING SERVICES OF COLUMBUS,            LLC**    

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF COOK COUNTY,            LLC**          

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF DISTRICT 6,            LLC**     

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF DISTRICT 7,            LLC**     

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF GAINESVILLE,            LLC**              

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF HERNANDO COUNTY,            LLC**            

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

13

**CARETENDERS VISITING SERVICES OF KENTUCKIANA,            LLC**          

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF OCALA,            LLC**               

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF ORLANDO,            LLC**       

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF PINELLAS COUNTY,            LLC** 

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF SOUTHERN ILLINOIS,            LLC**             

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**CARETENDERS VISITING SERVICES OF ST. AUGUSTINE,            LLC**   

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

14

             

**CARETENDERS VISITING SERVICES OF ST. LOUIS,            LLC**  

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **CARETENDERS VS OF                            BOSTON, LLC** |
|--------|--------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **CARETENDERS VS OF                            CENTRAL KY, LLC** |
|--------|------------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **CARETENDERS VS OF                            LOUISVILLE, LLC** |
|--------|------------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**CARETENDERS VS OF NORTHERN KY,            LLC**    

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **CARETENDERS VS OF                            WESTERN KY, LLC** |
|--------|------------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

 

15

             

**MEDERI CARETENDERS VS OF BROWARD,            LLC**    

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **MEDERI CARETENDERS VS                            OF SE FL, LLC** |
|--------|--------------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

|   | **MEDERI CARETENDERS VS                            OF SW FL, LLC** |
|--------|--------------------------------------------------------------------|

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

**MEDERI CARETENDERS VS OF TAMPA,            LLC**    

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

             

**PRINCETON HOME HEALTH, LLC**

             

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

             

Attachments:

 

Exhibit A:  List of New            Entities

Exhibit B: Modified Exhibit, Schedules or            Riders

 

16

**EXHIBIT A**

**List of New Entities**

 

| **name of new entity and federal Identification                            Number**             | **state of organization** | **ORGANIZATIONAL ID NUMBER** |
|-------------------------------------------------------------------------------------------------|---------------------------|------------------------------|
| **Almost Family PC of Kentucky, LLC**

**26-1259925**                                           | **kentucky**              | **0675489**                  |
| **Almost Family PC of Ft. Lauderdale,                            LLC**

**26-1261522**          | **florida**               | **l07000103414**             |
| **Almost Family PC of SW Florida, LLC**

**26-1261522**                                         | **Florida**               | **l07000103411**             |
| **Almost Family PC of West Palm, LLC**

**26-1263982**                                          | **Florida**               | **l07000103413**             |
| **Caretenders of Jacksonville, LLC**

**20-5898994**                                            | **FLORIDA**               | **l06000110767**             |
| **Caretenders VS of Boston, LLC**

**26-1259391**                                               | **Massachusetts**         | **000962269**                |
| **Caretenders VS of Western KY, LLC**

**26-1258938**                                           | **kentucky**              | **0675497**                  |
| **Caretenders VS of Northern KY, LLC**

**26-1259246**                                          | **kentucky**              | **0675495**                  |
| **Caretenders VS of Central KY, LLC**

**26-1259391**                                           | **kentucky**              | **0675492**                  |
| **Caretenders VS of Louisville, LLC**

**26-1264112**                                           | **kentucky**              | **0675491**                  |
| **CARETENDERS VISITING SERVICES OF COLUMBUS,                            LLC**

**20-8428138**   | **OHIO**                  | **1676001**                  |
| **Caretenders Visiting Services of Cook**

**County, LLC**

**20-5826574**                      | **illinois**              | **02013231**                 |
| **Caretenders Visiting Services of District 6,                            LLC**

**65-0747432** | **kentucky**              | **0565533**                  |
| **Caretenders Visiting Services of District 7,                            LLC**

**30-0425714** | **kentucky**              | **0565534**                  |
| **Caretenders Visiting Services of**

**Gainesville, LLC**

**30-0425715**                      | **FLORIDA**               | **l05000016996**             |
| **Caretenders Visiting Services of**

**Hernando County, LLC**

**20-5825497**                  | **FLORIDA**               | **l06000104096**             |
| **Caretenders Visiting Services of**

**Kentuckiana, LLC**

**20-5826598**                      | **kentucky**              | **0615538**                  |

 

17

 

| **Caretenders Visiting Services of                            Ocala,**

**LLC**

**20-4522444** | **FLORIDA**  | **l06000028455** |
|-------------------------------------------------------------------------------------------------|--------------|------------------|
| **Caretenders Visiting Services of**

**Orlando, LLC**

**30-0425717**                          | **FLORIDA**  | **m04000004879** |
| **Caretenders Visiting Services of**

**Pinellas County, LLC**

**20-5826531**                  | **FLORIDA**  | **l06000104100** |
| **Caretenders Visiting Services of**

**Southern Illinois, LLC**

**20-5826553**                | **ILLINOIS** | **02013258**     |
| **Caretenders Visiting Services of St.**

**Augustine, LLC**

**20-2910357**                    | **FLORIDA**  | **l05000052409** |
| **Caretenders Visiting Services of St.**

**Louis, LLC**

**20-5826598**                        | **missouri** | **lc0774505**    |
| **Princeton Home Health, LLC**

**20-5081107**                                                  | **alabama**  | **dll 480-611**  |
| **Caretenders Mobile Medical Services,                            LLC**

**26-1162933**         | **ohio**     | **1726247**      |
| **Mederi Caretenders VS of Tampa, LLC**

**26-1162933**                                         | **florida**  | **l07000104055** |
| **Mederi Caretenders VS of SE FL, LLC**

**26-1264234**                                         | **florida**  | **l07000103410** |
| **Mederi Caretenders VS of SW FL, LLC**

**26-1264384**                                         | **florida**  | **l07000103412** |
| **Mederi Caretenders VS of Broward, LLC**

**26-1264504**                                       | **florida**  | **l07000103409** |

 

 

18

**EXHIBIT B**

**Modified Exhibit, Schedules or            Riders**

 

19

**CAPITALIZATION SCHEDULE**

 

 

| **CORPORATIONS**                                                             |
|------------------------------------------------------------------------------|
|  

**Name**

                                                      |  

**Authorized Capital Stock** | **Number of**

**Issued and Outstanding Shares** |
| 1. Almost Family, Inc.                                                       | 10,000,000 shares of common stock, par value $.10 per                            share

2,000,000 shares of Series Preferred Stock, $.05 par                            value per share consisting of 66,600 shares of Series A Preferred                            Stock, par value $.05 per share and 100,000 shares of Series B Junior                            Participating Preferred Stock, par value $.05 per share | As of 9/30/07 Balance Sheet: 7,658,628 shares of common                            stock |
| 2. Adult Day Care of America, Inc.                                           | 1,000 shares of common stock, $.001 par value per                            share | 1,000 |
| 3. Adult Day Care of Louisville, Inc.                                        | 1,000 shares | 100 |
| 4. Adult Day Clubs of America Joint Venture,                            Ltd. | 1000 shares of common stock, $.01 par value per                            share | 1,000 |
| 5. Caretenders Homecare, Inc.                                                | 2,000 shares common stock, no par value | 100 |
| 6. Caretenders Infusion Corp.                                                | 1,000 shares common stock, no par value | 100 |
| 7. Caretenders Infusion of Birmingham, Inc.                                  | 5,000 shares common stock, no par value | 1,000 |
| 8. Caretenders of Birmingham, Inc.                                           | 5,000 shares common stock, no par value | 1,000 |
| 9. Caretenders of Boston, Inc.                                               | 1,000 shares common stock, no par value | 100 |
| 10. Caretenders of Charlotte, Inc.                                           | 1,000 shares | 100 |
| 11. Caretenders of Cincinnati, Inc.                                          | 1,000 shares | 100 |
| 12. Caretenders of Cleveland, Inc.                                           | 1,000 shares | 100 |
| 13. Caretenders of Columbus, Inc.                                            | 1,000 shares | 100 |
| 14. Caretenders of Elizabethtown, Inc.                                       | 1,000 shares common stock, no par value | 100 |
| 15. Caretenders of Evansville, Inc.                                          | 1,000 shares | 100 |
| 16. Caretenders of Fort Lauderdale, Inc.                                     | 1,000 shares | 100 |
| 17. Caretenders of Indiana, Inc.                                             | 1,000 shares, $1.00 par value per share | 100 |
| 18. Caretenders of Indianapolis, Inc.                                        | 1,000 shares | 100 |
| 19. Caretenders of Louisville, Inc.                                          | 1,000 shares of common stock, no par value |   |
| 20. Caretenders of Marshall County, Inc.                                     | 1,000 shares of common stock, $1.00 par value per                            share | 1,000 |
| 21. Caretenders of New Jersey, Inc.                                          | 1,000 shares | 100 |
| 22. Caretenders of Northern Kentucky, Inc.                                   | 1,000 shares of common stock, no par value | 100 |
| 23. Caretenders of Richmond, Inc.                                            | 1,000 shares common stock, no par value | 100 |
| 24. Caretenders of Southwest Florida, Inc.                                   | 1,000 shares | 100 |

 

 

20

 

| 25. Caretenders of The Bluegrass, Inc.                                                  | 1,000 shares common stock, no par value                                                | 100   |
|-----------------------------------------------------------------------------------------|----------------------------------------------------------------------------------------|-------|
| 26. Caretenders of West Palm Beach, Inc.                                                | 1,000 shares                                                                           | 100   |
| 27. Caretenders Visiting Services Employment,                            Inc.           | 1,000 shares                                                                           | 100   |
| 28. Caretenders Visiting Services of Central Indiana,                            Inc.   | 1,000 shares                                                                           | 100   |
| 29. Caretenders Visiting Services of Cincinnati,                            Inc.        | 1,000 shares                                                                           | 100   |
| 30. Caretenders Visiting Services of Southeast Florida,                            Inc. | 1,000 shares                                                                           | 100   |
| 31. Caretenders Visiting Services of Southwest Florida,                            Inc. | 1,000 shares                                                                           | 100   |
| 32. Freelife Medical Equipment, Inc.                                                    | 1,000 shares, $.01 par value per share                                                 | 850   |
| 33. HHJC Holdings, Inc.                                                                 | 1,000 shares of common stock, $.01 par value per                            share      | 1,000 |
| 34. Home Health of Jefferson County, Inc.                                               | 500 shares of common stock ,$1.00 par value per                            share       | 500   |
| 35. Housecalls of America, Inc.                                                         | 2,000 shares common stock, no par value                                                | 1,000 |
| 36. Housecalls, Inc.                                                                    | 1,000 shares of common stock, $.001 par value per                            share     | 1,000 |
| 37. Metro Home Care, Inc.                                                               | 1,000 shares, no par value                                                             | 1,000 |
| 38. National Health Industries, Inc.                                                    | 1,000 shares of common stock without par                            value              | 1,000 |
| 39. National Orthopedic & Rehabilitation Services,                            Inc.  | 2,000 shares, $.01 par value per share                                                 | 1,000 |
| 40. Pro-Care Home Health of Broward, Inc.                                               | 2,000,000 shares of common stock, $.001 par value per                            share | 100   |
| 41. Reliable Home Healthcare, Inc.                                                      | 750 shares of common stock ,without par value                                          | 100   |
| 42. Special Healthcare Services, Inc.                                                   | 2,000 shares of common stock, without par                            value             | 1,000 |

 

 

| **limited liability companies**                                               |
|-------------------------------------------------------------------------------|
| **Name**                                                                      | **Ownership** |
| 43. Almost Family PC of Ft. Lauderdale, LLC                                   | 100% by National Health Industries, Inc. |
| 44. Almost Family PC of Kentucky, LLC                                         | 100% by National Health Industries, Inc. |
| 45. Almost Family PC of SW Florida, LLC                                       | 100% by National Health Industries, Inc. |
| 46. Almost Family PC of West Palm, LLC                                        | 100% by National Health Industries, Inc. |
| 47. Caretenders Mobile Medical Services, LLC                                  | 100% by National Health Industries, Inc. |
| 48. Caretenders of Jacksonville, LLC                                          | 100% by Caretenders Visiting Services of Southeast                            Florida, Inc. |
| 49. Caretenders Visiting Services of Columbus,                            LLC | 100% by National Health Industries, Inc. |

 

 

21

 

| 50. Caretenders Visiting Services of Cook County,                            LLC | 100% by National Health Industries, Inc. |
|----------------------------------------------------------------------------------|------------------------------------------|

| 51. Caretenders Visiting Services of District 6,                            LLC        | 100% by Caretenders Visiting Services of Southwest                            Florida, Inc.    |
|----------------------------------------------------------------------------------------|------------------------------------------------------------------------------------------------|
| 52. Caretenders Visiting Services of District 7,                            LLC        | 100% by Caretenders Visiting Services of Southeast                            Florida, Inc.    |
| 53. Caretenders Visiting Services of Gainesville,                            LLC       | 100% by Caretenders Visiting Services of Southeast                            Florida, Inc.    |
| 54. Caretenders Visiting Services of Hernando County,                            LLC   | 100% by National Health Industries, Inc.                                                       |
| 55. Caretenders Visiting Services of Kentuckiana,                            LLC       | 100% by Housecalls of America, Inc.                                                            |
| 56. Caretenders Visiting Services of Ocala,                            LLC             | 100% by Caretenders Visiting Services of Southeast                            Florida, Inc.    |
| 57. Caretenders Visiting Services of Orlando,                            LLC           | 100% by Caretenders Visiting Services of Southeast                            Florida, Inc.    |
| 58. Caretenders Visiting Services of Pinellas County,                            LLC   | 100% by National Health Industries, Inc.                                                       |
| 59. Caretenders Visiting Services of Southern Illinois,                            LLC | 100% by National Health Industries, Inc.                                                       |
| 60. Caretenders Visiting Services of St. Augustine,                            LLC     | 100% by Caretenders Visiting Services of Southeast of                            Florida, Inc. |
| 61. Caretenders Visiting Services of St. Louis,                            LLC         | 100% by National Health Industries, Inc.                                                       |
| 62. Caretenders VS of Boston, LLC                                                      | 100% by National Health Industries, Inc.                                                       |
| 63. Caretenders VS of Central KY, LLC                                                  | 100% by National Health Industries, Inc.                                                       |
| 64. Caretenders VS of Louisville, LLC                                                  | 100% by National Health Industries, Inc.                                                       |
| 65. Caretenders VS of Northern KY, LLC                                                 | 100% by National Health Industries, Inc.                                                       |
| 66. Caretenders VS of Western KY, LLC                                                  | 100% by National Health Industries, Inc.                                                       |
| 67. Mederi Caretenders VS of Broward, LLC                                              | 100% by National Health Industries, Inc.                                                       |
| 68. Mederi Caretenders VS of SE FL, LLC                                                | 100% by National Health Industries, Inc.                                                       |
| 69. Mederi Caretenders VS of SW FL, LLC                                                | 100% by National Health Industries, Inc.                                                       |
| 70. Mederi Caretenders VS of Tampa, LLC                                                | 100% by National Health Industries, Inc.                                                       |
| 71. Princeton Home Health, LLC                                                         | 100% by Caretenders of Birmingham, Inc.                                                        |

 

 

 

22

**PROMISSORY NOTE**

(Revolving Credit - Chase Note)

| $40,000,000.00 | December 4, 2007 |
|----------------|------------------|

 

**FOR VALUE RECEIVED,**[i]**ALMOST FAMILY, INC.**, a Delaware corporation            (“AFI”), and            [ii]the undersigned Subsidiaries of AFI (AFI and each of the            undersigned Subsidiaries of AFI are referred to hereinafter each individually as a            “Maker” and collectively            as the “Makers”), each            hereby jointly and severally promises to pay to the order of**JPMORGAN CHASE****BANK,            N.A.**, anational banking association            (the “Payee”), on or            before the Termination Date (as defined in the Loan Agreement defined below), the            lesser of (x) the principal amount of Forty Million and No/100 Dollars            ($40,000,000.00), or (y) the unpaid aggregate principal amount of Revolving Loans made            by the Payee to the Makers pursuant to the Loan Agreement referred to            below.

The Makers also each jointly and severally promise to pay            interest on the unpaid principal amount hereof until paid at the rates, at the times            and from the dates which shall be determined in accordance with the provisions of that            certain Loan and Security Agreement dated as of August 3, 1999, as amended            (collectively, together with all future amendments, restatements, supplements and            modifications thereto from time to time, the “Loan            Agreement”; capitalized terms used herein without            definition shall have the meanings assigned to those terms in the Loan Agreement),            entered into by and among [i] the Makers, [ii] the financial institution(s) listed on            the signature pages thereof, and their respective successors and Eligible Assignees            (each individually a            “Lender” and            collectively “Lenders”)            and [iii] JPMorgan Chase Bank, N.A., a national banking association, for itself as a            Lender (“Chase”) and as            Agent (“Agent”) under            the Loan Agreement.

This Note is one of the “Revolving Notes” and            is issued pursuant to and is entitled to the benefits of the Loan Agreement to which            reference is hereby made for a more complete statement of the terms and conditions            under which the Revolving Loans evidenced hereby were or are made and are to be repaid.            The Note evidences indebtedness formerly evidenced by, but is not a novation of, the            Promissory Note (Revolving Credit - BOK Note) dated as of May 30, 2001 and made by            certain of Makers to the order of Lender in face principal amount of $22,500,000 (the            “Prior Note”), and this            Note shall be entitled to all of the benefits of the Collateral that secured the Prior            Note, and in the same relative priority, to the maximum extent permitted by            law.

All payments of principal and interest in respect of this            Note shall be made in lawful money of the United States of America in same day funds at            the office of the Agent located at 416 West Jefferson Street, Louisville, Kentucky, or            at such other place as shall be designated in writing for such purpose in accordance            with the terms of the Loan Agreement. Until notified in writing of the transfer of this            Note, the Makers and the Agent shall be entitled to deem the Payee or such person who            has been so identified by the transferor in writing to the Makers and the Agent as the            holder of this Note, as the owner and holder of this Note. Each of the Payee and any            subsequent holder of this Note agree that before disposing of this Note or any part            hereof it will make a notation hereon or in its records of all principal payments            previously

made hereunder and of the date to which interest hereon            has been paid;provided,however, that the failure to make a            notation of any payment made on this Note shall not limit or otherwise affect the            obligations of each of the Makers hereunder with respect to payments of principal or            interest on this Note.

Whenever any payment on this Note shall be stated to be            due on a day which is not a Business Day, such payment shall be made on the next            succeeding Business Day and such extension of time shall be included in the computation            of the payment of interest on this Note;provided,however, that if the day on which any            payment relating to a LIBOR Loan is due is not a Business Day but is a day of the month            after which no further Business Day occurs in such month, then the due date thereof            shall be the next preceding Business Day.

This Note is subject to prepayment at the option of the            Makers, as well as certain mandatory prepayments, all as provided in Section 2.4 of the            Loan Agreement.

This Note is subject to restriction on transfer or            assignment as provided in the Loan Agreement.

THE LOAN AGREEMENT AND THIS NOTE SHALL BE GOVERNED BY,            AND SHALL BE CONSTRUED AND ENFORCED IN ACCORDANCE WITH, THE INTERNAL LAWS OF THE            COMMONWEALTH OF KENTUCKY, WITHOUT REGARD TO CONFLICTS OF LAWS            PRINCIPLES.

Upon the occurrence of an Event of Default, the unpaid            balance of the principal amount of this Note may become, or may be declared to be, due            and payable in the manner, upon the conditions and with the effect provided in the Loan            Agreement.

The terms of this Note are subject to amendment only in            the manner provided in the Loan Agreement.

No reference herein to the Loan Agreement and no            provision of this Note or the Loan Agreement shall alter or impair the obligation of            each of the Makers, which are absolute, unconditional, joint and several, to pay the            principal of and interest on this Note at the place, at the respective times, and in            the currency herein prescribed.

Each of the Makers jointly and severally promises to pay            all reasonable costs and expenses of Agent and Lenders, including reasonable fees and            expenses of counsel, as provided in the Loan Agreement. Each of the Makers hereby            consents to all renewals and extensions of time at or after the maturity hereof,            without notice, and each Maker hereby jointly and severally waives diligence,            presentment, protest, demand and notice of every kind and, to the full extent permitted            by law, the right to plead any statute of limitations as a defense to any demand            hereunder.

<the balance of this page intentionally has been left            blank>

 

|   | 2 |
|--------|---|

**IN WITNESS WHEREOF**, the            Makers have caused this Note to be executed and delivered by their respective duly            authorized officers, as of the day and year and the place first above            written.

(the "Makers")

 

**ALMOST FAMILY, INC.,**a            Delaware corporation, for itself as a Borrower and as agent and attorney-in-fact for            the other Original Borrowers pursuant to the grant and provision for same under the            Loan Agreement

|   | By   /s/ C.                            Steven Guenthner    |
|--------|---------------------------------------------------------------------------|
|        | C. Steven Guenthner

Senior Vice President & Chief Financial

Officer |

 

**ADULT DAY CARE OF AMERICA, INC.,**

a Delaware corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**ADULT DAY CARE OF LOUISVILLE,            INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**ADULT DAY CLUBS OF AMERICA JOINT VENTURE            LTD.,**a Delaware corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS HOMECARE, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 3 |
|--------|---|

**CARETENDERS INFUSION CORP.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS INFUSION OF BIRMINGHAM, INC.,**an Alabama corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF BIRMINGHAM, INC.,**

an Alabama corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF BOSTON, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF CHARLOTTE, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF CINCINNATI, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF CLEVELAND, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 4 |
|--------|---|

 

**CARETENDERS OF COLUMBUS, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF ELIZABETHTOWN, INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF EVANSVILLE, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF FORT LAUDERDALE, INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF INDIANA, INC.,**

an Indiana corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF INDIANAPOLIS,            INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF LOUISVILLE, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 5 |
|--------|---|

 

**CARETENDERS OF MARSHALL COUNTY, INC.,**an Alabama corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF NEW JERSEY, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF NORTHERN KENTUCKY, INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF RICHMOND, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF SOUTHWEST FLORIDA, INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF THE BLUEGRASS, INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS OF WEST PALM BEACH, INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 6 |
|--------|---|

 

**CARETENDERS VISITING SERVICES EMPLOYMENT COMPANY,            INC.,**a

Kentucky corporation formerly known as Caretenders HME of            Florida, Inc.

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF CENTRAL INDIANA,            INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF CINCINNATI,            INC.,**a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES**

**OF SOUTHEAST FLORIDA, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES**

**OF SOUTHWEST FLORIDA, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**FREELIFE MEDICAL EQUIPMENT,            INC.,**

an Alabama corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 7 |
|--------|---|

**HHJC HOLDINGS, INC.,**an            Alabama corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**HOME HEALTH OF JEFFERSON COUNTY, INC.,**a Georgia corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**HOUSECALLS OF AMERICA, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**HOUSECALLS, INC.,**a Delaware            corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**METRO HOME CARE, INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**NATIONAL HEALTH INDUSTRIES,            INC.**,

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**NATIONAL ORTHOPEDIC & REHABILITATION SERVICES,            INC.,**

an Alabama corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 8 |
|--------|---|

**PRO-CARE HOME HEALTH OF BROWARD, INC.,**a Florida corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**RELIABLE HOME HEALTH CARE, INC.,**

an Ohio corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**SPECIAL HEALTHCARE SERVICES,            INC.,**

a Kentucky corporation

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

**“New Entities”**

 

**ALMOST FAMILY PC OF FT. LAUDERDALE            LLC**    

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **ALMOST FAMILY PC OF                            KENTUCKY, LLC** |
|--------|------------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

**ALMOST FAMILY PC OF SW FLORIDA,            LLC**    

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

|   | **ALMOST FAMILY PC OF                            WEST PALM, LLC** |
|--------|-------------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 9 |
|--------|---|

**CARETENDERS MOBILE MEDICAL SERVICES,            LLC**        

 

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **CARETENDERS OF                            JACKSONVILLE, LLC** |
|--------|-----------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF COLUMBUS,            LLC**   

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF COOK COUNTY,            LLC**          

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF DISTRICT 6,            LLC**     

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF DISTRICT 7,            LLC**     

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

|   | 10 |
|--------|----|

 

**CARETENDERS VISITING SERVICES OF GAINESVILLE,            LLC**              

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF HERNANDO COUNTY,            LLC**           

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF KENTUCKIANA,            LLC**          

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF OCALA,            LLC**              

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF ORLANDO,            LLC**       

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF PINELLAS COUNTY,            LLC**

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|

 

 

|   | 11 |
|--------|----|

 

|  | C. Steven Guenthner

Secretary and Treasurer |
|--|----------------------------------------------|

 

**CARETENDERS VISITING SERVICES OF SOUTHERN ILLINOIS,            LLC**            

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF ST. AUGUSTINE,            LLC**  

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**CARETENDERS VISITING SERVICES OF ST. LOUIS,            LLC** 

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **CARETENDERS VS OF                            BOSTON, LLC** |
|--------|--------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **CARETENDERS VS OF                            CENTRAL KY, LLC** |
|--------|------------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **CARETENDERS VS OF                            LOUISVILLE, LLC** |
|--------|------------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|

 

 

|   | 12 |
|--------|----|

 

|  | C. Steven Guenthner

Secretary and Treasurer |
|--|----------------------------------------------|

 

**CARETENDERS VS OF NORTHERN KY,            LLC**    

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **CARETENDERS VS OF                            WESTERN KY, LLC** |
|--------|------------------------------------------------------------------|

 

By:_______________________________________

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**MEDERI CARETENDERS VS OF BROWARD,            LLC**    

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **MEDERI CARETENDERS VS                            OF SE FL, LLC** |
|--------|--------------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

|   | **MEDERI CARETENDERS VS                            OF SW FL, LLC** |
|--------|--------------------------------------------------------------------|

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

**MEDERI CARETENDERS VS OF TAMPA,            LLC**    

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|

 

 

|   | 13 |
|--------|----|

 

|  | C. Steven Guenthner

Secretary and Treasurer |
|--|----------------------------------------------|

 

 

**PRINCETON HOME HEALTH, LLC**

 

|   | By   /s/ C.                            Steven Guenthner |
|--------|------------------------------------------------------------------------|
|        | C. Steven Guenthner

Secretary and Treasurer                           |

 

 

 

|   | 14 |
|--------|----|