Document:

Exhibit 10.9

                              FIRST AMENDMENT TO
                             SPECIAL LOAN AGREEMENT

     This First  Amendment to Special Loan Agreement is made and entered into as
of  February  7,  2000,  between  HOME-STAKE  OIL &  GAS  COMPANY,  an  Oklahoma
corporation (the  "Borrower"),  and BANK OF OKLAHOMA,  NATIONAL  ASSOCIATION,  a
national banking association (the "Bank").

                                    Recitals

     A. The  Borrower  and the Bank are  parties to that  certain  Special  Loan
Agreement dated November 8, 1999 (the "Loan Agreement").

     B. On January 3, 2000, the Borrower executed a new shareholder  rights plan
to replace its existing shareholder rights plan which expired on such date.

     C. The parties  hereto  desire to amend the Loan  Agreement  to reflect the
adoption of the new shareholder rights plan.

                                    Agreement

     In   consideration   of  the   foregoing   and  other  good  and   valuable
consideration, the Borrower and the Bank hereby agree as follows:

     1.  Paragraph  5.2 of the  Loan  Agreement  is  hereby  amended  to read as
follows:

          "5.2 Except as provided in the Rights Agreement dated January 3, 2000,
     between  the  Borrower  and UMB  Bank,  N.A.,  (copies  of which  have been
     delivered  to the Bank and which have not been  modified or amended,  as of
     the date  hereof) the Borrower  will not  declare,  pay (except as provided
     below) or become  obligated  to declare or pay any dividend on any class of
     its capital stock now or hereafter  outstanding,  make any  distribution of
     cash or property to holders of any shares of such stock, or redeem, retire,
     purchase or otherwise  acquire,  directly or indirectly,  any shares of any
     class of its capital stock now or hereafter outstanding; provided, however,
     that if no Event of Default or Default  shall then  exist,  notwithstanding

                                       -1-

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     the above,  the Borrower may declare and pay dividends upon its outstanding
     shares of capital  stock not in any fiscal year to exceed  fifteen  percent
     (15%)  of its net  cash  from  operations,  less  scheduled  payments  upon
     indebtedness  to the Bank.  For purposes of this  Agreement  "net cash from
     operations"  shall mean gross income (net of  production  taxes) paid minus
     cash paid to  suppliers  in the normal  course of  business."  2. Except as
     amended hereby, the Loan Agreement shall remain in full force and effect as
     written.

          IN WITNESS WHEREOF, the Borrower and the Bank have executed this First
     Amendment as of the day and year first above written.

                         HOME-STAKE OIL & GAS COMPANY

                         By    /s/ Robert C. Simpson
                             -----------------------
                             Robert C. Simpson, Chairman of the
                             Board, President and Chief Executive
                               Officer

                         BANK OF OKLAHOMA, NATIONAL
                         ASSOCIATION

                         By    /s/ W. L. Leo Morris
                             -----------------------
                             W.L. Morris, Vice President

                                       -2-

<PAGE>SIXTH AMENDMENT TO LEASE
                   DATE CHANGE/RENTAL ADJUSTMENT

That certain Lease dated 10/16/90 by and between Koll Copley partners
and Petula Associates, Ltd., assigned to Petula Associates Ltd., an
Iowa corporation and Principal Mutual Life Insurance company, an Iowa
corporation doing business as KC Creekside Phase I, assigned to PS
Business Parks, L.P., Landlord, and Protocol Systems, Inc., Tenant, is
amended this 19th day of March, 1999 solely as hereinafter described.

1.h.  Term of Lease:
      8500 SW Creekside Place
      Renewal Commencement Date:           January 1, 2001
      Expiration Date:                     December 31, 2005

      8605 SW Creekside Place
      Commencement Date:                   April 1, 1999
      Expiration Date:                     December 31, 2005

1.i.  Base Monthly Rent:
      8500 SW Creekside Place
      January 1, 2001 - December 31, 2003  $61,581
      January 1, 2004                      No rent, operating expenses
                                            only
      February 1, 2004 - December 31, 2005 $67,996

      8605 SW Creekside Place
      April 1, 1999 - June 30, 1999        $10,220 and operating
                                            expenses on 14,000 s.f.
      July 1, 1999 - June 30, 2002         $29,279
      July 1, 2002                         No rent, operating expenses
                                            only
      August 1, 2002 - December 31, 2005   $32,329

All other terms and conditions of said Lease shall remain in full force
and effect.

IN WITNESS WHEREOF, Landlord and Tenant have executed this Amendment as
of the date first written above.

LANDLORD:        PS Business Parks, L.P., a California limited
                  Partnership
By:              Eileen Newkirk, Assistant Vice President
                 By PS Business Parks, Inc., its general partner

TENANT:          Protocol Systems, Inc.AMENDMENT NUMBER ONE TO LOAN AGREEMENT

         First  Amendment  entered  into  as  of  September  25,  1998,  between
INTEGRAMED AMERICA,  INC. (the "Borrower") and FLEET BANK, NATIONAL  ASSOCIATION
(the "Bank").

         WHEREAS,  the  Borrower  and the Bank are  parties to a Loan  Agreement
dated as of September 11, 1998 (the "Agreement"); and

         WHEREAS,  the Borrower has requested that the Bank amend,  and the Bank
has agreed to amend, certain provisions of the Agreement.

         NOW THEREFORE, the parties hereto hereby agree as follows:

         1.       The Agreement is hereby amended as follows:

                  (a)  Section  1.1 is  amended by adding a new  definition  for
"Permitted Stock Repurchase" in the correct place  alphabetically to read in its
entirety as follows:

                           "Permitted   Stock   Repurchase"   shall   mean   the
                  Borrower's repurchase,  for cash consideration,  of certain of
                  its outstanding Capital Stock, which Capital Stock, after such
                  repurchase,  shall  become  treasury  stock  of the  Borrower;
                  provided,  that  the  total  cash  consideration  for all such
                  repurchases in the aggregate shall not exceed $2,000,000.

                  (b)      Section  2.12 is amended by adding a new  subsection
(d) as follows:

                           (d)   It is expressly agreed that the proceeds of any
Loans may be utilized to effectuate the Permitted Stock Repurchase.

                  (c)      Section  6.2 is amended to read in its  entirety  as
follows:

                           6.2 Consolidated  Effective Net Worth. Maintain as at
                  the last day of each fiscal quarter Consolidated Effective Net
                  Worth in an amount not less than $26,750,000,  plus 50% of the
                  Consolidated  Adjusted  Net  Income  of the  Borrower  and its
                  Subsidiaries,  on a cumulative basis, commencing with June 30,
                  1998,  for the fiscal  quarter  then ending  (provided,  that,
                  notwithstanding  the definition of Adjusted Net Income,  there
                  shall not be any reduction for any net loss),  plus 80% of the
                  net proceeds,  on a cumulative basis, received by the Borrower
                  in  connection  with any issuance of  securities  (whether for
                  cash or otherwise) by the Borrower  during the fiscal  quarter
                  than ending, minus the cash consideration actually paid by the
                  Borrower in connection with any Permitted Stock Repurchase.

                  (d)      Section  7.6 is amended to read in its  entirety  as
follows:

                           7.6  Dividends.  (a) Declare or pay any  dividends on
                  its Capital  Stock,  except (i)  dividends  payable  solely in
                  shares of its own common stock,  (ii) as long as no Default or
                  Event of Default has occurred and is continuing,  dividends in
                  connection with the Borrower's  outstanding preferred stock in
                  an  aggregate  amount not in excess of  $133,000 in any fiscal
                  year;  provided,  that, for the fiscal year ended December 31,
                  1998 such amount shall be $596,315.00 and (iii) any Subsidiary
                  wholly owned by the Borrower may declare and pay  dividends to
                  the  Borrower,  or (b) purchase,  redeem,  retire or otherwise
                  acquire  any of its  Capital  Stock at any  time  outstanding,
                  other than in  connection  with (I) the surrender of shares of
                  the Borrower's Series A Cumulative Convertible Preferred Stock
                  upon its conversion into shares of the Borrower's Common Stock
                  and (ii) any Permitted Stock Repurchase.

<PAGE>

         2.       The Borrower hereby represents and warrants to the Bank that:

                  (a) Each and every of the  representations  and warranties set
forth in the Agreement is true as of the date hereof and with the same effect as
though made on the date  hereof,  and is hereby  incorporated  herein in full by
reference as if fully restated herein in its entirety.

                  (b) No Default or Event of Default  and no event or  condition
which, with the giving of notice or lapse of time or both, would constitute such
a Default or Event of Default, now exists or would exit.

         3.       All capitalized  terms used herein,  unless otherwise defined
herein, have the same meanings provided therefor in the Agreement.

         4.       The  amendments  set forth  herein are limited  precisely  as
written  and shall not be deemed to (a) be a consent to or a waiver of any other
term or condition of the Agreement or any of the  documents  referred to therein
or (b)  prejudice any right or rights which the Bank may now have or may have in
the future under or in connection  with the Agreement or any documents  referred
to herein.  Whenever the Agreement is referred to in the Agreement or any of the
instruments,  agreements or other  documents or papers executed and delivered in
connection  therewith,  it shall be deemed to mean the  Agreement as modified by
the First Amendment.

         IN WITNESS WHEREOF, the parties hereto have caused this First Amendment
to be duly executed and delivered by their  respective duly authorized  officers
as of the date first above written.

                                    INTEGRAMED AMERICA, INC.

                                    By:   /s/Eugene Curcio
                                          -----------------------------
                                    Name:    Eugene R. Curcio
                                    Title:   Sir Vice President and CFO

                                    FLEET BANK, NATIONAL ASSOCIATION

                                    By:   /s/Thomas G. Carley
                                          -----------------------------
                                    Name:    Thomas G. Carley
                                    Title:   Vice President

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