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                                  EXHIBIT 10.19

            (FORM OF MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT)

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                 MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT

          THIS MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT (this
"AGREEMENT"), dated as of June 28, 2002, is made and entered into by MED
DIVERSIFIED, INC., a Nevada corporation ("COMPANY"), Chartwell Diversified
Services, Inc., a Delaware corporation, Tender Loving Care Health Care Services,
Inc., a Delaware corporation, Trestle, Inc., a Delaware corporation, Resource
Pharmacy, Inc., a Nevada corporation, and each of the other Med Subsidiaries
that, on or after the Closing Date, becomes a party to this Agreement by
executing a Subsidiary Joinder in substantially the form of the Subsidiary
Joinder attached hereto as EXHIBIT A (collectively, including each party that
joins this Agreement by executing a Subsidiary Joinder, "MED SUBSIDIARIES")
(Company and Med Subsidiaries are hereinafter sometimes referred to collectively
as "PLEDGORS" and individually as "PLEDGOR"), in favor of PRIVATE INVESTMENT
BANK LIMITED, Nassau, Bahamas ("HOLDER"), for the benefit of the Holders of the
Amended Debentures (as defined in the Amendment Agreement, defined below) in
reliance upon the following:

                                    RECITALS

          A.   Pursuant to that certain Amendment Agreement, of even date
herewith, entered into by and among Company, Med Subsidiaries, ARL, TEGCO, and
Holder (as the same may be modified, restated, supplemented and otherwise in
effect from time to time, the "AMENDMENT AGREEMENT"), Pledgors have agreed to
grant to Holder (i) a first priority security interest in any and all capital
stock or other equity securities of any of the Med Subsidiaries, (ii) a security
interest in any and all rights, title or interest of the Med Subsidiaries in and
to the Med Reserve Account Interests and (iii) a security interest in any and
all rights, title and interest of the Med Subsidiaries in and to the Med
Eligible Accounts Receivable (the items referred to in clauses (i), (ii) and
(iii), collectively, the "MED SUBSIDIARIES DEBENTURE COLLATERAL"). Each
capitalized term used in this Agreement that is not otherwise defined herein
shall have the meaning accorded to such term in the Amendment Agreement.

          B.   In order to evidence Holder's lien on the Med Debenture
Collateral granted pursuant to the Amendment Agreement, Pledgors hereby execute
and deliver this Agreement.

          C.   Pledgors understand that Holder is relying upon this Agreement
and the pledge of Med Subsidiaries Debenture Collateral granted hereunder as a
condition to accepting the terms contemplated by the Amendment Agreement.

                                    AGREEMENT

          NOW, THEREFORE, in consideration of the foregoing and for other good
and valuable consideration, the receipt and sufficiency of which are hereby
acknowledged by Pledgors, Pledgors hereby agree as follows:

     1. PLEDGE OF INTERESTS. Pledgors hereby pledge, hypothecate, assign and
transfer to Holder, as collateral security, in connection with the terms of the
Amendment Agreement, a first priority security interest in the following:

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          (a) all of the capital stock or other equity securities of Med
     Subsidiaries, whether currently issued and outstanding or to be issued and
     outstanding subsequent to the date of this Agreement, as well as all of
     Pledgors' rights under any option, warrant or other security instrument or
     agreement to acquire shares of the capital stock in any current or future
     subsidiary of Company (collectively, the "INTERESTS");

          (b) any and all rights of the Med Subsidiaries to receive, upon the
     terms and conditions set forth in the relevant Sale and Subservicing
     Agreement(s), $20,000,000 of funds that are currently held in reserves, as
     identified on an itemized schedule attached as an exhibit to the Amendment
     Agreement (the Med Subsidiaries rights in such accounts, collectively, the
     "MED RESERVE ACCOUNT INTERESTS"), for the benefit of NCFE and its
     affiliates pursuant to the relevant Sale and Subservicing Agreement(s),
     with all distributions from the Med Reserve Account Interests on account
     of, or in relation to, the Med Reserve Account Interests being directed to
     the Med Collection Account to be used exclusively for payments on the
     Amended Debentures; and

          (c) any and all rights of the Med Subsidiaries in and to the Med
     Eligible Accounts Receivable; PROVIDED, HOWEVER, that PIBL's security
     interest therein is subject to and (A) equal in right of priority with a
     security interest in favor of the financing source(s) for the purchase of
     the Transferred Debenture and (B) subordinate to a security interest in
     favor of NCFE or its affiliates as the purchaser(s) of accounts receivable
     in various financing transactions, which security interest collateralizes,
     among other things, a repurchase right for rejected receivables under the
     relevant documents for such financing arrangements;

In addition, Pledgors grant to Holder all proceeds to Company, net of the
reasonable and customary costs of the relevant Asset Sale (as defined below),
whether directly or indirectly via a distribution from any Med Subsidiaries
(collectively, "NET ASSET SALE PROCEEDS"), from any sales or other transfers,
during the term of the amended debentures issued pursuant to the Amendment
Agreement (such debentures, the "AMENDED DEBENTURES"), of any assets of Pledgors
or equity securities of Med Subsidiaries, as well as any and all options,
warrants or other security instrument or agreement to acquire shares of the
capital stock or other equity securities of Med Subsidiaries, in any
transaction, including without limitation any securities offering (each, an
"ASSET SALE"); PROVIDED, that an Asset Sale shall NOT include (i) ordinary
course of business sales of goods and provision of services, (ii) the offering
or sale of any debt securities unaccompanied by any equity right (i.e. warrants
or conversion rights) and (iii) any sale of accounts receivable under financing
arrangements with NCFE and its affiliates; and PROVIDED, FURTHER, that Net Asset
Sale Proceeds shall not include any Assets Sale proceeds of any Pledgor unless
and until such proceeds have been, directly or indirectly, distributed or
otherwise paid to, or for the benefit of, Company. Net Asset Sale Proceeds shall
be promptly deposited in collection accounts, established pursuant to that
certain deposit account control agreement, made and entered into as of the date
hereof, between Company and Holder, from which a special mandatory prepayment on
the Amended Debentures shall be made in the full amount of such net proceeds.
SCHEDULE 1 attached hereto completely and accurately sets forth all Interests in
Med Subsidiaries. Company covenants and agrees to give Holder ten (10) business
days advance written notice of the proposed consummation of any Asset Sale,
together with a description of the material terms of such proposed Asset Sale
(including, without limitation copies of draft documents relating thereto), as
they may reasonably request from time to time. Nothing herein or in any

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Modification Documents shall require Pledgors to consummate any Asset Sale, or
to sell any equity securities or other assets for its own account or to cause or
make any distribution to be made in connection with any such Asset Sale.

     2. OBLIGATIONS SECURED. The obligations secured by the pledge of the Med
Subsidiaries Debenture Collateral evidenced hereby includes the full and prompt
payment when due, whether by acceleration or otherwise, and at all times
thereafter, and the full and prompt performance when due, of all of the
Liabilities (as hereinafter defined), including interest on any such Liabilities
and further agrees to pay all reasonable expenses (including reasonable
attorneys' fees and legal expenses) paid or incurred by Holder in enforcing this
Agreement. The term "Liabilities", as used herein, shall mean all outstanding
principal under the Amended Debentures, all interest accrued thereon, and all
additional amounts and other sums at any time due and owing, and required to be
paid, to Holder or the Holders of the Amended Debentures under the terms of the
Amendment Agreement and any other Modification Documents, including without
limitation this Pledge, whether the same are matured or unmatured. Holder may,
from time to time at its discretion and without notice to or consent of Pledgors
(which notice and/or consent Pledgors hereby irrevocably waive to the full
extent permitted by law), take any or all of the following actions: (i) retain
or obtain a lien upon or a security interest in property, to secure any of the
Liabilities or any obligation hereunder; (ii) retain or obtain the primary or
secondary obligation of any obligor or obligors, in addition to Pledgors, with
respect to any of the Liabilities; (iii) extend or renew for one or more periods
(regardless of whether longer than the original period), alter or exchange any
of the Liabilities, or release or compromise any obligation of Pledgors
hereunder or any obligation of any nature of any other obligor (including
without limitation the Company) with respect to any of the Liabilities; (iv)
release or fail to perfect its lien upon or security interest in, or impair,
surrender, release or permit any substitution or exchange for, all or any part
of any property securing any of the Liabilities or any obligation hereunder, or
extend or renew for one or more periods (regardless of whether longer than the
original period) or release, compromise, alter or exchange any obligations of
any nature of any obligor with respect to any such property; and (v) upon the
occurrence and during the continuation of an Event of Default, look to and make
demand upon Pledgors for payment of any of the Liabilities (but only to the
extent and in the form of the Med Subsidiaries Debenture Collateral except as
otherwise provided herein), regardless of whether Holder or any other Person
shall have resorted to any property securing any of the Liabilities or any
obligation hereunder or shall have proceeded against any other obligor primarily
or secondarily obligated with respect to any of the Liabilities.

     3. HOLDER AS ATTORNEY-IN-FACT.

          3.1  APPOINTMENT. Pledgors hereby irrevocably constitute and appoint
Holder and any officer or agent of Holder, with full power of substitution, as
its true and lawful attorney-in-fact with full irrevocable power and authority
in the place and stead of Pledgors and in the name of Pledgors or in its own
name, without notice to or assent by Pledgors, to do the following:

               (i)     upon the occurrence and during the continuation of an
Event of Default, to ask, demand, collect, receive and give acquittances and
receipts for any and all moneys due and to become due under any Med
Subsidiaries Debenture Collateral and, in the

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name of Pledgors or its own name or otherwise, to take possession of and endorse
and collect any checks, drafts, notes, acceptances or other instruments for the
payment of moneys due under any Med Subsidiaries Debenture Collateral and to
file any claim or to take any other action or proceeding in any court of law or
equity or otherwise deemed appropriate by Pledgors for the purpose of collecting
any and all such moneys due under any Med Subsidiaries Debenture Collateral
whenever payable;

               (ii)    upon the occurrence and during the continuation of an
Event of Default, to pay or discharge taxes or liens levied or placed on or
threatened against the Med Subsidiaries Debenture Collateral.

               (iii)   upon the occurrence and during the continuation of an
Event of Default, to (A) direct any party liable for any payment under any of
the Med Subsidiaries Debenture Collateral to make payment of any and all moneys
due, and to become due thereunder, directly to Holder or as Holder shall direct;
(B) receive payment of and receipt for any and all moneys, claims and other
amounts due, and to become due at any time, with respect to or arising out of
any Med Subsidiaries Debenture Collateral; (C) sign and endorse any invoices,
freight or express bills, bills of lading, storage or warehouse receipts, drafts
against debtors, assignments, verifications and notices in connection with or
relating to the Med Subsidiaries Debenture Collateral; (D) settle and adjust any
claims under all policies of insurance covering the Med Subsidiaries Debenture
Collateral; (E) commence and prosecute any suits, actions or proceedings at law
or in equity in any court of competent jurisdiction to collect the Med
Subsidiaries Debenture Collateral or any part thereof and to enforce any other
right in respect of any Med Subsidiaries Debenture Collateral; (F) defend any
suit, action or proceeding brought against Pledgors with respect to any Med
Subsidiaries Debenture Collateral; (G) settle, compromise or adjust any suit,
action or proceeding described above and, in connection therewith, to give such
discharges or releases as Holder may deem appropriate; and (H) generally sell,
transfer, pledge, make any agreement with respect or otherwise deal with any of
the Med Subsidiaries Debenture Collateral as fully and completely as though
Holder were the absolute owner thereof for all purposes, and to do, at Holder's
option, at any time and or from time to time, all acts and things which Holder
reasonably deems necessary to protect, preserve or realize upon the Med
Subsidiaries Debenture Collateral and Holder's lien therein, in order to effect
the intent of this Agreement, all as fully and effectively as Pledgors might do;
and

               (iv)    at any time and from time to time after the occurrence
of a default or if Pledgors fail to do so after three (3) Business Days' prior
written notice from Holder, to take any and all appropriate action and to
execute and deliver any and all documents and instruments which may be necessary
or desirable to perfect or maintain Holder's liens against any of the Med
Subsidiaries Debenture Collateral.

          3.2  RATIFICATION. Pledgors hereby ratify, to the extent permitted by
law, all that said attorneys shall lawfully do or cause to be done by virtue
hereof, except for their respective gross negligence or willful misconduct and
for failure to act in a commercially reasonable manner with respect to any Med
Subsidiaries Debenture Collateral under their respective possession or control.
The power of attorney granted pursuant to SECTION 3.1 is a power coupled with an
interest and shall be irrevocable until the Liabilities are indefeasibly paid in
full. The powers conferred on Holder hereunder are solely to protect Holders'
interests in the

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Med Subsidiaries Debenture Collateral and shall not impose any duty upon Holder
to exercise any such powers. Holder shall be accountable only for amounts that
it actually receives as a result of the exercise of such powers, and neither it
nor any of its officers, directors, or employees shall be responsible to
Pledgors for any act or failure to act, except for its or their respective gross
negligence or willful misconduct and for failure to act in a commercially
reasonable manner with respect to any Med Subsidiaries Debenture Collateral
under its or their respective possession or control. Pledgors also authorize
Holder, at any time and from time to time upon the occurrence and during the
continuation of any Event of Default, to execute, in connection with a
foreclosure sale as contemplated by SECTION 11, any endorsements, assignments or
other instruments of conveyance or transfer with respect to the Med Subsidiaries
Debenture Collateral.

          3.3  DELIVERY OF MED SUBSIDIARIES DEBENTURE COLLATERAL.

               a.      CERTIFICATES. Concurrently with the execution and
delivery of this Pledge, Pledgors shall deliver to Citibank, F.S.B. in its
capacity as collateral agent under that certain Collateral Agency Agreement,
dated as of the date hereof, all of the Interests or other certificates
representing the Interests and any Med Subsidiaries Debenture Collateral arising
out of or relating to the Interests, together with stock powers or other
applicable instruments of transfer duly executed by Pledgors in blank.

               b.      UCC-1 FINANCING STATEMENTS. Concurrently with the
execution and delivery of this Pledge, Pledgors shall execute and deliver
to Holder UCC-1 Financing Statements covering the Med Subsidiaries Debenture
Collateral, in proper form for filing in all applicable jurisdictions.

          3.4  PERFORMANCE OF PLEDGORS' OBLIGATIONS. If Pledgors fail to perform
or comply with any of its agreements contained herein and Holder shall itself
perform or comply, or otherwise cause performance or compliance, with such
agreement, the reasonable expenses of Holder incurred in connection with such
performance or compliance, together with interest thereon at the rate then in
effect with respect to the debentures, shall be payable by Pledgors to Holder on
demand and shall constitute Liabilities secured hereby.

          3.5  ADDITIONAL RIGHTS.

               a.      VOTING RIGHTS. Unless and until an Event of Default
shall have occurred and be continuing and Holder has accelerated the
Liabilities, Pledgors shall have the right to vote the Med Subsidiaries
Debenture Collateral on all matters; PROVIDED, HOWEVER, that no vote shall be
cast, or consent, waiver or ratification given, or any action taken, that would
be inconsistent with or violate any provision of this Agreement or any
Modification Documents. Upon the occurrence and during the continuation of an
Event of Default and after acceleration by Holder, Holder shall thereafter be
entitled to exercise all voting powers pertaining to the Med Subsidiaries
Debenture Collateral.

               b.      SUBSEQUENT CHANGES AFFECTING COLLATERAL. Pledgors
represent to Holder that Pledgors have made their own arrangements for keeping
itself informed of changes or potential changes affecting the Med Subsidiaries
Debenture Collateral (including without

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limitation rights to convert, rights to subscribe, payment of dividends or other
cash distributions, reorganization or other exchanges, tender offers and voting
rights), and Pledgors agree that Holder shall not have any responsibility or
liability for informing Pledgors of any such changes or potential changes or for
taking any action or omitting to take any action with respect thereto.

               c.      STOCK DIVIDENDS AND OTHER DISTRIBUTIONS.

                       (i)   If at any time when this Agreement is effective
Pledgors shall become entitled to receive, or shall receive by reason of their
ownership of any Med Subsidiaries Debenture Collateral, any additional Interests
(including without limitation any Interests representing a stock dividend or a
distribution in connection with any reclassification, increase or reduction of
capital, or reorganization) whether as an addition to, in substitution of, or in
exchange for any of the Med Subsidiaries Debenture Collateral, whether by
declared dividend, stock split or other method, Pledgors agree it shall accept
the same as Holder's agent and hold the same in trust for Holder and deliver the
same forthwith to Holder in the exact form received, with the endorsement of
Pledgors when requested by Holder and/or appropriate undated stock powers duly
executed in blank, to be held by Holder as additional collateral security for
the Liabilities. Any sums or property paid upon or in respect of the Med
Subsidiaries Debenture Collateral or any other securities received under this
SECTION 3.5 upon the reorganization, liquidation (whether complete or partial)
or dissolution of the issuer of any of the Med Subsidiaries Debenture Collateral
or any such other securities shall immediately be paid over to Holder to be held
by Holder as additional collateral security for the Liabilities.

                       (ii)  Unless an Event of Default shall have occurred and
be continuing, Pledgors shall be entitled to receive all cash dividends or
distributions declared and paid with respect to any Med Subsidiaries Debenture
Collateral. Upon the occurrence and during the continuation of any Event of
Default, Holder shall be entitled to receive any and all such cash dividends or
distributions, and Pledgors shall promptly deliver to Holder any such cash
dividends or distributions which Pledgors subsequently receive. Holder shall
hold any such cash dividends or distributions as Med Subsidiaries Debenture
Collateral pursuant to this Agreement or, at the election of Holder and the
Pledgors, may apply any such cash dividends to the reduction of any Liabilities
then due and owing.

                       (iii) Nothing contained in this SECTION 3.5 or elsewhere
in this Agreement shall be deemed to permit any stock dividends, issuance of
additional stock, reclassification, readjustment, change in the capital
structure of any person, or issuance of any warrants, options or other rights by
any person which are otherwise prohibited pursuant to this Agreement.

          3.6  FURTHER ASSURANCES. Promptly upon request by Holder, Pledgors
shall: (i) correct any material defect or error that may be discovered in this
Agreement or any instrument or document executed in connection herewith or
pursuant hereto or in the execution, acknowledgment or recordation thereof; and
(ii) do, execute, acknowledge, deliver, record, re-record, file, re-file,
register and re-register any and all such FURTHER acts, deeds, conveyances,
pledge agreements, assignments, estoppel certificates, financing statements and
continuations thereof, termination statements, notices of assignment, transfers,
certificates, assurances, powers, proxies and other instruments as Holder may
reasonably require from time to time in order to

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(A) carry out more effectively the purposes of this Agreement, (B) perfect and
maintain the validity, effectiveness and priority of any of the liens and
security interests intended to be created hereby and (C) assure, convey, grant,
assign, transfer, preserve, protect and confirm to Holder the rights granted or
now or hereafter intended to be granted to it hereunder or under any other
instrument or document executed in connection herewith or pursuant hereto.

     4. NATURE OF PLEDGORS' OBLIGATIONS.

          4.1  UNCONDITIONAL AND PRIMARY. The covenants and agreements of
Pledgors set forth in this Agreement shall be primary obligations of Pledgors,
and such obligations shall be continuing, absolute and unconditional, shall not
be subject to any counterclaim, setoff, deduction, diminution, abatement,
recoupment, suspension, deferment, reduction or defense (other than full and
strict compliance by Pledgors with its obligations hereunder), whether based
upon any claim that Pledgor or any other person may have against Holder or any
other person, or otherwise, and shall remain in full force and effect without
regard to, and shall not be released, discharged or in any way affected by, any
circumstance or condition whatsoever (whether or not Pledgors shall have any
knowledge or notice thereof), including without limitation:

               (i)     any amendment, modification, addition, deletion,
supplement or renewal to or of, or other change in, the Liabilities (other than
payment in full thereof) or any Modification Documents, or any other instrument
or agreement applicable thereto or to any of the parties to the Amendment
Agreement, or to any Med Subsidiaries Debenture Collateral, or any furnishing or
acceptance of additional security for, pledge of or right of offset with respect
to, any of the Liabilities, or the failure of any security or the failure of
Holder to perfect or insure any interest in any Med Subsidiaries Debenture
Collateral;

               (ii)    any failure, omission or delay on the part of Holder to
conform or comply with any term of any instrument or agreement referred to in
clause (i) above;

               (iii)   any waiver, consent, extension, indulgence, compromise,
release or other action or inaction under or with respect to any instrument,
agreement, pledge, right of offset or security referred to in clause (i) above
or any obligation or liability of Holder, or any exercise or non-exercise by
Holder of any right, remedy, power or privilege under or in respect of any such
instrument, agreement, pledge, right of offset or security or any such
obligation or liability;

               (iv)    any bankruptcy, insolvency, reorganization, arrangement,
readjustment, composition, liquidation or similar proceeding with respect to any
Holder or any other person, or any of their respective properties or creditors,
or any action taken by any trustee or receiver or by any court in any such
proceeding;

               (v)     any limitation on the liability or obligations of any
Person under and Modification Documents, the Liabilities, any Med Subsidiaries
Debenture Collateral security for the Liabilities, or any discharge,
termination, cancellation, irregularity, invalidity or unenforceability, in
whole or in part, of any of the foregoing, or any other agreement, instrument,
pledge or security referred to in clause (i) above or any term of any thereof;

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               (vi)    any merger or consolidation of Holder into or with any
other person or any sale, lease or transfer of any of the assets of Holder to
any other person;

               (vii)   any change in the ownership of any Med Subsidiaries
Debenture Collateral or of any Holder, or any structural change in Holder; or

               (viii)  any other occurrence or circumstance whatsoever, whether
similar or dissimilar to the foregoing and any other circumstance that might
otherwise constitute a legal or equitable defense or discharge of the
liabilities of a Pledgor or surety, or that might otherwise limit Holder's
recourse against Pledgors with respect to the Med Subsidiaries Debenture
Collateral.

          4.2  WAIVERS. Pledgors waive any and all notice of the creation,
renewal, extension or accrual of any of the Liabilities and notice or proof of
reliance by Holder upon this Agreement or acceptance of this Agreement, and the
Liabilities, and any of them, shall conclusively be deemed to have been created,
contracted or incurred in reliance upon this Agreement. Pledgors unconditionally
waive, to the extent permitted by law: (i) notice of any of the matters referred
to in the foregoing clauses (i) through (viii) of SECTION 4.1, or any right to
consent or assent to any thereof; (ii) all notices that may be required by
statute, rule of law or otherwise, now or hereafter in effect, to preserve
intact any rights against Pledgors, including without limitation any demand,
presentment, protest, proof or notice of nonpayment under any Modification
Documents, and notice of default or any failure on the part of Holder to perform
and comply with any covenant, agreement, term or condition of any Modification
Documents; (iii) any right to the enforcement, assertion or exercise against any
Holder of any right, power, privilege or remedy conferred in any Modification
Documents or otherwise; (iv) any requirement of diligence on the part of any
Person; (v) any requirement of Holder to take any action whatsoever, to exhaust
any remedies or to mitigate the damages resulting from a default under any
Modification Documents; (vi) any notice of any sale, transfer or other
disposition by any person of any right under, title to or interest in any
Modification Documents or any collateral for the Liabilities; and (vii) any
other circumstance whatsoever that might otherwise constitute a legal or
equitable discharge, release or defense of Pledgors or surety, or that might
otherwise limit recourse against Pledgors. Without limiting the foregoing, and
to the full extent permitted by applicable law, Pledgors hereby absolutely,
unconditionally and irrevocably waive and agree not to assert or take advantage
of any defense based upon an election of remedies by Holder, including an
election to proceed by non-judicial rather than judicial foreclosure.

          4.3  TERMINATION AND REINSTATEMENT. This Agreement shall terminate
when all of the Liabilities have been paid or otherwise satisfied in full;
provided, however, that this Agreement shall be automatically reinstated if and
to the extent that for any reason any payment by or on behalf of Company is
rescinded or must be otherwise restored by Holder or in any other manner any
Liabilities have revived, whether as a result of any proceedings in bankruptcy
or reorganization or otherwise such that any Liability remains unpaid or
otherwise unperformed.

     5.   WAIVER OF SUBROGATION. Pledgors hereby irrevocably waive any claim or
other rights which they may now or hereafter acquire against Company that arise
from the existence, payment, performance or enforcement of Pledgors' obligations
under this Agreement, including any right of subrogation, reimbursement,
exoneration or indemnification, any right to participate

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in any claim or remedy of Holder against Company or any of its assets which
Holder now has or hereafter acquires, whether or not such claim, remedy or right
arises in equity, or under contract, statute or common law, including the right
to take or receive from Company, directly or indirectly, in cash or other
property or by set-off or in any manner, payment or security on account of such
claim or other rights. If any amount shall be paid to Pledgors in violation of
the preceding sentence and the Liabilities shall not have been fully paid in
cash, such amount shall be deemed to have been paid to Pledgors for the benefit
of, and held in trust for, Holder and shall forthwith be paid to Holder to be
credited and applied pursuant to the terms of the Amendment Agreement. Pledgors
acknowledge that it will receive substantial direct and indirect benefits from
the financing arrangements contemplated by the Amendment Agreement and that the
waiver set forth in this Section 5 is knowingly made in contemplation of such
benefits.

     6.   CERTAIN COVENANTS. In addition to any and all other agreements and
undertakings of Pledgors, in this Agreement or otherwise, Pledgors also
covenant and agree as follows:

          6.1  FURTHER ASSURANCES. Pledgors will promptly, from time to time and
at its own cost and expense, execute and deliver all further instruments and
documents, and take all further action, that may be necessary or desirable, or
that Holder may reasonably request, in order to perfect, preserve and protect
any security interest granted or purported to be granted hereby or to enable
Holder to exercise and enforce its rights and remedies hereunder with respect to
the Med Subsidiaries Debenture Collateral. With respect to the foregoing and the
grant of security interest hereunder, Pledgors hereby authorize Holder to file
all financing or continuation statements, and amendments thereto, relative to
all or any part of the Med Subsidiaries Debenture Collateral without the
signature of Pledgors where permitted by law in the event that Pledgors fail to
do so within three (3) Business Days of a request from Holder so to do;
PROVIDED, HOWEVER, that such notice and passage of time shall not apply after an
Event of Default has occurred. A carbon, photographic or other reproduction of
this Agreement shall be sufficient as a financing statement where permitted by
law.

          6.2  COMPLIANCE WITH LAWS. Pledgors will comply with all laws and
regulations relating to the possession and control of the Med Subsidiaries
Debenture Collateral and, in the event that Holder forecloses on the security
interest granted to Holder under this Agreement, or under the Amendment
Agreement or any other Modification Documents, Pledgors will cooperate with
Holder in any foreclosure or private sale as may be required to sell or transfer
the Med Subsidiaries Debenture Collateral.

          6.3  PROHIBITED ACTIONS. Pledgors shall not sell, assign, exchange,
grant a security interest in, transfer, encumber, grant any option of, or
otherwise dispose of, any of the Med Subsidiaries Debenture Collateral, or
attempt or contract to do so. It is understood and agreed that, in order to
secure certain obligations owed by Med and Med Subsidiaries, Pledgors have
previously granted a Security Interest in the Interests in favor of NCFE and its
affiliates, which Security Interest has not been perfected by possession or
otherwise and shall be subordinate in interest and right of payment to the
Security Interest granted to Holder, for the benefit of the Holders of the
Amended Debentures, under this Agreement.

     7.   ASSIGNMENT BY ANY HOLDER. Holder may, from time to time and without
notice to Pledgors but without cost or expense to Pledgors prior to an Event of
Default, assign or transfer

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any or all of the Liabilities, or any interest therein, in accordance with
the Amendment Agreement and, notwithstanding any such assignment or transfer or
any subsequent assignment or transfer thereof, such Liabilities shall be and
remain Liabilities for the purposes of this Agreement, and each and every
immediate and successive assignee or transferee of any of the Liabilities or of
any interest therein shall, to the extent of such assignee's or transferee's
interest in the Liabilities, be entitled to the benefits of this Agreement to
the same extent as if such assignee or transferee were the Holder.

     8.   NO WAIVER. No delay in the exercise by Holder of any right or remedy
shall operate as a waiver thereof, and no single or partial exercise by Holder
of any right or remedy shall preclude other or further exercise thereof or the
exercise of any other right or remedy; nor shall any modification or waiver of
any of the provisions of this Agreement be binding upon Holder except as
expressly set forth in a writing duly signed and delivered on its behalf. No
action permitted hereunder shall in any way affect or impair Holder's rights or
Pledgors' obligations under this Agreement. For the purposes of this Agreement,
Liabilities shall include all of the obligations described in the definition
thereof, notwithstanding any right or power of Pledgors or anyone else to assert
any claim or defense as to the invalidity or unenforceability of any such
obligation, and no such claim or defense shall affect or impair the obligations
of Pledgors hereunder. Pledgors' obligations under this Agreement shall be
absolute and unconditional irrespective of any circumstance whatsoever that
might constitute a legal or equitable discharge or defense of the Pledgor so
long as this Agreement is in effect. Pledgors hereby acknowledge that there are
no conditions to the effectiveness of this Agreement.

     9.   REPRESENTATIONS AND WARRANTIES. Pledgors hereby represent and warrant
to Holder as follows:

          9.1  DUE ORGANIZATION; AUTHORITY. Each of Pledgors is duly organized
and validly existing under the laws its formation, as applicable, is qualified
to do business in that state and in every other state in which the scope or
nature of its business requires it to be so qualified, has taken all actions and
has the power and authority to execute and deliver this Agreement and has duly
executed and delivered this Agreement;

          9.2  ENFORCEABILITY. This Agreement is the legal, valid and binding
obligation of Pledgors, enforceable in accordance with its terms.

          9.3  NO CONFLICT. The execution, delivery and performance of this
Agreement by Pledgors does not conflict with, or constitute a violation under,
any law, regulation order, agreement or instrument to which Pledgors are parties
or by which Pledgor or any of Pledgors' properties is bound.

          9.4  COLLATERAL. To the best of Pledgors' knowledge, each item of Med
Subsidiaries Debenture Collateral is genuine, validly issued and outstanding and
is fully paid and nonassessable and was issued in accordance with all applicable
laws and regulations. Each item of Med Subsidiaries Debenture Collateral is free
of any restriction on transfer or assignment created by Pledgors, and Pledgors
have the right to pledge the Med Subsidiaries Debenture Collateral to Holder
without restriction.

                                       10
<Page>

          9.5  OWNERSHIP OF COLLATERAL. Pledgors are, and at all times will be,
the beneficial owners of the Med Subsidiaries Debenture Collateral, and no one
else (other than Holder) has or will have, any pre-emptive right, title, claim,
lien, interest or other right in or against the Med Subsidiaries Debenture
Collateral that is superior in priority of payment to the rights granted to
Holder under this Agreement.

     10.  EVENTS OF DEFAULT. An "Event of Default" shall exist under this
Agreement if at any time: (i) any representation, warranty or certificate made
by Pledgors under this Agreement or any other Modification Documents is false or
misleading in any material respect when made, or Pledgors omit, or fail to
disclose any information to Holder that is material or could result in a
material adverse effect; (ii) any "Event of Default" under, and as defined in
the Amendment Agreement, shall occur and be continuing, or (iii) Pledgors fail
to perform any of its obligations hereunder.

     11.  REMEDIES AND APPLICATION OF PROCEEDS.

          11.1 REMEDIES. Upon the occurrence and during the continuation of any
Event of Default, Holder has the right to exercise any and all remedies
available to it at law or equity as well as any rights or remedies specified in
this Agreement. Without limiting the generality of the foregoing, Pledgors
expressly agree that in any such event Holder may, without demand of performance
or other demand, advertisement, legal process or notice of any kind (except as
may be required by law or provided herein) to or upon Pledgors or any other
Person (all and each of which demands, advertisements and/or notices are hereby
expressly waived to the maximum extent permitted by the UCC and other applicable
law):

               (i)     take and remove the Med Subsidiaries Debenture Collateral
or any part thereof, to such other places as Holder may desire;

               (ii)    forthwith collect, receive, appropriate and realize upon
the Med Subsidiaries Debenture Collateral, or any part thereof,

               (iii)   forthwith sell, lease, assign, give an option or options
to purchase, or sell or otherwise dispose of and deliver the Med Subsidiaries
Debenture Collateral (or contract to do so), or any part thereof, in one or more
parcels at public or private sale or sales, at any exchange or broker's board or
at any of Holder's offices or elsewhere at such prices and on such terms as are
commercially reasonable (irrespective of the impact of any such sales on the
market price of the Med Subsidiaries Debenture Collateral), for cash or on
credit or for future delivery;

               (iv)    receive all monies or other property which, but for the
occurrence of the Event of Default, Pledgors would have been entitled to retain;

               (v)     transfer registration of the Med Subsidiaries Debenture
Collateral into Holder's name;

               (vi)    exercise all voting rights with respect to the Med
Subsidiaries Debenture Collateral, give all consents, waivers and ratifications
with respect to them and otherwise act as if Holder were the outright owner of
such Med Subsidiaries Debenture

                                       11
<Page>

Collateral, and Pledgors hereby give Holder an irrevocable power of attorney
and proxy to do same; and

               (vii)   sell, assign or otherwise dispose of the Med Subsidiaries
Debenture Collateral, in the entirety or in separate lots, and generally in such
manner, at such time or times, at such place or places and on such terms as
Holder, in compliance with any mandatory requirements of applicable law, may
determine to be commercially reasonable, and, to the extent permitted by any
such requirement of law, Holder may bid (which may be a credit bid) for and
become the purchaser of the Med Subsidiaries Debenture Collateral (or any
portion thereof), offered for sale in accordance with this SECTION 11 without
accountability to Pledgors, except pursuant to clause 11.2 below and as
otherwise required by applicable law.

          11.2 APPLICATION OF PROCEEDS. The proceeds of any disposition of any
Med Subsidiaries Debenture Collateral obtained pursuant to this SECTION 11 shall
be applied as follows:

               (i)     first, to the payment of any and all expenses and fees
(including reasonable attorney's fees) incurred by Holder in foreclosing on and
disposing of the Med Subsidiaries Debenture Collateral;

               (ii)    any surplus then remaining to the payment of the
Liabilities then due and owing in such order as Holder may determine in their
sole discretion; and

               (iii)   thereafter, if no other Liabilities are outstanding, any
surplus then remaining shall be paid to Pledgors or to such other Person legally
entitled to same.

          11.3 WAIVER. To the maximum extent permitted by applicable law but
subject to SECTION 3.2, Pledgors waive all claims, damages and demands against
Holder arising out of the repossession, retention or sale of the Med
Subsidiaries Debenture Collateral. Pledgors agree that, to the extent notice of
sale shall be required by law, neither Holder need give more than ten (10) days'
notice of the time and place of any public sale or of the time after which a
private sale may take place and that such notice shall constitute reasonable
notification within the meaning of Section 9-504(3) of the UCC.

          11.4 ADDITIONAL REMEDIES. Without limiting the foregoing, if any Event
of Default shall occur and be continuing, Holder may exercise, in addition to
all other rights and remedies granted to it in this Agreement or by law, all
rights and remedies of a secured party under the UCC.

          11.5 COSTS. Pledgors also agree to pay all costs of Holder, including,
without limitation, reasonable attorneys' fees, incurred in connection with the
enforcement of any of Holder's rights and remedies hereunder, including without
limitation reasonable fees for attorneys employed by Holder to collect any
deficiency existing after the application of proceeds from any sale of Med
Subsidiaries Debenture Collateral hereunder in accordance with SECTION 11.2.

          11.6 NOTICE OF SALE. Unless any of the Med Subsidiaries Debenture
Collateral threatens to decline speedily in value or is or becomes of a type
customarily sold on a recognized

                                       12
<Page>

market, Holder will give Pledgors ten (10) days' notice of the time and place of
any public sale thereof, or of the time after which any private sale or other
intended disposition is to be made. Any sale of the Med Subsidiaries Debenture
Collateral conducted in conformity with reasonable commercial practices of
banks, commercial finance companies, insurance companies or other financial
institutions disposing of property similar to the Med Subsidiaries Debenture
Collateral shall be deemed to be commercially reasonable. Any other requirement
of notice, demand or advertisement for sale is, to the extent permitted by law,
waived. In addition, with respect to the Med Subsidiaries Debenture Collateral,
or any part thereof, Holder may in its sole discretion, without notice except as
may be specified herein, sell or cause the same to be sold at any exchange,
broker's board or at public or private sale, in one or more sales or lots, at
such price as Holder may deem best, and for cash or on credit or for future
delivery, without assumption of any credit risk, and the purchaser of any or all
of the Med Subsidiaries Debenture Collateral so sold shall thereafter hold the
same, absolutely free from any claim, encumbrance or right of any kind
whatsoever. Holder may, in its own name or in the name of a designee or nominee,
buy the Med Subsidiaries Debenture Collateral at any public sale and, if
permitted by applicable law, buy the Med Subsidiaries Debenture Collateral at
any private sale.

          11.7 COMPLIANCE WITH SECURITIES LAWS. In view of the fact that federal
and state securities laws may impose certain restrictions on the method by which
a sale of the Med Subsidiaries Debenture Collateral may be effected after an
Event of Default, Pledgors agree that, upon the occurrence and during the
continuation of an Event of Default, Holder may from time to time attempt to
sell all or any part of the Med Subsidiaries Debenture Collateral by means of a
private placement restricting the bidder and prospective purchasers to those who
will represent and agree that they are purchasing for investment only and not
for distribution. In so doing, Holder may solicit offers to buy the Med
Subsidiaries Debenture Collateral, or any part of it, for cash, from a limited
number of investors deemed by Holder, in its reasonable judgment, to be
qualified parties who might be interested in purchasing the Med Subsidiaries
Debenture Collateral, and if Holder solicits such offers from not less than five
(5) such investors, then the acceptance by same of the highest offer obtained
therefrom shall be deemed to be a commercially reasonable method of disposition
of such Med Subsidiaries Debenture Collateral.

     12.  CUMULATIVE RIGHTS. Holder's rights, powers and remedies under this
Agreement shall be in addition to all rights, powers and remedies given to same
under law or under the Amendment Agreement or under any other Modification
Documents between Pledgors (on the one hand) and Holder (on the other hand), all
of which rights, powers and remedies shall be cumulative and may be exercised
successively or concurrently.

     13.  MISCELLANEOUS.

          13.1 SUCCESSORS AND ASSIGNS. This Agreement shall be binding upon
Pledgors and upon Pledgors' successors; and all references herein to Pledgors
shall be deemed to include any successor or successors, whether immediate or
remote, to such Person. Pledgors shall have no right to assign its obligations
hereunder. This Agreement shall inure to Holder and its permitted successors,
assigns and transferees.

          13.2 SEVERABILITY. Wherever possible each provision of this Agreement
shall be interpreted in such manner as to be effective and valid under
applicable laws and regulations, but

                                       13
<Page>

if any provision of this Agreement shall be prohibited by or invalid thereunder,
such provision shall be ineffective only to the extent of such prohibition or
invalidity, without invalidating the remainder of such provision or the
remaining provisions of this Agreement.

          13.3 SERVICE OF PROCESS. Pledgors agree that service of process in any
such action or proceeding may be effected by mailing a copy thereof by
registered or certified mail (or any substantially similar form of mail),
postage prepaid, to it at its address set forth below or at such other address
of which Holder shall have been notified in writing, and agrees that nothing
herein shall affect the right to effect service of process in any other manner
permitted by law.

          13.4 NOTICES. All notices, demands, declarations, consents,
directions, approvals, instructions, requests and other communications required
or permitted by this Agreement shall be given in the manner provided for by
SECTION 20 of the Amendment Agreement, with all notices to Pledgors also being
addressed to Company.

          13.5 CHOICE OF LAW. This Agreement shall be construed in accordance
with and governed by the laws of the State of Nevada, without giving regard to
its conflict of laws principles.

          13.6 WAIVER OF JURY TRIAL. EACH PLEDGOR, BY ITS EXECUTION AND DELIVERY
OF THIS AGREEMENT, AND HOLDER, BY ACCEPTING THIS AGREEMENT, EACH EXPRESSLY WAIVE
ANY RIGHT TO A TRIAL BY JURY IN ANY ACTION OR PROCEEDING TO ENFORCE OR DEFEND
ANY RIGHTS UNDER THIS AGREEMENT OR UNDER ANY AMENDMENT, INSTRUMENT, DOCUMENT OR
AGREEMENT DELIVERED OR WHICH MAY IN THE FUTURE BE DELIVERED IN CONNECTION
HEREWITH OR ARISING FROM ANY RELATIONSHIP EXISTING IN CONNECTION WITH THIS
AGREEMENT, AND AGREES THAT ANY SUCH ACTION OR PROCEEDING SHALL BE TRIED BEFORE A
COURT AND NOT BEFORE A JURY.

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

    [Remainder of This Page Intentionally Left Blank; Signature Page Follows]

                                       14
<Page>

          IN WITNESS WHEREOF, Pledgors have caused this Agreement to be executed
and delivered as of the date first above written.

                              MED DIVERSIFIED, INC.

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

                              AMERICAN REIMBURSEMENT, LLC

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

                              CHARTWELL DIVERSIFIED SERVICES, INC.

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

                              TENDER LOVING CARE HEALTH CARE SERVICES, INC.

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

                              TRESTLE CORPORATION

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       15
<Page>

                              RESOURCE PHARMACY, INC.

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

                              CHARTWELL COMMUNITY SERVICES, INC.

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

                              CHARTWELL CARE GIVERS, INC.

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

                              CHARTWELL MANAGEMENT COMPANY, INC.

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       16
<Page>

                              CHARTWELL HOME THERAPIES, L.P.

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

                              CHARTWELL PENNSYLVANIA, L.P.

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

                              CHARTWELL MIDWEST INDIANA, LLC

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

                              CHARTWELL SOUTHERN NEW ENGLAND, LLC

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

                              CHARTWELL ROCKY MOUNTAIN REGIONAL SERVICES

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       17
<Page>

                              CHARTWELL U.C. DAVIS HEALTH SYSTEMS, LLC

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

                              CHARTWELL MICHIGAN, LLC

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

                              NORTHWEST HOME CARE, LLC

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

                              INNOVA HOME THERAPIES, LLC

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

                              CHARTWELL WISCONSIN ENTERPRISES, LLC

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       18
<Page>

                              CHARTWELL-MIDWEST WISCONSIN, LLC

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

                              CHARTWELL-MIDWEST WISCONSIN HEALTH RESOURCES,
                              LLC

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

                              ALBERT GALLATIN HOME CARE, INC.

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

                              CARECO, INC.

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

                              T.L.C. MIDWEST, INC.

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       19
<Page>

                              T.L.C. MEDICARE SERVICES OF DADE, INC.

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

                              T.L.C. MEDICARE SERVICES OF BROWARD, INC.

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

                              TENDER LOVING CARE HOME CARE SERVICES, INC.

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

                              U.S. ETHICARE CORPORATION

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

                              U.S. ETHICARE CHAUTAUQUA CORPORATION

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       20
<Page>

                              U.S. ETHICARE ERIE CORPORATION

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

                              U.S. ETHICARE NIAGARA CORPORATION

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

                              ETHICARE CERTIFIED SERVICES, INC.

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

                              STAFF BUILDERS, INC.

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

                              S.B.H.F., INC.

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       21
<Page>

                              STAFF BUILDERS SERVICES, INC.

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

                              STAFF BUILDERS HOME HEALTH CARE, INC.

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

                              STAFF BUILDERS INTERNATIONAL, INC.

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

                              A RELIABLE HOMEMAKER OF MARTIN-ST.
                              LUCIE COUNTY, INC.

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

                              ST. LUCIE HOME HEALTH AGENY, INC.

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

                                       22
<Page>

                              T.L.C. HOME HEALTH CARE, INC.

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

                              PRIVATE INVESTMENT BANK LIMITED

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

       [SIGNATURE PAGE TO MED SUBSIDIARIES PLEDGE AND SECURITY AGREEMENT]

                                       23
<Page>

                                   SCHEDULE 1

                          INTERESTS IN MED SUBSIDIARIES

<Table>
<Caption>
                   MED SUBSIDIARY                                            PLEDGED INTEREST
--------------------------------------------------          -------------------------------------------
<S>                                                          <C>
Trestle Corporation                                                    2,800,000 shares of common stock
Resource Pharmacy, Inc.                                                    1,000 shares of common stock
Chartwell Diversified Services, Inc.                                       1,000 shares of common stock
Chartwell Community Services, Inc.                                           100 shares of common stock
Chartwell Care Givers, Inc.                                                  100 shares of common stock
Chartwell Management Company, Inc.                                           100 shares of common stock
Chartwell Home Therapies, L.P.                               All Partnership Interests (Uncertificated)
Chartwell Pennsylvania, L.P.                                  All Membership Interests (Uncertificated)
Chartwell Midwest Indiana, LLC                                All Membership Interests (Uncertificated)
Chartwell Southern New England, LLC                           All Membership Interests (Uncertificated)
Chartwell Rocky Mountain Regional Services                    All Membership Interests (Uncertificated)
Chartwell U.C. Davis Health Systems, LLC                      All Membership Interests (Uncertificated)
Chartwell Michigan, LLC                                       All Membership Interests (Uncertificated)
Northwest Home Care, LLC                                      All Membership Interests (Uncertificated)
Innova Home Therapies, LLC                                    All Membership Interests (Uncertificated)
Chartwell Wisconsin Enterprises, LLC                          All Membership Interests (Uncertificated)
Chartwell-Midwest Wisconsin, LLC                              All Membership Interests (Uncertificated)
Chartwell-Midwest Wisconsin Health Resources, LLC             All Membership Interests (Uncertificated)
Tender Loving Care Health Care Services, Inc.                          5,000,000 shares of common stock
Albert Gallatin Home Care, Inc.                                            1,000 shares of common stock
Careco, Inc.                                                                 100 shares of common stock
T.L.C. Midwest, Inc.                                                       1,000 shares of common stock
T.L.C. Home Health Care, Inc.                                                100 shares of common stock
T.L.C. Medicare Services of Dade, Inc.                                       500 shares of common stock
T.L.C. Medicare Services of Broward, Inc.                                    500 shares of common stock
Tender Loving Care Home Care Services, Inc.                                  100 shares of common stock
U.S. Ethicare Corporation                                                    100 shares of common stock
U.S. Ethicare Chautauqua Corporation                                         500 shares of common stock
U.S. Ethicare Erie Corporation                                               500 shares of common stock
U.S. Ethicare Niagara Corporation                                            500 shares of common stock
Ethicare Certified Services, Inc.                                            100 shares of common stock
Staff Builders, Inc.                                                         100 shares of common stock
S.B.H.F., Inc.                                                               100 shares of common stock
Staff Builders Services, Inc.                                                100 shares of common stock
Staff Builders Home Health Care, Inc.                                        100 shares of common stock
Staff Builders International, Inc.                                           100 shares of common stock
St. Lucie Home Health Agency, Inc.                                           500 shares of common stock
A Reliable Homemaker of Martin-St. Lucie County, Inc.                      1,000 shares of common stock
</Table>

                                       24
<Page>

                                    Exhibit A

                           FORM OF SUBSIDIARY JOINDER

                        AGREEMENT TO BE BOUND BY GUARANTY

          This Agreement to be Bound by the Med Subsidiaries Pledge and Security
Agreement (this "AGREEMENT") is executed as of the _____ day of _________, ____,
by [NAME OF NEW SUBSIDIARY], a ____________ [corporation] [partnership] [etc.]
(the "NEW SUBSIDIARY"). Capitalized terms used herein by not defined herein
shall be as defined in the Med Subsidiaries Pledge and Security Agreement (THE
"PLEDGE AGREEMENT").

                                    RECITALS

     A.   Pursuant to that certain Amendment Agreement dated as of June 28,
2002, by and among Med Diversified, Inc., a Nevada corporation ("MED"), American
Reimbursement, LLC, a Delaware limited liability company, Private Investment
Bank Limited, Nassau, Bahamas ("PIBL"), TEGCO Investments, LLC, a Delaware
limited liability company; Chartwell Diversified Services, Inc., a Delaware
corporation, Tender Loving Care Health Care Services, Inc., a Delaware
corporation, and each of Med Subsidiaries that are a party thereto, (such
agreement, as the same may hereafter be amended, modified, restated,
supplemented and otherwise in effect from time to time, the "AMENDMENT
AGREEMENT"), PIBL accepted and agreed to the Amendment Agreement and extension
of the Original Debentures that was requested by Med. Capitalized terms used
herein without definition herein shall have the meanings assigned to them in the
Amendment Agreement

     B.   As a condition to the execution of the Amendment Agreement by the
PIBL, certain of the Subsidiaries of Med have executed the Med Subsidiaries
Pledge and Security Agreement, dated as of June 28, 2002 (such agreement, as
amended, the "PLEDGE AGREEMENT"), by and among PIBL and the entities listed in
the signature pages thereof, in favor of PIBL.

     C.   Section 7(d) of the Amendment Agreement provides that, whenever Med
acquires or forms a new Subsidiary, Med will cause such Subsidiary to deliver an
executed counterpart to the Pledge Agreement and such Subsidiary shall become a
party to the Pledge Agreement.

     D.   On [INSERT DATE], the New Subsidiary [DESCRIBE ACQUISITION/FORMATION
OF NEW SUBSIDIARY]. The New Subsidiary will benefit from the funds available to
the Med under the Amendment Agreement, and in recognition of this benefit and in
order to comply with the Amendment Agreement, the New Subsidiary is willing to
enter into this Agreement.

                                    AGREEMENT

     NOW, THEREFORE, the New Subsidiary agrees as follows:

     1.   REPRESENTATIONS AND WARRANTIES. On and as of the date of this
Agreement (the "EFFECTIVE DATE") and for the benefit of the PIBL, the New
Subsidiary hereby makes each of the representations and warranties contained in
the Pledge Agreement.

     2.   AGREEMENT TO BE BOUND. The New Subsidiary agrees that, on and as of
the Effective Date, it shall become a Pledgor under the Pledge Agreement and
shall be bound by all the provisions of the Pledge Agreement the same as if the
New Subsidiary had executed the Pledge Agreement on the Closing Date.

     3.   WAIVER. Without limiting the generality of the waivers in the Pledge
Agreement, the New Subsidiary specifically agrees to be bound by the Pledge
Agreement and waives any right to notice of acceptance of its execution of this
Agreement and of its agreement to be bound by the Pledge Agreement.

                                       25
<Page>

     4.   GOVERNING LAW. This Agreement shall be governed by, and construed in
accordance with, the laws of the State of New York.

      [Remainder of page intentionally left blank, signature page follows.]

                                       26
<Page>

     IN WITNESS WHEREOF, the New Subsidiary has caused this Agreement to be
Bound by the Pledge Agreement to be executed by its duly authorized officer as
of this __ day of _________, ____.

                                       [NAME OF NEW SUBSIDIARY]

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

           [SIGNATURE PAGE TO SUBSIDIARY JOINDER TO PLEDGE AGREEMENT]

                                       27<Page>

                                  EXHIBIT 10.20

             (FORM OF MED SUBSIDIARIES COLLATERAL AGENCY AGREEMENT)

<Page>

                       CITIBANK CUSTODY & ADVISOR SERVICES

                           Collateral Agency Agreement

                                  by and among

                                 Citibank, N.A.
                              as "Collateral Agent"

                        Private Investment Bank Limited,
                             as "Secured Party" and
                            collateral account holder

                                       and

                            Med Diversified, Inc. and
                      its direct and indirect subsidiaries
                                signatory hereto,
                                  as "Pledgors"

                                    361089
                     --------------------------------------
                                (Account Number)

                    CITIBANK COLLATERAL AGENT CUSTODY ACCOUNT

<Page>

THIS COLLATERAL AGENCY AGREEMENT (this Collateral Agency Agreement, including
all Schedules attached hereto, all of the terms and conditions which are
incorporated herein by reference, in each case as amended and/or supplemented
from time to time in accordance with the terms hereof, this "Collateral Agency
Agreement") is made this 14th day of August, 2002 by and among the following:

(i)   Private Investment Bank Limited, a Bahamas bank and trust company, as
secured party (the "Secured Party" herein);

(ii)  Med Diversified, Inc., a Nevada corporation ("Med"), and the direct or
indirect subsidiaries of Med who are signatories hereto as "Pledgors" (Med and
each such Med subsidiary, collectively, the "Pledgors" and, individually, a
"Pledgor", herein); and

(iii) CITIBANK, N.A., a national banking association organized and existing
under the laws of the United States of America acting in its capacity as
collateral agent for the Secured Party (the "Collateral Agent" herein).

                                    RECITALS

WHEREAS, pursuant to that certain Amendment Agreement dated as of June 28, 2002
by and among Med, the other Pledgors, Secured Party and certain other parties
thereto (as the same may be modified, restated, supplemented and otherwise in
effect from time to time, the "Amendment Agreement"), Pledgors have agreed to
grant to Secured Party, among other things, a first priority security interest
in any and all capital stock or other equity securities of certain Med
subsidiaries (collectively, the "Interests"), to secure certain indebtedness and
other obligations owed to Secured Party including certain debentures in an
aggregate original principal amount of $57.5 million (the "Indebtedness"); and

WHEREAS, pursuant to the Amendment Agreement, Med, the other Pledgors and
Secured Party have entered into that certain Medf Subsidiaries Pledge and
Security Agreement dated as of June 28, 2002 by and among Med, the other
Pledgors and Secured Party (as the same may be modified, restated, supplemented
and otherwise in effect from time to time, the "Med Subsidiaries Pledge and
Security Agreement"), Pledgors have, among other things, pledged to Secured
Party and granted Secured Party a security interest in the Interests; and

WHEREAS, the Amendment Agreement and the Med Subsidiaries Pledge and Security
Agreement contemplate that Collateral Agent shall hold the certificates,
instruments and other evidence of the Interests as the agent of Secured Party
(in an account opened by the Collateral Agent in the name of the Secured Party,
the "Account") pursuant to this Collateral Agency Agreement.

                                      - 1 -
<Page>

NOW, THEREFORE, the above-named parties appoint said Collateral Agent with the
duties and responsibilities and upon the terms and conditions provided in
SCHEDULES A and B annexed hereto and made apart hereof.

ARTICLE FIRST: The above-named parties agree that the following provisions shall
control with respect to the rights, duties, liabilities, privileges and
immunities of the Collateral Agent:

a)    The Collateral Agent shall hold the Interests, including all certificates,
      instruments and other evidence of the Interests, as the agent of Secured
      Party and in an account opened by the Collateral Agent by the Secured
      Party, all subject to the terms of this Collateral Agency Agreement.

b)    The Collateral Agent shall neither be responsible for or under, nor
      chargeable with knowledge of, the terms and conditions of any other
      agreement, instrument or document executed between/among the parties
      hereto, other than this Collateral Agency Agreement, including SCHEDULES
      A, B, C, D and E attached hereto. This Collateral Agency Agreement, along
      with SCHEDULES A, B, C, D and E attached hereto, sets forth all of the
      obligations of the parties hereto, and no additional obligations shall be
      implied from the terms of this Collateral Agency Agreement or any other
      agreement, instrument or document.

c)    The Collateral Agent may act in reliance upon any instructions, notice,
      certification, demand, consent, authorization, receipt, power of attorney
      or other writing delivered to it by any other party without being required
      to determine the authenticity or validity thereof or the correctness of
      any fact stated therein, the propriety or validity of the service thereof,
      or the jurisdiction of the court issuing any judgment or order. The
      Collateral Agent may act in reliance upon any signature believed by it to
      be genuine, and may assume that such person has been properly authorized
      to do so.

d)    Each of the Pledgors, jointly and severally, agrees to reimburse the
      Collateral Agent on demand for, and to indemnify and hold the Collateral
      Agent and its employees, officers and directors (each, an "INDEMNIFIED
      PARTY") harmless against and with respect to, any and all claims, loss,
      actions, liability, damage or expense (including, but without limitation,
      attorneys' fees, costs and disbursements) (collectively "LOSSES") that the
      Collateral Agent may suffer or incur in connection with this Collateral
      Agency Agreement and its performance hereunder or in connection herewith,
      except to the extent such loss, liability, damage or expense arises from
      its willful misconduct or gross negligence as adjudicated by a court of
      competent jurisdiction. In addition, when any Indemnified Party acts on
      any information, instructions, communications (including, but not limited
      to, communications with respect to the delivery of the Interests or the
      wire transfer of funds) sent by telex or facsimile, the Indemnified Party,
      absent gross negligence as adjudicated by a court of competent
      jurisdiction, shall not be responsible or liable in the event such
      information, instruction or communication is not an authorized or
      authentic information, instruction or communication or is not in the form
      sent or intended to be sent (whether due to fraud, distortion or
      otherwise). Each of the Pledgors, jointly and severally, shall indemnify
      any Indemnified Party against any Losses it may incur

                                      - 2 -
<Page>

      in connection with its acting in accordance with any such information,
      instruction or communication. This Article First, subsection 4(d) shall
      survive the termination of this Collateral Agency Agreement and the
      resignation or removal of the Collateral Agent.

e)    The Collateral Agent may consult with legal counsel of its selection in
      the event of any dispute or question as to the meaning or construction of
      any of the provisions hereof or its duties hereunder, and it shall incur
      no liability and shall be fully protected in acting in accordance with the
      opinion and instructions of such counsel. Each of the Pledgors, jointly
      and severally, agrees to reimburse the Collateral Agent on demand for such
      legal fees, disbursements and expenses and in addition, the Collateral
      Agent shall have the right to reimburse itself for such fees,
      disbursements and expenses from the property held in escrow hereunder.

f)    The Collateral Agent shall be under no duty to give the property held by
      it hereunder any greater degree of care than it gives its own similar
      property.

g)    The Collateral Agent shall invest the property held by it hereunder in
      such a manner as directed in SCHEDULE A annexed hereto, which may include
      deposits in Citibank and mutual funds advised, serviced or made available
      by Citibank or its affiliates even though Citibank or its affiliates may
      receive a benefit or profit therefrom.

THE PARTIES TO THIS AGREEMENT ACKNOWLEDGE THAT NON-DEPOSIT INVESTMENT PRODUCTS
ARE NOT OBLIGATIONS OF, OR GUARANTEED, BY CITIBANK/CITICORP NOR ANY OF ITS
AFFILIATES; ARE NOT FDIC INSURED; AND ARE SUBJECT TO INVESTMENT RISKS, INCLUDING
THE POSSIBLE LOSS OF PRINCIPAL AMOUNT INVESTED. ONLY DEPOSITS IN THE UNITED
STATES ARE SUBJECT TO FDIC INSURANCE.

h)    In the event of any disagreement between/among any of the parties to this
      agreement, or between/among them or either or any of them and any other
      person, resulting in adverse claims or demands being made in connection
      with the subject matter of this Collateral Agency Agreement, or in the
      event that the Collateral Agent, in good faith, be in doubt as to what
      action it should take hereunder, the Collateral Agent may, at its option,
      refuse to comply with any claims or demands on it, or refuse to take any
      other action hereunder, so long as such disagreement continues or such
      doubt exists, and in any such event, the Collateral Agent shall not become
      liable in any way or to any person for its failure or refusal to act, and
      the Collateral Agent shall be entitled to continue so to refrain from
      acting until (i) the rights of all parties shall have been fully and
      finally adjudicated by a court of competent jurisdiction, or (ii) all
      differences shall have been adjusted and all doubt resolved by agreement
      among all of the interested persons, and the Collateral Agent shall have
      been notified thereof in writing signed by all such persons. The
      Collateral Agent shall have the option, after 30 calendar days' notice to
      the other parties of its intention to do so, to file an action in
      interpleader requiring the parties to answer and litigate any claims and
      rights among themselves. The rights of the Collateral Agent under this
      paragraph are cumulative of all other rights which it may have by law or
      otherwise.

                                      - 3 -
<Page>

i)    The Collateral Agent is authorized, for any securities at any time held
      hereunder, to register such securities in the name of its nominee(s) or
      the nominees of any securities depository, and such nominee(s) may sign
      the name of any of the parties hereto to whom or to which such securities
      belong and guarantee such signature in order to transfer securities or
      certify ownership thereof to tax or other governmental authorities.

j)    Notice to the parties shall be given as provided in SCHEDULE B annexed
      hereto.

ARTICLE SECOND: The Collateral Agent shall make distributions of income earned
on the property held pursuant to this Collateral Agency Agreement as provided in
SCHEDULE A annexed hereto. Each such payee shall provide to the Collateral Agent
an appropriate W-9 form for tax identification number certification or a W-8
form for non-resident alien certification. The Collateral Agent shall be
responsible only for income reporting to the Internal Revenue Service with
respect to income earned on the escrowed property.

ARTICLE THIRD: (a) The Secured Party may remove the Collateral Agent at any time
by giving to the Collateral Agent thirty (30) calendar days' prior written
notice of removal signed by an authorized person of the Secured Party, with a
copy of such notice to Med. The Collateral Agent may resign at any time by
giving to each of Med and the Secured Party fifteen (15) calendar days' prior
written notice of resignation.

          (b)  Within thirty (30) calendar days after giving the foregoing
notice of removal to the Collateral Agent or within fifteen (15) calendar days
after receiving the foregoing notice of resignation from the Collateral Agent,
the Secured Party shall appoint a successor collateral agent and give notice of
such successor collateral agent to the Collateral Agent, with a copy of such
notice to Med. If a successor collateral agent has not accepted such appointment
by the end of such (i) 30-day period, in the case of the Collateral Agent's
removal, or (ii) 15-day period, in the case of the Collateral Agent's
resignation, the Collateral Agent may, in its sole discretion, either deliver
the Interests to the Secured Party at the address set forth in SCHEDULE B or may
apply to a court of competent jurisdiction for the appointment of a successor
collateral agent or for other appropriate relief.

          (c)  Upon receipt of notice of the identity of the successor
collateral agent, the Collateral Agent shall either deliver the Interests then
held hereunder to the successor collateral agent, less the Collateral Agent's
fees, costs, expenses and the value of other obligations owed to the Collateral
Agent hereunder, or hold such Interests (or any portion thereof) pending
distribution, until all such fees, costs and expenses or the value of other
obligations are paid to it.

          (d)  Upon delivery of the Interests to the successor collateral agent
or to the Secured Party, the Collateral Agent shall have no further duties,
responsibilities or obligations hereunder.

ARTICLE FOURTH: The Collateral Agent shall receive from Med the fees provided in
SCHEDULE E annexed hereto. In the event that such fees are not paid to the
Collateral Agent within 30 calendar days of presentment to Med as set forth in
said SCHEDULE E, then the Collateral Agent may pay itself such fees from the
property held in escrow hereunder.

                                      - 4 -
<Page>

ARTICLE FIFTH: Secured Party hereby guarantees Pledgors' performance of their
obligation to reimburse, indemnify and hold harmless the Collateral Agent, and
pay fees to the Collateral Agent, pursuant to the provisions of the First and
Fourth Articles of this Collateral Agency Agreement. Pledgors shall, jointly and
severally, reimburse Secured Party for any and all loss, liability, damage or
expense (including, but without limitation, attorneys' fees, costs and
disbursements and all payments to the Collateral Agent by Secured Party or out
of property held hereunder) that the Secured Party may suffer or incur in
connection with its guaranty of the Pledgors' obligations to the Collateral
Agent.

ARTICLE SIXTH: Any modification of this Collateral Agency Agreement or any
additional obligations assumed by any party hereto shall be binding only if
evidenced by a writing signed by each of the parties hereto.

ARTICLE SEVENTH: In the event funds transfer instructions are given (other than
in writing at the time of execution of this Collateral Agency Agreement),
whether in writing, by telecopier or otherwise, the Collateral Agent is
authorized to seek confirmation of such instructions by telephone call back to
the person or persons designated in SCHEDULE C or D annexed hereto (as
applicable), and the Collateral Agent may rely upon the confirmations of anyone
purporting to be the person or persons so designated. To assure accuracy of the
instructions it receives, the Collateral Agent may record such call backs. If
the Collateral Agent is unable to verify the instructions, or is not satisfied
with the verification it receives, it will not execute the instruction until all
issues have been resolved. The persons and telephone numbers for call backs may
be changed only in writing actually received and acknowledged by the Collateral
Agent. The parties agree to notify the Collateral Agent of any errors, delays or
other problems within 30 calendar days after receiving notification that a
transaction has been executed. If it is determined that the transaction was
delayed or erroneously executed as a result of the Collateral Agent's error, the
Collateral Agent's sole obligation is to pay or refund such amounts as may be
required by applicable law. In no event shall the Collateral Agent be
responsible for any incidental or consequential damages or expenses in
connection with the instruction. Any claim for interest payable will be at the
Collateral Agent's published savings account rate in effect in New York, New
York.

ARTICLE EIGHTH: This Collateral Agency Agreement shall be governed by the law of
the State of New York in all respects (without regard for its conflict of laws
principles). The parties hereto irrevocably and unconditionally submit to the
jurisdiction of a federal or state court located in the Borough of Manhattan,
City, County and State of New York, in connection with any proceedings commenced
regarding this Collateral Agency Agreement, including but not limited to, any
interpleader proceeding or proceeding for the appointment of a successor
collateral agent the Collateral Agent may commence pursuant to this Collateral
Agency Agreement, and all parties irrevocably submit to the jurisdiction of such
courts for the determination of all issues in such proceedings, without regard
to any principles of conflicts of laws, and irrevocably waive any objection to
venue or inconvenient forum. The parties hereto irrevocably and unconditionally
waive, to the fullest extent permitted by law, and agree not to plead or claim,
any right of immunity from legal action, suit or proceeding, from setoff or
counterclaim, from the jurisdiction of any court, from service of process, from
attachment upon or prior to judgment, from attachment in aid of execution or
judgment, from execution of judgment, or from any other legal process or
proceeding for the giving of any relief or for the enforcement of any judgment,
and consents

                                      - 5 -
<Page>

to such relief and enforcement against it, its assets and its revenues in any
jurisdiction, in each case with respect to any matter arising out of, or in
connection with, this Collateral Agency Agreement.

ARTICLE NINTH: This Collateral Agency Agreement may be executed in one or more
counterparts, each of which counterparts shall be deemed to be an original and
all of which counterparts, taken together, shall constitute but one and the same
Agreement. Facsimile signatures on counterparts of this Collateral Agency
Agreement shall be deemed original signatures with all rights accruing thereto.
Each of the parties hereto agrees to provide original signatures to the
Collateral Agency Agent within 15 business days after execution.

                     [REST OF PAGE LEFT BLANK INTENTIONALLY]

                                      - 6 -
<Page>

In witness whereof, the parties have executed this Collateral Agency Agreement
as of the date first above written.

CITIBANK, N.A.
as Collateral Agent

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------
Title
      --------------------------------

SECURED PARTY:                            MED:

PRIVATE INVESTMENT BANK LIMITED           MED DIVERSIFIED, INC.

By                                        By
   -----------------------------------       -----------------------------------
             (SIGNATURE)                                (SIGNATURE)

Name: Francois Rouge                      Name
Title: Chairman                                ---------------------------------
                                          Title
                                                --------------------------------

By
   -----------------------------------
             (SIGNATURE)

Name: Jean-Francois Furrer
Title: Director

                                      - 7 -
<Page>

OTHER PLEDGORS:

AMERICAN REIMBURSEMENT, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL DIVERSIFIED SERVICES, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

TENDER LOVING CARE HEALTH CARE
SERVICES, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

TRESTLE CORPORATION

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                      - 8 -
<Page>

RESOURCE PHARMACY, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL COMMUNITY SERVICES, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL CARE GIVERS, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL MANAGEMENT COMPANY, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL HOME THERAPIES, L.P.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                      - 9 -
<Page>

CHARTWELL PENNSYLVANIA, L.P.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL MIDWEST INDIANA, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL SOUTHERN NEW ENGLAND, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL ROCKY MOUNTAIN REGIONAL SERVICES

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL U.C. DAVIS HEALTH SYSTEMS, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                     - 10 -
<Page>

CHARTWELL MICHIGAN, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

NORTHWEST HOME CARE, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

INNOVA HOME THERAPIES, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL WISCONSIN ENTERPRISES, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CHARTWELL-MIDWEST WISCONSIN, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                     - 11 -
<Page>

CHARTWELL-MIDWEST WISCONSIN HEALTH
RESOURCES, LLC

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

ALBERT GALLATIN HOME CARE, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

CARECO, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

T.L.C. MIDWEST, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

T.L.C. MEDICARE SERVICES OF DADE, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                     - 12 -
<Page>

T.L.C. MEDICARE SERVICES OF BROWARD, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

TENDER LOVING CARE HOME CARE SERVICES, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

U.S. ETHICARE CORPORATION

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

U.S. ETHICARE CHAUTAUQUA CORPORATION

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

U.S. ETHICARE ERIE CORPORATION

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                     - 13 -
<Page>

U.S. ETHICARE NIAGARA CORPORATION

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

ETHICARE CERTIFIED SERVICES, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

STAFF BUILDERS, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

S.B.H.F., INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

STAFF BUILDERS SERVICES, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                     - 14 -
<Page>

STAFF BUILDERS HOME HEALTH CARE, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

STAFF BUILDERS INTERNATIONAL, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

A RELIABLE HOMEMAKER OF MARTIN-ST.
LUCIE COUNTY, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

ST. LUCIE HOME HEALTH AGENCY, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

T.L.C. HOME HEALTH CARE, INC.

By
   -----------------------------------
             (SIGNATURE)

Name
     ---------------------------------

Title
      --------------------------------

                                     - 15 -
<Page>

                                   SCHEDULE A

1.    The Interests initially held by the Collateral Agent shall include the
      following (other than the Interests described below as "Uncertificated"):

<Table>
<Caption>
                       MED SUBSIDIARY                                     PLEDGED INTEREST
-------------------------------------------------                 -------------------------------------------
<S>                                                                <C>
Trestle Corporation                                                          2,800,000 shares of common stock
Resource Pharmacy, Inc.                                                          1,000 shares of common stock
Chartwell Diversified Services, Inc.                                             1,000 shares of common stock
Chartwell Community Services, Inc.                                                 100 shares of common stock
Chartwell Care Givers, Inc.                                                        100 shares of common stock
Chartwell Management Company, Inc.                                                 100 shares of common stock
Chartwell Home Therapies, L.P.                                     All Partnership Interests (Uncertificated)
Chartwell Pennsylvania, L.P.                                        All Membership Interests (Uncertificated)
Chartwell Midwest Indiana, LLC                                      All Membership Interests (Uncertificated)
Chartwell Southern New England, LLC                                 All Membership Interests (Uncertificated)
Chartwell Rocky Mountain Region                                     All Membership Interests (Uncertificated)
Chartwell U.C. Davis Health Systems, LLC                            All Membership Interests (Uncertificated)
Chartwell Michigan, LLC                                             All Membership Interests (Uncertificated)
Northwest Home Care, LLC                                            All Membership Interests (Uncertificated)
Innova Home Therapies, LLC                                          All Membership Interests (Uncertificated)
Chartwell Wisconsin Enterprises, LLC                                All Membership Interests (Uncertificated)
Chartwell-Midwest Wisconsin Health Resources, LLC                   All Membership Interests (Uncertificated)
Tender Loving Care Health Care Services, Inc.                                5,000,000 shares of common stock
Albert Gallatin Home Care, Inc.                                                  1,000 shares of common stock
Careco, Inc.                                                                       100 shares of common stock
T.L.C. Midwest, Inc.                                                             1,000 shares of common stock
T.L.C. Home Health Care, Inc.                                                      100 shares of common stock
T.L.C. Medicare Services of Dade, Inc.                                             500 shares of common stock
T.L.C. Medicare Services of Broward, Inc.                                          500 shares of common stock
Tender Loving Care Home Care Services, Inc.                                        100 shares of common stock
U.S. Ethicare Corporation                                                          100 shares of common stock
U.S. Ethicare Chautauqua Corporation                                               500 shares of common stock
U.S. Ethicare Erie Corporation                                                     500 shares of common stock
U.S. Ethicare Niagara Corporation                                                  500 shares of common stock
Ethicare Certified Services, Inc.                                                  100 shares of common stock
Staff Builders, Inc.                                                               100 shares of common stock
S.B.H.F., Inc.                                                                     100 shares of common stock
Staff Builders Services, Inc.                                                      100 shares of common stock
Staff Builders Home Health Care, Inc.                                              100 shares of common stock
Staff Builders International, Inc.                                                 100 shares of common stock
St. Lucie Home Health Agency, Inc.                                                 500 shares of common stock
A Reliable Homemaker of Martin-St. Lucie County, Inc.                            1,000 shares of common stock
</Table>

      In addition, the Collateral Agent shall hold any other Interests from time
      to time hereafter pledged to Secured Party pursuant to the Med
      Subsidiaries Pledge and Security Agreement and delivered to the Collateral
      Agent. The Collateral Agent shall, however, have no obligation to solicit
      the delivery of any Interests to the Collateral Agent.

2.    Each of the Secured Party, the Pledgors and the Collateral Agent
      acknowledge and agree that (a) the Interests held by the Collateral Agent
      hereunder are restricted securities

                                     - 16 -
<Page>

      evidencing ownership interests in privately-held entities which are
      subsidiaries of Med and, as such, are illiquid assets not readily amenable
      to valuation; (b) in the ordinary course of business under this Collateral
      Agency Agreement, it is not expected that the Interests will be converted
      into anything other than such restricted securities evidencing ownership
      interests in privately-held entities, and (c) in the event the Interest
      should be converted (including without limitation in any merger,
      consolidation, reorganization or similar transaction) into different
      securities or assets, the Collateral Agent shall, except as expressly
      instructed by the Secured Party, hold such different securities or assets
      as Interests hereunder in whatever form they come to the Collateral Agent.

3.    The Collateral Agent shall invest and reinvest any moneys and funds in the
      Account solely in the Citibank Custody Institutional Market Deposit
      Account, a dollar-for-dollar interest-bearing deposit obligation of
      Citibank, N.A., FDIC insured up to $100,000, unless such investment is
      changed from time to time thereafter as the Secured Party shall direct the
      Collateral Agent in a written instruction signed by an authorized person
      of the Secured Party, notwithstanding that (A) the Collateral Agent or an
      affiliate of the Collateral Agent charges and collects fees and expenses
      from such fund for services rendered (provided that such charges, fees and
      expenses are on terms consistent with terms negotiated at arm's length)
      and (B) the Collateral Agent charges and collects fees and expenses for
      services rendered pursuant to this Agreement. Neither the Collateral Agent
      nor any of its affiliates shall be required to Account for any profits or
      benefits received for services described in clause (A) or (B) above.
      Neither the Collateral Agent nor any of its affiliates assume any duty or
      liability for monitoring the rating of the selected investment. The
      Collateral Agent shall have no responsibility for any investment losses
      resulting from the investment, reinvestment or liquidation of the
      Interests on deposit in the Account, provided that the Collateral Agent
      has made such investment, reinvestment or liquidation of the funds on
      deposit in the Account in accordance with the terms, and subject to the
      conditions, of this Collateral Agency Agreement. The investment(s) in
      which the moneys on deposit in the Account are invested from time to time
      may be held by the Collateral Agent directly or through any clearing
      agency or depository (collectively, the "Clearing Agency") including the
      Federal Reserve/Treasury Book-Entry System for United States and federal
      agency securities, and the Depository Trust Company. The Collateral Agent
      shall not have any responsibility or liability for the actions or
      omissions to act on the part of any Clearing Agency. Any investment
      direction contained herein may be executed through an affiliated broker or
      dealer of the Collateral Agent and such broker or dealer shall be entitled
      to its usual and customary fee. The Collateral Agent shall have no
      obligation to invest or reinvest any portion of the Account on the day of
      the deposit if such funds are deposited with the Collateral Agent after
      11:00 a.m. (New York time) on such day. In such event, the Collateral
      Agent shall invest or reinvest such funds no later than the close of
      business on the following business day in New York. Instructions to invest
      or reinvest that are received after 11:00 a.m. (New York time) will be
      treated as if received on the following business day in New York.

4.    The Collateral Agent shall hold any distributions made or income earned on
      the Interests during the term of this Collateral Agency Agreement in the
      Account, and any distributions, interest accruing on, and other earnings
      on investment of, the Interests shall be deemed to be a part of the
      Interests, and Med shall be liable for taxes thereon.

                                     - 17 -
<Page>

      Any loss or expense incurred as a result of an investment will be borne by
      the Interests. The parties recognize and agree that the Collateral Agent
      will not provide supervision, recommendations or advice relating to either
      the investment of the Interests or the purchase, sale, retention or other
      disposition of any investment. The Collateral Agent is hereby authorized
      to execute purchases and sales of investments as permitted hereunder
      through the facilities of its own trading or capital markets operations or
      those of any affiliated entity.

5.    If Secured Party delivers to Collateral Agent a written notice signed by
      an authorized person of the Secured Party that there is an "Event of
      Default" under the Amendment Agreement or under the Med Subsidiaries
      Pledge and Security Agreement, subject to the other provisions of this
      Collateral Agency Agreement, Collateral Agent shall thereafter follow
      Secured Party's written directions with respect to the Interests and
      Secured Party's rights therein, including without limitation Secured
      Party's directions regarding foreclosure upon or the exercise of any other
      rights or remedies of Secured Party with respect to such Interests.

                                     - 18 -
<Page>

                                   SCHEDULE B

Unless otherwise set forth herein, all capitalized terms used but not otherwise
defined herein shall have the meaning given to such terms in the Collateral
Agency Agreement. All terms and conditions of the Collateral Agency Agreement
are incorporated herein by reference.

APPOINTMENT & ACCEPTANCE OF COLLATERAL AGENT. Each of the parties hereto hereby
appoints Citibank, N.A. as the Collateral Agent for the Interests (as
hereinafter defined) and directs Citibank, N.A., as the Collateral Agent, to
open and maintain the Account, in each case upon the terms and conditions set
forth in the Collateral Agency Agreement. Citibank, N.A. hereby accepts such
appointment as the Collateral Agent for the Interests and agrees to open and
maintain the Account and to act as the Collateral Agent for the Interests, in
each case upon the terms and conditions set forth in the Collateral Agency
Agreement.

AUTHORIZED PERSON. Each of the parties hereto hereby designates each of the
persons identified in SCHEDULE C or D hereto (as applicable), and shall from
time to time hereafter designate one or more persons in writing, as persons
authorized to act on its behalf with respect to the Interests and the Collateral
Agency Agreement, including, without limitation, instructions to designate
additional or substitute persons authorized to so act.

DISTRIBUTION. The Collateral Agent shall distribute the Interests solely in
accordance with written instructions, signed by an authorized person of the
Secured Party, as soon as practicable upon receipt of such instructions
(together with any necessary stock or bond powers or similarly necessary
transfer documentation). The parties hereto agree that the Collateral Agent
shall incur no liability for any acts or omissions made in accordance with the
signed instructions of the Secured Party.

EXCLUSIVE BENEFIT; ASSIGNMENT. Except as specifically set forth in the
Collateral Agency Agreement, the Collateral Agency Agreement is for the
exclusive benefit of the parties hereto and their respective permitted
successors hereunder, and shall not be deemed to give, either expressly or
implicitly, any legal or equitable right, remedy, or claim to any other entity
or person whatsoever. No party may assign any of its rights or obligations under
the Collateral Agency Agreement without the prior written consent of the other
parties except that the Collateral Agent may resign upon the terms described
herein.

CORPORATE ACTIONS. The Collateral Agent does not, and shall not be deemed to,
assume any responsibility to monitor any corporate actions affecting the
Interests. The Collateral Agent shall have no responsibility and shall not be
liable for ascertaining or acting upon any calls, conversions, exchange offers,
tenders, interest rate changes, or similar matters relating to the Interests
unless the Collateral Agent shall have received actual and timely notice of the
same. The Collateral Agent does not, and shall not be deemed to, assume any
responsibility or incur any liability for any act or omission to act with
respect to any discretionary corporate action affecting the Interests. In the
event the Collateral Agent receives notice of any discretionary corporate action
in respect of the Interests, including, without limitation, the solicitation of
a vote or consent in respect of the Interests, the Collateral Agent shall
request written instructions from the person identified in SCHEDULE C or D (as
applicable) to give instructions in respect of discretionary corporate actions
and shall use commercially

                                     - 19 -
<Page>

reasonable efforts to act upon such instructions. In the absence of such
instructions, the Collateral Agent shall not be obligated to take any action in
respect of the discretionary corporate action affecting the Interests.

USE OF NAME. No printed or other material for publication or general
distribution in any language, including prospectuses, notices, reports, and
promotional material which mentions "Citibank" by name or the rights, powers, or
duties of the Collateral Agent under the Collateral Agency Agreement shall be
issued by any other parties hereto, or on such party's behalf, without the prior
written consent of the Collateral Agent.

FORCE MAJEURE. The Collateral Agent shall not incur any liability for not
performing any act or fulfilling any obligation hereunder by reason of any
occurrence beyond its control (including, but not limited to, any provision of
any present or future law or regulation or any act of any governmental
authority, any act of God or war or terrorism, or the unavailability of the
Federal Reserve Bank wire services or any electronic communication facility).

SEVERABILITY. The invalidity, illegality or unenforceability of any provision of
the Collateral Agency Agreement shall in no way affect the validity, legality or
enforceability of any other provision. If any provision of the Collateral Agency
Agreement is held to be unenforceable as a matter of law, the other provisions
shall not be affected thereby and shall remain in full force and effect.

REPRESENTATIONS & WARRANTIES. Each of the parties hereto hereby represents and
warrants that (i) the Collateral Agency Agreement has been duly authorized,
executed and delivered on its behalf by a person thereunto duly and validly
authorized and constitutes its legal, valid and binding obligation, and (ii) the
execution and delivery of, and the performance of its obligations under, the
Collateral Agency Agreement do not violate any law or regulation applicable to
it.

LIMITATION ON LIABILITY. The Collateral Agent shall not be liable for any action
taken or omitted or for any loss or injury resulting from its actions or its
performance or lack of performance of its duties hereunder in the absence of
gross negligence or willful misconduct on its part as adjudicated by a court of
competent jurisdiction. The Collateral Agent is authorized to act, and shall not
be liable for acting, in reliance upon any judgment, order, instruction, notice,
certification, demand, consent, authorization, receipt, power of attorney or
other writing delivered to it by any other party without being required to
determine the authenticity or validity thereof, the correctness of any fact
stated therein, the propriety or validity of the service thereof, or the
jurisdiction of the court issuing any judgement or order. The Collateral Agent
may act in reliance upon any signature believed by it to be genuine and may
assume that such person has been properly authorized to do so. The Collateral
Agent shall not be liable (i) for the acts or omissions of any nominees,
correspondents, designees, agents, subagents or subcustodians, (ii) for the
investment or reinvestment of any funds in the Account held by it hereunder, in
each case in good faith, in accordance with the terms hereof, including without
limitation any liability for any delays (not resulting from its gross negligence
or willful misconduct as adjudicated by a court of competent jurisdiction) in
the investment or reinvestment of said funds in the Account, or any loss of
interest incident to any such delays, or (iii) for an amount in excess of the
value of the Interests, valued as of the date of deposit, but only to the extent
of direct monetary damages.

                                     - 20 -
<Page>

NOTICES. Any notice or other communication required or permitted under the
Collateral Agency Agreement shall be deemed to have been duly given (i) five (5)
business days following deposit in the mails if sent by registered or certified
mail, postage prepaid, (ii) when sent, if sent by facsimile transmission, if
receipt thereof is confirmed by successful transmission, (iii) when delivered,
if delivered personally to the intended recipient and (iv) three (3) business
days following deposit with a nationally recognized courier service, in each
case addressed as follows:

               (a) If to the Collateral Agent, to:

                    Citibank, N.A.
                    120 Broadway, 2nd Floor
                    New York, NY 10271
                    Attn.: Kerry McDonough
                    Phone: 212.804.5499
                    Facsimile: 212.804.5401

               With a copy (which shall not constitute notice) to:

                    Patterson, Belknap, Webb & Tyler LLP
                    1133 Avenue of the Americas
                    New York, NY 10036
                    Attn.: Herman H. Raspe, Esq.
                    Phone: 212.336.2301
                    Facsimile: 212.336.2222

               (b) If to Med or any other Pledgor, to:

                    Med Diversified, Inc.
                    200 Brickstone Square, Suite 403
                    Andover, Massachusetts 01810
                    Attn.: Chief Executive Officer
                    Phone: 978.323.2500
                    Facsimile: 978.656.9691

               With a copy (which shall not constitute notice) to:

                    Manatt, Phelps & Phillips LLP
                    11355 West Olympic Blvd., 10th Floor
                    Los Angeles, CA 90064
                    Attn.: Gordon M. Bava, Esq.
                    Phone: 310.312.4000
                    Facsimile: 310.312.4224

               (c) If to the Secured Party, to:

                    Private Investment Bank Limited
                    Devonshire House
                    Queen Street

                                     - 21 -
<Page>

                    P.O. Box N-3918
                    Attn.: Chairman or General Manager
                    Phone: 242.302.5950
                    Facsimile: 242.302.5970

               With a copy (which shall not constitute notice) to:

                    Irell & Manella LLP
                    1800 Avenue of the Stars, Suite 900
                    Los Angeles, CA 90067
                    Attn.: Eric A. Webber, Esq.
                    Phone: 310.277.1010
                    Facsimile: 310.203.7623

or to such other address as any party may have furnished to the other parties in
writing in accordance with this paragraph.

ENTIRE AGREEMENT; KNOWLEDGE. Except as otherwise specifically set forth herein,
the Collateral Agency Agreement supersedes all prior oral or written agreements
or understandings in respect of the subject matter hereof. The Collateral Agency
Agreement sets forth the entire understanding of the parties with respect to the
Collateral Agent's duties and obligations regarding the Interests and the
Account, and no duties or obligations shall be implied from the terms of the
Collateral Agency Agreement or any other agreement, instrument or document
referenced herein. Notwithstanding anything else contained in this Collateral
Agency Agreement, the Collateral Agent shall neither be responsible for or
under, nor chargeable with knowledge of the existence, the content, or the terms
and conditions of, any other agreement, instrument or document, whether or not
referenced herein. The Collateral Agent shall not be attributed with any
knowledge or information that any other department or division of Citibank, N.A.
or any of Citibank, N.A.'s affiliates may have from time to time.

TERMINATION. The Collateral Agency Agreement shall terminate upon the earlier of
(a) the distribution of all Interests from the Account established hereunder in
accordance with the terms, and subject to the conditions, of the Collateral
Agency Agreement, and (b) a written notice to the Collateral Agent signed by an
authorized person of the Secured Party that this Collateral Agency Agreement is
terminated.

                                     - 22 -
<Page>

                                   SCHEDULE C

            INCUMBENCY CERTIFICATE OF PRIVATE INVESTMENT BANK LIMITED

The undersigned certifies that he is the Chairman of Private Investment Bank
Limited, a Bahamas bank and trust company (the "Company"), and as such s/he is
authorized to execute this Certificate and further certifies that the following
persons have been elected or appointed, are qualified, and are now acting as
officers of the Company in the capacity or capacities indicated below, and that
the signatures set forth opposite their respective names are their true and
genuine signatures. He further certifies that any of the persons listed below
are authorized, individually, to sign agreements and give written instructions
with regard to any matters pertaining to the Collateral Agency Agreement, dated
August __, 2002:

<Table>
<Caption>
Name                   Title             Phone          Signature
----                   -----             -----          ---------
<S>                    <C>               <C>            <C>
Francois Rouge         Chairman          242.302.5950
Jean-Francois Furrer   Director          242.302.5950
Bruno Duenki           General Manager   242.302.5950
</Table>

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal
of the Company this _____ day of August, 2002.

                                      -----------------------------
                                      Name: John F. Watts
                                      Title: Director & Secretary

      Call Back Authorized Individuals:

      The below listed persons (must list at least two individuals) have been
      designated Call Back Authorized Individuals of the Company and will be
      notified by Citibank, N.A. upon the release of any Interests from the
      account unless an original "Standing or Predefined Instruction" letter is
      on file with Citibank, N.A.

<Table>
<Caption>
Name                Phone
----                -----
<S>                 <C>
Francois Rouge      242.302.5950
Bruno Duenki        242.302.5950
</Table>

                                     - 23 -
<Page>

                                   SCHEDULE D

                 INCUMBENCY CERTIFICATE OF MED DIVERSIFIED, INC.

The undersigned certifies that s/he is the [INSERT TITLE] of Med Diversified,
Inc., a Nevada corporation (the "Company"), and as such s/he is authorized to
execute this Certificate and further certifies that the following persons have
been elected or appointed, are qualified, and are now acting as officers of the
Company in the capacity or capacities indicated below, and that the signatures
set forth opposite their respective names are their true and genuine signatures.
S/he further certifies that any of the persons listed below [is/are] authorized
[please choose one] [individually or jointly] to sign agreements and give
written instructions with regard to any matters pertaining to the Collateral
Agency Agreement, dated [DATE]:

<Table>
<Caption>
Name                   Title             Phone          Signature
----                   -----             -----          ---------
<S>                    <C>               <C>            <C>

</Table>

IN WITNESS WHEREOF, I have hereunto set my hand and affixed the corporate seal
of the Company this __ day of August, 2002

                                          [SIGNED BY SOMEONE WHOSE NAME
                                          IS NOT INCLUDED IN THE ABOVE LIST]

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

      Call Back Authorized Individuals:

      The below listed persons (must list at least two individuals) have been
      designated Call Back Authorized Individuals of the Company and will be
      notified by Citibank, N.A. upon the release of any Interests from the
      account unless an original "Standing or Predefined Instruction" letter is
      on file with Citibank, N.A.

<Table>
<Caption>
Name                Phone
----                -----
<S>                 <C>

</Table>

6.

                                     - 24 -
<Page>

                                   SCHEDULE E

                                 FEES AND COSTS

                                   [ATTACHED]

                                     - 25 -
<Page>

                                                                 [CITIBANK LOGO]

                                   SCHEDULE E

                        SCHEDULE OF FEES FOR SERVICES AS

                                COLLATERAL AGENT

                      FOR PRIVATE INVESTMENT BANK LIMITED &

                              MED DIVERSIFIED, INC.

                                 AUGUST 13, 2002
ACCEPTANCE FEE

To cover the acceptance of the Escrow Agency appointment, the study of the
Escrow Agreement, and supporting documents submitted in connection with the
execution and delivery thereof, communication with other members of the working
group:

      WAIVED

ANNUAL ADMINISTRATION FEE

To cover maintenance of accounts including safekeeping of assets, normal
administrative functions of the Escrow Agent, including maintenance of the
Escrow Agent's records, follow-up of the Escrow Agreement's provisions, and any
other duties required by the Escrow Agent under the terms of the Escrow
Agreement:

      $12,500 PER ANNUM (OR ANY PART OF A YEAR THEREOF)

TRANSACTION FEE

      WAIVED              (CONDITIONAL UPON COLLATERAL FUNDS INVESTED IN THE
                          CITIBANK INSTITUTIONAL MARKET DEPOSIT ACCOUNT AS
                          APPLICABLE)

LEGAL FEE

To cover review of legal documents by Citibank's outside counsel on behalf of
Citigroup's Private Bank Custody & Advisor Services:

INITIAL REVIEW OF THE COLLATERAL AGENCY AGREEMENT $5,000 (ESTIMATE) +
DISBURSEMENTS, PENDING ENSUING NEGOTIATIONS

<Page>

                                                                 [CITIBANK LOGO]
OTHER FEES

      $2,500 per amendment when necessary

ASSUMPTIONS:

-  Funds deposited in the Collateral Account to be invested in the Citibank
   Institutional Market Deposit Account (as applicable).
================================================================================
The above schedule of fees does not include charges for out-of-pocket expenses
or for any services of an extraordinary nature that we or our legal counsel may
be called upon from time to time to perform in either an agency or fiduciary
capacity, nor does it include the fees of our legal counsel. Fees are also
subject to satisfactory review of the documentation, and we reserve the right to
modify them should the characteristics of the transaction change. Our
participation in this program is subject to internal approval of the third party
depositing monies into the escrow account. The acceptance fee is payable upon
execution of the documents. Should this schedule of fees be accepted and agreed
upon and work commenced on this program but subsequently halted and the program
is not brought to market, the Acceptance Fee and legal fees incurred, if any,
will still be payable in full. This Fee Schedule is offered for, and applicable
to the program cited on page one only, and is guaranteed for thirty calendar
days from the date on this proposal. After thirty calendar days, this offer can
be extended in writing only by an authorized representative of Citibank, N.A.

Agreed and Accepted:
AUTHORIZED REPRESENTATIVE FOR MED
DIVERSIFIED

---------------------------------
           (Signature)

---------------------------------
    (Print Name/Company Name)

---------------------------------
            (Title)

---------------------------------
            (Date)

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00042-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00042-of-00352.parquet"}]]