Document:

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                                  EXHIBIT 10.9

                 ($10,267,857.14 AMENDED AND RESTATED SHORT FORM
                      DEBENTURE DATED AS OF JUNE 28, 2002.)

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                       $10,267,857.14 AMENDED AND RESTATED
AS OF JUNE 28, 2002           SHORT FORM DEBENTURE        ANDOVER, MASSACHUSETTS

          This Amended and Restated Short Form Debenture (this "AMENDED
DEBENTURE") is issued pursuant to that certain Amendment Agreement, dated as of
even date herewith (the "AMENDMENT AGREEMENT"; capitalized terms used herein and
without definition shall have the meanings ascribed to them in the Amendment
Agreement), by and among Private Investment Bank Limited, Nassau, Bahamas or its
affiliates, acting in its name but on behalf and at the exclusive risk of
certain of Private Investment Bank Limited's clients (collectively "PIBL"), Med
Diversified, Inc., a Nevada corporation ("MED"), American Reimbursement, LLC, a
Delaware limited liability company, TEGCO Investments, LLC, a Delaware limited
liability company and each of the Med Subsidiaries, a copy of which is attached
hereto as EXHIBIT A and incorporated herein by this reference, and this Amended
Debenture amends and restates in its entirety that certain Short Form Debenture,
dated December 28, 2001, regarding the advance made on December 28, 2001 of
US$12,500,000 (the "PRINCIPAL SUM") by PIBL to MED, a copy of which is attached
hereto as EXHIBIT B and incorporated herein by this reference (the "ORIGINAL
DEBENTURE").

          This Amended Debenture shall be subject to the following terms and
conditions and the parties executing this Amended Debenture shall be obligated
to perform in accordance with such terms and conditions:

          1.   TERMS OF PAYMENT. This Amended Debenture shall have a final
maturity date of June 28, 2004, subject to acceleration of payment by MED of the
Principal Sum following an "EVENT OF DEFAULT" (the "TERM") and MED shall repay
the Principal Sum to PIBL or its designee together with interest thereon at the
rate of seven percent (7%) per annum, payable quarterly in arrears as of the
last Business Day (as defined below) of each March, June, September and December
during the Term, subject to default interest at an additional 100 basis points
(1% per annum) during the continuation of any Event of Default.

          2.   MANDATORY PRE-PAYMENT. Without limiting Section 6 below, this
Amended Debenture is subject to the mandatory prepayment provisions set forth in
Section 2(a) of the Amendment Agreement and the holder of this Amended Debenture
shall be entitled to a pro rata share of any such mandatory prepayment upon the
terms and conditions set forth therein.

          3.   ELIMINATION OF CONVERSION RIGHTS. All conversion rights granted
to PIBL or its designee(s) or assignee(s) under the Original Debenture or the
Escrow Agreement relating thereto are hereby eliminated, cancelled, and of no
further effect.

          4.   OBLIGATIONS OF PIBL. Upon execution of this Amended Debenture by
the parties hereto, and in exchange therefor, PIBL shall surrender the
instrument evidencing the Original Debenture to MED for cancellation.

          5.   TRANSFERABILITY. The parties agree that, subject to the
restrictions set forth in Section 10, below, and to any restrictions imposed
under the Securities Act of 1933, as amended, and other applicable securities
laws, this Amended Debenture is transferable by PIBL or any other holder of this
Amended Debenture from time to time (each such holder, individually, a "HOLDER"
and all such holders, collectively, the "HOLDERS").

          6.   BENEFITS AND BURDENS UNDER THE AMENDMENT AGREEMENT AND OTHER
MODIFICATION DOCUMENTS. The Holder of this Amended Debenture shall be entitled
to the rights, privileges, remedies and other benefits, and shall be subject to
the restrictions, obligations and other benefits, of a Holder of Amended
Debentures as set forth in and pursuant to the Amendment Agreement and other
Modification Documents (as defined therein), all of which are deemed
incorporated herein by this reference.

          7.   LOSS, THEFT, DESTRUCTION OR MUTILATION OF AMENDED DEBENTURE. Upon
receipt by MED of evidence reasonably satisfactory to it of the loss, theft,
destruction or mutilation of this Amended Debenture, and in case of loss, theft
or destruction, of indemnity reasonably satisfactory to it, and upon surrender
and cancellation of

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this Amended Debenture, if mutilated, MED will make and deliver a new debenture
identical in tenor and date in lieu of this Amended Debenture.

          8.   COMPUTATION OF INTEREST. The amount of interest payable for any
period shall be computed on the basis of twelve 30-day months and a 360-day
year. The amount of interest payable for any partial period shall be computed on
the basis of the number of days elapsed in a 360-day year of twelve 30-day
months.

          9.   DEFINITIONS.

               "BUSINESS DAY" means any day other than a Saturday or Sunday or a
day on which banking institutions in New York City are authorized or required by
law or executive order to remain closed.

          10.  INTERPRETATION. The validity, interpretation and performance of
this Amended Debenture shall be construed under and controlled by the laws of
the State of New York, without regard to choice-of-law principles.

          11.  COUNTERPARTS. This Amended Debenture may be executed in
counterparts, each of which shall be deemed to be an original, but which
together shall be deemed to constitute a single document. Copies of this Amended
Debenture shall have the same effect and enforceability as the original.

          12.  LEGEND.

     THIS AMENDED DEBENTURE HAS NOT BEEN REGISTERED UNDER THE FEDERAL SECURITIES
ACT OF 1933, AS AMENDED ("THE ACT") OR ANY STATE SECURITIES LAW. THE AMENDED
DEBENTURE HAS BEEN ACQUIRED FOR INVESTMENT AND NEITHER SAID AMENDED DEBENTURE
NOR ANY INTEREST THEREIN MAY BE TRANSFERRED, SOLD OR OFFERED FOR SALE UNLESS (1)
THERE IS AN EFFECTIVE REGISTRATION STATEMENT FOR THE AMENDED DEBENTURE AS A
SECURITY UNDER THE ACT AND QUALIFICATION UNDER ANY APPLICABLE STATE SECURITIES
LAW, OR (2) SUCH TRANSFER IS MADE IN COMPLIANCE WITH RULE 144 UNDER THE ACT AND
PURSUANT TO QUALIFICATION UNDER ANY APPLICABLE STATE SECURITIES LAW OR EXEMPTION
THEREFROM, OR (3) THERE IS AN OPINION OF COUNSEL SATISFACTORY TO MED THAT SUCH
REGISTRATION AND QUALIFICATION ARE NOT REQUIRED AS TO SAID TRANSFER, SALE OR
OFFER.

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Acknowledged, agreed to and accepted this 28th day of June, 2002, at Andover,
Massachusetts.

PRIVATE INVESTMENT BANK LIMITED                   MED DIVERSIFIED, INC.

By:                                               By:
    --------------------------                        --------------------------

              [SIGNATURE PAGE TO $10,267,857.14 AMENDED DEBENTURE]<Page>

                                  EXHIBIT 10.10

                 ($12,321,428.57 AMENDED AND RESTATED SHORT FORM
                      DEBENTURE DATED AS OF JUNE 28, 2002.)

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                      $12,321,428.57 AMENDED AND RESTATED
AS OF JUNE 28, 2002          SHORT FORM DEBENTURE         ANDOVER, MASSACHUSETTS

          This Amended and Restated Short Form Debenture (this "AMENDED
DEBENTURE") is issued pursuant to that certain Amendment Agreement, dated as of
even date herewith (the "AMENDMENT AGREEMENT"; capitalized terms used herein and
without definition shall have the meanings ascribed to them in the Amendment
Agreement), by and among Private Investment Bank Limited, Nassau, Bahamas or its
affiliates, acting in its name but on behalf and at the exclusive risk of
certain of Private Investment Bank Limited's clients (collectively "PIBL"), Med
Diversified, Inc., a Nevada corporation ("MED"), American Reimbursement, LLC, a
Delaware limited liability company, TEGCO Investments, LLC, a Delaware limited
liability company and each of the Med Subsidiaries, a copy of which is attached
hereto as EXHIBIT A and incorporated herein by this reference, and this Amended
Debenture amends and restates in its entirety that certain Short Form
Convertible Debenture, dated December 28, 2001, regarding the advance made on
December 28, 2001 of US$15,000,000 (the "PRINCIPAL SUM") by PIBL to MED, a copy
of which is attached hereto as EXHIBIT B and incorporated herein by this
reference (the "ORIGINAL DEBENTURE").

          This Amended Debenture shall be subject to the following terms and
conditions and the parties executing this Amended Debenture shall be obligated
to perform in accordance with such terms and conditions:

          1.   TERMS OF PAYMENT. This Amended Debenture shall have a final
maturity date of June 28, 2004, subject to acceleration of payment by MED of the
Principal Sum following an "EVENT OF DEFAULT" (the "TERM") and MED shall repay
the Principal Sum to PIBL or its designee together with interest thereon at the
rate of seven percent (7%) per annum, payable quarterly in arrears as of the
last Business Day (as defined below) of each March, June, September and December
during the Term, subject to default interest at an additional 100 basis points
(1% per annum) during the continuation of any Event of Default.

          2.   MANDATORY PRE-PAYMENT. Without limiting Section 6 below, this
Amended Debenture is subject to the mandatory prepayment provisions set forth in
Section 2(a) of the Amendment Agreement and the holder of this Amended Debenture
shall be entitled to a pro rata share of any such mandatory prepayment upon the
terms and conditions set forth therein.

          3.   ELIMINATION OF CONVERSION RIGHTS. All conversion rights granted
to PIBL or its designee(s) or assignee(s) under paragraphs 4 and 5 of the
Original Debenture are hereby eliminated, cancelled, and of no further effect.

          4.   OBLIGATIONS OF PIBL. Upon execution of this Amended Debenture by
the parties hereto, and in exchange therefor, PIBL shall:

               (a)  surrender the instrument evidencing the Original Debenture
to MED for cancellation; and

               (b)  return the share certificates representing four million nine
hundred fifty thousand (4,950,000) shares of MED common stock previously
provided by MED to PIBL pursuant to paragraph 5 of the Original Debenture to MED
for cancellation.

          5.   TRANSFERABILITY. The parties agree that, subject to the
restrictions set forth in Section 10, below, and to any restrictions imposed
under the Securities Act of 1933, as amended, and other applicable securities
laws, this Amended Debenture is transferable by PIBL or any other holder of this
Amended Debenture from time to time (each such holder, individually, a "HOLDER"
and all such holders, collectively, the "HOLDERS").

          6.   BENEFITS AND BURDENS UNDER THE AMENDMENT AGREEMENT AND OTHER
MODIFICATION DOCUMENTS. The Holder of this Amended Debenture shall be entitled
to the rights, privileges, remedies and other

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benefits, and shall be subject to the restrictions, obligations and other
benefits, of a Holder of Amended Debentures as set forth in and pursuant to the
Amendment Agreement and the other Modification Documents (as defined therein),
all of which are deemed incorporated herein by this reference.

          7.   LOSS, THEFT, DESTRUCTION OR MUTILATION OF AMENDED DEBENTURE. Upon
receipt by MED of evidence reasonably satisfactory to it of the loss, theft,
destruction or mutilation of this Amended Debenture, and in case of loss, theft
or destruction, of indemnity reasonably satisfactory to it, and upon surrender
and cancellation of this Amended Debenture, if mutilated, MED will make and
deliver a new debenture identical in tenor and date in lieu of this Amended
Debenture.

          8.   COMPUTATION OF INTEREST. The amount of interest payable for any
period shall be computed on the basis of twelve 30-day months and a 360-day
year. The amount of interest payable for any partial period shall be computed on
the basis of the number of days elapsed in a 360-day year of twelve 30-day
months.

          9.   DEFINITIONS.

               "BUSINESS DAY" means any day other than a Saturday or Sunday or a
day on which banking institutions in New York City are authorized or required by
law or executive order to remain closed.

          10.  INTERPRETATION. The validity, interpretation and performance of
this Amended Debenture shall be construed under and controlled by the laws of
the State of New York, without regard to choice-of-law principles.

          11.  COUNTERPARTS. This Amended Debenture may be executed in
counterparts, each of which shall be deemed to be an original, but which
together shall be deemed to constitute a single document. Copies of this Amended
Debenture shall have the same effect and enforceability as the original.

          12.  LEGEND.

     THIS AMENDED DEBENTURE HAS NOT BEEN REGISTERED UNDER THE FEDERAL SECURITIES
ACT OF 1933, AS AMENDED ("THE ACT") OR ANY STATE SECURITIES LAW. THE AMENDED
DEBENTURE HAS BEEN ACQUIRED FOR INVESTMENT AND NEITHER SAID AMENDED DEBENTURE
NOR ANY INTEREST THEREIN MAY BE TRANSFERRED, SOLD OR OFFERED FOR SALE UNLESS (1)
THERE IS AN EFFECTIVE REGISTRATION STATEMENT FOR THE AMENDED DEBENTURE AS A
SECURITY UNDER THE ACT AND QUALIFICATION UNDER ANY APPLICABLE STATE SECURITIES
LAW, OR (2) SUCH TRANSFER IS MADE IN COMPLIANCE WITH RULE 144 UNDER THE ACT AND
PURSUANT TO QUALIFICATION UNDER ANY APPLICABLE STATE SECURITIES LAW OR EXEMPTION
THEREFROM, OR (3) THERE IS AN OPINION OF COUNSEL SATISFACTORY TO MED THAT SUCH
REGISTRATION AND QUALIFICATION ARE NOT REQUIRED AS TO SAID TRANSFER, SALE OR
OFFER.

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Acknowledged, agreed to and accepted this 28th day of June, 2002, at Andover,
Massachusetts.

PRIVATE INVESTMENT BANK LIMITED                   MED DIVERSIFIED, INC.

By:                                               By:
    --------------------------                        --------------------------

              [SIGNATURE PAGE TO $12,321,428.57 AMENDED DEBENTURE]

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