Document:

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                                   CORAM, INC.

                     CERTIFICATE OF DESIGNATION, PREFERENCES
                    AND RELATIVE, PARTICIPATING, OPTIONAL AND
                     OTHER SPECIAL RIGHTS OF PREFERRED STOCK
                       AND QUALIFICATIONS, LIMITATIONS AND
                              RESTRICTIONS THEREOF
                            ------------------------

                         Pursuant to Section 151 of the
                        Delaware General Corporation Law
                            ------------------------

                  Coram, Inc. (the "Company"), a corporation organized and
existing under the laws of the State of Delaware, hereby certifies that pursuant
to the provisions of Section 151 of the Delaware General Corporation Law, its
Board of Directors, by unanimous written consent, dated December 28, 2000
adopted the following resolution, which resolution remains in full force and
effect as of the date hereof:

                  WHEREAS, in order to effectuate the issuance of the Series A
Preferred Stock (as set forth below), the Board deems it in the best interest of
the Corporation and its stockholder to create a series of preferred stock,
designated as Series A Preferred Stock, with certain rights, designations,
preferences, qualifications and/or restrictions.

                  NOW, THEREFORE, BE IT RESOLVED, that pursuant to the authority
vested in the Board by Section 151 of the DGCL and in accordance with the
provisions of its Certificate of Incorporation, as amended and restated as of
the date hereof, a class of preferred stock of the Corporation to be known as
Series A Preferred Stock be, and it hereby is, created and provided for, and the
Board hereby fixes, states and expresses the terms, designations, relative
rights, preferences and limitations of such class in the particulars as set
forth in the Certificate of Designation attached as EXHIBIT A hereto (the
"CERTIFICATE OF DESIGNATION"); and be it

                  FURTHER RESOLVED, that the President or the Treasurer or any
other officer of the Corporation (each, an "AUTHORIZED OFFICER") be, and each of
them hereby is, authorized, empowered and directed, on behalf of the Corporation
and in its name, to execute and deliver any and all documents in connection with
the foregoing, to execute, deliver and file with the Secretary of State of the
State of Delaware, in accordance with the requirements of the DGCL, the
Certificate of Designation and to take any and all action as he may deem
necessary or appropriate in connection with the foregoing, all on such terms and
conditions he deems necessary or appropriate; and be it

                  FURTHER RESOLVED, that the Authorized Officer be, and each of
them hereby is, authorized, empowered and directed to take all such action as he
deems necessary or appropriate to implement and carry out the intent of the
foregoing resolutions.

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                   TERMS, PREFERENCES, RIGHTS AND LIMITATIONS

                                       of

                            SERIES A PREFERRED STOCK

                                       of

                                   CORAM, INC.

                  The relative rights, preferences, powers, qualifications,
limitations and restrictions granted to or imposed upon the Series A Preferred
Stock or the holders thereof are as follows:

                  1.       DEFINITIONS. For purposes of this Designation, the
following definitions shall apply:

                  "Appraised Value" shall mean, in respect of any share of
Common Stock on any date herein specified, the fair market value of such share
of Common Stock (determined without giving effect to the discount for (i) a
minority interest or (ii) any lack of liquidity of the Common Stock or to the
fact that Company may have no class of equity registered under the Exchange Act)
as of the last day of the most recent fiscal month to end within 60 days prior
to such date specified, based on the fair market value of the Company (the
"Company Value"), as determined by a nationally reputable appraisal firm or
investment banking firm selected by the Company and the holders of the Common
Stock (the "Company's Investment Banking Firm"), divided by the number of Fully
Diluted Outstanding shares of Common Stock.

                  (i)      The Required Holders shall have a period of 15 days
         after delivery of the Appraised Value to present in writing to the
         Company's Investment Bank (with a copy to the Company and the holders
         of the Common Stock) any objections the Required Holders may have to
         any of the matters set forth therein, which objections shall be set
         forth in reasonable detail. If no objections are raised within such
         15-day period, the Company Value shall be deemed accepted and approved
         by the Required Holders, on the one hand, and by the Company and the
         holders of the Common Stock, on the other hand.

                  (ii)     If the Required Holders shall raise any objections
         within such 15-day period, a nationally reputable appraisal firm or
         investment banking firm selected by the Required Holders (the "Required
         Holders' Investment Banking Firm") and the Company's Investment Banking
         Firm shall attempt to resolve the matter or matters in dispute and, if
         resolved, such firms shall send a joint notice to the Company, the
         holders of the Common Stock and the Required Holders, stating the
         manner in which the dispute was resolved, whereupon the confirmed or
         revised Company Value shall be final and binding on such parties.

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                  (iii)    If such dispute cannot be resolved by the Company and
         the holders of the Common Stock, on the one hand, and the Required
         Holders, on the other hand, nor by such Investment Banking Firms within
         30 days after the date of the delivery of the objection by Required
         Holders, then the specific matters in dispute shall be submitted to a
         nationally reputable appraisal firm or investment banking firm mutually
         selected by the Company's Investment Banking Firm and the Required
         Holders' Investment Banking Firm (the "Mutual Investment Banking
         Firm"), which Mutual Investment Banking Firm shall make a final and
         binding determination as to such matter or matters. The Mutual
         Investment Banking Firm shall send its written determination to the
         Company, the holders of the Common Stock, the Required Holders, the
         Company's Investment Banking Firm and the Required Holders' Investment
         Banking Firm. The Company's Investment Banking Firm shall then send to
         the Company, the holders of the Common Stock and the Required Holders a
         confirmation of the Company Value, as determined by the Mutual
         Investment Banking Firm, and the Required Holders' Investment Banking
         Firm shall send a letter to the Company, the holders of the Common
         Stock and the Required Holders confirming that such confirmed or
         revised Company Value is in accordance with such determination,
         whereupon the confirmed or revised Company Value shall be binding on
         such parties.

                  (iv)     The parties hereto shall cooperate with each other
         and each other's authorized representatives and with Mutual Investment
         Banking Firm in order that any and all matters in dispute shall be
         resolved as soon as practicable and that a final determination of the
         Company Value and the Appraised Value shall be made.

                  "Board" shall mean the Board of Directors of the Company.

                  "Business Day" shall mean any day other than a Saturday,
Sunday, or a day on which banking institutions in the State of New York are
authorized or obligated by law or executive order to close.

                  "Common Stock" shall mean the Common Stock, $1.00 par value
per share, of the Company.

                  "Company" shall mean Coram, Inc., a Delaware corporation.

                  "Dividend Rate" shall mean a cumulative compound annual rate
of 15%, calculated on a 360 day per year basis, based on the actual number of
days elapsed.

                  "Event of Default" shall have the meaning assigned to it in
the Exchange Agreement.

                  "Exchange Act" shall mean the Securities Exchange Act of 1934,
as amended, or any similar Federal statute, and the rules and regulations of the
Securities and Exchange Commission thereunder, all as the same shall be in
effect at the time.

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Reference to a particular section of the Securities Exchange Act of 1934, as
amended, shall include reference to the comparable section, if any, of any such
similar Federal statute.

                  "Exchange Agreement" shall mean the Exchange Agreement, dated
as of December 29, 2000, by and among the Company and the Persons named therein,
as it may be amended from time to time, a copy of which is on file at the
principal office of the Company.

                  "Fully Diluted Outstanding" shall mean, with reference to
Common Stock, at any date as of which the number of shares thereof is to be
determined, all shares of Common Stock outstanding at such date and all shares
of Common Stock issuable upon the exercise or conversion of options or warrants
to purchase, or securities convertible into, shares of Common Stock outstanding
on such date which would be deemed outstanding in accordance with GAAP for
purposes of determining book value or net income per share (other than shares of
Common Stock issuable by the Company as a dividend, prior to such issuance).

                  "GAAP" shall mean generally accepted accounting principles in
the United States of America as in effect from time to time.

                  "Liquidation Preference" shall mean $120,802 per share.

                  "Noteholders" shall have the meaning assigned to it in the
Exchange Agreement.

                  "Organic Change" shall mean (A) any sale, lease, exchange or
other transfer of more than 50% of the property and assets of the Company, (B)
any liquidation, dissolution or winding up of the Company, whether voluntary or
involuntary, (C) any merger or consolidation to which the Company is a party and
which the holders of the voting securities of the Company immediately prior
thereto own less than a majority of the outstanding voting securities of the
surviving entity immediately following such transaction, or (D) any Person or
group of Persons (as such term is used in Section 13(d) of the Exchange Act),
other than the Noteholders, shall beneficially own (as defined in Rule 13d-3
under the Exchange Act) securities of the Company representing 50% or more of
the voting securities of the Company then outstanding. For purposes of the
preceding sentence, "voting securities" shall mean securities, the holders of
which are ordinarily, in the absence of contingencies, entitled to elect the
corporate directors (or Persons performing similar functions).

                  "Original Issue Date" shall mean the date of the original
issuance of shares of Preferred Stock.

                  "Person" shall mean any individual, firm, corporation or other
entity, and shall include any successor (by merger or otherwise) of such entity.

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                  "Preferred Stock" shall refer to shares of Series A Preferred
Stock, $0.001 par value per share, of the Company.

                  "Redemption Date" shall mean the date on which any shares of
Preferred Stock are redeemed by the Company.

                  "Redemption Price" has the meaning set forth in Section
6(a)(i) of this Certificate of Designation.

                  "Required Holders" shall mean the holders of all of the
outstanding shares of Preferred Stock.

                  "Subsidiary" of any Person means any corporation or other
entity of which a majority of the voting power or the voting equity securities
or equity interest is owned, directly or indirectly, by such Person.

                  "Trading Day" shall mean a Business Day or, if the Common
Stock is listed or admitted to trading on any national securities exchange or
Nasdaq market, a day on which such exchange or market is open for the
transaction of business.

                  "Vote Multiple" has the meaning set forth in Section 5(a) of
this Certificate of Designation.

                  2.       DESIGNATION; NUMBER OF SHARES. The designation of the
preferred stock authorized by this resolution shall be "Series A Preferred
Stock" and the number of shares of Series A Preferred Stock designated hereby
shall be 1125 shares.

                  3.       DIVIDENDS.

                  (a) So long as any shares of Preferred Stock shall be
outstanding, the holders of such Preferred Stock shall be entitled to receive
out of any funds legally available therefor, preferential dividends at the
Dividend Rate on the Liquidation Preference hereunder, payable quarterly on the
last Business Day of each calendar quarter. Such dividends shall be cumulative
and begin to accrue from the Original Issue Date, whether or not declared and
whether or not there shall be net profits or net assets of the Company legally
available for the payment of those dividends.

                  (b) The dividend will be payable (i) prior to the effective
date of a Chapter 11 plan of reorganization with respect to the Company, in the
form of additional shares of Preferred Stock having a Liquidation Preference
equal to such dividend amount, or (ii) following the effective date of a Chapter
11 plan of reorganization with respect to the Company and at the Company's
election, in cash or in shares of Common Stock having an Appraised Value equal
to such cash dividend payment.

                  (c) So long as any shares of Preferred Stock shall be
outstanding, (i) no dividend whatsoever shall be paid or declared, and no
distribution shall be made, on account of any Common Stock until all dividends
in respect of the Preferred Stock for all

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past and current dividend periods have been paid and all amounts in respect of
the redemption of Preferred Stock pursuant to Section 6 have been paid, and (ii)
no shares of Common Stock shall be purchased, redeemed or acquired by the
Company and no funds shall be paid into or set aside or made available for a
sinking fund for the purchase, redemption or acquisition thereof until all
dividends in respect of the Preferred Stock for all past and current dividend
periods have been paid and all amounts in respect of the redemption of Preferred
Stock pursuant to Section 6 have been paid.

                  (d) Notwithstanding anything to the contrary contained herein,
if, on any date, an Event of Default shall have occurred and be continuing,
whether or not by reason of the absence of legally available funds therefor,
then the Dividend Rate on the shares of Preferred Stock shall be increased to a
compound annual rate of 16%, for as long as such Event of Default is continuing.

                  4.       LIQUIDATION RIGHTS OF PREFERRED STOCK.

                  (a) In the event of any sale, liquidation, dissolution or
winding up of the Company, whether voluntary or involuntary, the holders of
Preferred Stock then outstanding shall be entitled to be paid out of the assets
of the Company available for distribution to its stockholders, whether such
assets are capital, surplus or earnings, before any payment or declaration and
setting apart for payment of any amount shall be made in respect of any shares
of Common Stock or any share of any other class or series of the Company's
preferred stock ranking junior to the Preferred Stock with respect to the
payment of dividends or distribution of assets on the sale, liquidation,
dissolution or winding up of the Company, an amount equal to the Liquidation
Preference plus all declared or accrued and unpaid dividends in respect of any
sale, liquidation, dissolution or winding up consummated.

                  (b) If upon any sale, liquidation, dissolution or winding up
of the Company, whether voluntary or involuntary, the assets to be distributed
among the holders of Preferred Stock shall be insufficient to permit the payment
to such stockholders of the full preferential amounts aforesaid, then the entire
assets of the Company to be distributed shall be distributed ratably among the
holders of Preferred Stock, based on the full preferential amounts for the
number of shares of Preferred Stock held by each holder.

                  (c) After payment to the holders of Preferred Stock of the
amounts set forth in Section 4(a), the entire remaining assets and funds of the
Company legally available for distribution, if any, shall be distributed among
the holders of any preferred stock of the Company entitled to a preference over
the Common Stock in accordance with the terms thereof and, thereafter, to the
holders of Common Stock and Preferred Stock, in proportion to their ownership of
such shares.

                  5.       VOTING RIGHTS. In addition to any voting rights
provided by law, the holders of shares of Preferred Stock shall have the
following voting rights:

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                  (a) Subject to the provisions for dilution hereinafter set
forth, so long as any of the Preferred Stock is outstanding, each share of
Preferred Stock shall entitle the holder thereof to vote on all matters voted on
by the holders of Common Stock, voting together as a single class with other
shares entitled to vote at all meetings of the stockholders of the Company. The
number of votes which a holder of Preferred Stock is entitled to cast, as the
same may be adjusted from time to time as hereinafter provided, is hereinafter
referred to as the "VOTE MULTIPLE," which, as of the Original Issue Date, will
be equal to one. In the event the Corporation shall at any time after Original
Issue Date declare or pay any dividend on Common Stock payable in shares of
Common Stock, or effect a subdivision or split or a combination, consolidation
or reverse split of the outstanding shares of Common Stock into a greater or
lesser number of shares of Common Stock, or issue additional shares of Common
Stock at a purchase price which is less than the Appraised Value of such shares
on the date of issuance, then in each such case the Vote Multiple thereafter
applicable to the determination of the number of votes per share to which
holders of shares of Preferred Stock shall be entitled after such event shall be
the Vote Multiple immediately prior to such event multiplied by a fraction the
numerator of which is the number of shares of Common Stock and Preferred Stock
outstanding immediately after such event and the denominator of which is the
number of shares of Common Stock and Preferred Stock that were outstanding
immediately prior to such event.

                  (b) The unanimous affirmative vote of all of the shares of
Preferred Stock, voting together as a class, in person or by proxy, at a special
or annual meeting of stockholders called for the purpose, or pursuant to a
written consent of stockholders shall be necessary to:

                  (i)      authorize, adopt or approve an amendment to the
         Certificate of Incorporation or By-laws of the Company, including,
         without limitation, (A) to increase the size of the Board, (B) reduce
         the stated value or Liquidation Preference of, or Dividend Rate on, the
         Preferred Stock, (C) change the place or currency of payment of stated
         value or Liquidation Preference of, or Dividend Rate on, the Preferred
         Stock (D) impair the right to institute suit for the enforcement of any
         payment on or with respect to the Preferred Stock, or (E) reduce the
         percentage of outstanding shares of Preferred Stock necessary to modify
         or amend the terms hereof or to grant waivers;

                  (ii)     issue any shares of the capital stock of the Company
         ranking senior to, or pari passu with (either as to dividends or upon
         voluntary or involuntary liquidation, dissolution or winding up) the
         Preferred Stock, or issue any securities convertible into or
         exchangeable for such shares, except shares of Common Stock; or

                  (iii)    take any action which would result in an Organic
         Change.

                  (c) The holders of shares of Preferred Stock shall have, in
addition to the other voting rights set forth herein, the exclusive right,
voting separately as a single class,

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to elect three directors of the Company; provided, however, that if the holders
of shares of Preferred Stock do not elect any directors to the Board of
Directors, such holders will have the right to appoint an observer to the Board.

                  (d) If, on any date, an Event of Default shall have occurred
and be continuing, whether or not by reason of the absence of legally available
funds therefor, then the holders of shares of Preferred Stock shall have, in
addition to their other voting rights set forth herein, the exclusive right,
voting separately as a single class, to elect two additional directors of the
Company in accordance with this Section 5.

                  (e) (i) The foregoing rights of holders of shares of Preferred
Stock to take any actions as provided in this Section 5 may be exercised at any
annual meeting of stockholders or at a special meeting of stockholders held for
such purpose as hereinafter provided or at any adjournment thereof or pursuant
to any written consent of stockholders.

                  (ii)     If (A) the annual meeting of stockholders of the
         Company is not, for any reason, held within the time fixed in the
         by-laws of the Company, or (B) vacancies shall exist in the offices of
         directors elected by the holders of Preferred Stock, or (C) the holders
         of the Preferred Stock have the right to elect additional directors
         pursuant to Section 5(d) above, a proper officer of the Company, upon
         the written request of the holders of record of at least ten percent
         (10%) of the shares of Preferred Stock then outstanding, addressed to
         the Secretary of the Company, shall call a special meeting in lieu of
         the annual meeting of stockholders or a special meeting of the holders
         of Preferred Stock, for the purpose of electing or, if necessary,
         removing directors. Any such meeting shall be held at the earliest
         practicable date at the place for the holding of the annual meetings of
         stockholders. If such meeting shall not be called by the proper officer
         of the Company within twenty (20) days after personal service of said
         written request upon the Secretary of the Company, or within twenty
         (20) days after mailing the same within the United States by certified
         mail, addressed to the Secretary of the Company at its principal
         executive offices, then the holders of record of at least ten percent
         (10%) of the outstanding shares of Preferred Stock may designate in
         writing one of their member to call such meeting at the expense of the
         Company, and such meeting may be called by the person so designated
         upon the notice required for the annual meetings of stockholders of the
         Company and shall be held at the place for holding the annual meetings
         of stockholders. Any holder of Preferred Stock so designated shall have
         access to the lists of stockholders to be called pursuant to the
         provisions hereof.

                  (f) Any vacancy occurring in the office of director elected by
the holders of Preferred Stock or any additional director to be elected pursuant
to Section 5(d) above may be filled by the remaining director(s) elected by the
holders of Preferred Stock unless and until such vacancy shall be filled by the
holders of Preferred Stock. The term of office of the directors elected by the
holders of Preferred Stock shall terminate upon

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the election of their successors at any meeting of stockholders held for the
purpose of electing directors.

                  (g) The directors elected by the holders of shares of
Preferred Stock voting separately as a single class may be removed from office
with or without cause by the vote of the holders of at least a majority of the
outstanding shares of Preferred Stock. A special meeting of the holders of
shares of Preferred Stock may be called in accordance with the procedures set
forth in Section 5(e) above.

                  6.       REDEMPTION OF PREFERRED STOCK.

                  (a) The Company may, at any time, redeem, and the holders of
the outstanding Preferred Stock shall sell to the Company, at the redemption
price equal to the sum of the Liquidation Preference per share plus an amount
equal to all accrued and unpaid dividends per share (the "Redemption Price"),
all or a portion of the outstanding Preferred Stock.

                  (b) (i) At least thirty (30) days prior to the date fixed for
the redemption of the Preferred Stock, written notice (the "Redemption Notice")
shall be mailed, postage prepaid, to each holder of record of the Preferred
Stock at its post office address last shown on the records of the Company. The
Redemption Notice shall state:

                           (1) the number of shares of Preferred Stock held by
the holder that the Company intends to redeem;

                           (2) the date fixed for redemption and the Redemption
Price; and

                           (3) that the holder is to surrender to the Company,
in the manner and at the place designated, its certificate or certificates
representing the shares of Preferred Stock to be redeemed.

                  (ii)     On or before the Redemption Date, each holder of
         Preferred Stock shall surrender the certificate or certificates
         representing such shares of Preferred Stock to the Company, in the
         manner and at the place designated in the Redemption Notice, and
         thereupon the Redemption Price for such shares shall be payable in cash
         on the Redemption Date to the person whose name appears on such
         certificate or certificates as the owner thereof, and each surrendered
         certificate shall be cancelled and retired. In the event that less than
         all of the shares represented by any such certificate are redeemed, a
         new certificate shall be issued representing the unredeemed shares.

                  (c) Dividends on the Preferred Stock called for redemption
shall cease to accumulate on the Redemption Date, and the holders of such shares
redeemed shall cease to have any further rights with respect thereto on the
Redemption Date.

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                  (d) If, at the time of any redemption pursuant to this Section
6, the funds of the Company legally available for redemption of Preferred Stock
are insufficient to redeem the number of shares required to be redeemed, those
funds which are legally available shall be used to redeem the maximum possible
number of such shares, pro rata based upon the number of shares to be redeemed.
At any time thereafter when additional funds of the Company become legally
available for the redemption of Preferred Stock, such funds shall immediately be
used to redeem the balance of the shares of Preferred Stock which the Company
has become obligated to redeem pursuant to this subparagraph, but which it has
not redeemed.

                  (e) The Company may not otherwise redeem or repurchase the
Preferred Stock.

                  7.       CERTAIN COVENANTS. Any registered holder of Preferred
Stock may proceed to protect and enforce its rights and the rights of such
holders by any available remedy by proceeding at law or in equity to protect and
enforce any such rights, whether for the specific enforcement of any provision
in this Certificate of Designation or in aid of the exercise of any power
granted herein, or to enforce any other proper remedy.

                  8.       NO REISSUANCE OF PREFERRED STOCK. No Preferred Stock
acquired by the Company by reason of redemption, purchase, or otherwise shall be
reissued, and all such shares shall be cancelled, retired and eliminated from
the shares which the Company shall be authorized to issue.

                  9.       NOTICES. All notices to the Company permitted
hereunder shall be personally delivered or sent by first class mail, postage
prepaid, addressed to its principal office located at 1125 Seventeenth Street,
Suite 2100, Denver, CO 80202 or to such other address at which its principal
office is located and as to which notice thereof is similarly given to the
holders of the Preferred Stock at their addresses appearing on the books of the
Company.

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                  IN WITNESS WHEREOF, Coram, Inc. has caused this Certificate to
be signed by an appropriate officer on this 29th day of December, 2000.

                                      -------------------------<PAGE>

                                 AMENDMENT NO. 4

                                IN RESPECT OF THE

                          SECURITIES EXCHANGE AGREEMENT

                                      AMONG

                                   CORAM, INC.

                          CORAM HEALTHCARE CORPORATION

                                       AND

                             CERBERUS PARTNERS, L.P.

                       GOLDMAN SACHS CREDIT PARTNERS L.P.

                          FOOTHILL CAPITAL CORPORATION

                                 AS NOTEHOLDERS

                            DATED: DECEMBER 29, 2000

<PAGE>

                  Amendment No. 4 (this "Agreement"), dated as of December 29,
2000, in respect of the Securities Exchange Agreement dated as of May 6, 1998,
as heretofore amended (said Securities Exchange Agreement, as so amended, being
the "Securities Exchange Agreement", and the terms defined therein being used
herein as therein defined unless otherwise defined herein) among CORAM, INC., a
Delaware corporation (the "Company"), CORAM HEALTHCARE CORPORATION, a Delaware
corporation ("Holdings"), CERBERUS PARTNERS, L.P. ("Cerberus"), GOLDMAN SACHS
CREDIT PARTNERS L.P. ("GSCP") and FOOTHILL CAPITAL CORPORATION ("Foothill")
(each a "Noteholder" and, together with any other holders from time to time of
interests in the Series A Notes or Series B Notes, collectively, the
"Noteholders").

                              W I T N E S S E T H :

                  WHEREAS, the Original Noteholders, the Company and Holdings
entered into the Securities Exchange Agreement, pursuant to which the Original
Noteholders received, among other things, Series A Notes and Series B Notes, as
the case may be, in exchange for the Original Noteholders' interests in the
Subordinated Rollover Notes and the Warrants; and

                  WHEREAS, as of the date hereof, the Original Noteholders own
in the aggregate 100% of the outstanding principal amount of the Series A Notes
and Series B Notes; and

                  WHEREAS, pursuant to an Exchange Agreement, dated as of the
date hereof, among the Company, Holdings and the Noteholders (the "Exchange
Agreement"), the Noteholders have agreed to exchange (the "Exchange")
approximately $97,715,434 aggregate principal amount of Series A Notes and
$11,610,542 of accrued interest on the Series A Notes and the Series B Notes for
shares of Preferred Stock (as defined in the Exchange Agreement) of the Company;
and

                  WHEREAS, following the Exchange, the Noteholders will hold
$61,207,938 aggregate principal amount of Series A Notes and $92,084,099
aggregate principal amount of Series B Notes (collectively, the "Remaining
Notes"); and

                  WHEREAS, as further consideration for the Exchange, the
Company, Holdings and the Noteholders have agreed to amend the interest rate and
maturity of the Remaining Notes; and

                  WHEREAS, the Company, Holdings and the Noteholders have agreed
to amend the Securities Exchange Agreement and to enter into this Agreement upon
the terms and subject to the conditions contained herein;

                  NOW, THEREFORE, the parties hereto agree as follows:

                  Section 1. AMENDMENTS TO THE SECURITIES EXCHANGE AGREEMENT.
Upon the satisfaction of the conditions contained in Section 4 of this
Agreement, Section 1 to

<PAGE>

the Securities Exchange Agreement is hereby amended by deleting the existing
definitions of "Applicable Series A Rate," "Applicable Series B Rate," "Series A
Maturity Date" and "Series B Maturity Date" and replacing them with the
following:

                           "Applicable Series A Rate" shall mean (i) from the
                  Effective Date to the Amendment Date, 9-7/8% per annum, (ii)
                  from the Amendment Date to November 15, 1999, 11-1/2% per
                  annum, (iii) from November 15, 1999 to the Interest Restart
                  Date, 0.00% per annum, (iv) from the Interest Restart Date to
                  December 29, 2000, 11-1/2% per annum and (v) thereafter, 9.00%
                  per annum.

                           "Applicable Series B Rate" shall mean (i) from the
                  Effective Date to November 15, 1999, 8.00% per annum, (ii)
                  from November 15, 1999 to the Interest Restart Date, 0.00% per
                  annum, (iii) from the Interest Restart Date to December 29,
                  2000, 8.00% per annum and (v) thereafter, 9.00% per annum.

                           "Series A Maturity Date" shall mean June 30, 2001.

                           "Series B Maturity Date" shall mean June 30, 2001.

                  Section 2. REPRESENTATIONS AND WARRANTIES OF THE COMPANY AND
HOLDINGS. Each of the Company and Holdings hereby represents and warrants as to
itself and the Coram Parties that the execution, delivery and performance of
this Agreement, the Amended and Restated Series A Senior Subordinated Note and
the Amended and Restated Series B Senior Subordinated Convertible Note
(collectively, the "Amendment Agreements") have each duly authorized by all
necessary corporate action on the part of such Coram Party and the Amendment
Agreements and the Securities Exchange Agreement amended hereby each constitute
a legal, valid and binding obligation of such Coram Party, enforceable against
it in accordance with their terms.

                  Section 3. REPRESENTATIONS AND WARRANTIES OF THE NOTEHOLDERS.
Each of the Noteholders hereby represents and warrants as to itself that the
execution, delivery and performance of this Agreement have been duly authorized
by all necessary corporate or partnership action on the part of such Noteholder.

                  Section 4. CONDITIONS TO EFFECTIVENESS. The amendments
contained in Section 1 of this Agreement shall be subject to the satisfaction of
the following conditions precedent:

                           (a) the due execution and delivery of this Agreement
         by each of the Noteholders, Holdings and the Company;

                           (b) the due execution and delivery of a consent and
         confirmation of guaranty, in the form attached hereto as Exhibit A, by
         Holdings and each Subsidiary Guarantor listed on Annex A attached
         hereto;

                                       2
<PAGE>

                           (c) the due execution and delivery of an Amended and
         Restated Series A Senior Subordinated Note by the Company to each of
         the Noteholders;

                           (d) the due execution and delivery of an Amended and
         Restated Series B Senior Subordinated Convertible Note to each of the
         Noteholders;

                           (e) the consent of the Lenders, as lenders party to
         the Senior Loan Agreement, to this Agreement, the Exchange Agreement
         and the transactions contemplated thereby;

                           (f) the consent of Madeleine L.L.C., an affiliate of
         Cerberus, to this Agreement, the Exchange Agreement and the
         transactions contemplated thereby; and

                           (g) the conditions precedent set forth in Section 6
         of the Exchange Agreement have been satisfied in full by the Company or
         have been waived by the Noteholders, in their sole discretion.

                  Section 5. EFFECT ON THE SECURITIES EXCHANGE AGREEMENT. Except
as amended hereby, the Securities Exchange Agreement and the other Note
Documents shall remain in full force and effect. Except as set forth herein,
nothing in this Agreement shall be deemed to (i) constitute a forbearance or
waiver of compliance by any of the Coram Parties of any term, provision or
condition of the Securities Exchange Agreement or any other instrument or
agreement referred to therein or under the Note Documents or (ii) prejudice any
right or remedy that any Noteholder may now have or may have in the future under
or in connection with the Securities Exchange Agreement or any other Note
Document.

                  Section 6. COUNTERPARTS. This Agreement may be executed in any
number of counterparts and by different parties hereto in separate counterparts,
each of which when so executed and delivered shall be deemed to be an original
and all of which taken together constitute one and the same agreement.

                  Section 7. GOVERNING LAW. The validity, interpretation and
enforcement of this Agreement shall be governed by, and construed in accordance
with, the laws of the State of New York, without regard to the conflict of laws
principles thereof.

                  Section 8. HEADINGS. Section headings in this Agreement are
included herein for the convenience of reference only and shall not constitute
part of this Agreement for any other purpose.

                  Section 9. REFERENCES. References herein and in the other Note
Documents to the "Securities Exchange Agreement", "this Agreement", "hereunder",
"hereof", or words of like import referring to the Securities Exchange
Agreement, shall mean and be a reference to the Securities Exchange Agreement as
amended hereby.

                                       3
<PAGE>

                         [Signatures on following page]

                                       4
<PAGE>

                  IN WITNESS WHEREOF, the parties hereto have caused this
Agreement to be executed and delivered by their proper and duly authorized
officers as of the date set forth above.

                                          CORAM, INC.

                                          By:  /S/  SCOTT R. DANITZ
                                               ---------------------------------
                                          Name:  Scott R. Danitz
                                          Title:  Vice President and Treasurer

                                          CORAM HEALTHCARE CORPORATION

                                          By:  /S/   SCOTT R. DANITZ
                                               ---------------------------------
                                          Name: Scott R. Danitz
                                          Title:  Senior Vice President, Finance
                                                  and Chief Accounting Officer

                                          CERBERUS PARTNERS, L.P.

                                          By:  /S/  MARK NEPORENT
                                               ---------------------------------
                                          Name:  Mark Neporent
                                          Title:  Chief Operating Officer

                                          GOLDMAN SACHS CREDIT PARTNERS L.P.

                                          By:  /S/  DAN ALLEN
                                               ---------------------------------
                                          Name:  Dan Allen
                                          Title:

                                          FOOTHILL CAPITAL CORPORATION

                                          By:  /S/   ED STERNS
                                               ---------------------------------
                                          Name:  Ed Sterns
                                          Title:  Senior Vice President

                                       5
<PAGE>

                                                                       EXHIBIT A

                                     CONSENT

                          Dated as of December 29, 2000

                  Each of the undersigned, in its capacity as a Guarantor under
the Securities Exchange Agreement referred to in the foregoing Agreement, hereby
consents to the said Agreement and hereby confirms and agrees that its guaranty
of the Guaranteed Obligations (as such term is defined in the Guarantee
Agreements) is, and shall continue to be, in full force and effect and is hereby
ratified and confirmed in all respects except that, upon the effectiveness of,
and on and after the date of, the said Agreement, each reference in each
Guarantee Agreement to "this Agreement", "hereunder", "thereunder", "thereof" or
words of like import shall mean and be a reference to the Securities Exchange
Agreement as amended by said Agreement.

                  This Consent may be executed in any number of counterparts
each of which, when executed and delivered, shall constitute an original, but
all executed counterparts together shall constitute one and the same instrument.
Delivery of an executed counterpart of a signature page to this Consent by
telecopier shall be effective as delivery of a manually executed counterpart of
this Consent.

                                          CORAM HEALTHCARE CORPORATION

                                          By:  /S/  SCOTT R. DANITZ
                                               ---------------------------------
                                          Name:    Scott R. Danitz
                                          Title:   Senior Vice President,
                                                   Finance and Chief Accounting
                                                   Officer

                                          FOR EACH OF THE SUBSIDIARY GUARANTORS
                                          LISTED ON ANNEX A HERETO

                                          By: /S/  SCOTT R. DANITZ
                                              ----------------------------------
                                          Name: Scott R. Danitz
                                          Title:  Vice President and Treasurer

                                          c/o Coram Healthcare Corporation
                                          1125 Seventeenth Street, Suite 1500
                                          Denver, CO 80202

<PAGE>

                                                                         ANNEX A

                                  SUBSIDIARIES

         Coram International Holdings Ltd.
         Coram Healthcare Limited

         Coram Physician Services, Inc.
                  Fairfax Hematology Oncology Associates, Inc.
         Healthinfusion, Inc.
         H.M.S.S., Inc.
                  Coram Homecare of Texas, Inc.
                  Infusion Affiliates of Dallas, Inc.
         Medisys, Inc.
                  Coram Homecare of Illinois, Inc.
         T2 Medical, Inc.
                  Columbia Home Therapeutics, Inc.
                  Coram Healthcare Corporation of Alabama
                  Coram Healthcare Corporation of Colorado
                  Coram Healthcare Corporation of Connecticut
                  Coram Healthcare Corporation of Delaware
                  Coram Healthcare Corporation of Florida
                  Coram Healthcare Corporation of Greater D.C.
                  Coram Healthcare Corporation of Greater New York
                  Coram Healthcare Corporation of Illinois
                  Coram Healthcare Corporation of Indiana
                  Coram Healthcare Corporation of Iowa
                  Coram Healthcare Corporation of Kansas
                  Coram Healthcare Corporation of Kentucky
                  Coram Healthcare Corporation of Louisiana
                  Coram Healthcare Corporation of Michigan
                  Coram Healthcare Corporation of Minnesota
                  Coram Healthcare Corporation of Missouri
                  Coram Healthcare Corporation of Mississippi
                  Coram Healthcare Corporation of Nebraska
                  Coram Healthcare Corporation of Nevada
                  Coram Healthcare Corporation of New Hampshire
                  Coram Healthcare Corporation of New Jersey
                  Coram Healthcare Corporation of New Mexico
                  Coram Healthcare Corporation of North Carolina
                  Coram Healthcare Corporation of Northern California
                  Coram Healthcare Corporation of Ohio
                  Coram Healthcare Corporation of Oklahoma

<PAGE>

                  Coram Healthcare Corporation of Oregon
                  Coram Healthcare Corporation of Pennsylvania
                  Coram Healthcare Corporation of Rhode Island
                  Coram Healthcare Corporation of South Carolina
                  Coram Healthcare Corporation of Southern California
                  Coram Healthcare Corporation of Southern Florida
                  Coram Healthcare Corporation of Tennessee
                  Coram Healthcare Corporation of Texas
                  Coram Healthcare Corporation of Virginia
                  Coram Healthcare Corporation of Washington
                  Coram Healthcare Corporation of West Virginia
                  Coram Healthcare Corporation of Wisconsin
                  Coram Homecare of Arizona, Inc.
                  Coram Homecare of Kansas, Inc.
                  Coram Homecare of Michigan, Inc.
                  Coram Homecare of Minnesota, Inc.
                  Coram Homecare of Nebraska, Inc.
                  Coram Homecare of Northern California, Inc.
                  Coram Homecare of Ohio, Inc.
                  Coram Homecare of South Carolina, Inc.
                  Coram Homecare of South Carolina, L.L.C.
                  Coram Homecare of Virginia, Inc.
                  Coram Homecare of Wisconsin, Inc.
                  Coram Management of Hawaii, Inc.
                  Coram Service Corporation
                  Curaflex Health Services, Inc.
                           Caremark Pharmacy Services, Inc.
                           Comprehensive Pharmacy Home IV Services, Inc.
                           Coram Alternative Site Services, Inc.
                           Coram Healthcare Corporation of Massachusetts
                                    Clinical Homecare Corporation Coram
                           Healthcare Corporation of New York Coram Healthcare
                           Corporation of North Texas Coram Healthcare
                           Corporation of Utah Coram Healthcare of Wyoming,
                           L.L.C. Stratogen of Rhode Island, Inc.
                  Dallas Home Therapeutics, Inc.
                  Extendacare Health Systems, Inc.
                  Intracare Holdings Corporation

                                       2

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