Document:

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                                                                   Exhibit 10(x)

             AGREEMENT BETWEEN OHIO BUREAU OF WORKERS' COMPENSATION
                         AND COMMUNITY INSURANCE COMPANY
                    D/B/A ANTHEM BLUE CROSS AND BLUE SHIELD,
                     DATED NOVEMBER 10, 1998, AS ASSIGNED TO
              COMPMANAGEMENT HEALTH SYSTEMS, INC. ON JULY 16, 1999

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                                AGREEMENT BETWEEN
                    OHIO BUREAU OF WORKERS' COMPENSATION AND
       COMMUNITY INSURANCE COMPANY D/B/A ANTHEM BLUE CROSS AND BLUE SHIELD

         This is an Agreement by and between Community Insurance Company d/b/a
Anthem Blue Cross and Blue Shield (the "MCO"), having offices at 8845 Governor's
Hill Drive, Cincinnati, Ohio 45249, and the State of Ohio, Bureau of Workers'
Compensation (the "Bureau" or "BWC"), having offices at 30 W. Spring Street,
Columbus, Ohio 43215-2256, entered into the day, month and year set out below.

         Whereas, the Bureau is required to administer the Health Partnership
Program ("HPP") under the provisions of Revised Code Section 4121.44 and the
Rules promulgated under the authority of Revised Code Section 4121.441; and,

         Whereas, the Bureau desires to obtain the services of one or more
managed care organizations to provide medical management and cost containment
services to Ohio employers and injured workers in accordance with the HPP; and,

         Whereas, the MCO desires to provide medical management and cost
containment services in support of the Bureau's administration of the HPP:

         Now, therefore, the parties hereto in consideration of the services to
be performed and the compensation to be paid mutually agree to the following:

1.       SCOPE OF SERVICES. The MCO shall provide for and perform the following
         services and activities:

         A.       MEDICAL MANAGEMENT.

         The MCO shall provide medical management services for all workers'
         compensation cases that result from injuries and occupational diseases
         to employees arising out of the course and scope of employment as
         provided by law, including Medical Case Management services as defined
         under Appendix G of this Agreement). The MCO recognizes that (1) all
         services provided are linked to the successful return to work or
         resolution for injured workers, (2) close interaction between the MCO
         and the employer is critical to the program's success, (3) close
         attention to treatment protocols and Treatment Plans is required, (4)
         provider networks must emphasize the appropriate provider composition
         to treat occupational injuries and illness, and (5) continually meeting
         data requirements is essential for effecting and measuring return to
         work.

         B.       HEALTH CARE PROVIDER NETWORK.

         (1) The MCO shall provide for and maintain a health care provider
         network (the "Network"). The MCO shall not discriminate against any
         category of health care provider when establishing categories of
         providers for participation in its Network. However, the MCO is not
         required to accept or retain any individual provider in its Network.
         The MCO shall submit to the Bureau for prior approval any changes in
         the Network that would materially change Network provider composition.

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         (2) In addition to primary care physicians specifically selected and
         recruited to treat workers' compensation patients under the HPP, the
         Network shall continually provide access to specialty providers
         recruited to treat workers' compensation patients under the HPP,
         including but not limited to:

<TABLE>
<S>                                                                    <C>
                  Orthopedic Surgeons                                  Psychologists
                  Physical Therapists                                  Plastic Surgeons
                  Occupational Therapists                              Neurosurgeons
                  Chiropractors                                        Podiatrists
                  Occupational Medicine Physicians                     Dentists
                  General Surgeons                                     Ophthalmologists
                  Radiologists                                         Prosthetists and Orthotists
                  Anesthesiologists                                    Pulmonary Disease Specialists
                  Neurologists                                         Infectious Disease Specialists
                  Physiatrists (Physical Medicine Physicians)          Dermatologists
                  Hand Surgeons
                  Psychiatrists
</TABLE>

         (3) Maintaining appropriate Network provider composition is the sole
         responsibility of the MCO and not the responsibility of any leased
         provider network.

         (4) The MCO's Network shall consist of providers sufficient in number
         and type to meet the needs of employers and employees in each county in
         which the MCO is certified. All Network providers shall be Bureau
         certified. The MCO shall credential all Network providers in terms of
         qualifications to provide treatment for workers' compensation patients
         and to meet HPP return to work objectives. All Network providers shall
         be credentialed by the MCO as of the Effective Date of this Agreement.
         The Bureau retains the discretion to require that Network providers be
         re-credentialed by the MCO during the term of this Agreement.

         (5) The MCO shall provide access to the following health care
         facilities, supplies and services as part of its Network:

                  Acute Care Hospitals
                  Urgent Care Centers
                  Laboratories
                  Diagnostic Radiology Centers
                  Medical Equipment Suppliers
                  Home Health Agencies
                  Acute Rehabilitation Centers
                  Sub-Acute Facilities (including Sub-Acute Rehabilitation and
                  Skilled Medical Facilities)
                  Rehabilitation Hospitals
                  Long Term Care Facilities
                  Traumatic Brain Injury Facilities

         C.       ADHERENCE TO PRESCRIBED TREATMENT GUIDELINES.

         (1) The MCO services shall include implementation of treatment
         guidelines, return to work guidelines and utilization review to
         evaluate the necessity and/or effectiveness of medical care. The
         treatment and return to work guidelines utilized by the MCO shall be
         nationally recognized guidelines and shall include one or more of the
         guidelines specified in Sections 1C(1)(a), (b), or (c) of this
         Agreement.

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                  (a) The Bureau shall distribute the following treatment
                  guidelines, as applicable, to Bureau certified providers
                  designated by the Bureau. The MCO may use any of these
                  guidelines to comply with Section 1C(1) of this Agreement:

                           Milliman and Robertson, Healthcare Management
                           Guidelines, Volume 7.

                           InterQual Clinical Decision Support Criteria:
                           Indications for Workers' Compensation Clinical
                           Management.

                           Scott Haldeman, D.C., M.D., Ph.D., David
                           Chapman-Smith, LLB, Donald M. Petersen, Jr., B.S.,
                           eds., Guidelines for Chiropractic Quality Assurance
                           and Practice Parameters, Proceedings of the Mercy
                           Center Consensus Conference, 1993.

                  (b) If the MCO does not wish to use the guidelines listed in
                  Section 1C(1)(a) of this Agreement, the MCO may use any of the
                  following treatment guidelines to comply with Section 1C(1) of
                  this Agreement. The MCO shall distribute any treatment
                  guidelines it opts to use under this Section to all Bureau
                  certified Network providers designated by the Bureau to
                  receive treatment guidelines under Section 1C(1)(a) of this
                  Agreement:

                           The American Accreditation Healthcare Commission,
                           URAC National Workers' Compensation Utilization
                           Management Standards.

                           Jeffrey S. Harris, M.D., M.P.H., M.B.A., Chair,
                           American College of Occupational and Environmental
                           Medicine, ed., Occupational Medicine Practice
                           Guidelines.

                           Institute for Health Care Quality, Quality First Risk
                           Management System Practice Guidelines.

                           Presley Reed, M.D., The Medical Disability Advisor -
                           Workplace Guidelines for Disability Duration, Second
                           Edition.

                           U.S. Department of Health and Human Services, Public
                           Health Service, Agency for Health Care Policy and
                           Research, Acute Low Back Problems in Adults -
                           Assessment and Treatment.

                  (c) If the MCO does not wish to use the guidelines listed in
                  Section 1C(1)(a) or (b) of this Agreement, the MCO may use any
                  alternative guidelines that are approved in advance by the
                  Bureau as being at least equal in effectiveness to the
                  guidelines listed in Section 1C(1)(a) or (b) of this Agreement
                  to comply with Section 1C(1) of this Agreement. The MCO shall
                  distribute any treatment guidelines it opts to use under this
                  Section to all of its Bureau certified Network providers
                  designated by the Bureau to receive treatment guidelines under
                  Section 1C(1)(a) of this Agreement:

         (3) All MCO Medical Case Management staff members shall complete annual
         training on the MCO's treatment guidelines, return to work guidelines,
         utilization review and protocols.

         D.       SUBMISSION OF PLANS OF CARE.

         (1) The MCO shall submit coordinated Plans of Care on all lost-time
         injured workers and injured workers with designated medical-only
         diagnosis codes as designated in the MCO Policy Reference Guide
         (Appendix A) to the Bureau as follows: (a) if hard copy, must be
         submitted

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       within five (5) Business Days of the Bureau's allowance decision; (b) if
       electronic 278 Plan of Care or equivalent (when reinstated by the Bureau
       pursuant to Section 1J(3) of this Agreement), must be available for
       pickup by the EDI system provider designated by the Bureau no later than
       2:00 P.M. Eastern Time the fifth Business Day after the Bureau's
       allowance decision; and (c) in all cases, must be re-submitted or updated
       when significant changes in the Treatment Plan occur as defined in the
       MCO Policy Reference Guide, but no less often than every sixty (60) days
       for so long as treatment is ongoing unless otherwise specified in writing
       by an appropriate Bureau representative.

       (2) A submitted Plan of Care shall include the diagnosis (including
       designation of the primary diagnosis), prognosis, expected outcomes
       (including anticipated return to work date) and provider Treatment Plan
       (including prescribed medications, duration and frequency of treatment).

       (3) Not later than March 1, 1999, the MCO's process of reviewing medical
       bills shall be integrated with the associated Plan of Care. Plan of Care
       compliance by the MCO and integration with bill review are subject to
       periodic audit by the Bureau.

       E.       TREATMENT REIMBURSEMENT AUTHORIZATIONS/DENIALS.

       (1) Treatment reimbursement authorizations and denials by the MCO shall
       be evaluated using the following three-part test (all parts must be met
       to authorize treatment reimbursement):

                   - The requested services are reasonably related to the
                     injury;
                   - The requested services are reasonably necessary for
                     treatment of the injury;
                   - The costs of the services are medically reasonable.

       (2) Treatment reimbursement decisions shall be communicated in writing,
       with an appropriate explanation, within three (3) Business Days from the
       MCO's treatment reimbursement request Receipt Date as follows: all
       treatment reimbursement decisions shall be sent to the Bureau and the
       provider; treatment reimbursement denials shall also be provided to the
       injured worker and his or her representative, if any; treatment
       reimbursement approvals shall also be provided to the employer and its
       representative, if any, upon request and as set forth in the MCO Policy
       Reference Guide (Appendix A).

       (3) The MCO shall respond to a provider's proposed Treatment Plan
       (submitted on a C-9 or other appropriate form) within three (3) Business
       Days from the MCO's Treatment Plan Receipt Date, either authorizing,
       denying, or pending reimbursement approval for the proposed Treatment
       Plan due to insufficient information, in accordance with the provisions
       of the MCO Policy Reference Guide (Appendix A). A Clinician (as defined
       in Appendix G of this Agreement) shall make all treatment reimbursement
       denials on behalf of the MCO.

       (4) The MCO shall phase in the appropriate certification requirements for
       its Medical Case Management staff (including vendors and subcontractors)
       as follows: twenty-five percent (25%) of all MCO staff performing Medical
       Case Management (as defined in Appendix G of this Agreement) shall be
       certified as medical case managers as defined in Rule 4123-6-022(C)(32)
       of the Ohio Administrative Code by December 31, 1999; fifty percent (50%)
       of all MCO staff performing Medical Case Management (as defined in
       Appendix G of this Agreement) shall be certified as medical case managers
       as defined in Rule 4123-6-022(C)(32) of the Ohio Administrative Code by
       September 15, 2000.

       F.       ALTERNATIVE DISPUTE RESOLUTION.

       The MCO shall have an alternative dispute resolution ("ADR") process for
       the resolution of medical disputes that includes one independent level of
       review. If an individual health care

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       provider is involved in the dispute, the independent level of review
       shall consist of a peer review conducted by an individual or individuals
       licensed pursuant to the same section of the Ohio Revised Code as the
       health care provider. The MCO shall conduct its ADR process in accordance
       with the provisions of Rule 4123-6-16 of the Ohio Administrative Code and
       the MCO Policy Reference Guide.

       G.       HEALTH CARE QUALITY ASSURANCE/PROVIDER QUALITY IMPROVEMENT.

       The MCO shall have a medical management quality assurance program that
       includes the use of an updated quality assurance policies and procedures
       manual that is in compliance with American Accreditation Health Care
       Commission/URAC standards. The MCO shall continually assess the quality
       of treatment reimbursement decisions and billing procedures in connection
       with approved treatment reimbursement.

       H.       PROVIDER PAYMENTS.

       (1) The MCO shall submit medical provider bills electronically to the
       Bureau within seven (7) Business Days from the MCO's provider bill
       Receipt Date. The Bureau shall review all bills for allowed conditions
       and allowed claims and shall pay the MCO for allowed payments after
       receipt of a proper invoice and after a final adjudication permitting
       payment for the claim. The Bureau shall make Electronic Fund Transfer
       ("EFT") to the MCO within seven (7) Business Days after receipt of a
       proper invoice and after a final adjudication permitting payment for the
       claim. The MCO shall pay the provider within seven (7) Business Days from
       receipt of the EFT. The MCO shall pay interest to the Bureau at the rate
       established by the Office of Budget and Management, if the provider is
       not paid within thirty (30) days of receipt of the EFT from the Bureau.

       (2) The MCO shall retrieve electronic bills from the Bureau's World Wide
       Web site (www.ohiobwc.com) no later than 5:00 P.M. the next Business Day
       after the bills are placed in the MCO's directory by the Bureau.

       (3) The MCO shall pay provider bills in accordance with Rules 4123-6-10,
       4123-6-11, and 4123-6-12 of the Ohio Administrative Code. However, if the
       MCO utilizes a leased provider network to fulfill the requirements of
       Section 1B. of this Agreement, the MCO shall not apply the discounted
       payment rates of the leased network to its payments to any provider
       within that network without first obtaining the signed written consent of
       the provider.

       (4) Not later than March 1, 1999, the MCO shall have and use a system
       that tracks the status of provider bills at any stage of the bill
       adjudication process. Such a system must allow the MCO to respond to
       inquiries by authorized parties and to the Bureau as to the disposition
       of a bill and the expected payment date of a bill. The Bureau may require
       the MCO to issue reports to the Bureau and/or medical providers on the
       status of payments to providers.

       (5) The MCO shall educate providers, both in-state and out-of-state, on
       correct billing procedures and the MCO's prior authorization methods.

       (6) Following termination of this Agreement the Bureau shall reimburse
       the MCO for providers' services only if invoices are submitted within
       sixty (60) days of the termination date and only if such payment is not
       subject to deduction.

       I.       EMPLOYER EDUCATION/INJURED WORKER ASSISTANCE.

       (1) The MCO shall have an employer education program where the MCO (or
       its vendor or subcontractor) shall visit each employer with an experience
       modification of one hundred twenty-five percent (125%) or greater that is
       serviced by the MCO for the purposes of educating the

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       employer on effective return to work programs and learning more about the
       employer's work site and operations. Such visits are subject to audit by
       the Bureau and Bureau staff may accompany the MCO representatives to
       on-site visits at the Bureau's discretion.

       (2) The MCO shall provide MCO identification ("I.D.") cards to all
       employers within thirty (30) days of employer assignment to the MCO. The
       Bureau may reassign an employer from the MCO if the Bureau determines
       that the reassignment is in the best interest of both the employer and
       the MCO.

       (3) The MCO shall provide Network provider directories to employers upon
       request. The MCO shall assist the injured worker in locating a Bureau
       certified provider, whether in-state or out-of-state, if the injured
       worker or employer requests assistance.

       J.     ELECTRONIC DATA INTERCHANGE ("EDI") REQUIREMENTS.

       (1) The MCO shall comply with all requirements for submission and receipt
       of EDI transactions as set forth in the EDI Implementation Documentation
       (Appendix B) and within this Agreement. The EDI Implementation
       Documentation may be modified by the Bureau from time to time to comply
       with Bureau policies, the Health Insurance Portability & Accountability
       Act of 1996 ("HIPAA") and the Accredited Standards Committee ("ASC") X12
       versions. The MCO shall have in force a contract with an EDI system
       provider designated by the Bureau. The MCO will be given a minimum of six
       (6) weeks for implementation of any EDI modification unless both parties
       mutually agree to a shorter time frame.

       (2) EDI pick-up and delivery is the responsibility of the MCO. The MCO
       shall pick-up EDI transactions according to its EDI system provider
       contract and the EDI Implementation Documentation from a location
       determined by the Bureau. The MCO will deliver all EDI transactions
       according to its EDI system provider contract and the EDI Implementation
       Documentation to a location approved by the Bureau.

       (3) The MCO shall meet and implement whenever applicable all requirements
       for submission to the Bureau of the following EDI transaction types as
       defined by the EDI Implementation Documentation:

       -      148 Report of Injury, Illness or Accident (including all planned
              changes as defined in the 148 Summary of Planned Changes for 1999
              section of the EDI Implementation Documentation)
              -     First Report Of Injury ("FROI") -- must be available for
                    pickup by the EDI system provider designated by the Bureau
                    no later than 2:00 P.M. Eastern Time the second FROI
                    Business Day after the MCO's FROI Receipt Date
              -     Subsequent Claim Information
       -      837 Health Care Claim
              -     Medical Bill for an allowed claim -- within seven (7)
                    Business Days of the MCO's Receipt Date for the bill
       -      278 Health Care Services Review Information
              -     Plan of Care or equivalent (when reinstated)
       -      997 Functional Acknowledgment
              -     Within twenty-four (24) hours of transactions received from
                    the Bureau.

       (4) The MCO shall meet and implement whenever applicable all requirements
       for receipt from the Bureau of the following EDI transaction types as
       defined by the EDI Implementation Documentation:

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        -     835 Health Care Claim Payment/Advice
        -     824 Application Advice
              -     Initial Claim Acknowledgment or Denial, Subsequent Claim
                    Denial, Plan of Care or Equivalent Denial, Medical Bill
                    Denial, and Positive Bill Receipt Acknowledgment if and when
                    implemented.
        -     997 Functional Acknowledgment
        -     816 Organizational Relationships
              -     Employer Information
              -     Employer & Injured Worker Representative(s) Demographic Data
                    once implemented
        -     148 Report of Injury, Illness or Accident (including all planned
              changes as defined in the 148 Summary of Planned Changes for 1999
              section of the EDI Implementation Documentation)
              -     Subsequent Claim Information
        -     Electronic provider information or equivalent once implemented

       (5) The MCO shall meet and implement whenever applicable all requirements
       for receipt of the following EDI transaction types from medical providers
       as defined by the EDI Implementation Documentation:

        -     837 Health Care Claim by February 1,1999.
        -     148 Report of Injury, Illness or Accident (Inbound FROI) once
              implemented
        -     Electronic Treatment Plan or equivalent once implemented

       (6) The MCO shall meet and implement whenever applicable all requirements
       for submission of the following EDI transaction types to medical
       providers as defined by the EDI Implementation Documentation:

        -     Advice and Response to the Provider 837 by February 1, 1999
        -     835 Health Care Claim Payment/Advice once implemented
        -     Electronic fund transfers once implemented

       (7) The Bureau's required data element criteria is defined for each
       transaction set, where applicable, in the transaction set overview in the
       EDI Implementation Documentation. The required data element criteria is
       listed alphabetically for each data element for each transaction set,
       where applicable, in the Business Rules Matrix in the EDI Implementation
       Documentation.

       K.     INFORMATION SYSTEMS CAPABILITY.

       (1) The MCO shall have a Year 2000 Compliant integrated information
       system that supports each business function throughout the lifecycle of a
       claim. The MCO warrants that all products or services provided under this
       Agreement shall be Year 2000 Compliant, as defined in Appendix G of this
       Agreement. The provisions of this paragraph shall survive any termination
       or expiration of this Agreement.

       (2) The MCO shall periodically demonstrate to the satisfaction of the
       Bureau that its information system is capable of supporting its managed
       care process through the effective integration of its technical
       information processing components.

       (3) The MCO shall have the capacity to access claim information via the
       Bureau's External Data Access (EDA) program and to bear its own equipment
       and Network Service Provider (NSP) costs where applicable.

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       (4) The MCO shall demonstrate its ability to capture data required for
       the Return to Work Degree of Disability Management (DoDM) measurement set
       forth in Appendix E of this Agreement.

       (5) In addition to electronic bills, the MCO shall have Internet access
       and shall retrieve files available for download from the Bureau World
       Wide Web site (www.ohiobwc.com) no later than 5:00 P.M. the next Business
       Day after the files are placed in the MCO's directory by the Bureau.
       These files include but are not limited to Provider List Update, Customer
       Service Team (CST) update, Open Enrollment Claim Update File, the
       Foresight Corporation's EDISIM product along with the Ambassador Kit and,
       when available, the Employer and Injured Worker Representative(s)
       demographic data.

       (6) The MCO shall have the capability to communicate with the Bureau via
       Internet e-mail, including the capability to access e-mail attachments.
       The MCO shall also have the capability to create and interpret text-based
       documents.

       (7) The MCO shall have at least one personal computer that is capable of
       executing downloaded computer programs, including but not limited to,
       Foresight EDISIM and Ambassador Kit products from the Bureau World Wide
       Web site (www.ohiobwc.com).

       L.     MCO REVIEWS AND AUDITS.

       (1) The Bureau may conduct random, unannounced reviews or audits of the
       MCO. The scope of such reviews or audits shall include, but is not
       limited to, substantial performance with the terms and conditions of this
       Agreement, consistent and appropriate use of treatment guidelines and
       return to work guidelines, compliance with any and all technical
       requirements and time deadlines, financial and accounting information and
       return to work results.

       (2) On or before June 30, 1999, the Bureau shall require an independent
       auditor's report on the policies and procedures placed in operation at
       the MCO and tests of operating effectiveness, specifically the Statement
       on Auditing Standards No. 70, Level 2 Report ("SAS 70"). This report
       shall cover at a minimum a ten (10) month period occurring between July
       1, 1998 and June 30, 1999. The SAS 70 report shall be prepared using the
       control objectives provided by the Bureau and in the format specified by
       the Bureau. During the term of this Agreement the MCO shall submit such
       reports on or before June 30 of each year covering at a minimum a ten
       (10) month period occurring between July 1 of the preceding year and the
       filing deadline. The MCO shall implement all SAS 70 audit recommendations
       resulting from deficiencies identified in the report.

       (3) On or before June 30, 1999, the Bureau shall require independently
       audited financial statements from the MCO. The audit report shall be
       prepared using Generally Accepted Accounting Principles ("GAAP"), and
       shall cover a twelve (12) month period ending between July 1, 1998 and
       June 30, 1999. During the term of this Agreement, the MCO shall submit
       such reports on or before June 30 of each year covering the MCO's most
       recent fiscal year.

       (4) The MCO shall retain copies of canceled checks, original provider
       bills and other documentation for provider payments as provided in the
       MCO Policy Reference Guide (Appendix A) and shall make copies available
       to the Bureau upon request for audit. If supporting documentation is not
       received, administrative payment to the MCO will be withheld until the
       requested information is provided. Each review or audit will be based on
       the information received as of the due date. Documentation not received
       by due date will not be included.

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       (5) The MCO shall permit any authorized representative of the Bureau to
       inspect, copy and audit such records, books, vouchers, invoices, and
       medical bill payment information as is reasonably required to
       substantiate the fees billed to or paid by the Bureau, upon prior written
       notice, during Normal Business Hours, Monday through Friday 9:00 A.M
       through 5:00 P.M. Eastern Time.

        M.       MCO CUSTOMER SERVICE COMMUNICATIONS.

       (1) The MCO shall assign cases to appropriate staff no later than 5:00
       P.M. Eastern Time the next Business Day after the MCO's FROI Receipt
       Date. The MCO shall respond to all communications (e-mail, fax, phone,
       mail) within a reasonable period of time.

       (2) The MCO shall have one toll-free telephone number through which all
       types of issues can be addressed as well as a toll-free fax telephone
       number. Customer service telephone lines shall be staffed during Normal
       Business Hours, Monday through Friday 9:00 A.M through 5:00 P.M. Eastern
       Time.

       (3) The MCO (or any vendor or subcontractor) shall use only fax machines
       with date/time indicators (showing either A.M./P.M. or military time),
       and shall leave the date/time indicators on at all times.

2.     OBLIGATIONS OF MCO

       A.     GENERAL.

       The MCO agrees to perform the services required by this Agreement in
       accordance with all rules, regulations, guidelines, standards and
       procedures of the Bureau and according to commercially reasonable
       business practices. The MCO's Application to be certified for the HPP is
       hereby incorporated into this Agreement by reference. The MCO hereby
       acknowledges that it has provided the Bureau with a list of Bureau
       certified providers who are enrolled in its provider Network. The MCO
       agrees to review the treatment rendered by all providers and assist its
       providers in any manner or means necessary to return the injured worker
       to work.

       B.     RULES.

       The MCO agrees to abide by all rules established for the HPP as set forth
       in Rule 4123-6-01, et seq. of the Ohio Administrative Code (the "HPP
       Rules"). The MCO hereby acknowledges that as part of the application
       process to become certified as a Bureau managed care organization under
       the HPP, it has provided the Bureau with the internal guidelines,
       standards and procedures established for the medical management of
       workers' compensation cases and that such procedures are in accordance
       with all applicable Federal and Ohio laws.

       C.     CURRENT POLICIES.

       The MCO agrees to abide by all Bureau policies and MCO reporting
       requirements that are set forth in the MCO Policy Reference Guide
       (Appendix A). The MCO is responsible for communication with the Bureau
       Customer Service Teams and for the medical management of employers' cases
       for employers who have selected them and for employers who have been
       assigned to them.

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       D.       FRAUD.

       (1) The MCO agrees to identify and report any suspected fraudulent or
       deceptive behavior committed by injured workers, employers, providers or
       any other person or entity (as defined in Ohio Revised Code Sections
       2913.01(A) and (B), Ohio Revised Code Section 2913.48 and the criteria
       and requirements that are hereby incorporated by reference and attached
       hereto as "Appendix C: Fraud/Special Investigations-MCO Fraud Reporting
       and Referral Requirements," as may be modified during the term of this
       Agreement) to the Bureau's Fraud/Special Investigations Department. The
       MCO agrees to report these incidents and shall supply supporting
       preliminary documentation to the Bureau's Fraud/Special Investigations
       Department within ten (10) Business Days of discovery. The MCO and it
       agents, subcontractors and assignees agree to provide the Bureau's
       Fraud/Special Investigations Department with immediate and reasonable
       investigative access to any and all records, data, electronic storage
       media, personnel, and information relating to any subjects of an
       investigation.

       (2) The Bureau agrees to provide the MCO with fraud reporting criteria,
       requirements and processes as defined in Appendix C. The Bureau and MCO
       agree to jointly develop and provide supportive training to the MCO and
       to the Bureau's Fraud/Special Investigations Department personnel in the
       identification and detection of fraud or deceptive behavior or patterns.
       The Bureau and the MCO agree to jointly develop and refine detection,
       reporting and recovery processes as needed.

       E.       EMPLOYER AND CASE ASSIGNMENT.

       The parties agree that the cases subject to this Agreement shall be all
       cases of employers who select the MCO and all cases of employers assigned
       to the MCO by the Bureau. In addition to managing the cases of employers
       who select the MCO, the MCO agrees that the Bureau may assign other
       employers to the MCO and the MCO shall service those employers in
       accordance with the provisions of this Agreement. The MCO agrees that the
       Bureau may revoke any assignment made in error.

       F.       CAPACITY.

       (1) The MCO may limit assignment and employer selection by providing the
       Bureau with written notice that it is at capacity and that it will accept
       no further employer selections or assignments as of the date identified
       in the notice. The request should fully disclose and detail any and all
       reasons for the capacity limitation request and it should identify the
       counties where capacity will be limited.

       (2) In addition, the Bureau may declare the MCO ineligible to solicit or
       accept selection of the MCO by an employer or assignment of an employer
       to the MCO by the Bureau by placing the MCO at capacity. The Bureau may
       place the MCO at capacity for the following reasons: (a) The MCO is
       undergoing the decertification process pursuant to Rule 4123-6-17 of the
       Ohio Revised Code; (b) The MCO has notified the Bureau, pursuant to
       Section 3(C) of this Agreement, that it proposes to merge into or be
       acquired by another MCO; (c) the MCO has notified the Bureau, pursuant to
       Section 5(B) of this Agreement, that it intends to terminate this
       Agreement without cause; (d) the MCO's Capacity Bill Timing (as defined
       in Appendix G of this Agreement) is greater than fourteen (14.00)
       calendar days.

                                       10
<PAGE>   12

3.       ADMINISTRATIVE REQUIREMENTS

         A.       MCO BANK ACCOUNTS.

         The MCO's check stock shall bear the name, address, and telephone
         number of the MCO for identification purposes. The MCO provider account
         and the MCO administrative account shall be separate accounts with
         account numbers provided to and kept current with the Bureau. The MCO
         provider account shall be a dedicated account for the funds provided to
         the MCO by the Bureau to pay providers and shall only be used to pay
         providers. The MCO provider account shall not be an interest-bearing
         account and shall not be a "sweep account" (an account where funds over
         a certain amount are temporarily placed in an interest-bearing account
         until called on for payment).

         B.       MCO ORGANIZATIONAL STRUCTURE.

         The MCO shall provide to the Bureau a detailed description of the MCO's
         current organizational structure, including all subsidiary, parent and
         affiliate relationships. The MCO shall identify its principals, provide
         the date of incorporation or formation of partnership or limited
         liability company, and provide any fictitious names the managed care
         organization is, or has been, doing business under. The MCO shall
         provide the Bureau with the number of years it has operated as a
         managed care organization in the State of Ohio and the number of
         employees in each job description, identify other states in which the
         MCO has or is currently conducting business in the last five (5) years,
         and identify any banking relationships including all account
         information with any financial institutions doing business in Ohio.
         Information relating to the immediately preceding five years and
         current data shall be provided to the Bureau as of the effective date
         of this Agreement.

         C.       CHANGE IN MCO ORGANIZATION OR OPERATION.

         Any Changes to the MCO organizational structure or business operations
         must be approved in advance by the Bureau in writing. The MCO shall
         submit any proposed Change to the Bureau at least ninety (90) days in
         advance of the proposed effective date of the Change, unless the Bureau
         approves in advance a shorter period. The MCO shall comply with the
         Bureau's Merger and Acquisition Policy, which is attached hereto as
         Appendix D. For purposes of this Agreement "Change" means a
         reorganization, consolidation, merger or other combination with an
         unaffiliated party, the acquisition of substantially all the assets of
         the MCO by an unaffiliated party, any action causing the dissolution,
         insolvency or voluntary bankruptcy of the MCO, a change in the right to
         appoint, reelect or approve more than fifty percent (50%) of the
         directors or members of the controlling body of the MCO, or the MCO's
         becoming subject to a management agreement that covers all or
         substantially all the business operations of the MCO or any
         subcontractor or change in subcontractors, or any material change in
         the business operations of the MCO, including but not limited to
         changes in information technology or systems. Any unapproved Change to
         the MCO organizational structure or business operations shall permit
         the Bureau at its discretion to terminate this Agreement in accordance
         with the provisions of Section 5B of this Agreement.

         D.       MCO RECORD KEEPING AND DOCUMENTATION REQUIREMENTS.

         (1) The MCO shall ensure confidentiality of hard copy and electronic
         files. MCOs shall retain records received from providers and
         subcontractors that are utilized by the MCO to develop electronic
         billings to the Bureau. The MCO shall retain any records obtained from
         the providers and subcontractors that are utilized by the MCO to
         perform its medical management functions or to substantiate the
         delivery, value, necessity and appropriateness of goods and services to
         injured workers. MCOs shall retain records for the period of time and
         in the format provided in the MCO Policy Reference Guide (Appendix A).
         The MCO, upon request of the Bureau, shall

                                       11
<PAGE>   13

         provide all requested records to another MCO in conjunction with the
         reassignment of any employer.

         (2) Any medical and claim information that is part of the Bureau's
         claim file, including hard copies and electronic copies gathered by the
         MCO in the course of providing services under the HPP, is the property
         of the Bureau and such files shall be returned to the Bureau
         immediately upon termination of this Agreement. All documents received
         by the MCO shall be date stamped by the MCO on the document's Receipt
         Date as defined in Appendix G of this Agreement. Any equipment
         materials or supplies provided to the MCO by the Bureau shall be
         returned to the Bureau upon request.

4.       AMOUNT AND METHOD OF PAYMENT.

         A.       MCO PAYMENT METHODOLOGY.

         (1) The parties agree to the payment calculations and the payment
         schedules described in Appendix E of this Agreement. Reimbursement to
         the MCO for the period from January 1, 1999 to March 31, 1999 shall be
         as set forth in Appendix E of this Agreement.

         (2) Starting April 1, 1999, reimbursement to the MCO shall be based on
         a flat monthly administrative fee payment of one-twelfth (1/12) of four
         percent (4%) of annual workers' compensation premium for employers
         assigned to the MCO, to be paid in monthly installments as set forth in
         Appendix E of this Agreement. The administrative fee shall be
         calculated using the premium base set forth in Section 4B below and
         shall be subject to the setoffs set forth in Section 4C below.

         (3) Starting April 1, 1999, the MCO shall be eligible to earn an
         additional quarterly incentive fee payment of up to one-fourth (1/4) of
         three percent (3%) of annual workers' compensation premium for
         employers assigned to the MCO, based on its performance on the Return
         to Work Degree of Disability Management ("DoDM") measurement used under
         this Agreement, to be paid in quarterly installments as set forth in
         Appendix E of this Agreement. The incentive fee shall be calculated
         using the premium base set forth in Section 4B below. A description of
         the DoDM measurement approach is contained in Appendix E: MCO Payment
         Methodology.

         (4) In addition to the administrative and incentive fee payments set
         forth above, the MCO shall have the opportunity to recoup expenditures
         associated with upgrading its systems capabilities and transmission of
         data to the Bureau as required under this Agreement. Reimbursement to
         the MCO for these transmission and developmental acquisition costs
         shall be calculated as set forth in Appendix E of this Agreement.

         B.       MCO PAYMENT PREMIUM BASE.

         (1) From April 1, 1999 to December 31, 1999, the premium base used to
         calculate the administrative and incentive fees due to the MCO under
         this Agreement shall consist of (1) for private employers assigned to
         the MCO, the premium associated with the employers' July 1, 1997 - June
         30, 1998 rating year (as of December 31, 1998) and (2) for public
         employers assigned to the MCO, the premium associated with the
         employers' January 1, 1997 - December 31, 1997 rating year (as of
         December 31, 1998).

         (2) The premium base used to calculate the administrative and incentive
         fees due to the MCO under this Agreement from April 1, 1999 to December
         31, 1999 shall be adjusted monthly (starting January 1999) to reflect
         changes in the employer assignment to the MCO, including the addition
         of employers through auto-assignment and the loss of employers who are
         granted self-insured status, as set forth in Appendix E of this
         Agreement.

                                       12
<PAGE>   14

         (3) The premium base used to calculate the administrative and incentive
         fees due to the MCO under this Agreement during calendar year 2000
         shall consist of the premium base used for calendar year 1999 (as
         adjusted through December 31, 1999, in accordance with Sections 4B(1)
         and 4B(2) of this Agreement) with the following additional adjustments:
         (1) the MCO's December 31, 1999 premium base shall be increased by the
         percentage difference in the Consumer Price Index - Urban (CPIU), All
         Urban, Base Years 82-84, from July 1998 to July 1999; and (2) the
         appropriate premium for those employers who were zero premium employers
         during the 1999 premium year shall be added to the MCO's December 31,
         1999 premium base.

         (4) The premium base used to calculate the administrative and incentive
         fees due to the MCO under this Agreement during calendar year 2000
         shall be adjusted monthly to reflect changes in the employer assignment
         to the MCO, including the addition of employers through auto-assignment
         and the loss of employers who are granted self-insured status, as set
         forth in Appendix E of this Agreement.

         (5) The premium base used to calculate the administrative, performance
         and incentive fees due to the MCO under this Agreement for the period
         from January 1, 1999 to March 31, 1999 shall be as set forth in
         Appendix E of this Agreement.

         C.       SETOFFS.

         (1) The monthly administrative fee payment to the MCO shall be subject
         to the following setoffs or deductions:

                  (a) FROI Timing - Defined as the average number of calendar
                  days between Date of Injury (DOI) and Bureau Filing Date for
                  all claims (with a DOI of March 1, 1997 or later) filed during
                  each reporting period (set forth in Appendix E of this
                  Agreement), excluding the five percent (5%) of claims with the
                  longest lag time between DOI and Bureau Filing Date. Starting
                  April 1, 1999, the Bureau shall deduct a percentage of the
                  MCO's monthly administrative fee payment as set forth in
                  Section 4C(2) of this Agreement if the MCO's FROI Timing for
                  the applicable reporting period (set forth in Appendix E of
                  this Agreement) was greater than twenty-one (21.00) calendar
                  days.

                  (b) Bill Timing: MCO Receipt - Bureau Receipt - Defined as the
                  average lag time in calendar days from the MCO's Receipt Date
                  for a provider medical bill or the most recent date the claim
                  in which the bill was incurred was placed in an Allowed
                  status, whichever is later ("MCO Receipt") to the date the
                  MCO's outgoing provider bill 837 transmission is accepted by
                  the EDI system provider designated by the Bureau ("Bureau
                  Receipt"), calculated on the basis of all bills with a paid
                  amount greater than $0.00 received by the Bureau from the MCO
                  during each reporting period (set forth in Appendix E of this
                  Agreement). Starting April 1, 1999, the Bureau shall deduct a
                  percentage of the MCO's monthly administrative fee payment as
                  set forth in Section 4C(2) of this Agreement if the MCO's Bill
                  Timing: MCO Receipt - Bureau Receipt for the applicable
                  reporting period (set forth in Appendix E of this Agreement)
                  was greater than twenty-one (21.00) calendar days.

                  (c) Data Accuracy -- Starting January 1, 2000, the Bureau
                  shall deduct twelve and one-half percent (12.5%) of the MCO's
                  monthly administrative fee payment if the MCO's MCO-to-Bureau
                  148 and 837 EDI transaction data accuracy percentages for the
                  period being measured (as further set forth in Appendix E of
                  this Agreement) fall below the criteria set forth in Appendix
                  E of this Agreement.

                                       13
<PAGE>   15

                  (d) Misfiling of Death Claims - Starting January 1, 1999, if
                  the MCO submits a claim as a medical-only or lost-time claim
                  where the claim should have been submitted as a death claim
                  because the injured worker is deceased, the Bureau shall
                  deduct the lesser of two thousand dollars ($2,000.00) or one
                  percent (1%) of the MCO's monthly administrative fee payment
                  per instance.

         (2) For the period from April 1, 1999 to December 31, 1999, the FROI
         TIMING and BILL TIMING: MCO RECEIPT - BUREAU RECEIPT setoffs shall each
         be equal to twelve and one-half percent (12.5%) of the MCO's monthly
         administrative fee payment in any given month. For the period from
         January 1, 2000 to December 31, 2000, the FROI TIMING and BILL TIMING:
         MCO RECEIPT - BUREAU RECEIPT setoffs shall each be equal to six and
         one-quarter percent (6.25%) of the MCO's monthly administrative fee
         payment in any given month.

         B.       EXPENSES.

         Except as otherwise provided in Section 4A(4) and Appendix E of this
         Agreement, the payment of expenses associated with this Agreement is
         the sole responsibility of the MCO. The Bureau shall not be required to
         pay for or reimburse the MCO for any expenses incurred or paid by the
         MCO in connection with the performance of services, including
         publication, travel and staffing requirements, pursuant to this
         Agreement.

5.       TERM AND TERMINATION.

         A.       TERM.

         This Agreement shall become effective January 1, 1999 (the "Effective
         Date") and shall continue in force for a period of two years unless
         earlier terminated in accordance with this Agreement. All terms and
         conditions set forth in this Agreement shall go into effect on the
         Effective Date unless otherwise stated.

         B.       TERMINATION.

         (1) The MCO may terminate this Agreement without cause upon sixty (60)
         days written notice to the Bureau. The Bureau may terminate this
         Agreement for cause at any time upon (a) the insolvency of the MCO, (b)
         any act of fraud or misrepresentation by the MCO of the amount or cost
         of services or supplies rendered or provided to an injured worker, (c)
         any act of fraud or misrepresentation by an MCO in reporting or
         submitting data to the Bureau, including but not limited to data used
         by the Bureau to calculate or determine the MCO's administrative,
         performance, or incentive payments, (d) an unapproved Change in the
         organizational structure of the MCO or a material Change in its
         business operations, (e) decertification of the MCO or (f) substantial
         failure to perform on the part of the MCO.

         (2) Prior to terminating this contract for 5B(1)(f) substantial failure
         to perform, the Bureau shall send written notice to the MCO containing
         a statement of the reasons for the proposed termination of the
         contract; a citation to the statutes, rules, or contract provisions
         forming the basis for the termination of the contract; a statement
         indicating that the MCO shall be provided a hearing, if requested
         within thirty (30) days of the time of the mailing of the notice; and a
         statement informing the MCO that if a hearing is not requested within
         thirty (30) days, the Bureau shall terminate the MCO contract.

         (3) If the MCO does not timely request a hearing, the Bureau may
         terminate this contract for substantial failure to perform. If the MCO
         timely requests a hearing, the Bureau shall

                                       14
<PAGE>   16

         immediately set the date, time, and place for such hearing, and shall
         notify the MCO of the hearing. The hearing shall be held at the Bureau
         central office in Columbus.

         (4) The Administrator may conduct the hearing personally or may
         delegate the hearing to a designee, who shall be an attorney at law.
         The designee may be from the Bureau law section or an attorney employed
         by the Administrator especially for such purpose. Should the hearing be
         conducted by a designee, the designee shall issue a report and
         recommendation, a copy of which shall be mailed to all parties and
         representatives, and which may be objected to in writing within ten
         (10) days. The Administrator may approve, disapprove, or modify the
         report and recommendation of the designee, but shall not take such
         action until after the expiration of the period for objection to the
         designee's report. The Administrator shall issue a decision in writing
         to the MCO and any representative informing them of the Administrator's
         decision as to the proposed termination. The Administrator's final
         decision as to termination of this Agreement, whether a hearing was
         conducted or not, shall not be appealable.

         (5) In the event of termination for any reason, the Bureau shall
         determine a transition plan for the transfer of services to another
         managed care organization selected by employers or assigned by the
         Bureau. In the event of termination for any reason the Bureau may
         withhold further payment due to the MCO pursuant to this Agreement, or
         otherwise, for the purpose of set-off until such time as any damages
         due to the Bureau are determined.

         C.       DAMAGES.

         The MCO acknowledges that the Bureau may suffer damages due to the
         failure of the MCO to act in accordance with the terms and conditions
         of this Agreement. The MCO agrees that if the Bureau does not give
         prompt notice of such failure the Bureau has NOT WAIVED any of its
         rights or remedies concerning the failure of performance by the MCO. In
         the event that this Agreement is terminated for any reason the MCO
         shall be liable for any damages and additional costs the Bureau incurs
         in seeking replacement services.

         D.       FORCE MAJEURE

         Neither the MCO nor the Bureau shall be liable to the other for any
         delay or failure of performance of any provisions contained herein, to
         the extent that such delay or failure is caused by any act of God, such
         as earthquake; fire; storms; tornadoes; floods, or other severe weather
         disturbances; explosions; civil disturbances; war; and other such
         events or any other cause that could not be reasonably foreseen in the
         exercise of ordinary care, and that is beyond the reasonable control of
         the party affected, and that the party is unable to prevent.

         E.       DECERTIFICATION.

         The Bureau retains the discretion to initiate decertification
         proceedings against the MCO upon termination of this Agreement.

6.       GENERAL AND PROFESSIONAL LIABILITY INSURANCE.

The MCO shall maintain general and professional liability insurance against
claims for bodily injury, personal injury, death or property damage arising from
the services performed by the MCO, its employees, agents, representatives, or
subcontractors, under this Agreement for the duration of this Agreement,
together with any renewals. Such insurance shall afford initial protection of
not less than three million dollars ($3,000,000.00) for each occurrence with
respect to bodily injury, personal injury or death and not less than three
million dollars ($3,000,000.00) for each occurrence with respect to property
damage.

                                       15
<PAGE>   17

7.       AMENDMENT.

The parties may, by mutual agreement, amend, modify, supplement or rescind the
terms of this Agreement. The term "this Agreement" shall be deemed to include
any such future amendments, modifications, renewals, extensions, and
supplements. Any such amendment, modification, renewal, extension, supplement or
rescission shall not be effective unless expressed in writing and signed by the
parties hereto; provided, however, the MCO agrees to permit the Bureau to update
and substitute, from time to time, its policies, procedures and guidelines that
are referred to in this Agreement.

8.       ENTIRE AGREEMENT.

It is mutually understood and agreed that this Agreement, with its Appendices,
and the MCO's Application, with any amendments, and the "MCO Application &
Requirements Training Manual" are incorporated by reference into this Agreement,
and together, represent the entire Agreement between the MCO and the Bureau. The
parties have entered into no agreements, express or implied, other than the
Agreement set forth in this writing. It is further agreed that no parole
representation of any amendment, modification, supplement or rescission of the
terms set forth herein shall be given any force or effect unless such amendment,
modification, supplement or rescission has been expressed in writing and signed
by the parties and meets any and all conditions precedent deemed applicable by
the Bureau.

9.       ORDER OF PRIORITIES.

To the extent that the terms and provisions of the MCO's Application, with any
amendments, may be inconsistent with this writing, and cannot be harmonized
herewith, the terms and provisions of this Agreement shall control followed in
order of priority by the Application, with any amendments, then the "MCO
Application & Requirements Training Manual."

10.      SEVERABILITY.

If for any reason any provision or part of this Agreement is declared void,
invalid, or unenforceable, the validity of the rest of this Agreement shall not
be affected and the Agreement shall remain in full force and effect with the
void, invalid, or unenforceable provision(s) eliminated.

11.      WAIVER.

No waiver of any provision of this Agreement shall be valid unless it is in
writing and signed by the party against whom the waiver is sought to be
enforced. Failure of a party to insist upon strict performance of any provision
of this Agreement in any one or more instances shall not be construed as a
waiver or relinquishment of the right to insist upon strict compliance with such
provision in the future.

12.      ASSIGNABILITY AND SUBCONTRACTING.

(A) MCOs are permitted to subcontract services and the MCO is accountable for
the actions and performance of any subcontractors engaged by the MCO. The MCO
shall not assign, sell, or subcontract any rights, duties or obligations
acquired pursuant to this Agreement without prior written approval by the Bureau
as provided under Section 3C and/or Appendix D of this Agreement. Such prior
written approval by the Bureau shall not be construed to modify or abrogate the
MCO's responsibility and liability pursuant to this Agreement.

(B) In the event the MCO assigns or subcontracts its duties or obligations under
this Agreement, the MCO shall develop with the Bureau a transition plan for the
transfer of services to a new MCO selected

                                       16
<PAGE>   18

by employers or assigned by the Bureau as provided under Appendix D of this
Agreement. The MCO shall bear any expenses related to any transitioning or
transfer of services by assignment or otherwise.

13.      NON-DISCRIMINATION.

The hiring of employees for the performance of work under this Agreement shall
be done in accordance with Ohio Revised Code Section 125.111 and the Governor's
amended Executive Order 84-9 of November 30, 1984. The contract shall not
discriminate against or intimidate any person hired for the performance of the
work by reason of race, color, religion, national origin, ancestry, sex,
handicap, or disability as that term is defined by the Americans with
Disabilities Act (ADA).

14.      INDEPENDENT MCO RELATIONSHIP.

It is mutually understood and agreed that the MCO is at all times acting as an
independent MCO in performing services under this Agreement and shall be
responsible for compliance with all laws, rules, and regulations involving, but
not limited to, employment of labor, hours of labor, health and safety, working
conditions and payment of wages. The persons provided by the MCO shall be solely
the MCO's employees and subcontractors of the MCO and shall not be considered
employees of the Bureau. The MCO shall be responsible for payment of federal,
state, and municipal taxes and costs such as Social Security, unemployment,
workers' compensation, disability insurance, and federal and state withholding
with respect to its employees.

15.      CONFIDENTIALITY.

The MCO, its officers, agents, employees, representatives, subcontractors and
assigns shall keep confidential all information, in whatever form obtained, in
the performance of this Agreement, including but not limited to knowledge of the
contents of confidential records of the Bureau. Any information subject to the
confidentiality laws of this state shall not be released to any person other
than authorized representatives of the Bureau, unless the Bureau directs its
release.

16.      HOLD HARMLESS AND INDEMNIFICATION.

The MCO shall hold the Bureau harmless and indemnify the Bureau from and against
any and all claims, demands, losses, and causes of action asserted against or
incurred by the Bureau that result from or arise out of the work performed by
the MCO, its agents, employees, representatives, and subcontractors, under this
Agreement, or any errors, omissions, negligent conduct or intentional acts of
the MCO, its agents, employees, representatives, and subcontractors.

17.      LIMITATION OF LIABILITY.

The Bureau's liability for damages for services rendered pursuant to this
Agreement, whether in contract or in tort, shall not exceed the total amount of
compensation payable to the MCO pursuant to this Agreement, or the amount of
direct damages incurred by the MCO, whichever is less. The MCO's sole and
exclusive remedies for the Bureau's failure to perform shall be subject to the
jurisdiction of the Ohio Court of Claims. In no event shall the Bureau be liable
for any consequential, incidental, or punitive losses, damages, expenses,
including the loss of profits, even if the Bureau knew or should have known of
the possibility of such damages.

18.      APPLICABLE STATE LAW.

The terms and conditions contained herein shall be construed and interpreted in
accordance with the laws of the State of Ohio. Any and all disputes arising from
this Agreement shall be governed by the laws of

                                       17
<PAGE>   19

the State of Ohio, and the MCO agrees to submit exclusively to the jurisdiction
of the Ohio Court of Claims in any and all disputes arising from this Agreement.

19.      COMPLIANCE WITH THE LAWS OF OHIO.

The MCO agrees and covenants that it at this time is not and for the duration of
this Agreement will not knowingly violate the laws of Ohio specifically
including, but not limited to, the workers' compensation laws of Ohio, the
corporate laws of Ohio, and all rules and regulations promulgated under those
laws.

20.      CONFLICTS OF INTEREST.

(A) The MCO affirms that it presently has no interest and shall not acquire any
interest, direct or indirect, which would conflict, in any manner or degree,
with the performance of services which are required to be performed under any
resulting Agreement. In addition, the MCO affirms that a person who is or may
become an agent of MCO not having such interest upon the execution of this
Agreement shall likewise advise the Bureau in the event it acquires such
interest during the term of this Agreement.

(B) Furthermore, any such person who is or may become an agent of the MCO who
acquires an incompatible or conflicting personal interest, prior to, on or after
the effective date of this Agreement, or who involuntarily acquires any such
incompatible or conflicting personal interest, shall immediately disclose his or
her interest to the Bureau in writing. Thereafter, such person shall not
participate in any action affecting the work under this Agreement, unless the
Bureau determines that, in light of the personal interest disclosed, such
person's participation in any such action would not be contrary to the public
interest.

(C) The MCO and any affiliated Third Party Administrators ("TPAs"), if
applicable, shall have complete separation of functions, offices, systems, and
staff. The MCO shall not use or contract with any provider who has an ownership
interest in, or who is the medical director for, the MCO to provide Independent
Medical Examination ("IME") services for injured workers assigned to the MCO.
The MCO and any subcontractor(s) must be separate legal entities and may not
have the same Bureau provider number or tax identification number. The MCO shall
not be a Bureau certified health care provider.

21.      HEADINGS.

The headings in this Agreement and its appendices are for convenience only and
are not intended to be part of, or to affect the interpretation of, the terms of
this Agreement.

22.      CERTIFICATION.

The MCO is certified to provide services under this Agreement only in the
counties listed in Appendix F of this Agreement, as may be modified during the
term of this Agreement.

23.      OHIO ELECTIONS LAW.

The MCO affirms that, as applicable to the MCO, no party listed in Division (I)
or (J) of Section 3517.13 of the Revised Code, or spouse of such party, has
made, as an individual, within the two previous calendar years, one or more
political contributions totaling in excess of $1,000.00 to the Governor of Ohio
or to his campaign committees.

24.      DEFINITIONS.

Unless otherwise defined in the text of this Agreement, the capitalized terms
and capitalized abbreviations as used in this Agreement shall have the same
meaning as defined in Rule 4123-6-01 of the Ohio Administrative Code. A Glossary
of the defined terms used in this Agreement is attached as Appendix G.

                                       18
<PAGE>   20

IN WITNESS WHEREOF, the parties hereunto affix their signatures this 10th day of
November, 1999.

COMMUNITY INSURANCE COMPANY                   STATE OF OHIO
d/b/a Anthem Blue Cross And Blue Shield       BUREAU OF WORKERS' COMPENSATION
TAX ID #____________________________

------------------------------------          --------------------------------

Name:                                         Name:  James Conrad
     -------------------------------                 ------------

Title:                                        Title: Administrator
     -------------------------------                 -------------

                                       19
<PAGE>   21

IN WITNESS WHEREOF, the parties hereunto affix their signatures this 10th day of
November, 1999.

COMMUNITY INSURANCE COMPANY                   STATE OF OHIO
d/b/a Anthem Blue Cross And Blue Shield       BUREAU OF WORKERS' COMPENSATION
TAX ID #____________________________

------------------------------------          --------------------------------

Name:                                         Name:  James Conrad
     -------------------------------                 ------------

Title:                                        Title: Administrator
     -------------------------------                 -------------

                                       19<PAGE>   1
                                                                    Exhibit 10.3

                                 PROMISSORY NOTE
                          ADJUSTABLE RATE MORTGAGE LOAN

Date of Note:      February 29, 2000
------------

Amount of Note:    Eight Million and 00/100 Dollars ($8,000,000.00)
--------------

Maturity Date:     February 28, 2010
-------------

Interest Rate:
-------------

         The "Interest Rate" shall be the Prime Rate of the Lender, as defined
herein, charged by the Lender, computed daily for the actual number of days
elapsed over a year of 360 days. For purposes hereof, Prime Rate shall mean the
rate charged by Lender as its "Prime Rate", computed daily for the actual number
of days elapsed over a year of 360 days. Prime Rate is that percentage rate of
interest which is announced by Lender from time to time as its Prime Rate, which
is in effect until a new rate is announced and which provides a base to which
loan rates may be referenced; it is not necessarily the Lender's lowest loan
rate. In the event of a change in such Prime Rate, the interest rate hereunder
shall be adjusted accordingly, and such adjustment shall become effective on the
date such Prime Rate changes.

Amortization Period:
-------------------

         The "Amortization Period" shall equal twenty (20) years.

Principal and Interest Monthly Payment:
--------------------------------------

         Commencing on April 1, 2000 and on the first Business Day, as defined
herein, of each calendar month thereafter during the term hereof, principal
payments shall be due and payable in the amount of Thirty-Three Thousand Three
Hundred Thirty-Three and 33/100 Dollars ($33,333.33) each. Commencing on April
1, 2000 and on the first Business Day of each calendar month thereafter during
the term hereof, Borrower shall make interest payments to Lender as accrued and
as determined in accordance with the Interest Rate provided above. Business Day
shall mean any day of the year on which banks are not required or authorized to
close in Cincinnati, Ohio.

         FOR VALUE RECEIVED, the undersigned ("Borrower") does hereby covenant
and promise to pay to the order of THE PROVIDENT BANK, an Ohio banking
corporation, or its successors or assigns, at its principal office located at
One East Fourth Street, Cincinnati, Ohio, 45202 ("Lender"), or at such other
place as the Lender may designate to Borrower in writing from time to time, in
legal tender of the United States, the Amount of Note, together with interest at
the Interest Rate on the
<PAGE>   2
                                      - 2 -

Amount of Note until this Note is paid in full. Borrower shall pay a late
payment premium of five percent (5%) of any principal or interest payment made
more than ten (10) days after the due date which shall be due with any such late
payment.

         All payments of principal and interest made hereunder by Borrower shall
be applied monthly, first to the payment of sums advanced by the Lender, if any,
as provided in this Note, the Open-End Mortgage dated of even date herewith
granted by Borrower to Lender ("Mortgage") or in any other document executed as
collateral security for the Note ("Loan Documents"); second, to interest which
became due previously; third, to interest which became due for the month for
which payment is being made; fourth, to the payment of late charges provided
herein; and the balance to principal, until the full amount of principal and
interest has been paid, or until the unpaid balance of this Note matures, if
sooner.

         Upon each monthly determination of the Interest Rate and in accordance
with Lender's normal billing process, the Lender will mail a statement to the
Borrower at the address then listed for Borrower on the Lender's records. Such
statement will provide notice that the Interest Rate has changed, the effective
date of such change, the revised amount of the Borrower's Principal and Interest
Monthly Payment as determined in accordance with the adjusted Interest Rate
which will continue to include a monthly principal payment of Thirty-Three
Thousand Three Hundred Thirty-Three and 33/100 Dollars ($33,333.33) per month,
and will contain such other information as may be required by law or which the
Lender may elect to provide to Borrower. Borrower promises to pay to Lender such
revised Principal and Interest Monthly Payment as determined in accordance with
the terms hereof.

         Unless sooner paid, the outstanding principal balance and all accrued
interest remaining due hereunder shall be payable on the Maturity Date.

         This Note is secured by the Mortgage and the other Loan Documents which
Mortgage and other Loan Documents specify various defaults (each, a "Default")
upon the happening of which all sums owing on this Note may, at the Lender's
option, be declared immediately due and payable without demand or notice.

         During the continuance of a Default, the Amount of Note outstanding
shall bear interest at four percent (4%) per annum in excess of the Interest
Rate in effect from time to time, each change in such rate to be effective as of
the date of such change ("Default Rate").

         Should the indebtedness represented by this Note or any part thereof be
collected at law or in equity, or in bankruptcy, receivership or any other court
proceedings (whether at the trial or appellate level), or should this Note be
placed in the hands of attorneys for collection upon the occurrence of a
Default, Borrower agrees to pay, in addition to the principal, premium and
interest due and payable hereon, all costs of collection, including reasonable
attorneys' fees and expenses.
<PAGE>   3
                                      - 3 -

         All parties to this Note, whether Borrower, principal, surety,
guarantor or endorser, hereby jointly and severally waive presentment for
payment, demand, protest, notice of protest, notice of dishonor and any other
notice required to be given by law in connection with the delivery, acceptance,
performance, default or enforcement of this Note or any endorsement or guaranty
of this Note, except as provided in the Mortgage or the Guaranty, and consent to
all forbearance or waiver of any term hereof or release or discharge by the
holder hereof of any of the Borrower, guarantors, endorsers or sureties or the
release, substitution or exchange of any security for the payment hereof or the
failure to act on the part of the holder or any other indulgence shown by the
holder from time to time, in one or more instances (without notice to or further
assent from the Borrower, guarantors, endorsers or sureties) and the Borrower,
guarantors, endorsers or sureties agree that no such action, failure to act or
failure to exercise any right or remedy on the part of the holder shall in any
way affect or impair the obligations of the Borrower hereunder or of any
guarantors, endorsers or sureties or be construed as a waiver by the holder of
or otherwise affect any of the holder's rights under this Note, under any
endorsement or guaranty of this Note or under any document or instrument
evidencing any security for payment of this Note.

         This Note may not be changed orally, but only by an agreement in
writing, signed by the party against whom enforcement of any change or
modification is sought.

         Anything herein to the contrary notwithstanding, the obligations of
Borrower under this Note, the Mortgage or other Loan Documents shall be subject
to the limitation that payments of interest shall not be required to the extent
that receipt of any such payment by the Lender would be contrary to provisions
of law applicable to the Lender limiting the maximum rate of interest that may
be charged or collected by the Lender.

         The Borrower shall have the right to prepay all, or any part, of the
Amount of Note outstanding and all accrued interest thereon without premium or
penalty. Any partial prepayments of principal shall be applied against
installments of principal due hereunder in the inverse order of maturity.

         This Note shall be governed by, and shall be construed and enforced in
accordance with, the laws of the State of Ohio.

         Remainder of page intentionally left blank. Signature page follows.
<PAGE>   4
         AS A SPECIFICALLY BARGAINED INDUCEMENT FOR LENDER TO EXTEND CREDIT TO
BORROWER, THE BORROWER HEREBY EXPRESSLY WAIVES THE RIGHT TO TRIAL BY JURY IN ANY
LAWSUIT OR PROCEEDING RELATED TO THIS NOTE OR ARISING IN ANY WAY FROM THE
INDEBTEDNESS OR TRANSACTIONS INVOLVING THE LENDER AND THE BORROWER.

         IN WITNESS WHEREOF, Borrower has executed and delivered this Note on
the day and year first above written.

                                     BORROWER:

                                     DURAMED PHARMACEUTICALS, INC.
                                     a Delaware corporation

                                     By: /s/ Timothy J. Holt
                                        ----------------------------------------
                                     Name:   Timothy J. Holt
                                          --------------------------------------
                                     Title:  Senior Vice President
                                             Finance & Administration
                                           -------------------------------------

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