Document:

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                                                                Exhibit 10.22(d)

                             THIRD AMENDMENT TO THE

                              LIFEMARK CORPORATION

                     (FORMERLY MANAGED CARE SOLUTIONS, INC.)

                          EMPLOYEE STOCK PURCHASE PLAN

         Lifemark Corporation (the "Corporation"), under its former name of
Managed Care Solutions, Inc., adopted the Managed Care Solutions, Inc. Employee
Stock Purchase Plan (the "Plan"), effective June 1, 1996, and has previously
adopted two amendments to the Plan. The Plan, as previously amended, is hereby
further amended, pursuant to the authority of Section 17 of the Plan, as
follows:

         1. The name of the Plan is changed to the Lifemark Corporation Employee
Stock Purchase Plan, and all references in the Plan to Managed Care Solutions,
Inc., are amended to refer to Lifemark Corporation

         2. A new sentence is added to the end of Section 13 of the Plan to read
as follows:

         "Notwithstanding the foregoing, if any participating employee's
employment is terminated within three months from the end of the current
offering period as a result of the sale or other transfer of a portion of the
Corporation's business (including the management of any health plan) to a
successor employer, such employee may elect to leave the balance in his account
until the end of the offering period, to be used to purchase stock on the same
terms as if he were still employed on the last day of the offering period,
provided that no additional amounts shall be added to his account after his
employment is terminated, and any balance remaining after the purchase of stock
at the end of the offering period shall be distributed to him."

         3. This amendment shall not require the approval of the Corporation's
stockholders, and shall be effective on the date on which it is approved by the
Board of Directors. Except as otherwise amended herein, the Plan shall remain in
full force and effect, except that the Committee is authorized to make any
additional changes to the Plan of an administrative or ministerial nature which
may be appropriate to implement the amendments set forth herein.
         IN WITNESS WHEREOF, the Corporation has caused this Amendment to be
executed this 8th day of November, 1999.

                                          LIFEMARK CORPORATION

                                          By: /s/Michael J. Kennedy
                                          Its: Chief Financial Officer<PAGE>   1
                                                                Exhibit 10.27(b)

                              Lifemark Corporation
                             7600 North 16th Street
                                    Suite 150
                             Phoenix, Arizona 85020

                                 August 11, 2000

Mrs. Rhonda Brede
7600 North 16th Street
Suite 150
Phoenix, Arizona  85020

Dear Rhonda:

         This letter amends the October 14, 1999 agreement pursuant to which
Lifemark Corporation ("Lifemark") has agreed to employ you and you have agreed
to serve as President and Chief Executive Officer of Lifemark effective October
14, 2000.

         As of October 14, 2000, Lifemark granted you ten year stock options to
purchase 150,000 shares of Lifemark common stock. You also agreed to exercise
these options at the time of their vesting by delivering to Lifemark a secured
nine-year promissory note in the full amount of your exercise price. 90,000 of
the options granted to you vested immediately and were exercised by you on
October 14, 1999. The remaining 60,000 options granted to you under the 1999
Executive Stock Option and Ownership Plan will vest immediately if the Plan is
approved by the Company's stockholders.

         Lifemark and you agree to amend the October 14, 1999 agreement to
provide that you are entitled, but have no obligation, to exercise the remaining
options immediately upon their vesting.

         The substance of the terms of this letter was negotiated and agreed to
in Arizona and it is solely for the convenience of the parties that it is being
signed by facsimile outside of Arizona. Arizona law applicable to contracts made
and to be performed in Arizona shall therefore apply to and govern all aspects
of this Agreement.

         Please confirm your agreement with and acceptance of the provisions of
this letter by signing and returning the enclosed copy of this letter where
indicated.

                                               Sincerely,

                                               /s/Richard C. Jelinek
                                               Richard C. Jelinek,
                                               Chairman

ACCEPTED AND AGREED:

/s/Rhonda E. Brede
Rhonda Brede<PAGE>   1
                                                                Exhibit 10.28(b)

                              Lifemark Corporation
                             7600 North 16th Street
                                    Suite 150
                             Phoenix, Arizona 85020

                                 August 11, 2000

Richard M. Jelinek
7600 North 16th Street, Suite 150
Phoenix, Arizona  85020

Dear Rick:

         This letter amends the October 14, 1999 agreement between us pursuant
to which Lifemark Corporation ("Lifemark") agreed to employ you and you have
agreed to serve as a Vice President of Lifemark.

         As of October 14, 2000, Lifemark granted you ten year stock options to
purchase 100,000 shares of Lifemark common stock. You also agreed to exercise
these options at the time of their vesting by delivering to Lifemark a secured
nine-year promissory note in the full amount of your exercise price. 60,000 of
the options granted to you vested immediately and were exercised by you on
October 14, 1999. The remaining 40,000 options granted to you under the 1999
Executive Stock Option and Ownership Plan will vest immediately if the Plan is
approved by the Company's stockholders.

         Lifemark and you agree to amend the October 14, 1999 agreement to
provide that you are entitled, but have no obligation, to exercise the remaining
options immediately upon their vesting.

         Please confirm your agreement with and acceptance of the provisions of
this letter by signing and returning the enclosed copy of this letter where
indicated.

                                         Sincerely,

                                         /s/Rhonda E. Brede
                                         Rhonda Brede,
                                         President

ACCEPTED AND AGREED:

/s/ Richard M. Jelinek
Richard M. Jelinek<PAGE>   1
                                                                Exhibit 10.29(b)

                              Lifemark Corporation
                             7600 North 16th Street
                                    Suite 150
                             Phoenix, Arizona 85020

                                 August 11, 2000

Dave Decker
7600 North 16th Street, Suite 150
Phoenix, Arizona  85020

Dear Dave:

         This letter amends the October 14, 1999 agreement between us pursuant
to which Lifemark Corporation ("Lifemark") agreed to employ you and you have
agreed to serve as a Vice President of Lifemark.

         As of October 14, 2000, Lifemark granted you ten year stock options to
purchase 50,000 shares of Lifemark common stock. You also agreed to exercise
these options at the time of their vesting by delivering to Lifemark a secured
nine-year promissory note in the full amount of your exercise price. 25,000 of
the options granted to you vested immediately and were exercised by you on
October 14, 1999. The remaining 25,000 options granted to you under the 1999
Executive Stock Option and Ownership Plan will vest immediately if the Plan is
approved by the Company's stockholders.

         Lifemark and you agree to amend the October 14, 1999 agreement to
provide that you are entitled, but have no obligation, to exercise the remaining
options immediately upon their vesting.

         Please confirm your agreement with and acceptance of the provisions of
this letter by signing and returning the enclosed copy of this letter where
indicated.

                                                 Sincerely,

                                                 /s/Rhonda E. Brede
                                                 Rhonda Brede,
                                                 President

ACCEPTED AND AGREED:

/s/David Decker
Dave Decker<PAGE>   1
                                                                Exhibit 10.30(b)

                              Lifemark Corporation
                             7600 North 16th Street
                                    Suite 150
                             Phoenix, Arizona 85020

                                 August 11, 2000

Michael Kennedy
7600 North 16th Street, Suite 150
Phoenix, Arizona  85020

Dear Michael:

         This letter amends the October 14, 1999 agreement between us pursuant
to which Lifemark Corporation ("Lifemark") agreed to employ you and you have
agreed to serve as a Vice President of Lifemark.

         As of October 14, 2000, Lifemark granted you ten year stock options to
purchase 100,000 shares of Lifemark common stock. You also agreed to exercise
these options at the time of their vesting by delivering to Lifemark a secured
nine-year promissory note in the full amount of your exercise price. 60,000 of
the options granted to you vested immediately and were exercised by you on
October 14, 1999. The remaining 40,000 options granted to you under the 1999
Executive Stock Option and Ownership Plan will vest immediately if the Plan is
approved by the Company's stockholders.

         Lifemark and you agree to amend the October 14, 1999 agreement to
provide that you are entitled, but have no obligation, to exercise the remaining
options immediately upon their vesting.

         Please confirm your agreement with and acceptance of the provisions of
this letter by signing and returning the enclosed copy of this letter where
indicated.

                                          Sincerely,

                                          /s/Rhonda E. Brede
                                          Rhonda Brede,
                                          President

ACCEPTED AND AGREED:

/s/Michael J. Kennedy
Michael Kennedy

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