Document:

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                                                                    Exhibit 10.1

                        USP PROPERTY MANAGEMENT AGREEMENT

         This Agreement is made and entered into, effective as of July 1, 1981,
by and between USP Real Estate Investment Trust, a common law trust organized
under the laws of the State of Iowa, with its principal place of business at
4333 Edgewood Road N.E., Cedar Rapids, Iowa 52499 (hereinafter referred to as
"Owner") and AEGON USA Realty Management, Inc., with its principal place of
business at 4333 Edgewood Road N.E., Cedar Rapids, Iowa 52499 (hereinafter
referred to as "Manager"). In consideration of the mutual covenants, promises
and agreements herein contained, Owner and Manager do hereby covenant, promise
and agree to and with each other as follows:

                                   WITNESSETH

1.       PARTIES AND INTEREST:

         Owner is the owner of commercial real property located throughout the
continental United States (hereinafter referred to collectively as the
"Premises"). Manager has the experience and staff necessary and suitable for the
management and operation of real estate properties in the United States and
desires to undertake the management and operation of the real estate properties
of Owner. Manager is an independent contractor and Owner shall have no voice in
the selection or discharge of Manager's servants, representatives, or
sub-contractors, or in their number or in the compensation to be received by
them or in the period of hours of their employment, and no control over the
specific manner in which the work shall be done, but Manager shall be
responsible for the quality of work done and of the materials furnished, and
warrants that they shall conform to the terms of this Agreement.

2.       TERM:

         Owner does hereby designate Manager the exclusive manager of all of
Owner's real estate interests for the term of one (1) year commencing on the
effective date hereof. This designation shall be automatically renewed annually
on each anniversary of the effective date hereof for an additional one (1) year
period, subject to the right of either party to cancel this Agreement at any
time by giving the other party not less than thirty (30) days written notice of
its intention to so terminate.

3.       DUTIES OF MANAGER:

         Manager shall serve as an independent contractor, as Owner's sole and
exclusive agent for the management of the Premises. Both parties acknowledge
that certain individual properties owned by Owner are presently operated
pursuant to "net leases" and other similar arrangements with third parties.
These individual properties will not be covered by this Agreement until any such
net leases are terminated, at which time operation of these properties shall be
turned over to Manager pursuant to this Agreement. Owner and Manager agree, upon
the request of either party at any time during the term of this Agreement, to
acknowledge a schedule of properties covered hereby, including the legal
description thereof if desired.

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4.       SERVICES OF MANAGER:

         Subject to such express restrictions or limitations on its authority
and to such written instructions as may from time be imposed or given by Owner,
Manager shall, on behalf and for the account of Owner:

         A.       Use its best efforts to lease and keep leased to desirable
                  tenants all space held for lease. Manager shall lease the
                  Premises with each lease identifying Owner (or the trade name
                  of the Premises) as the title holder of the Premises and owner
                  of the lease.

                  Without the prior approval of Owner, no lease, including
                  renewal options, shall exceed (i) one year for apartment
                  leases, (ii) ten years for office or warehouse leases or (iii)
                  twenty years for shopping center leases. In the event that a
                  lease contract contemplated to be entered into by Manager in
                  the name of the Owner is not within the limitations set forth
                  in the preceding sentence, such lease contract shall be first
                  subject to the written approval of Owner, which approval shall
                  not be unreasonably withheld. Manager shall advise Owner
                  personally or by certified mail of any such proposed lease or
                  amendment thereto. If Owner fails to advise Manager within ten
                  (10) days after receipt of such notice, it shall be presumed
                  that Owner granted Owner's written approval thereto and,
                  accordingly, Manager shall be authorized to execute such lease
                  contract in the name of Owner without being in violation of
                  Manager's duties hereunder. All leases of the Premises shall
                  remain the property of Owner and, regardless of their terms,
                  copies shall be promptly provided to Owner. Manager shall have
                  the right, without prior consent, at Owner's expense, to
                  repair, alter, modify and improve (as distinguished from
                  expansion) the existing structures, in connection with any
                  such lease; prior approval, however, of Owner to be secured by
                  Manager on all such matters involving costs in excess of
                  Twenty-Five Thousand Dollars ($25,000.00) for any one item.

                  Manager may collect from lessees, security deposits as
                  deposits for the performance under the leases, the amount of
                  such security deposits to be for such sum as is customary in
                  the locality of said real estate. Failure by Manager to obtain
                  any security deposit shall not constitute any nature of
                  default by Manager hereunder. The security deposits, as
                  collected, shall be paid over each month to Owner following
                  the month of collection by Manager.

B.       BOOKS AND RECORDS:

                  The term "Agreement Year" as used herein shall mean the
                  calendar year ending December 31st each year. The first
                  Agreement Year shall be the period beginning on the date
                  hereof and ending on the next December 31st, and the last
                  Agreement Year shall be the period beginning January 1st of
                  the last year of the term of this Agreement and ending with
                  the last day of the term of this Agreement.

                  Manager shall maintain, in a manner and form consistent with
                  generally accepted methods of accounting, at its office,
                  during each Agreement Year and retain such for a period of
                  three (3) consecutive years thereafter, complete and accurate
                  general books of account, which will reflect all receipts
                  derived from the operation of the Premises by

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                  Manager during such Agreement Year, including but not limited
                  to, original invoices, sales and other records pertaining to
                  the business of operating the Premises and other pertinent
                  papers and documents which will enable Owner to determine the
                  gross receipts derived by Manager from the Premises. All of
                  the aforementioned records shall be open to inspection and
                  audit by Owner or its agents at all reasonable times during
                  ordinary business hours. On termination of this Agreement, all
                  records shall be delivered to Owner at the Premises. Owner and
                  Manager recognize that Owner, itself, may have records
                  pertaining to the Premises as to which Manager does not have
                  actual knowledge; and nothing in this paragraph shall be
                  interpreted to impose any duty on Manager with respect to such
                  records or any other records of a type which would not be kept
                  by a reasonably prudent business manager.

                  Manager shall establish a bank account into which receipts
                  relating to the Premises of the Owner transmitted to Manager
                  or collected by Manager shall be deposited. From the funds in
                  such bank account, Manager shall pay the following types of
                  expenses associated with operation of the Premises (it being
                  understood that nothing herein shall be interpreted to impose
                  on Manager liability for the payment of any such expenses from
                  Manager's own funds): on-site salary expenses of every kind
                  and nature, utility charges, custodial service, management
                  fees hereunder to Manager and all other recurring-type charges
                  relating to the operation of the Premises (all of the
                  aforesaid being herein sometimes referred to as "Premises
                  Operating Expenses"). Manager shall submit to Owner on or
                  before the tenth (10th) day of each month during the term
                  hereof (including the tenth (10th) day of the month following
                  the end of the term) at the place then fixed for the payments
                  hereunder, a check in a sum equal to all funds in the bank
                  account for the Premises except a nominal sum to pay
                  obligations due prior to receipt of additional rentals, and a
                  written statement, certified by Manager to be true and correct
                  to the best of his knowledge and belief, showing in reasonably
                  accurate detail, the amount of aforesaid receipts and the
                  amount of Premises Operating Expenses disbursed from such bank
                  account and the resulting difference for the preceding month
                  accompanied by copies of invoices or statements paid, if
                  applicable. Manager shall submit to the Owner on or before the
                  thirtieth (30th) day following the end of each Agreement Year,
                  at the place then fixed for payments, a complete statement of
                  the aforesaid annual figures for the preceding Agreement Year
                  in reasonable detail certified by Manager. Relative to the
                  authority of Manager to pay from the bank account Premises
                  Operating Expenses (as hereinabove referred to), such
                  authority of Manager shall be limited as stated in
                  subparagraph 4(C) hereof.

         C.       MAINTENANCE:

                  (1)      Manager shall, at Owner's expense (but subject to the
                           limitations hereinafter set forth), at all times
                           during the term of this Agreement, keep the Premises,
                           both exterior and interior, structural and otherwise,
                           in good repair, and shall make all repairs and
                           replacements, both exterior and interior, structural
                           and otherwise; and Manager shall, at Owner's expense
                           (subject, however, to the limitations hereinafter set
                           forth) satisfy each and every obligation, duty or
                           payment required of the lessor on the leases or any
                           substitute leases entered into during the term of

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                           this Agreement. Manager shall also, at Owner's
                           expense (subject, however, to the limitations
                           hereinafter set forth), keep the Premises in a clean
                           condition, free from noxious odors, and shall not
                           permit or allow any refuse or debris of Manager to
                           accumulate thereon, or upon the sidewalks, alleys or
                           streets adjoining the same, and shall remove any
                           obstruction from the sidewalks adjoining the
                           Premises. Manager shall exercise reasonable efforts
                           to see that no article deemed extra hazardous on
                           account of fire or other dangerous properties, nor
                           any explosive shall be brought on or into the
                           Premises, except that this provision shall not apply
                           to articles usually held for storage in substantially
                           similar buildings.

                  (2)      The funds of Owner shall be utilized by Manager for
                           the purpose of fulfilling the foregoing
                           responsibilities subject, however, to the following
                           limitations:

                           (a)      Manager is authorized to enter into any
                                    agreement, verbal or written, for
                                    performance of its responsibilities only if
                                    the consideration payable by Owner pursuant
                                    to such agreement is Twenty-Five Thousand
                                    Dollars ($25,000) or less (however, Manager
                                    may enter into such agreements where the
                                    consideration payable pursuant thereto is
                                    more than Twenty-Five Thousand Dollars
                                    ($25,000) if, in Manager's sole opinion,
                                    such repairs are necessary to protect the
                                    Premises, fulfill obligations of Owner under
                                    leases or rental agreements or prevent
                                    bodily injury).

                           (b)      If any written contract for the performance
                                    of such responsibilities is in the name of
                                    Owner, then irrespective of the amount
                                    payable pursuant thereto, only an authorized
                                    agent of Owner shall be authorized to
                                    execute any such contract (and for these
                                    purposes Manager shall not be deemed to be
                                    an authorized agent of Owner).

                           (c)      If any contract for the performance of the
                                    aforesaid duties is not cancellable by
                                    Manager on sixty (60) days' notice or less,
                                    then Manager shall not enter into such
                                    contract without the prior written approval
                                    of Owner, notwithstanding that the
                                    consideration payable thereunder may be
                                    Twenty-Five Thousand Dollars ($25,000) or
                                    less.  The preceding provisions do not
                                    relate to the contractual authority of
                                    Manager as to signing leases of building
                                    space and such authority shall be restricted
                                    only as specifically provided in paragraph
                                    4(A) hereof.

                           (d)      Notwithstanding Paragraph 4(C)(2)(a), if any
                                    contract for performance of the aforesaid
                                    duties is cancellable by Manager on sixty
                                    (60) days' notice or less, then Manager may
                                    enter into such contract without the prior
                                    written approval of Owner so long as the
                                    maximum consideration payable, upon the
                                    giving of notice of cancellation, does not
                                    exceed Twenty-Five Thousand Dollars
                                    ($25,000).

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         D.       Employees:

                  Manager shall engage such employees as it deems necessary for
                  the operation and maintenance of the Premises. Such employees
                  shall be deemed employees of Manager, or such local agent or
                  agents as may be retained by Manager and not in the employ of
                  Owner. Manager, at its expense, shall maintain adequate
                  fidelity insurance on those of its home office employees who
                  handle funds or assets of Owner. Owner shall reimburse Manager
                  for all direct and indirect salary, moving and traveling
                  expenses of those personnel of Manager performing on-site
                  property management and maintenance functions, but Manager
                  shall not be reimbursed for such expenses incurred with
                  respect to its off-site supervisor and administrative
                  personnel.

         E.       Workmen's Compensation:

                  Manager agrees to provide and Owner agrees to reimburse
                  Manager for all premiums, contributions and taxes for
                  Workmen's Compensation insurance, unemployment insurance, and
                  for old age pensions, annuities and retirements benefits, now
                  or hereafter imposed by or pursuant to federal and state laws,
                  which are measured by the wages, salaries or other
                  remuneration paid to persons employed by Manager in connection
                  with the performance of the Management Agreement except as
                  related to personnel of Manager performing property management
                  functions operating out of the home office of Manager. Manager
                  agrees to carry Workmen's Compensation Insurance and
                  Employer's Liability Insurance in accordance with the laws of
                  the states in which Owner owns real estate to be at all times
                  in force and Owner agrees to reimburse Manager for the cost
                  thereof.

         F.       Code Requirements:

                  Manager shall use its best efforts to comply with all building
                  costs, zoning and licensing requirements, and other
                  requirements of the duly constituted federal, state and local
                  governmental authorities with respect to the Premises. Manager
                  may, in its discretion and at Owner's expense, appeal from any
                  requirement it deems unwarranted and it may compromise or
                  settle any dispute regarding such requirements.

         G.       Condemnation Proceedings:

                  Manager may act on behalf of Owner in any eminent domain
                  proceedings for the condemnation of the Premises and may, if
                  Manager deems it advisable, at Owner's expense, employ
                  independent real estate experts for appraisal and testimony in
                  connection with any such proceedings. Manager will make
                  recommendations as to the advisability of compromise or
                  settlement of any such proceedings.

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         H.       Real Estate Experts:

                  Manager may enlist the services of other real estate brokers
                  or agents in the performance of its duties hereunder to the
                  extent deemed necessary or appropriate. The expense of the
                  services will be paid by Owner.

         I.       Rent Collection:

                  Use its best efforts to collect rent and other income relating
                  to the Premises. Manager may, in its discretion, compromise
                  claims for such rent and other income and, at the expense of
                  Owner, institute legal proceedings in its own name or in the
                  name of Owner to collect the same, to oust or dispossess
                  tenants or others occupying such real estate interests, and
                  otherwise to enforce the rights of Owner with respect thereto
                  and in its discretion may compromise or settle such
                  proceedings.

         J.       Public Liability Insurance:

                  Manager, at Owner's expense, shall at all times during the
                  term of this Agreement carry general liability, accident and
                  property damage insurance and such other insurance as shall be
                  carried for the protection of Owner and Manager as
                  contemplated in this paragraph. Such liability, accident and
                  property damage insurance shall be to protect Owner and
                  Manager against any claims for injuries to person or persons
                  or property arising or growing out of the use of the Premises,
                  and the amount of liability insurance shall not be less than
                  the sum of One Hundred Thousand ($100,000) per person and
                  Three Hundred Thousand ($300,000) per accident, and the amount
                  of public liability property damage insurance shall not be
                  less than the sum of Fifty Thousand ($50,000) per accident.

         K.       Fire Insurance:

                  Manager, at Owner's expense, at all times during the term of
                  this Agreement shall carry fire, extended coverage, vandalism
                  and malicious mischief insurance in an amount equal to not
                  less than ninety percent (90%) of the replacement value of all
                  buildings and improvements on the Premises without deduction
                  for depreciation, in good and solvent insurance companies
                  authorized to do business in the state and approved by Owner.
                  All insurance policies shall contain a replacement cost
                  endorsement and be in the name of Owner as the insured.

         L.       Rent Insurance:

                  Manager, at Owner's expense, shall carry rental insurance in
                  an amount equal to fifty percent (50%) or more of the annual
                  gross receipts from the lessees of the Premises in good and
                  solvent insurance companies authorized to do business in the
                  state and approved by Owner. All such policies shall be in the
                  name of and made payable to Owner.

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5.       COMPENSATION:

         Owner hereby agrees to pay Manager compensation in the amount of five
percent (5%) of gross income derived from the operation of the Premises. "Gross
Income" shall mean any and all income from the Premises including: rents,
percentage rents, overage rents, expense participation rents and all rents or
payment from tenants of any nature, income from services rendered to tenants
(i.e., maid service, janitorial or cleaning service, trash collection, elevator
service, etc.), and all income from concessions of any kind, including all
coin-operated facilities on the Premises. Also included in gross income shall be
any amounts collected in lieu of the above-enumerated items such as forfeited
security deposits and judgments or awards collected in the enforcement of any
lease or rental agreement. In addition, Manager shall be entitled to
reimbursement of expenses incurred by Manager in attending meetings at the
request of Owner.

6.       LIABILITY OF MANAGER:

         Manager will give Owner the benefit of its best judgment and efforts in
rendering the foregoing services to Owner. Manager shall not be liable for any
act or omission whatsoever of any agent or representative, or for Manager's
negligence or error in judgment except its willful misfeasance, bad faith or
gross negligence in the conduct of its duties; and Owner shall indemnify and
save harmless Manager from and against any and all liabilities, claims and
damages, costs and expenses (including reasonable attorney's fees) to which
Manager may become subject by reason or arising out of the performance or
non-performance of its duties as Manager; provided, however, that no such return
will be made of damages, costs or expenses which may be incurred by Manager by
reason of its willful misfeasance, bad faith or gross negligence in the conduct
of its duties. The foregoing provisions of this paragraph shall survive the
termination of this Agreement, but this shall not be construed to mean that
Owner's liabilities or obligations hereunder do not survive as to the other
provisions of this Agreement.

7.       STATUS OF TRUST:

         In the event that the terms of this Agreement at any time shall, in the
opinion of the counsel for Owner, impair the status of Owner as a "Real Estate
Investment Trust" within the meaning of Part II, subcharacter M of the Internal
Revenue Code of 1954, as now enacted or hereafter amended, the parties shall,
within 30 days after Owner shall have given to Manager written notice of such
impairment, negotiate such amendments as may be necessary to restore, in the
opinion of counsel for Owner, such status of Owner.

8.       MECHANIC'S LIENS:

         Manager shall not have nor shall anyone claiming by, through or under
Manager have the right to file or place any mechanic's liens or other lien of
any kind or character whatsoever upon the Premises, or upon the interest of
Manager therein, and notice is hereby given that no contractor, subcontractor or
anyone else who may furnish any material, service or labor for any building,
improvements, alternations, repairs or any part thereof shall at any time be or
become entitled to any lien thereon.

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9.       CONFORMITY OF LAW:

         Manager covenants, with respect to the Premises, fixtures and
appurtenances, that at Owner's expense (subject to the limitations on Manager's
contractual authority as herein set forth), Manager shall use due diligence to
cause them to conform to every applicable requirement of law or duly constituted
authority, and to the applicable requirements of all carriers of insurance on
the Premises, any Board of Underwriters, Rating Bureau or similar organization
including, but not limited to, requirements pertaining to the health, welfare or
safety of employees or the public, such as adequate toilet facilities, fire
exits, exit signs, safe electrical wiring and elevators. Manager shall, at
Owner's cost and expense (but subject to the herein set forth limitations on
Manager's contractual authority), make such improvements or installations as may
be necessary to satisfy this requirement and shall, at all times during the
term, promptly comply with all such requirements whether now or hereafter in
effect and whether now or hereafter applicable for any reason whatsoever.
Anything contained herein to the contrary notwithstanding, should Manager use
the Premises for any purpose other than the purposes as are normally incidental
to such uses, or should Manager permit any area of the Premises to remain vacant
while they are usable for such purposes, Manager shall, at Owner's expense (but
subject to the herein set forth limitations of Manager's contractual authority),
cause the Premises to conform to any additional requirements of law, duly
constituted authorities, carriers of insurance on the Premises and any Rating
Bureau, Board of Underwriters or similar organization applicable to the Premises
solely because of such other use, or such non-use of the Premises.

10.      STATE AND LOCAL LAW:

         Manager shall use due diligence to prevent the Premises from being used
for any unlawful purpose and shall at all times comply with the laws and the
rules and regulations of the applicable governmental bodies and fire inspection
and rating bureaus relating to the use of the Premises, including sidewalks,
alleys and streets adjoining, the cost and expense of such compliance to be the
responsibility of Owner (but Manager's contractual authority with respect
thereto shall be limited as herein set forth).

11.      INSURANCE CLAIMS:

         Manager shall settle and adjust any claims against any insurance
company under the fire or extended coverage policies of insurance as described
in paragraph 4(K) hereof, but before making final settlement of all claims over
Ten Thousand Dollars ($10,000), the written approval of Owner shall be had.

12.      SUBORDINATION:

         Owner and Manager agree that this Agreement is and shall be
subordinated to any mortgages or trust deeds held by or for any bank, insurance
company, seller or other lending institution that may be now on or hereafter
placed upon the Premises, and to any and all advances to be made thereunder, and
to the interests thereon and all renewals, replacements and extensions thereof.
The preceding sentence shall not be interpreted to enlarge the duties of Manager
hereunder or to diminish the rights of Manager hereunder, the sole purpose of
the preceding sentence being to indicate the agreement of Owner and Manager that
a

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foreclosure of any such mortgage or trust deed shall terminate this Management
Agreement (but shall not release the then accrued obligations of the parties
hereunder).

13.      CONDEMNATION:

         In the event of any condemnation or taking, all damages shall be the
exclusive property of Owner, provided, however, Manager shall be entitled to any
proceeds recovered by Manager in its own right on account of any and all damage
to Manager's business by reason of condemnation.

14.      INDEMNIFICATION:

         If either party shall default, the successful party shall be reimbursed
by the other for all costs and expenses incurred in the enforcement of any of
the provisions of this Agreement, including reasonable attorney's fees.

15.      REPRESENTATIONS:

         The following covenants, representations, warranties and restrictions
are made by Manager:

         A.       Manager will not assign, sell or otherwise dispose of or
                  permit any other person to acquire any title to its interest
                  in this Agreement.

         B.       Manager will not directly or indirectly create, assume, incur
                  or suffer to exist any mortgage, pledge, encumbrance, lien or
                  charge of any kind upon this Agreement or upon any income or
                  fees therefrom except as provided in this Agreement.

16.      NOTICE:

         Whenever, under the terms of this Agreement, any notice is required to
be served upon the other party, said notice shall be served upon the other party
by personal service or by sending said notice by certified mail to the other
party. Notice to each party shall be in writing, and until further notification
in writing, shall be mailed as follows:

         Notice to Owner shall be mailed as follows:

         USP Real Estate Investment Trust
         4333 Edgewood Road N.E.
         Cedar Rapids, Iowa   52499

         Notice to Manager shall be mailed as follows:

         AEGON USA Realty Management, Inc.\
         4333 Edgewood Road N.E.
         Cedar Rapids, Iowa   52499

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17.      CUMULATIVE RIGHTS:

         The various rights, powers, objects, elections and remedies of Owner
and Manager provided in this Agreement shall be construed as cumulative and no
one of them is exclusive of the others or exclusive of any rights or remedies
allowed Owner and Manager by law.

18.      CONSENT:

         Owner and Manager shall not unreasonably withhold their consent
whenever such consent shall be required under the terms of this Agreement.

19.      PARAGRAPH HEADINGS:

         The paragraph headings contained herein are inserted only as a matter
of convenience and for reference and in no way define, limit or describe the
scope or intent of this Agreement or in any way affect the terms and provisions
hereof.

20.      RULES OF CONSTRUCTION:

         Where necessary herein, the terms "Owner" and "Manager" shall apply to
the plural or the agents or employees of Owner, or Manager, and all terms used
in the singular or in the masculine shall apply to the plural or to the feminine
or neuter gender.

21.      AMENDMENTS:

         This Agreement may be amended only by the mutual consent of the
parties. However, no such amendment shall become effective unless it be reduced
to an instrument in writing specifically referring to this Agreement, is signed
by both parties and dated.

22.      SUCCESSORS AND ASSIGNS:

         The provisions of this Agreement shall apply to and bind the immediate
parties and the heirs, executors, administrators, successors and assigns of the
respective parties. Owner may assign this Agreement without the consent of
Manager, however, Manager may only assign this Agreement with the prior written
consent of Owner. Until such time, however, as Manager has received written
notice from Owner of the party to which Owner has assigned this Agreement,
Manager shall continue to tender performance hereunder to Owner as herein
provided. This Agreement supersedes any and all prior agreements or
understandings, oral or written, by and between the parties hereto relating to
leasing or managing the Premises.

23.      TRUST:

         It is understood and agreed by the parties hereto:

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         A.       That Owner is a common law trust organized under the laws of
                  the State of Iowa pursuant to a Declaration of Trust dated
                  October 5, 1972, as amended, and recorded in the Office of the
                  Recorder of Linn County, Iowa.

         B.       That the holders of shares of beneficial interest in
                  Owner shall not be personally liable hereon, and,

         C.       That the other party hereto shall look solely to the funds and
                  property of Owner for the payment of any claim arising
                  hereunder.

         IN WITNESS WHEREOF, the parties hereto have executed this Agreement
effective as of the date first above written.

OWNER:                                        MANAGER:

USP REAL ESTATE INVESTMENT TRUST              AEGON USA REALTY MANAGEMENT, INC.

By:    /s/ Patrick E. Falconio                By:    /s/ Dennis Roland
   ----------------------------------------      ------------------------------
       Patrick E. Falconio                         Dennis Roland, President
       Chairman of the Board of Trustees

                                       11<PAGE>
                                                                    Exhibit 10.7

                    AMENDED AND RESTATED EMPLOYMENT AGREEMENT
                                 BY AND BETWEEN
                 CARESCIENCE, INC. AND ALFREDO CZERWINSKI, M.D.

         WHEREAS Alfredo Czerwinski, M.D. (hereinafter "Executive") and
CareScience, Inc., a Pennsylvania corporation (hereinafter "Company") desire and
intend to enter into an employment relationship, all as set forth below;

         NOW THEREFORE, the parties hereto, in consideration of the promises and
mutual covenants and agreements contained herein, voluntarily and knowingly, and
intending to be legally bound hereby, covenant and agree as follows:

         1.       EMPLOYMENT AND DUTIES.

                  (a) Company hereby employs Executive for the Term (as such
term is hereinafter defined) to render services to the Company as its CHIEF
MEDICAL OFFICER, CADUCIS DIVISION. Executive shall have the overall duties as
described in the job description attached hereto as Exhibit A "Chief Medical
Officer Job Description," as well as any other duties that are generally
consistent with the role and duties of a Chief Medical Officer as may be
directed from time to time by the Chief Operating Officer. Executive will be
based from his home, but will be required to travel regularly (typically
averaging once per week), to destinations that will include CareScience' offices
in Philadelphia and customer sites during the course of his employment.
Executive hereby accepts such employment and agrees to render the services
described herein, all on the terms and conditions of this Agreement.

                  (b) Executive agrees to devote his entire working time,
attention and energies to the performance of the business of the Company and its
affiliates (as hereinafter defined); and Executive shall not, directly or
indirectly, alone or as a member of any partnership or other organization, or as
an officer, director or employee of any other corporation, partnership or other
organization, be actively engaged in or concerned with any other duties or
pursuits which, in the reasonable judgment of the Company, interfere with the
performance of his duties hereunder, or which, even if non-interfering, are
contrary to the best interests of the Company and its affiliates; PROVIDED,
HOWEVER, that Executive may invest his personal or family assets in such form or
manner as will not require any services on his part in the operation of the
affairs of the enterprises in which such investments are made and in which his
participation is solely that of a minority investor; FURTHER, PROVIDED, that the
Executive may engage in charitable, civic, fraternal or trade group activities,
so long as such activities shall not violate any provision of this Agreement or
interfere with his performance hereunder or compliance with the restrictions
contained herein. As used herein, the term "affiliate" means and includes any
person, corporation or other entity controlling, controlled by or under common
control with the Company.

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         2.       TERM OF EMPLOYMENT.

                  The term of Executive's employment under this Agreement (the
"Term") will commence as March 29,1999 (the "Effective Date") and shall end on
the fourth anniversary hereof (the "Initial Term"). Unless either party provides
at least six (6) months advance written notice of termination to the other party
prior to the expiration of the Initial Term, this Agreement shall automatically
continue, on the same terms and conditions as contained herein, until such time
as one party provides the other with at least six (6) months advance written
notice of termination (any such period beyond the Initial Term being referred to
as the "Extension Term", and both the Initial Term and any Extension Term
referred to collectively as the "Term"). A notice of termination during any
Extension Term may be provided for any reason by either party with at least six
(6) months advance written notice as established above.

         3.       COMPENSATION AND BENEFITS.

                  (a)      BASE SALARY. As compensation for the services to be
                           rendered by Executive hereunder, including all
                           services to any subsidiary or affiliate of the
                           Company, the Company agrees to pay or cause to be
                           paid to Executive, during the first year of the term
                           of his Employment hereunder, an annual base salary of
                           $185,000 (the "Base Salary"). For each subsequent
                           year of the Term, the Base Salary will be reviewed
                           annually by the Company and may be increased, but may
                           not be decreased for subsequent years. Executive's
                           Base Salary shall be payable in such installments as
                           is the policy of the Company generally with respect
                           to employees of the Company.

                  (b) STOCK OPTION GRANT. In addition to his Base Salary,
Executive was previously awarded the stock option grants attached hereto as
Exhibits 3B-1 and 3B-2 "Non-Qualified Stock Option Grants."

                  (c) EXPENSE REIMBURSEMENT. The Company shall pay or reimburse
Executive for all reasonable business expenses actually incurred or paid by him
during the Term in the performance of his services under this Agreement, upon
presentation of expense statements or vouchers or such other supporting
information as it reasonably may require. Executive agrees to adhere to
Company's travel policy requirements in determining reasonableness for such
expenses.

                  (d) FRINGE BENEFITS. Executive shall be eligible under any
incentive plan, stock option plan, bonus, profit participation, pension, group
insurance or other benefit plans (both qualified and non-qualified for federal
tax purposes) or other so-called "fringe" benefits, if any, which the Company
generally provides to its executives.

                  (e) MEDICAL BENEFITS. Executive shall have the option of
either: (a) participating in the Company's medical plans as for all Company
executives or (b) receiving a premium

                                       2
<PAGE>

contribution equal to the average contribution made by the Company for the
appropriate category (currently "individual plus spouse") across the medical
plans offered by the Company. If Executive selects the premium contribution
(option (b)), he shall separately purchase medical insurance and provide proof
of such insurance to the Company or otherwise provide a written waiver of
medical benefits to the Company.

                  (f) VACATION. Executive shall be entitled to three weeks paid
vacation plus all federal holidays, in each calendar year.

                  (g) CONFERENCES. Executive and Company will mutually agree
upon one or more Continuing Medical Education ("CME") conferences that support
the Company's sales and/or marketing objectives. When possible, due
consideration will be given to Executive's need to maintain his active medical
license, though both parties acknowledge that these continuing education
requirements may be maintained through activities other than CME conference
attendance.

         4.       CONFIDENTIALITY AND PROPRIETARY INFORMATION.

                  (a) Subject to the provisions below, Executive shall not,
during the Term of this Agreement, or at any time following the expiration or
termination of this Agreement, directly or indirectly, disclose or permit to be
known (other than (i) as is reasonably required in the regular course of his
duties, including disclosures to the Company's advisors and consultants, (ii) as
required by law or (iii) with the prior written consent of the Company), to any
person firm or corporation, any confidential or proprietary information acquired
by him during the course of or as an incident to, his employment or the
rendering of services hereunder, relating to the Company or any of its
subsidiaries, or any corporation, partnership or other entity owned or
controlled, directly or indirectly, by or controlling the Company or its
subsidiaries or any customer of the Company. Such confidential information shall
include, but shall not be limited to, confidential business affairs, proprietary
technology, proprietary methodologies, proprietary business practices, trade
secrets, patented or copyrighted processes, research and development data,
market studies and forecasts, competitive analyses, pricing policies, employee
lists, personnel policies, the substance of agreements with customers, suppliers
and others, marketing or dealership arrangements, servicing and training
programs and arrangements, customer lists and any other documents embodying such
confidential information. This confidentiality obligation shall not apply to any
confidential information which becomes publicly available other than pursuant to
a breach of this Section 4 by Executive or which was obtained from a third party
not acquiring the information under an obligation of confidentiality from the
disclosing party and intended for the benefit of the Company.

                  (b) All information and documents relating to the Company and
its affiliates as hereinabove described shall be the exclusive property of the
Company and upon termination of Executive's employment with the Company, all
documents, records, reports, writings and other similar documents containing
confidential information, including copies thereof, then in Executive's
possession or control shall be returned to and left exclusively with the
Company.

                                       3
<PAGE>

         5.       NON-COMPETITION.

                  As a condition precedent to this Agreement, Executive has
previously executed a Non-Competition Agreement in the form attached hereto as
Exhibit D, "Non-Competition Agreement".

         6.       EQUITABLE REMEDIES AND ENFORCEABILITY OF COVENANTS.

                  (a) If Executive commits a breach, or threatens to commit a
breach, of any of the material provisions hereof or under the Non-Competition or
Invention Assignment Agreements (attached hereto as Exhibit E), it is
acknowledged and agreed that any such breach or threatened breach will cause
irreparable injury to the Company and that money damages will not provide an
adequate remedy to the Company.

                  (b) If any of the covenants contained herein or under the
Non-Competition or Invention Assignment Agreements, or any part hereof or
thereof, is hereafter construed to be invalid or unenforceable, the same shall
not affect the remainder of the covenant or covenants, which shall be given full
effect without regard to the invalid portions.

                  (c) If any of the covenants contained herein or under the
Non-Competition or Invention Assignment Agreements, or any part hereof or
thereof, is held to be unenforceable because of the duration of such provision
or the area covered thereby, the parties agree that the court making such
determination shall have the power to reduce the duration, scope and/or areas of
such provision and, in its reduced form, such provision shall then be
enforceable.

                  (d) The existence of any claim or cause of action by Executive
against the Company or any affiliate of the Company shall not constitute a
defense to the enforcement by the Company of the covenants contained herein, but
such claim or cause of action shall be pursued separately.

         7.       TERMINATION.

                  The Company may terminate Executive's employment under this
Agreement upon written notice to Executive if any one or more of the following
shall occur:

                  (a) THERE EXISTS CAUSE FOR TERMINATION. For the purposes of
this Agreement, the term "Cause" means: (i) the failure by Executive to perform
his duties or obligations hereunder (other than such failure resulting from
Executive's incapacity due to illness or leaves of absence approved by the
Company) PROVIDED such failure remains uncured for a period of 20 business days
after written notice describing the same is received by Executive; (ii)
Executive's conviction of any felonious crime or offense; (iii) the unauthorized
securing by Executive of any personal profit in connection with the business of
the Company or any of its subsidiaries; (iv) use of any unlawful controlled
substance under any circumstances or the use of

                                       4
<PAGE>

alcohol to the extent that it interferes with the performance of Executive's
duties hereunder, or which, in the good faith opinion of the Company, are
harmful to the Company; (v) the commission of any acts involving dishonesty or
fraud, which, in the good faith opinion of the Company, are harmful to the
Company; or (vi) any breach by Executive of the terms of Section 4 of this
Agreement or under the Non-Competition or Invention Assignment Agreements;
PROVIDED such breach continues uncured for 10 business days after written notice
of such breach has been received by Executive from the Company. In the event of
termination under this section (a), Executive's duties and obligations under
this Agreement shall immediately cease.

                  (b) EXECUTIVE'S DEATH DURING THE TERM; PROVIDED, HOWEVER, that
Executive's legal representatives shall be entitled to receive his Base Salary
through the last day of the second month after the month in which his death
occurs, along with any other compensation and benefits to which Executive and
his legal representatives may be entitled under applicable plans, programs and
agreements of the Company, including but not limited to, the proceeds of any
applicable life insurance policies through the date of death.

                  (c) EXECUTIVE'S PHYSICAL OR MENTAL DISABILITY such that he is
unable to perform his services hereunder for a period of 90 consecutive days or
120 non-consecutive days in any 365 day period. Notwithstanding such disability,
the Company shall continue to pay Executive his Base Salary through the date of
such termination, along with any other compensation and benefits to which
Executive and his legal representatives may be entitled under applicable plans,
programs and agreements of the Company. In addition, the proceeds of any
applicable disability insurance policies also shall be paid through a date that
is at least one year beyond the date of such termination.

                  (d) AT THE COMPANY'S SOLE DISCRETION so long as Company pays
to Executive an amount equal to twelve (12) months Base Salary along with any
other compensation and benefits to which Executive may be entitled under
applicable plans, PRO rated through the date of Executive's termination of
employment (the sum of these amounts collectively defines the "Severance
Amount")..

          Payment of such Severance Amount, if required, shall be made in equal
monthly installments over six (6) months.

                  (e) Executive may terminate this Agreement upon the occurrence
of one or more of the following:

                  i)       a "major life event" defined for the purposes of this
                           Agreement as the occurrence of a permanent disability
                           of a primary family member or other similar,
                           unavoidable event;

                  ii)      for any other reason with the mutual consent of the
                           Company;

         8.       ASSIGNMENT OF INVENTIONS DISCOVERED BY EXECUTIVE.

                                       5
<PAGE>

                  As a condition precedent to this Agreement, Executive shall
sign, contemporaneously with this Agreement, an Invention Assignment Agreement
in the form attached hereto as EXHIBIT E.

         9.       REPRESENTATIONS AND AGREEMENTS OF EXECUTIVE.

                  (a) Executive represents and warrants that he is free to enter
into this Agreement and to perform the duties required hereunder, and that there
are no employment contracts or understandings, restrictive covenants or other
restrictions, whether written or oral, preventing the performance of his duties
hereunder or which would be harmful to the Company.

                  (b) Executive agrees to submit to a medical examination and to
cooperate and supply such other information and documents as may be required by
any insurance company in connection with the Company's obtaining life insurance
on the life of Executive, if the Company so desires, or any other type of
insurance or fringe benefits as the Company shall determine from time to time to
obtain.

         10.      ARBITRATION.

                  Any controversy or claim arising out of or relating to this
Agreement (or breach thereof) shall be settled by arbitration in Philadelphia,
Pennsylvania, provided, however, that Company shall pay Executive's reasonable
travel expenses (as defined by the Company's Travel Policy) associated with
participation in such arbitration, in accordance with the rules then existing of
the American Arbitration Association (three arbitrators), and judgment upon the
award rendered may be entered in any court having jurisdiction thereof.
Notwithstanding the foregoing, the Company, at its sole option, shall be
entitled to seek and obtain equitable relief from any court of competent
jurisdiction, including, without limitation, temporary, preliminary and
permanent injunctive relief and specific performance with respect to alleged
violations of Sections 4 and 5 of this Agreement, Section 1 of the
Non-Competition Agreement or under the Invention Assignment Agreement, and the
Company's pursuit of the remedies described in Section 6 hereof in connection
therewith. The parties shall be free to pursue any remedy before the arbitration
tribunal that they shall be otherwise permitted to pursue in a court of
competent jurisdiction. The award of the arbitrators shall be final and binding
and may be enforced by any court as if it were a judgment of that court, and may
include interest at a rate or rates considered just under the circumstances by
the arbitrators. The arbitrators to the resolution of the dispute shall apply
the substantive law of the Commonwealth of Pennsylvania, provided that the
arbitrators shall base their decision on the express terms, covenants and
conditions of this Agreement. The arbitrators shall be required to produce a
written decision setting forth the reasons for the decision or award to be made.
The parties agree that the arbitrators shall have no power to alter or modify
any express provision of this Agreement or to render any award which, by its
terms, effects any such alteration or modification. Upon written demand to any
party to the arbitration for the production of documents and things reasonably
related to the issues being arbitrated, the party upon whom such demand is made
shall promptly produce, or make available for inspection and copying, such
documents and things without the necessity of any action by the

                                       6
<PAGE>

arbitrators. The party, which does not prevail in the arbitration, shall be
responsible for all fees and expenses incurred, including, without limitation,
reasonable attorneys' fees, for both parties.

         11.      NOTICES.

                  All notices, requests, consents and other communications
required or permitted to be given hereunder shall be in writing and shall be
deemed to have been duly given if sent by private overnight mail service
(delivery confirmed by such service), registered or certified mail (return
receipt requested and received), telecopy (confirmed receipt by return fax from
the receiving party) or delivered personally, as follows (or to such other
address as either party shall designate by notice in writing to the other in
accordance herewith:

                  If to the Company:
                  CareScience, Inc.
                  3600 Market Street, 6th Floor
                  Philadelphia, PA  19104

                  Attention:        President
                  Telephone:        215/387-9401
                  Fax:              215/387-9406

                  If to Executive:
                  1065 41st Street
                  Sacramento, CA  95819-3618
                  Attention: Alfredo Czerwinski, M.D.
                  Telephone: 916-455-2083
                  Fax: 916-455-1152

         12.      GENERAL.

                  (a) This Agreement shall be governed by and construed and
enforced in accordance with the laws of the Commonwealth of Pennsylvania
applicable to agreements made and to be performed entirely in Pennsylvania.

                  (b) This Agreement and the Exhibits attached hereto set forth
the entire agreement and understanding of the parties relating to the subject
matter hereof, and supersedes all prior agreements, arrangements and
understandings, written or oral, relating to the subject matter hereof. No
representation, promise or inducement has been made by either party that is not
embodied in this Agreement or any of the agreements referred to herein, and
neither party shall be bound by or liable for any alleged representation,
promise or inducement not so set forth.

                  (c) This Agreement may be amended, modified, superseded,
canceled, renewed or extended, and the terms or covenants hereof may be waived,
only by a written instrument executed by the parties hereto, or in the case of a
waiver, by the party waiving compliance. The

                                       7
<PAGE>

failure of a party at any time or times to require performance of any provision
hereof shall in no manner affect the right at a later time to enforce the same.
No waiver by a party of the breach of any term or covenant contained in this
Agreement, whether by conduct or otherwise, or any one or more continuing
waivers of any such breach, shall constitute a waiver of the breach of any other
term or covenant contained in this Agreement.

                  (d) This Agreement shall be binding upon the legal
representatives, heirs, distributes, successors and assigns of the parties
hereto.

                  IN WITNESS WHEREOF, the parties have executed this Agreement
as of the date first above written.

CareScience, Inc.

By:
     --------------------------------                ---------------------------
Name:                                                Date
Title:

EXECUTIVE:

-------------------------------------------          ---------------------------
      Alfredo Czerwinski, M.D.                       Date

                                       8
<PAGE>

                                    EXHIBIT A
                      CHIEF MEDICAL OFFICER JOB DESCRIPTION

DUTIES AND KEY TASKS:

1)       Be the principal spokesman for the CaduCIS Division of CareScience to
         Chief Medical Officers of health care plans and systems through
         activities such as marketing events and speaking at national and
         regional conferences to increase market awareness regarding, goodwill
         toward and buzz about CareScience.

2)       Participate in Institute for Management Development programs and take a
         lead role in delivering services from it.

3)       Lead efforts to support physician-to-physician selling of CaduCIS
         products including the participation in scheduled CaduCIS sales
         activities along with other physicians at CareScience.

         3)       Organize efforts to gain physician and physician leader input
                  into CareScience products and services (e.g., through such
                  activities as organizing a CMO Advisory Panel).

5)       Participate on CaduCIS Division's management team.

6)       Generate a target amount of $150,000 annually in directly-provided
         speaking, consulting and/or Institute of Management Development service
         fees.

;

7)       Other activities generally consistent with this position as may be
         requested from time to time by the Chief Operating Officer, President
         or Chief Executive Officer.

                                       9
<PAGE>

                                  EXHIBIT B - 1
                              EMPLOYEE GRANT LETTER
                       CARE MANAGEMENT SCIENCE CORPORATION
                          1995 EQUITY COMPENSATION PLAN
                         NONQUALIFIED STOCK OPTION GRANT

         THIS NONQUALIFIED STOCK OPTION GRANT, dated as of MARCH 29, 1999 (the
"Date of Grant"), is delivered by CARE MANAGEMENT SCIENCE CORPORATION (together
with its subsidiaries hereinafter collectively referred to as the "Company"), to
ALFREDO CZERWINSKI, M.D., a key employee of the Company (the "Grantee").

                                    RECITALS

         A. The Care Management Science Corporation 1995 Equity Compensation
Plan (the "Plan") provides for the grant of stock options to key employees of
the Company, to purchase shares of Common Stock, no par value, of the Company
(the "Shares"), in accordance with the terms and conditions of the Plan.

         B. The Board of Directors of the Company (the "Board") has determined
that it would be to the advantage and interest of the Company to make the grant
provided for herein as an inducement for the Grantee to continue as a key
employee of the Company and to promote the best interests of the Company and its
stockholders.

         NOW, THEREFORE, the parties hereto, intending to be legally bound
hereby, agree as follows:

1.       GRANT OF OPTION.

         Subject to the terms and conditions hereinafter set forth, the Company
     hereby grants to the Grantee an option to purchase an aggregate number of
     Shares at the option price set forth below (the "Option"):

     A Nonqualified Stock Option to purchase 40,750 Shares at an option price of
     $1.25 per Share, which shall be exercisable to the extent vested as
     provided in Paragraph 6 below.

2.       NATURE OF OPTION.

         The Option designated hereunder shall be a Nonqualified Stock Option
     which is not intended to be an Incentive Stock Option within the meaning of
     Section 422 of the Internal Revenue Code of 1986, as amended (the "Code").
     The Board shall interpret and construe the

                                       10
<PAGE>

     Option in accordance with this designation and pursuant to the terms of
     the Plan, and its decisions shall be conclusive as to any question
     arising hereunder.

3.       RESTRICTIONS ON EXERCISE.

         During the Grantee's lifetime, exercise of the Option shall be solely
     by the Grantee and, upon the Grantee's death, the Option shall be
     exercisable (subject to the limitations specified in the Plan) solely by
     the legal representatives of the Grantee, or by the person or persons who
     acquire the right to exercise the Option by will or by the laws of descent
     and distribution, to the extent that the Option is exercisable pursuant to
     the provisions of Paragraphs 5 and 6.

4.       EXERCISE PROCEDURES.

         The Grantee may exercise the Option with respect to all or any part of
     the Shares then subject to such exercise by giving the Board written notice
     of intent to exercise in the manner provided in Paragraph 17 hereof. Such
     notice shall specify the number of Shares as to which this Option is to be
     exercised and the date of delivery thereof, which date shall be at least 15
     days after the giving of such notice unless an earlier date shall have been
     mutually agreed upon; PROVIDED, HOWEVER, THAT NO SUCH EXERCISE MAY OCCUR
     DURING ANY PERIOD WHICH THE COMMITTEE HAS DESIGNATED IN WRITING AS A
     PROHIBITED EXERCISE PERIOD. On such delivery date, the Grantee shall pay
     the applicable exercise price in cash, by surrender of Shares of the
     Company at their fair market value on the date of delivery or pursuant to a
     loan from the Company in accordance with Section 5(g) of the Plan. Upon
     such payment, the Company shall deliver to the Grantee at the then
     executive office of the Company, or such other place as may be mutually
     acceptable to the Company and the Grantee, a certificate or certificates
     for such Shares out of heretofore unissued Shares or reacquired Shares, as
     the Company may elect.

         On and after the date of the initial registration of the Company's
     securities under Section 12(g) of the Securities Exchange Act of 1934 (the
     "Exchange Act"), in lieu of the foregoing, such notice may instruct the
     Company to deliver Shares due upon the exercise of the Option to any
     registered broker or dealer in lieu of delivery to the Grantee. Such
     instructions must designate the account into which the Shares are to be
     deposited. The Grantee may tender this notice of exercise, which has been
     properly executed by the Grantee, and the aforementioned delivery
     instructions to any broker or dealer.

         The obligation of the Company to deliver Shares upon such exercise of
     the Option shall be subject to all applicable laws, rules, regulations and
     such approvals by governmental agencies as may be deemed appropriate by the
     Board, including, among other things, such steps as Company counsel shall
     deem necessary or appropriate to comply with relevant securities laws and
     regulations. All obligations of the Company hereunder shall be subject to

                                       11
<PAGE>

     the rights of the Company as set forth in the Plan to withhold amounts
     required to be withheld for any taxes. If the Grantee fails to accept
     delivery of, or to pay for, any of the Shares specified in such notice upon
     tender of delivery thereof, the Grantee's right to purchase such
     undelivered Shares may be terminated, at the sole discretion of the Board.
     The date that notice of an election to exercise is received by the Company
     shall be deemed the date of exercise hereunder.

5.       TERM OF OPTION.

         The Option granted hereunder shall have a term of ten (10) years from
     the Date of Grant shall terminate at the expiration of that period, unless
     it is terminated at an earlier date pursuant to the further provisions of
     this Agreement.

         The Option shall automatically terminate upon the happening of certain
     events, including (i) the expiration of the 60-day period after the
     Grantee's termination of employment from the Company for any reason other
     than disability (within the meaning of section 22(e)(3) of the Code),
     death, retirement approved by the Company or "termination for cause," (ii)
     the expiration of the six-month period after the Grantee's termination of
     employment from the Company on account of disability (as defined herein),
     or retirement approved by the Company, (iii) the expiration of the one-year
     period after the Grantee's termination of employment from the Company on
     account of death, or (iv) the date of the Grantee's "termination for cause"
     by the Company, as determined in Executive's Employment Agreement with the
     Company.

6.       VESTING AND FORFEITURE OF OPTION.

         The Option shall become vested in four (4) installments (50% of the
     shares in four equal yearly installments of 12.5% each, and a single lump
     sum installment of 50% upon the conclusion of the fourth year), the Grantee
     having the right hereunder to purchase from the Company, on and after the
     following dates, the following numbers of shares of Common Stock if the
     Grantee is employed by the Company on such date:

<TABLE>
<S>                                      <C>              <C>
March 29, 2000                           12.5%            5,09410,188 shares;
March 29, 2001                           12.5%            an additional 5,094 shares;
March 29, 2002                           12.5%            an additional 5,094 shares;
March 29, 2003                           62.5%            an additional 25,468 shares.
</TABLE>

     PROVIDED, HOWEVER, that the Option shall become fully-vested upon a Change
     of Control of the Company (as defined in Section 11 of the Plan) and the
     other provisions specified in the

                                       12
<PAGE>

     Plan relating to the consequences of a Change of Control shall apply,
     including Sections 5(f)(1)(B) and 12.

         NOTWITHSTANDING ANY OTHER PROVISIONS SET FORTH HEREIN OR IN THE PLAN,
     IF THE GRANTEE SHALL CEASE TO BE AN EMPLOYEE ON ACCOUNT OF "TERMINATION FOR
     CAUSE", AS DETERMINED IN ACCORDANCE WITH EXECUTIVE'S EMPLOYMENT AGREEMENT
     WITH THE COMPANY BEFORE ANY CHANGE OF CONTROL OF THE COMPANY, THE
     UNEXERCISED PORTION OF THE OPTION AND ANY AND ALL RIGHTS HEREUNDER SHALL
     IMMEDIATELY TERMINATE AND BE VOID.

7.       RIGHT OF FIRST REFUSAL

         Prior to the date of the initial registration of the Company's
     securities under Section 12(g) of the Exchange Act, if at any time the
     Grantee desires to sell, encumber, or otherwise dispose of the Shares, he
     shall first offer the same to the Company by giving the Company written
     notice disclosing: (a) the name(s) of the proposed transferee of the
     Shares; (b) the certificate number and number of Shares proposed to be
     transferred or encumbered; (c) the proposed price; and (d) all other terms
     of the proposed transfer. Within fourteen (14) days after receipt of such
     notice, the Company shall have the option to purchase all or part of such
     Shares. If the Company decides to exercise this option, the purchase price
     of the Shares shall be the proposed price and may be payable, at the
     discretion of the Board, in substantially equal installments over the
     one-year period from the date of purchase.

         In the event the Company does not exercise the option to purchase the
     Shares, as provided above, the Grantee shall have the right to sell,
     encumber, or otherwise dispose of his Shares on the terms of the transfer
     set forth in the written notice to the Company, provided such transfer is
     effected within fifteen (15) days after the expiration of the option
     period. If the transfer is not effected within such period, the Company
     must again be given an option to purchase, as provided above.

         Notwithstanding the foregoing, the Board, in its sole discretion, may
     waive the Company's right of first refusal pursuant to this Paragraph to
     the extent that exercise of such right would cause any share of Company
     Stock issued by the Company to fail to meet the requirements of "qualified
     small business stock" within the meaning of Section 1202 of the Code. To
     the extent that the Company's right of first refusal is so waived, the
     Board may, in its sole discretion, pass-through such right to the remaining
     stockholders of the Company on a pro-rata basis. To the extent that a
     stockholder has been given such right and does not purchase his pro-rata
     allotment, the other stockholders shall have the right to purchase such
     allotment on a pro-rata basis.

                                       13
<PAGE>

         On and after the date of the initial registration of the Company's
     securities under Section 12(g) of the Exchange Act, the Company shall have
     no further right to purchase the Shares pursuant to this Paragraph and its
     limitations shall be null and void.

8.       RIGHT OF REPURCHASE UPON DEATH OR TERMINATION OF EMPLOYMENT.

         PRIOR TO THE DATE OF THE INITIAL REGISTRATION OF THE COMPANY'S
     SECURITIES UNDER SECTION 12(g) OF THE EXCHANGE ACT, THE COMPANY SHALL HAVE
     THE RIGHT TO REPURCHASE THE SHARES UPON THE DEATH OR TERMINATION OF
     EMPLOYMENT OF THE GRANTEE FOR ANY REASON AT A PRICE PAID IN CASH EQUAL TO
     THE FAIR MARKET VALUE OF THE SHARES AS DETERMINED BY THE BOARD IMMEDIATELY
     PRECEDING THE DATE THE SHARES ARE TO BE SOLD. AT THE DISCRETION OF THE
     BOARD, PAYMENT FOR THE REPURCHASE OF SUCH SHARES MAY BE MADE IN
     SUBSTANTIALLY EQUAL INSTALLMENTS OVER THE ONE-YEAR PERIOD FROM THE DATE OF
     PURCHASE.

         Notwithstanding the foregoing, the Board, in its sole discretion, may
     waive the Company's right of repurchase pursuant to this Paragraph to the
     extent that the repurchase would cause any Company Stock issued by the
     Company to fail to meet the requirements of "qualified small business
     stock" within the meaning of Section 1202 of the Code. To the extent that
     the Company's repurchase right is so waived, the Board may, in its sole
     discretion, pass-through such right to the remaining stockholders of the
     Company on a pro-rata basis. To the extent that a stockholder has been
     given such right and does not purchase his pro-rata allotment, the other
     stockholders shall have the right to purchase such allotment on a pro-rata
     basis.

         On and after the date of the initial registration of the Company's
     securities under Section 12(g) of the Exchange Act, the Company shall have
     no further right to purchase the Shares pursuant to this Paragraph and its
     limitations shall be null and void.

9.       NON-COMPETE.

         This grant is made subject to the terms and conditions of the
     non-compete/confidentiality agreement attached as Exhibit D to the
     Employment Agreement, the terms of which are incorporated herein by
     reference.

10.      GRANT SUBJECT TO PLAN PROVISIONS.

         This Grant is made pursuant to the terms of the Plan, the terms of
     which are incorporated herein by reference, and shall in all respects be
     interpreted in accordance therewith. The granting and exercise of the
     Option are subject to the provisions of the Plan and to interpretations,
     regulations and determinations concerning the Plan established from time to
     time by the Board in accordance with the provisions of the Plan, including,
     but not limited to, provisions pertaining to (i) rights and obligations
     with respect to withholding taxes, (ii) the

                                       14
<PAGE>

     registration, qualification or listing of the Shares, (iii) capital or
     other changes of the Company and (iv) other requirements of applicable law.

11.      NO RIGHTS TO EMPLOYMENT.

         Neither the granting of the Option nor any other action taken with
     respect to the Option or the Plan shall confer upon the Grantee any right
     to continue as an employee of the Company or interfere in any way with the
     right of the Company to terminate Grantee's employment with the Company at
     any time. Except as may be otherwise limited by another written agreement,
     the right of the Company to terminate at will the Grantee's employment with
     it at any time (whether by dismissal, discharge, retirement or otherwise)
     is specifically reserved.

12.      NO STOCKHOLDER RIGHTS.

         Neither the Grantee, nor any person entitled to exercise the Grantee's
     rights in the event of the Grantee's death, shall have any of the rights
     and privileges of a stockholder with respect to the Shares subject to the
     Option, except to the extent that certificates for such Shares shall have
     been issued upon the exercise of the Option as provided herein.

13.      CANCELLATION OR AMENDMENT.

         This grant may be canceled or amended by the Board, in whole or in
     part, at any time if the Board determines, in its sole discretion, that
     cancellation or amendment is necessary or advisable in light of any change
     after the Date of Grant in (a) the Code or the regulations issued
     thereunder or (b) any federal or state securities law or other law or
     regulation, which change by its term is effective retroactively to a date
     on or before the Date of Grant; provided, however, that no such
     cancellation or amendment shall, without the Grantee's consent, apply to or
     affect installments that matured on or before the date on which the Board
     makes such determination.

14.      BOARD AUTHORITY.

         The Board shall have the right to interpret the Option, to make factual
     determinations and this instrument and its decisions with respect thereto
     shall be conclusive upon any question arising hereunder.

                                       15
<PAGE>

15.      ASSIGNMENT AND TRANSFERS.

         The rights and interests of the Grantee under this Agreement may not be
     sold, assigned, encumbered or otherwise transferred except, in the event of
     the death of the Grantee, by will or by the laws of descent and
     distribution. In the event of any attempt by the Grantee to alienate,
     assign, pledge, hypothecate, or otherwise dispose of the Option or any
     right hereunder, except as provided for herein, or in the event of the levy
     of any attachment, execution or similar process upon the rights or interest
     hereby conferred, the Company may terminate the Option by notice to the
     Grantee and the Option and all rights hereunder shall thereupon become null
     and void.

16.      APPLICABLE LAW.

         The validity, construction, interpretation and effect of this
     instrument shall be governed by and determined in accordance with the laws
     of the Commonwealth of Pennsylvania.

17.      NOTICE.

         Any notice to the Company provided for in this instrument shall be
     addressed to it in care of the Board, Care Management Science Corporation,
     ATTENTION Secretary and any notice to the Grantee shall be addressed to
     such Grantee at the current address shown on the payroll of the Company, or
     to such other address as the Grantee may designate to the Company in
     writing. Any notice provided for hereunder shall be delivered by hand, sent
     by telecopy or telex or enclosed in a properly sealed envelope addressed as
     stated above, registered and deposited, postage and registry fee prepaid,
     in a post office or branch post office regularly maintained by the United
     States Postal Service.

                  IN WITNESS WHEREOF, Care Management Science Corporation has
caused its duly authorized officers to execute and attest this instrument, and
the Grantee has placed his or her signature hereon, effective as of the Date of
the Grant.

CARE MANAGEMENT SCIENCE CORPORATION

By:
    ----------------------------------
Its: Chief Executive Officer

Accepted:
         -----------------------------
     Alfredo Czerwinski, M.D.

                                       16
<PAGE>

                                  EXHIBIT B - 2
                              EMPLOYEE GRANT LETTER
                       CARE MANAGEMENT SCIENCE CORPORATION
                          1995 EQUITY COMPENSATION PLAN

                         NONQUALIFIED STOCK OPTION GRANT

         THIS NONQUALIFIED STOCK OPTION GRANT, dated as of MARCH 29, 1999 (the
"Date of Grant"), is delivered by CARE MANAGEMENT SCIENCE CORPORATION (together
with its subsidiaries hereinafter collectively referred to as the "Company"), to
ALFREDO CZERWINSKI, M.D., a key employee of the Company (the "Grantee").

                                    RECITALS

         A. The Care Management Science Corporation 1995 Equity Compensation
Plan (the "Plan") provides for the grant of stock options to key employees of
the Company, to purchase shares of Common Stock, no par value, of the Company
(the "Shares"), in accordance with the terms and conditions of the Plan.

         B. The Board of Directors of the Company (the "Board") has determined
that it would be to the advantage and interest of the Company to make the grant
provided for herein as an inducement for the Grantee to continue as a key
employee of the Company and to promote the best interests of the Company and its
stockholders.

         NOW, THEREFORE, the parties hereto, intending to be legally bound
hereby, agree as follows:

7.       GRANT OF OPTION.

         Subject to the terms and conditions hereinafter set forth, the Company
     hereby grants to the Grantee an option to purchase an aggregate number of
     Shares at the option price set forth below (the "Option"):

         A Nonqualified Stock Option to purchase 19,702 Shares at an option
     price of $2.59 per Share, which shall be exercisable to the extent vested
     as provided in Paragraph 6 below.

8.       NATURE OF OPTION.

         The Option designated hereunder shall be a Nonqualified Stock Option
     which is not intended to be an Incentive Stock Option within the meaning of
     Section 422 of the Internal Revenue Code of 1986, as amended (the "Code").
     The Board shall interpret and construe the

                                       17
<PAGE>

     Option in accordance with this designation and pursuant to the terms of the
     Plan, and its decisions shall be conclusive as to any question arising
     hereunder.

9.       RESTRICTIONS ON EXERCISE.

         During the Grantee's lifetime, exercise of the Option shall be solely
     by the Grantee and, upon the Grantee's death, the Option shall be
     exercisable (subject to the limitations specified in the Plan) solely by
     the legal representatives of the Grantee, or by the person or persons who
     acquire the right to exercise the Option by will or by the laws of descent
     and distribution, to the extent that the Option is exercisable pursuant to
     the provisions of Paragraphs 5 and 6.

10.      EXERCISE PROCEDURES.

         The Grantee may exercise the Option with respect to all or any part of
     the Shares then subject to such exercise by giving the Board written notice
     of intent to exercise in the manner provided in Paragraph 17 hereof. Such
     notice shall specify the number of Shares as to which this Option is to be
     exercised and the date of delivery thereof, which date shall be at least 15
     days after the giving of such notice unless an earlier date shall have been
     mutually agreed upon; PROVIDED, HOWEVER, THAT NO SUCH EXERCISE MAY OCCUR
     DURING ANY PERIOD WHICH THE COMMITTEE HAS DESIGNATED IN WRITING AS A
     PROHIBITED EXERCISE PERIOD. On such delivery date, the Grantee shall pay
     the applicable exercise price in cash, by surrender of Shares of the
     Company at their fair market value on the date of delivery or pursuant to a
     loan from the Company in accordance with Section 5(g) of the Plan. Upon
     such payment, the Company shall deliver to the Grantee at the then
     executive office of the Company, or such other place as may be mutually
     acceptable to the Company and the Grantee, a certificate or certificates
     for such Shares out of heretofore unissued Shares or reacquired Shares, as
     the Company may elect.

         On and after the date of the initial registration of the Company's
     securities under Section 12(g) of the Securities Exchange Act of 1934 (the
     "Exchange Act"), in lieu of the foregoing, such notice may instruct the
     Company to deliver Shares due upon the exercise of the Option to any
     registered broker or dealer in lieu of delivery to the Grantee. Such
     instructions must designate the account into which the Shares are to be
     deposited. The Grantee may tender this notice of exercise, which has been
     properly executed by the Grantee, and the aforementioned delivery
     instructions to any broker or dealer.

         The obligation of the Company to deliver Shares upon such exercise of
     the Option shall be subject to all applicable laws, rules, regulations and
     such approvals by governmental agencies as may be deemed appropriate by the
     Board, including, among other things, such steps as Company counsel shall
     deem necessary or appropriate to comply with relevant securities laws and
     regulations. All obligations of the Company hereunder shall be subject to

                                       18
<PAGE>

     the rights of the Company as set forth in the Plan to withhold amounts
     required to be withheld for any taxes. If the Grantee fails to accept
     delivery of, or to pay for, any of the Shares specified in such notice upon
     tender of delivery thereof, the Grantee's right to purchase such
     undelivered Shares may be terminated, at the sole discretion of the Board.
     The date that notice of an election to exercise is received by the Company
     shall be deemed the date of exercise hereunder.

11.      TERM OF OPTION.

         The Option granted hereunder shall have a term of ten (10) years from
     the Date of Grant shall terminate at the expiration of that period, unless
     it is terminated at an earlier date pursuant to the further provisions of
     this Agreement.

         The Option shall automatically terminate upon the happening of certain
     events, including (i) the expiration of the 60-day period after the
     Grantee's termination of employment from the Company for any reason other
     than disability (within the meaning of section 22(e)(3) of the Code),
     death, retirement approved by the Company or "termination for cause," (ii)
     the expiration of the six-month period after the Grantee's termination of
     employment from the Company on account of disability (as defined herein),
     or retirement approved by the Company, (iii) the expiration of the one-year
     period after the Grantee's termination of employment from the Company on
     account of death, or (iv) the date of the Grantee's "termination for cause"
     by the Company, as determined in Executive's Employment Agreement with the
     Company.

12.      VESTING AND FORFEITURE OF OPTION.

         The Option shall become vested in four (4) installments (50% of the
     shares in four equal yearly installments of 12.5% each, and a single lump
     sum installment of 50% upon the conclusion of the fourth year), the Grantee
     having the right hereunder to purchase from the Company, on and after the
     following dates, the following numbers of shares of Common Stock if the
     Grantee is employed by the Company on such date:

<TABLE>
<S>                                     <C>              <C>
March 29, 2000                           12.5%            2,463 shares;

March 29, 2001                           12.5%            an additional 2,463 shares;

March 29, 2002                           12.5%            an additional 2,463 shares;

March 29, 2003                           62.5%            an additional 12,313 shares.
</TABLE>

     PROVIDED, HOWEVER, that the Option shall become fully-vested upon a Change
     of Control of the Company (as defined in Section 11 of the Plan) and the
     other provisions specified in the

                                       19
<PAGE>

     Plan relating to the consequences of a Change of Control shall apply,
     including Sections 5(f)(1)(B) and 12.

         NOTWITHSTANDING ANY OTHER PROVISIONS SET FORTH HEREIN OR IN THE PLAN,
     IF THE GRANTEE SHALL CEASE TO BE AN EMPLOYEE ON ACCOUNT OF "TERMINATION FOR
     CAUSE", AS DETERMINED IN ACCORDANCE WITH EXECUTIVE'S EMPLOYMENT AGREEMENT
     WITH THE COMPANY BEFORE ANY CHANGE OF CONTROL OF THE COMPANY, THE
     UNEXERCISED PORTION OF THE OPTION AND ANY AND ALL RIGHTS HEREUNDER SHALL
     IMMEDIATELY TERMINATE AND BE VOID.

18.      RIGHT OF FIRST REFUSAL

         Prior to the date of the initial registration of the Company's
     securities under Section 12(g) of the Exchange Act, if at any time the
     Grantee desires to sell, encumber, or otherwise dispose of the Shares, he
     shall first offer the same to the Company by giving the Company written
     notice disclosing: (a) the name(s) of the proposed transferee of the
     Shares; (b) the certificate number and number of Shares proposed to be
     transferred or encumbered; (c) the proposed price; and (d) all other terms
     of the proposed transfer. Within fourteen (14) days after receipt of such
     notice, the Company shall have the option to purchase all or part of such
     Shares. If the Company decides to exercise this option, the purchase price
     of the Shares shall be the proposed price and may be payable, at the
     discretion of the Board, in substantially equal installments over the
     one-year period from the date of purchase.

         In the event the Company does not exercise the option to purchase the
     Shares, as provided above, the Grantee shall have the right to sell,
     encumber, or otherwise dispose of his Shares on the terms of the transfer
     set forth in the written notice to the Company, provided such transfer is
     effected within fifteen (15) days after the expiration of the option
     period. If the transfer is not effected within such period, the Company
     must again be given an option to purchase, as provided above.

         Notwithstanding the foregoing, the Board, in its sole discretion, may
     waive the Company's right of first refusal pursuant to this Paragraph to
     the extent that exercise of such right would cause any share of Company
     Stock issued by the Company to fail to meet the requirements of "qualified
     small business stock" within the meaning of Section 1202 of the Code. To
     the extent that the Company's right of first refusal is so waived, the
     Board may, in its sole discretion, pass-through such right to the remaining
     stockholders of the Company on a pro-rata basis. To the extent that a
     stockholder has been given such right and does not purchase his pro-rata
     allotment, the other stockholders shall have the right to purchase such
     allotment on a pro-rata basis.

                                       20
<PAGE>

         On and after the date of the initial registration of the Company's
     securities under Section 12(g) of the Exchange Act, the Company shall have
     no further right to purchase the Shares pursuant to this Paragraph and its
     limitations shall be null and void.

19.      RIGHT OF REPURCHASE UPON DEATH OR TERMINATION OF EMPLOYMENT.

         PRIOR TO THE DATE OF THE INITIAL REGISTRATION OF THE COMPANY'S
     SECURITIES UNDER SECTION 12(g) OF THE EXCHANGE ACT, THE COMPANY SHALL HAVE
     THE RIGHT TO REPURCHASE THE SHARES UPON THE DEATH OR TERMINATION OF
     EMPLOYMENT OF THE GRANTEE FOR ANY REASON AT A PRICE PAID IN CASH EQUAL TO
     THE FAIR MARKET VALUE OF THE SHARES AS DETERMINED BY THE BOARD IMMEDIATELY
     PRECEDING THE DATE THE SHARES ARE TO BE SOLD. AT THE DISCRETION OF THE
     BOARD, PAYMENT FOR THE REPURCHASE OF SUCH SHARES MAY BE MADE IN
     SUBSTANTIALLY EQUAL INSTALLMENTS OVER THE ONE-YEAR PERIOD FROM THE DATE OF
     PURCHASE.

         Notwithstanding the foregoing, the Board, in its sole discretion, may
     waive the Company's right of repurchase pursuant to this Paragraph to the
     extent that the repurchase would cause any Company Stock issued by the
     Company to fail to meet the requirements of "qualified small business
     stock" within the meaning of Section 1202 of the Code. To the extent that
     the Company's repurchase right is so waived, the Board may, in its sole
     discretion, pass-through such right to the remaining stockholders of the
     Company on a pro-rata basis. To the extent that a stockholder has been
     given such right and does not purchase his pro-rata allotment, the other
     stockholders shall have the right to purchase such allotment on a pro-rata
     basis.

         On and after the date of the initial registration of the Company's
     securities under Section 12(g) of the Exchange Act, the Company shall have
     no further right to purchase the Shares pursuant to this Paragraph and its
     limitations shall be null and void.

20. NON-COMPETE.

         This grant is made subject to the terms and conditions of the
     non-compete/confidentiality agreement attached as Exhibit D to the
     Employment Agreement, the terms of which are incorporated herein by
     reference.

21.      GRANT SUBJECT TO PLAN PROVISIONS.

         This Grant is made pursuant to the terms of the Plan, the terms of
     which are incorporated herein by reference, and shall in all respects be
     interpreted in accordance therewith. The granting and exercise of the
     Option are subject to the provisions of the Plan and to interpretations,
     regulations and determinations concerning the Plan established from time to
     time by the Board in accordance with the provisions of the Plan, including,
     but not limited to, provisions pertaining to (i) rights and obligations
     with respect to withholding taxes, (ii) the

                                       21
<PAGE>

     registration, qualification or listing of the Shares, (iii) capital or
     other changes of the Company and (iv) other requirements of applicable law.

22.      NO RIGHTS TO EMPLOYMENT.

         Neither the granting of the Option nor any other action taken with
     respect to the Option or the Plan shall confer upon the Grantee any right
     to continue as an employee of the Company or interfere in any way with the
     right of the Company to terminate Grantee's employment with the Company at
     any time. Except as may be otherwise limited by another written agreement,
     the right of the Company to terminate at will the Grantee's employment with
     it at any time (whether by dismissal, discharge, retirement or otherwise)
     is specifically reserved.

23.      NO STOCKHOLDER RIGHTS.

         Neither the Grantee, nor any person entitled to exercise the Grantee's
     rights in the event of the Grantee's death, shall have any of the rights
     and privileges of a stockholder with respect to the Shares subject to the
     Option, except to the extent that certificates for such Shares shall have
     been issued upon the exercise of the Option as provided herein.

24.      CANCELLATION OR AMENDMENT.

         This grant may be canceled or amended by the Board, in whole or in
     part, at any time if the Board determines, in its sole discretion, that
     cancellation or amendment is necessary or advisable in light of any change
     after the Date of Grant in (a) the Code or the regulations issued
     thereunder or (b) any federal or state securities law or other law or
     regulation, which change by its term is effective retroactively to a date
     on or before the Date of Grant; provided, however, that no such
     cancellation or amendment shall, without the Grantee's consent, apply to or
     affect installments that matured on or before the date on which the Board
     makes such determination.

25.      BOARD AUTHORITY.

         The Board shall have the right to interpret the Option, to make factual
     determinations and this instrument and its decisions with respect thereto
     shall be conclusive upon any question arising hereunder.

                                       22
<PAGE>

26.      ASSIGNMENT AND TRANSFERS.

         The rights and interests of the Grantee under this Agreement may not be
     sold, assigned, encumbered or otherwise transferred except, in the event of
     the death of the Grantee, by will or by the laws of descent and
     distribution. In the event of any attempt by the Grantee to alienate,
     assign, pledge, hypothecate, or otherwise dispose of the Option or any
     right hereunder, except as provided for herein, or in the event of the levy
     of any attachment, execution or similar process upon the rights or interest
     hereby conferred, the Company may terminate the Option by notice to the
     Grantee and the Option and all rights hereunder shall thereupon become null
     and void.

27.      APPLICABLE LAW.

         The validity, construction, interpretation and effect of this
     instrument shall be governed by and determined in accordance with the laws
     of the Commonwealth of Pennsylvania.

28.      NOTICE.

         Any notice to the Company provided for in this instrument shall be
     addressed to it in care of the Board, Care Management Science Corporation,
     ATTENTION Secretary and any notice to the Grantee shall be addressed to
     such Grantee at the current address shown on the payroll of the Company, or
     to such other address as the Grantee may designate to the Company in
     writing. Any notice provided for hereunder shall be delivered by hand, sent
     by telecopy or telex or enclosed in a properly sealed envelope addressed as
     stated above, registered and deposited, postage and registry fee prepaid,
     in a post office or branch post office regularly maintained by the United
     States Postal Service.

                  IN WITNESS WHEREOF, Care Management Science Corporation has
caused its duly authorized officers to execute and attest this instrument, and
the Grantee has placed his or her signature hereon, effective as of the Date of
the Grant.

CARE MANAGEMENT SCIENCE CORPORATION

By:____________________________
Its: Chief Executive Officer

Accepted:______________________
     Alfredo Czerwinski, M.D.

                                       23
<PAGE>

                                    EXHIBIT D
                                CARESCIENCE, INC.
                            NON-COMPETITION AGREEMENT

     CareScience, Inc., a Pennsylvania corporation (the "Company"),
contemporaneously with the execution of this Agreement is providing "Insert
Employee Name" ("Employee"), with a Nonqualified Stock Option Grant of even date
herewith (the "Stock Option Grant"). In addition to the Company's desire to
incent the Employee and the Employee's desire to serve the Company, the Employee
understands that the Company wishes to ensure that the Employee does not compete
with the Company, on the terms and conditions specified below and in the Stock
Option Grant, in the event the Employee's employment with the Company is
terminated.

     In consideration of the Company's employment of me and in order to induce
the Company to provide me with the Stock Option Grant, the Company and Employee
hereby agree as follows:

1. NON-COMPETITION; APPLICATION AND DURATION; NON-INTERFERENCE.

     The Employee will not, during the term of the Employee's employment by the
Company and for a period of one year following the termination of employment if
Employee's employment is terminated within the first year of his employment or
two years following the termination of employment if Employee's employment is
terminated after the first year of his employment (the term of Employee's
employment and the one or two years as the case may be following termination
collectively represent the "Non-Competitive Period"):

         (a) as owner, partner, joint venturer, stockholder, employee, broker,
     agent, principal, trustee, corporate officer, director, licensor, or in any
     capacity whatsoever engage in, become financially interested in, be
     employed by, or render any consultation or business advice with respect to
     any business which business is engaged in by the Company on the date hereof
     or during the course of Employee's employment or which business ("Company
     Business") is engaged in development or commercialization of any
     technologies or products related to the development of software and
     databases that transform data into tools to be used by managers in the
     health care information industry or the provision of services with respect
     thereto (collectively, "Health Care Decision Support"), in any geographic
     area where, during the time of Employee's employment, the business of the
     Company or any of its subsidiaries is being, had been or was proposed to
     be, conducted in any manner whatsoever, which technologies, products or
     services are (i) competitive with any Health Care Decision Support or other
     Company Business technology or application thereof or products based
     thereon designed, marketed, announced, leased or sold by the Company or any
     of its subsidiaries during the term of employment or at the time of the
     termination of the Employee's employment; or (ii) substantially similar to
     any technology or service involving Health Care Decision Support or other
     Company Business which the Company was designing, marketing, announcing,
     leasing

<PAGE>

     or selling or proposing to design, market, lease or sell during the term of
     Employee's employment; or (iii) substantially similar to any technology or
     service involving Health Care Decision Support of which the Employee had
     knowledge at the time of the termination of the Employee's employment that
     the Company was proposing to design, market, announce, lease or sell;
     PROVIDED, HOWEVER, that the Employee may own any securities of a
     corporation which is engaged in such business and is publicly owned and
     traded but in amount not to exceed at any one time one percent (1%) of any
     class of stock or securities of such company; PROVIDED FURTHER that
     Employee is not personally engaged in any way, directly or indirectly, in
     any scientific or business activity within such entity, which competes with
     the Company as described above.

     Notwithstanding the foregoing, with regard to Executive's ability to
     provide consulting services during any Non-Competitive Period, the parties
     hereby agree as follows:

          (i)  Executive may not work, whether directly or indirectly, for a
               competitor of the Company;

          (ii) Executive may not work to reproduce or otherwise transfer Company
               services for any company, whether or not a competitor of the
               Company;

          (iii) Executive may not solicit or contract with any Company client
               during the Non-Competitive Period without the Company's advance
               written approval; notwithstanding the foregoing, the Company may
               not unreasonably withhold such approval and such approval must be
               provided by the Company so long as the Customer does not want CMS
               to provide the same service and the service is not competitive as
               defined herein;

          (iv) Executive agrees to provide a list of Lawson & Associates clients
               attached hereto as Exhibit D-1. Executive may solicit and
               contract with any party on Exhibit D-1 subject to items (i) and
               (ii) above

                  (b) during the Non-Competitive Period, request or cause any
     suppliers or customers with whom the Company or any of its subsidiaries has
     a business relationship to cancel or terminate any such business
     relationship with the Company or any of its subsidiaries or solicit,
     interfere with or entice from the Company any employee (or former employee)
     of the Company;

                  (c) solicit, interfere with, hire, offer to hire, persuade or
     induce any person who is or was an officer, employee, customer or supplier
     of the Company or any of its subsidiaries or affiliates to discontinue
     his/her relationship with the Company or any of its subsidiaries or
     affiliates or accept employment by or enter into contractual relations for
     compensation with any other entity or person, or approach any such employee
     of the Company or any of its subsidiaries or affiliates for any such
     purpose or authorize or knowingly approve the taking of any such actions by
     any other individual or entity. The term "affiliate" shall mean any person
     or entity that directly or indirectly through one or more intermediaries,
     controls or is controlled by, or is under common control with, the Company.

<PAGE>

2.       EQUITABLE REMEDIES AND ENFORCEABILITY OF COVENANTS

         (a) if Employee Commits a breach, or threatens to commit a breach, of
     any of the provisions hereof or under the Employment or Invention
     Assignment Agreement, it is acknowledged and agreed that any such breach or
     threatened breach will cause irreparable injury to the Company and that
     money damages will not provide an adequate remedy to the Company. In the
     event of such breach the Company shall be entitled to terminate all or any
     part of the Stock Option Grant which has not been exercised on the date the
     Company determines that the Employee has breached these restrictions. In
     addition, in the event of such a breach or threatened breach the Company
     shall be entitled to obtain from any court of competent jurisdiction,
     preliminary and permanent injunctive relief to restrain such activity or
     otherwise to specifically enforce any covenant, as well as to obtain
     damages, including reasonable attorneys fees incurred by the Company to
     enforce this Agreement or the Employment or Invention Assignment Agreement,
     and an equitable accounting of all earnings, profits and other benefits
     arising from such violation, which rights shall be cumulative and in
     addition to any other rights or remedies to which the Company may be
     entitled.

         (b) if any of the covenants contained herein or under the under the
     Employment or Invention Assignment Agreement, or any part hereof or
     thereof, is hereafter construed to be invalid or unenforceable, the same
     shall not affect the remainder of the covenant or covenants, which shall be
     given full effect without regard to the invalid portions.

         (c) if any of the covenants contained herein or under the Employment or
     Invention Assignment Agreement, or any part hereof or thereof, is held to
     be unenforceable because of the duration of such provision or the area
     covered thereby, the parties agree that the court making such determination
     shall have the power to reduce the duration, scope, and/or area of such
     provision and, in its reduced form, such provision shall then be
     enforceable.

         (d) the existence of any claim or cause of action by Employee against
     the Company or any affiliate of the Company shall not constitute a defense
     to the enforcement by the Company of the covenants contained herein, but
     such claim or cause of action shall be litigated separately.

3.       MISCELLANEOUS.

         (a) This Agreement, together with the Employment Agreement, supersedes
     all prior agreements, written or oral, between the Employee and the Company
     relating to the subject matter of this Agreement. This Agreement may not be
     modified, changed or discharged in whole or in part, except by an agreement
     in writing signed by the Employee and the Company. The Employee agrees that
     any change or changes in his/her duties, salary or compensation after the
     signing of this Agreement shall not affect the validity or scope of this
     Agreement.

<PAGE>

         (b) This Agreement will be binding upon the Employee's heirs, executors
     and administrators and will inure to the benefit of the Company and its
     successors and assigns.

         (c) No delay or omission by either party in exercising any right under
     this Agreement will operate as a waiver of that or any other right. A
     waiver or consent given by either party on any one occasion is effective
     only in that instance and will not be construed as a bar to or waiver of
     any right on any other occasion.

         (d) The Employee expressly consents to be bound by the provisions of
     this Agreement for the benefit of the Company or any parent, subsidiary or
     affiliate thereof to whose employ the Employee may be transferred without
     the necessity that this Agreement be re-signed at the time of such
     transfer.

         (e) The restrictions contained in this Agreement are necessary for the
     protection of the business and goodwill of the Company and are considered
     by the Employee to be reasonable for such purpose.

         (f) This Agreement is governed by and will be construed as a sealed
     instrument under and in accordance with the laws of the Commonwealth of
     Pennsylvania. Any action, suit, or other legal proceeding which is
     commenced to resolve any matter arising under or relating to any provision
     of this Agreement shall be arbitrated or commenced in a court as the
     Company may see fit.

The Employee understands that nothing in this Agreement shall otherwise affect
the Employee's obligations under the Employment Agreement of even date herewith
between the Company and Employee.

Dated:                                    By:
       -------------------                    ----------------------------------
                                              Alfredo Czerwinski, M.D.

CARE MANAGEMENT SCIENCE CORPORATION

By:
    --------------------------------
Name:
Title:

<PAGE>

                 EXHIBIT D -1 - LAWSON & ASSOCIATES CLIENT LIST

Lawson & Associates Clients with
significant involvement by Dr. Czerwinski

Abbot Laboratories

American College of Physician Executives (ACPE)

American Healthcare Consultants

American Medical Group Association

AmeriNet and member hospitals

Baptist Memorial Health Care Corporation

Bristol-Myers-Squibb

Care Management Science

Cascade Healthcare Alliance

Central DuPage Health System

Contra Costa Health Services

Ellis Marketing Management Group

Genentech

Harvard Pilgrim Health Care

Hospital Council of Western Pennsylvania
and its member hospitals

Huntington Provider Group

IdeaScope Associates, Inc.

Independent Health

Hemophilia Foundation

J. Glynn & Company

Knowledge Research Institute

Lakeside Medical Group

Lifemasters

Lifescan, Inc.

Medical Economics

Medical Group Management Association

Merck

Mission Health (Baptist-St. Vincent's)

Morrison-Knudsen Corporation

National PACE Association (Program of All-inclusive Care for the Elderly)

North Idaho Health Network

Novartis

On Lok

Oxford Health Plan

Pacific Business Group on Health

University of Pennsylvania Health System

Palo Alto Medical Foundation

Parke-Davis

Pfizer

St. Charles Medical Center

San Jose Medical Clinic

Sherman Hospital

Society of Chief Medical Officers

Sutter Medical Group

Sutter West Medical Group

The Advisory Board

The Leadership Institute / BDC Advisors

Unimed Medical Management

VHA, Inc.

Warner-Lambert Company

Yukon-Kuskokwim Health Corporation

Zitter Group

<PAGE>

                                    EXHIBIT E

                         INVENTION ASSIGNMENT AGREEMENT

                  CareScience, Inc., a Pennsylvania corporation (the "Company")
and "Alfredo Czerwinski, M.D." ("Executive"), contemporaneously with the
execution of this Agreement are entering into an Employment Agreement of even
date herewith (the "Employment Agreement"), pursuant to which, among other
things, the Executive will be employed by the Company in the capacity of Chief
Medical Officer. Capitalized terms used in this Agreement and not otherwise
defined herein shall have the meanings given such terms in the Employment
Agreement. In addition to the Company's desire to engage the Executive and the
Executive's desire to serve the Company, under the terms and conditions of the
Employment Agreement, the Executive understands that the Company wishes to
ensure that any of Executive's inventions during the term of his employment by
the Company are and remain the exclusive property of the Company.

                  In consideration for, and in order to induce my employment by
the Company, I hereby agree as follows:

         1.       INVENTION ASSIGNMENT.

                           Whereas I  will be participating in the preparation,
writing, creation, or development of certain business ideas, strategies,
analyses, reports, software, computer programs or other business activities
collectively referred to as the "Work";

                           (a) As an employee of the Company, any and all
materials created by me relating to the Work shall be considered as a "work made
for hire". Without limiting the foregoing, I hereby grant, transfer, assign, and
convey to the Company, its successors and assigns, the entire title, right,
interest, ownership and all subsidiary rights in and to the Work, all
intellectual property rights relating to the Work, and all copyrights, trade or
service marks, patents or other evidence of ownership and title pertaining to
the Work, including but not limited to the right to secure copyright, trade or
service mark or patent registration(s) in the Company' name as claimant and the
right to secure renewals, reissues, and extensions of any such filings in the
United States of America or any other country.

                           (b) I acknowledge that the Company, in its sole
discretion, shall determine whether copyright(s), trade or service mark(s) or
patent registration(s) in the Work shall be filed and/or preserved and
maintained or registered in the United States of America or any other country.

                           (c) I confirm that by this instrument, the Company
and its successors and assigns shall own the entire title, right and interest in
and to the Work, including the right to reproduce, display publicly, prepare
derivative Works from or distribute by sale, rental, lease lending or by other
transfer of ownership even if the Work does not constitute a "Work made for
hire" as defined in 17 U.S.C. Sections 101 and 201(b).

<PAGE>

                           (d) I agree to take all actions and cooperate as is
necessary to protect the copyrights or other evidence of title in and to the
Work and further agree to execute any document(s) that may be necessary to
perfect the Company' ownership of copyrights, trade or service marks, patent(s)
or other evidence of ownership and title in the Work and the registration
thereof, without further compensation by the Company.

                           (e) I agree that all terms of this Agreement are
applicable to each portion or part of the Work, as well as to the Work in its
entirety.

                           (f) Notwithstanding anything contained herein, the
terms of this Agreement shall not apply to any invention for which no equipment,
supplies, facility, time, proprietary or trade secret information of the Company
was used and which can be demonstrated was developed entirely on my own time, at
my own expense and which: (i) does not relate in any way to the business of the
Company or to the Company's actual or demonstrably anticipated expansion
research or development; and (ii) which does not result from any Work performed
by me for the Company.

         2.       REPRESENTATIONS OF EXECUTIVE.

                           Executive represents and warrants that he is free to
enter into this Agreement and that there are no preceding claims or
understandings, restrictive covenants or other restrictions, whether written or
oral, preventing the performance of his duties hereunder.

         3.       MISCELLANEOUS.

                           (a) The invalidity or unenforceability of any
provision of this Agreement shall not affect the validity or enforceability of
any other provision of this Agreement.

                           (b) This Agreement, together with the Employment and
Non-Competition Agreements, supersedes all prior agreements, written or oral,
between the Executive and the Company relating to the subject matter of this
Agreement. This Agreement may not be modified, changed or discharged in whole or
in part, except by an agreement in writing signed by the Executive and the
Company. The Executive agrees that any change or changes in his/her duties,
salary or compensation after the signing of this Agreement shall not affect the
validity or scope of this Agreement.

                           (c) This Agreement will be binding upon the
Executive's heirs, executors and administrators and will inure to the benefit of
the Company and its successors and assigns.

                           (d) No delay or omission by either party in
exercising any right under this Agreement will operate as a waiver of that or
any other right. A waiver or consent given by either party on any one occasion
is effective only in that instance and will not be construed as a bar to or
waiver of any right on any other occasion.

<PAGE>

                           (e) The Executive expressly consents to be bound by
the provisions of this Agreement for the benefit of the Company or any parent,
subsidiary or affiliate thereof to whose employ the Executive may be transferred
without the necessity that this Agreement be re-signed at the time of such
transfer.

                           (f) The restrictions contained in this Agreement are
necessary for the protection of the Company and are considered by the Executive
to be reasonable for such purpose. The Executive agrees that any breach of this
Agreement is likely to cause the Company substantial and irrevocable damage and
therefore, in the event of any such breach, the Executive agrees that a remedy
at law, in addition to such other remedies which may be available, may be
inadequate.

                           (g) This Agreement is governed by and will be
construed as a sealed instrument under and in accordance with the laws of the
Commonwealth of Pennsylvania. Any action, suit, or other legal proceeding which
is commenced to resolve any matter arising under or relating to any provision of
this Agreement shall be arbitrated or commenced in a court, as and to the extent
set forth in the Employment Agreement.

                  The Executive understands that nothing in this Agreement shall
otherwise affect the Executive's obligations under the Employment Agreement of
even date herewith between the Company and Executive.

By my signature below, I hereby agree to the above.

By:
    ------------------------------------                    --------------------
    Name:                                                   Date

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