Document:

<PAGE>   1
                                                                    EXHIBIT 10.5
                      NON-QUALIFIED STOCK OPTION AGREEMENT
                                    under the
                          ACCREDO HEALTH, INCORPORATED
                          1999 LONG-TERM INCENTIVE PLAN

                  Optionee:              Kenneth R. Masterson
                            ----------------------------------------------------

                  Number Shares Subject to Option:    10,000
                                                  ------------------------------

                  Exercise Price per Share:          $41.625
                                            ------------------------------------

                  Date of Grant:                     November 1, 2000
                                ------------------------------------------------

         1.       Grant of Option. Accredo Health, Incorporated (the "Company")
hereby grants to the Optionee named above (the "Optionee"), under the Accredo
Health, Incorporated 1999 Long-Term Incentive Plan (the "Plan"), a Non-Qualified
Stock Option to purchase, on the terms and conditions set forth in this
agreement (this "Option Agreement"), the number of shares indicated above of the
Company's $0.01 par value common stock (the "Stock"), at the exercise price per
share set forth above (the "Option"). Capitalized terms used herein and not
otherwise defined shall have the meanings assigned such terms in the Plan.

         2.       Vesting of Option. The Option shall be 100% vested upon the
date of grant.

         3.       Period of Option and Limitations on Right to Exercise. The
Option will, to the extent not previously exercised, lapse under the earliest of
the following circumstances; provided, however, that the Committee may, prior to
the lapse of the Option under the circumstances described in paragraph below,
provide in writing that the Option will extend until a later date:

         (a)      The  Option shall lapse as of 5:00  p.m., Eastern Time, on the
tenth anniversary of the date of grant (the "Expiration Date").

         (b)      The Option shall lapse three months after the Optionee's
termination of service as a director for any reason.

         If the Optionee or his beneficiary exercises an Option after
termination of service as a director, the Option may be exercised only with
respect to the shares that were otherwise vested on the Optionee's termination
of service (including vesting by acceleration in accordance with Article 13 of
the Plan).

<PAGE>   2

         4.       Exercise of Option. The Option shall be exercised by written
notice directed to the Secretary of the Company at the principal executive
offices of the Company, in substantially the form attached hereto as Exhibit A,
or such other form as the Committee may approve. Unless the exercise is a
broker-assisted "cashless exercise" as described below, such written notice
shall be accompanied by full payment in cash, shares of Stock previously
acquired by the Optionee, or any combination thereof, for the number of shares
specified in such written notice; provided, however, that if shares of Stock are
used to pay the exercise price, such shares must have been held by the Optionee
for at least six months. The Fair Market Value of the surrendered Stock as of
the last trading day immediately prior to the exercise date shall be used in
valuing Stock used in payment of the exercise price. To the extent permitted
under Regulation T of the Federal Reserve Board, and subject to applicable
securities laws, the Option may be exercised through a broker in a so-called
"cashless exercise" whereby the broker sells the Option shares and delivers cash
sales proceeds to the Company in payment of the exercise price. In such case,
the date of exercise shall be deemed to be the date on which notice of exercise
is received by the Company and the exercise price shall be delivered to the
Company on the settlement date.

         Subject to the terms of this Option Agreement, the Option may be
exercised at any time and without regard to any other option held by the
Optionee to purchase stock of the Company. Upon the Optionee's death, the Option
may be exercised by the Optionee's beneficiary.

         5.       Beneficiary Designation. The Optionee, by written notice to
the Committee, may designate one or more persons (and from time to time change
such designation) including the Optionee's legal representative, who, by reason
of the Optionee's death, shall acquire the right to exercise all or a portion of
the Option. If no beneficiary has been designated or survives the Optionee, the
Option may be exercised by the personal representative of the Optionee's estate.
If the person with exercise rights desires to exercise any portion of the
Option, such person must do so in accordance with the terms and conditions of
this Agreement and the Plan.

         6.       Withholding. The Company has the authority and the right to
deduct or withhold, or require the Optionee to remit to the Company, an amount
sufficient to satisfy federal, state, and local taxes (including the Optionee's
FICA obligation) required by law to be withheld with respect to any taxable
event arising as a result of the exercise of the Option. Such withholding
requirement may be satisfied, in whole or in part, at the election of the
Company, by withholding from the Option shares of Stock having a Fair Market
Value on the date of withholding equal to the minimum amount (and not any
greater amount) required to be withheld for tax purposes, all in accordance with
such procedures as the Committee establishes.

         7.       Limitation of Rights. The Option does not confer to the
Optionee or the Optionee's personal representative any rights of a shareholder
of the Company unless and until shares of Stock are in fact issued to such
person in connection with the exercise of

                                      -2-
<PAGE>   3

the Option. Nothing in this Option Agreement shall confer upon the Optionee any
right to continue as a director of the Company or any Parent or Subsidiary.

         8.       Stock Reserve. The Company shall at all times during the term
of this Option Agreement reserve and keep available such number of shares of
Stock as will be sufficient to satisfy the requirements of this Option
Agreement.

         9.       Restrictions on Transfer and Pledge. The Option may not be
pledged, encumbered, or hypothecated to or in favor of any party other than the
Company or a Parent or Subsidiary, or be subject to any lien, obligation, or
liability of the Optionee to any other party other than the Company or a Parent
or Subsidiary. The Option is not assignable or transferable by the Optionee
other than by will or the laws of descent and distribution or pursuant to a
domestic relations order that would satisfy Section 414(p)(1)(A) of the Code;
provided, however, that the Committee may (but need not) permit other transfers
where the Committee concludes that such transferability (i) does not result in
accelerated taxation and (ii) is otherwise appropriate and desirable, taking
into account any factors deemed relevant, including without limitation, state or
federal tax or securities laws applicable to transferable options. The Option
may be exercised during the lifetime of the Optionee only by the Optionee or any
permitted transferee.

         10.      Restrictions on Issuance of Shares. If at any time the Board
shall determine in its discretion, that listing, registration or qualification
of the shares of Stock covered by the Option upon any securities exchange or
under any state or federal law, or the consent or approval of any governmental
regulatory body, is necessary or desirable as a condition to the exercise of the
Option, the Option may not be exercised in whole or in part unless and until
such listing, registration, qualification, consent or approval shall have been
effected or obtained free of any conditions not acceptable to the Board.

         11.      Plan Controls. The terms contained in the Plan are
incorporated into and made a part of this Option Agreement and this Option
Agreement shall be governed by and construed in accordance with the Plan. In the
event of any actual or alleged conflict between the provisions of the Plan and
the provisions of this Option Agreement, the provisions of the Plan shall be
controlling and determinative.

         12.      Successors. This Option Agreement shall be binding upon any
successor of the Company, in accordance with the terms of this Option Agreement
and the Plan.

         13.      Severability. If any one or more of the provisions contained
in this Option Agreement are invalid, illegal or unenforceable, the other
provisions of this Option Agreement will be construed and enforced as if the
invalid, illegal or unenforceable provision had never been included.

                                      -3-
<PAGE>   4

         14.      Notice. Notices and communications under this Option Agreement
must be in writing and either personally delivered or sent by registered or
certified United States mail, return receipt requested, postage prepaid. Notices
to the Company must be addressed to:

                  Accredo Health, Incorporated
                  1640 Century Center Parkway
                  Suite 101
                  Memphis, Tennessee  38134
                  Attn:  Secretary

or any other address designated by the Company in a written notice to the
Optionee. Notices to the Optionee will be directed to the address of the
Optionee then currently on file with the Company, or at any other address given
by the Optionee in a written notice to the Company.

         15.      Binding Effect. The grant of the Options referenced herein is
subject to Optionee being bound by all of the terms set out in this Agreement.
The acceptance of the Options and the exercise of any right hereunder, including
but not being limited to the giving of written notice to exercise any Option,
shall constitute conclusive evidence of acceptance by the Optionee of all of the
terms and conditions set out herein, and Optionee by such actions shall be bound
by, and shall be deemed to have agreed to these terms and conditions, the same
as if Optionee had affixed his or her signature to this Incentive Stock Option
Agreement.

         IN WITNESS WHEREOF, Accredo Health, Incorporated, acting by and through
its duly authorized officers, has caused this Option Agreement to be executed,
all as of the day and year first above written.

                                            ACCREDO HEALTH, INCORPORATED

                                            By:    /s/  Thomas W. Bell, Jr.
                                               ----------------------------

                                            Name:  Thomas W. Bell, Jr.
                                            Title: Sr. Vice President and
                                                   General Counsel
                                      -4-
<PAGE>   5

                                    EXHIBIT A

                    NOTICE OF EXERCISE OF OPTION TO PURCHASE
                                 COMMON STOCK OF
                          ACCREDO HEALTH, INCORPORATED

Name
     ---------------------------------------
Address:
         -----------------------------------

         -----------------------------------
Date
     ---------------------------------------

Accredo Health, Incorporated
1640 Century Center Parkway
Suite 101
Memphis, Tennessee  38134
Attn: Secretary

Re:      Exercise of Non-Qualified Stock Option

         I elect to purchase ______________ shares of Common Stock of Accredo
Health, Incorporated (the "Company") pursuant to the Accredo Health,
Incorporated Non-Qualified Stock Option Agreement dated ______________ and the
Accredo Health, Incorporated 1999 Long-Term Incentive Plan. The purchase will
take place on the Exercise Date, which will be (i) as soon as practicable
following the date this notice and all other necessary forms and payments are
received by the Company, unless I specify a later date (not to exceed 30 days
following the date of this notice), or (ii) in the case of a Broker-assisted
cashless exercise (as indicated below), the date of this notice.

         On or before the Exercise Date (or, in the case of a Broker-assisted
cashless exercise, on the settlement date following the Exercise Date), I will
pay the full exercise price in the form specified below (check one):

[ ]      Cash Only: by delivering a check to the Company for $___________.

[ ]      Cash and Shares: by delivering a check to the Company for $_________
         for the part of the exercise price. I will pay the balance of the
         exercise price by delivering to the Company a stock certificate with my
         endorsement for shares of Company Stock that I have owned for at least
         six months. If the number of shares of Company Stock represented by
         such stock certificate exceeds the number needed to pay the exercise
         price, the Company will issue me a new stock certificate for the
         excess.

[ ]      Shares Only: by delivering to the Company a stock certificate with my
         endorsement for shares of Company Stock that I have owned for at least
         six

<PAGE>   6

         months. If the number of shares of Company Stock represented by such
         stock certificate exceeds the number needed to pay the exercise price,
         the Company will issue me a new stock certificate for the excess.

[ ]      Cash From Broker: by delivering the purchase price from
         _______________________, a broker, dealer or other "creditor" as
         defined by Regulation T issued by the Board of Governors of the Federal
         Reserve System (the "Broker"). I authorize the Company to issue a stock
         certificate in the number of shares indicated above in the name of the
         Broker in accordance with instructions received by the Company from the
         Broker and to deliver such stock certificate directly to the Broker (or
         to any other party specified in the instructions from the Broker) upon
         receiving the exercise price from the Broker.

         On or before the Exercise Date, I will pay satisfy any applicable tax
withholding obligations in the form specified below (check one):

[ ]      Cash Only: by delivering a check to the Company for the full tax
         withholding amount.

[ ]      Cash and Shares: by delivering a check to the Company for $_________
         for part of the tax withholding amount. I will pay the balance of the
         tax withholding amount by delivering to the Company a stock certificate
         with my endorsement for shares of Company Stock that I have owned for
         at least six months. If the number of shares of Company Stock
         represented by such stock certificate exceeds the number needed to pay
         the tax withholding amount, the Company will issue me a new stock
         certificate for the excess.

[ ]      Shares Only: by delivering to the Company a stock certificate with my
         endorsement for shares of Company Stock that I have owned for at least
         six months. If the number of shares of Company Stock represented by
         such stock certificate exceeds the number needed to pay the tax
         withholding amount, the Company will issue me a new stock certificate
         for the excess.

[ ]      Withholding of Shares to Cover Minimum Obligation: by having the
         Company withhold shares of Stock from the Option having a Fair Market
         Value on the date of withholding equal to the minimum amount (and not
         any greater amount) required to be withheld for tax purposes. Only
         whole shares may be withheld.

                                      -2-
<PAGE>   7

         Please deliver the stock certificate to me (unless I have chosen to pay
the purchase price through a Broker).

                                        Very truly yours,

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

AGREED TO AND ACCEPTED:

ACCREDO HEALTH, INCORPORATED

By
    -------------------------------------
Title:
       ----------------------------------
Number of Option Shares
Exercised:
           ------------------------------
Number of Option Shares
Remaining:
           ------------------------------
Date:
      -----------------------------------

                                      -3-<PAGE>   1
                                                                    EXHIBIT 10.6

                      NON-QUALIFIED STOCK OPTION AGREEMENT
                                    under the
                          ACCREDO HEALTH, INCORPORATED
                          1999 LONG-TERM INCENTIVE PLAN

                  Optionee:              Dick R. Gourley
                           -----------------------------------------------------

                  Number Shares Subject to Option:    10,000
                                                  ------------------------------

                  Exercise Price per Share:          $41.625
                                           -------------------------------------

                  Date of Grant:                     November 1, 2000
                                ------------------------------------------------

         1.       Grant of Option. Accredo Health, Incorporated (the "Company")
hereby grants to the Optionee named above (the "Optionee"), under the Accredo
Health, Incorporated 1999 Long-Term Incentive Plan (the "Plan"), a Non-Qualified
Stock Option to purchase, on the terms and conditions set forth in this
agreement (this "Option Agreement"), the number of shares indicated above of the
Company's $0.01 par value common stock (the "Stock"), at the exercise price per
share set forth above (the "Option"). Capitalized terms used herein and not
otherwise defined shall have the meanings assigned such terms in the Plan.

         2.       Vesting of Option. The Option shall be 100% vested upon the
date of grant.

         3.       Period of Option and Limitations on Right to Exercise. The
Option will, to the extent not previously exercised, lapse under the earliest of
the following circumstances; provided, however, that the Committee may, prior to
the lapse of the Option under the circumstances described in paragraph below,
provide in writing that the Option will extend until a later date:

         (a)      The Option shall lapse as of 5:00 p.m., Eastern Time, on the
tenth anniversary of the date of grant (the "Expiration Date").

         (b)      The Option shall lapse three months after the Optionee's
termination of service as a director for any reason.

         If the Optionee or his beneficiary exercises an Option after
termination of service as a director, the Option may be exercised only with
respect to the shares that were otherwise vested on the Optionee's termination
of service (including vesting by acceleration in accordance with Article 13 of
the Plan).

<PAGE>   2
         4.       Exercise of Option. The Option shall be exercised by written
notice directed to the Secretary of the Company at the principal executive
offices of the Company, in substantially the form attached hereto as Exhibit A,
or such other form as the Committee may approve. Unless the exercise is a
broker-assisted "cashless exercise" as described below, such written notice
shall be accompanied by full payment in cash, shares of Stock previously
acquired by the Optionee, or any combination thereof, for the number of shares
specified in such written notice; provided, however, that if shares of Stock are
used to pay the exercise price, such shares must have been held by the Optionee
for at least six months. The Fair Market Value of the surrendered Stock as of
the last trading day immediately prior to the exercise date shall be used in
valuing Stock used in payment of the exercise price. To the extent permitted
under Regulation T of the Federal Reserve Board, and subject to applicable
securities laws, the Option may be exercised through a broker in a so-called
"cashless exercise" whereby the broker sells the Option shares and delivers cash
sales proceeds to the Company in payment of the exercise price. In such case,
the date of exercise shall be deemed to be the date on which notice of exercise
is received by the Company and the exercise price shall be delivered to the
Company on the settlement date.

         Subject to the terms of this Option Agreement, the Option may be
exercised at any time and without regard to any other option held by the
Optionee to purchase stock of the Company. Upon the Optionee's death, the Option
may be exercised by the Optionee's beneficiary.

         5.       Beneficiary Designation. The Optionee, by written notice to
the Committee, may designate one or more persons (and from time to time change
such designation) including the Optionee's legal representative, who, by reason
of the Optionee's death, shall acquire the right to exercise all or a portion of
the Option. If no beneficiary has been designated or survives the Optionee, the
Option may be exercised by the personal representative of the Optionee's estate.
If the person with exercise rights desires to exercise any portion of the
Option, such person must do so in accordance with the terms and conditions of
this Agreement and the Plan.

         6.       Withholding. The Company has the authority and the right to
deduct or withhold, or require the Optionee to remit to the Company, an amount
sufficient to satisfy federal, state, and local taxes (including the Optionee's
FICA obligation) required by law to be withheld with respect to any taxable
event arising as a result of the exercise of the Option. Such withholding
requirement may be satisfied, in whole or in part, at the election of the
Company, by withholding from the Option shares of Stock having a Fair Market
Value on the date of withholding equal to the minimum amount (and not any
greater amount) required to be withheld for tax purposes, all in accordance with
such procedures as the Committee establishes.

         7.       Limitation of Rights. The Option does not confer to the
Optionee or the Optionee's personal representative any rights of a shareholder
of the Company unless and until shares of Stock are in fact issued to such
person in connection with the exercise of

                                      -2-

<PAGE>   3

the Option. Nothing in this Option Agreement shall confer upon the Optionee any
right to continue as a director of the Company or any Parent or Subsidiary.

         8.       Stock Reserve. The Company shall at all times during the term
of this Option Agreement reserve and keep available such number of shares of
Stock as will be sufficient to satisfy the requirements of this Option
Agreement.

         9.       Restrictions on Transfer and Pledge. The Option may not be
pledged, encumbered, or hypothecated to or in favor of any party other than the
Company or a Parent or Subsidiary, or be subject to any lien, obligation, or
liability of the Optionee to any other party other than the Company or a Parent
or Subsidiary. The Option is not assignable or transferable by the Optionee
other than by will or the laws of descent and distribution or pursuant to a
domestic relations order that would satisfy Section 414(p)(1)(A) of the Code;
provided, however, that the Committee may (but need not) permit other transfers
where the Committee concludes that such transferability (i) does not result in
accelerated taxation and (ii) is otherwise appropriate and desirable, taking
into account any factors deemed relevant, including without limitation, state or
federal tax or securities laws applicable to transferable options. The Option
may be exercised during the lifetime of the Optionee only by the Optionee or any
permitted transferee.

         10.      Restrictions on Issuance of Shares. If at any time the Board
shall determine in its discretion, that listing, registration or qualification
of the shares of Stock covered by the Option upon any securities exchange or
under any state or federal law, or the consent or approval of any governmental
regulatory body, is necessary or desirable as a condition to the exercise of the
Option, the Option may not be exercised in whole or in part unless and until
such listing, registration, qualification, consent or approval shall have been
effected or obtained free of any conditions not acceptable to the Board.

         11.      Plan Controls. The terms contained in the Plan are
incorporated into and made a part of this Option Agreement and this Option
Agreement shall be governed by and construed in accordance with the Plan. In the
event of any actual or alleged conflict between the provisions of the Plan and
the provisions of this Option Agreement, the provisions of the Plan shall be
controlling and determinative.

         12.      Successors. This Option Agreement shall be binding upon any
successor of the Company, in accordance with the terms of this Option Agreement
and the Plan.

         13.      Severability. If any one or more of the provisions contained
in this Option Agreement are invalid, illegal or unenforceable, the other
provisions of this Option Agreement will be construed and enforced as if the
invalid, illegal or unenforceable provision had never been included.

                                      -3-

<PAGE>   4

         14.      Notice. Notices and communications under this Option Agreement
must be in writing and either personally delivered or sent by registered or
certified United States mail, return receipt requested, postage prepaid. Notices
to the Company must be addressed to:

                  Accredo Health, Incorporated
                  1640 Century Center Parkway
                  Suite 101
                  Memphis, Tennessee  38134
                  Attn:  Secretary

or any other address designated by the Company in a written notice to the
Optionee. Notices to the Optionee will be directed to the address of the
Optionee then currently on file with the Company, or at any other address given
by the Optionee in a written notice to the Company.

         15.      Binding Effect. The grant of the Options referenced herein is
subject to Optionee being bound by all of the terms set out in this Agreement.
The acceptance of the Options and the exercise of any right hereunder, including
but not being limited to the giving of written notice to exercise any Option,
shall constitute conclusive evidence of acceptance by the Optionee of all of the
terms and conditions set out herein, and Optionee by such actions shall be bound
by, and shall be deemed to have agreed to these terms and conditions, the same
as if Optionee had affixed his or her signature to this Incentive Stock Option
Agreement.

         IN WITNESS WHEREOF, Accredo Health, Incorporated, acting by and through
its duly authorized officers, has caused this Option Agreement to be executed,
all as of the day and year first above written.

                          ACCREDO HEALTH, INCORPORATED

                          By:    /s/  Thomas W. Bell, Jr.
                             ---------------------------------------------------

                          Name:  Thomas W. Bell, Jr.
                          Title: Sr. Vice President and
                                 General Counsel

                                      -4-

<PAGE>   5

                                    EXHIBIT A

                    NOTICE OF EXERCISE OF OPTION TO PURCHASE
                                 COMMON STOCK OF
                          ACCREDO HEALTH, INCORPORATED

Name
     -----------------------------------
Address:
         -------------------------------
Date
     -----------------------------------

Accredo Health, Incorporated
1640 Century Center Parkway
Suite 101
Memphis, Tennessee  38134
Attn: Secretary

Re:      Exercise of Non-Qualified Stock Option

         I elect to purchase ______________ shares of Common Stock of Accredo
Health, Incorporated (the "Company") pursuant to the Accredo Health,
Incorporated Non-Qualified Stock Option Agreement dated ______________ and the
Accredo Health, Incorporated 1999 Long-Term Incentive Plan. The purchase will
take place on the Exercise Date, which will be (i) as soon as practicable
following the date this notice and all other necessary forms and payments are
received by the Company, unless I specify a later date (not to exceed 30 days
following the date of this notice), or (ii) in the case of a Broker-assisted
cashless exercise (as indicated below), the date of this notice.

         On or before the Exercise Date (or, in the case of a Broker-assisted
cashless exercise, on the settlement date following the Exercise Date), I will
pay the full exercise price in the form specified below (check one):

[ ]      Cash Only: by delivering a check to the Company for $___________.

[ ]      Cash and Shares: by delivering a check to the Company for $_________
         for the part of the exercise price. I will pay the balance of the
         exercise price by delivering to the Company a stock certificate with my
         endorsement for shares of Company Stock that I have owned for at least
         six months. If the number of shares of Company Stock represented by
         such stock certificate exceeds the number needed to pay the exercise
         price, the Company will issue me a new stock certificate for the
         excess.

[ ]      Shares Only: by delivering to the Company a stock certificate with my
         endorsement for shares of Company Stock that I have owned for at least
         six

<PAGE>   6

         months. If the number of shares of Company Stock represented by such
         stock certificate exceeds the number needed to pay the exercise price,
         the Company will issue me a new stock certificate for the excess.

[ ]      Cash From Broker: by delivering the purchase price from
         _______________________, a broker, dealer or other "creditor" as
         defined by Regulation T issued by the Board of Governors of the Federal
         Reserve System (the "Broker"). I authorize the Company to issue a stock
         certificate in the number of shares indicated above in the name of the
         Broker in accordance with instructions received by the Company from the
         Broker and to deliver such stock certificate directly to the Broker (or
         to any other party specified in the instructions from the Broker) upon
         receiving the exercise price from the Broker.

         On or before the Exercise Date, I will pay satisfy any applicable tax
withholding obligations in the form specified below (check one):

[ ]      Cash Only: by delivering a check to the Company for the full tax
         withholding amount.

[ ]      Cash and Shares: by delivering a check to the Company for $_________
         for part of the tax withholding amount. I will pay the balance of the
         tax withholding amount by delivering to the Company a stock certificate
         with my endorsement for shares of Company Stock that I have owned for
         at least six months. If the number of shares of Company Stock
         represented by such stock certificate exceeds the number needed to pay
         the tax withholding amount, the Company will issue me a new stock
         certificate for the excess.

[ ]      Shares Only: by delivering to the Company a stock certificate with my
         endorsement for shares of Company Stock that I have owned for at least
         six months. If the number of shares of Company Stock represented by
         such stock certificate exceeds the number needed to pay the tax
         withholding amount, the Company will issue me a new stock certificate
         for the excess.

[ ]      Withholding of Shares to Cover Minimum Obligation: by having the
         Company withhold shares of Stock from the Option having a Fair Market
         Value on the date of withholding equal to the minimum amount (and not
         any greater amount) required to be withheld for tax purposes. Only
         whole shares may be withheld.

                                      -2-

<PAGE>   7

         Please deliver the stock certificate to me (unless I have chosen to pay
the purchase price through a Broker).

                                            Very truly yours,

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

AGREED TO AND ACCEPTED:

ACCREDO HEALTH, INCORPORATED

By
    -------------------------------------
Title:
       ----------------------------------
Number of Option Shares
Exercised:
           ------------------------------
Number of Option Shares
Remaining:
           ------------------------------
Date:
      -----------------------------------

                                      -3-

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