Document:

KEY EMPLOYEE INCENTIVE COMPENSATION PLAN

                         Penn-America Insurance Company
                                   Hatboro, PA

                            Effective January 1, 2001

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                         Penn-America Insurance Company
                    KEY EMPLOYEE INCENTIVE COMPENSATION PLAN

                                Plan Description

I.   Compensation Philosophy

     Penn-America Insurance Company ("Penn-America" or the "Company") wishes to
     provide a comprehensive, competitive compensation program for its
     management and professional personnel. The Key Employee Incentive
     Compensation Plan (the "Plan") is intended to be an integral part of the
     total compensation opportunity offered by the Company to its key employees.
     The Plan is an adjunct, not an offset, to other forms of compensation
     provided by Penn-America.

II.  Plan Purposes

     The purposes of the Plan are two-fold: to foster achievement of corporate
     performance objectives and to recognize participants' contributions to
     corporate success. Participating employees realize current operating period
     and longer-term incentive awards when their collective performances result
     in attainment of pre-determined Company goals for growth, profitability,
     and efficiency.

     While performance-based variable compensation is intended to be an ongoing
     element of key employee compensation, the Plan as constituted herein is
     intended to operate for calendar years 2001 through 2003 only.

III. Participation

     Participation in the Plan is open to any employee of Penn-America deemed to
     have significant impact on the business and a high potential for long-term
     professional growth within the Penn-America organization. Typically,
     participation will be limited to those senior level positions (managers and
     individual contributors) who have broad responsibilities for product line
     management, revenue generation, client relationship management, support
     system management, or project management responsibilities, and have
     demonstrated their ability to contribute to the business over time.

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     The President of Penn-America will, at his discretion, recommend employees
     for participation to the Board of Directors of Penn-America's parent,
     Penn-America Group, Inc. ("PAGI") which, through its Compensation and Stock
     Option Committee (the "Committee"), is responsible for the operation of the
     Plan. Once selected, participation is intended to be on going, but is not
     guaranteed. Changes in organizational responsibilities and/or personal
     performance levels may affect individual future participation.

     Officers and other key employees who may be considered insiders under the
     Securities Exchange Act of 1934, as amended (the "Act") will participate in
     the Plan under the same eligibility guidelines defined for all other
     participants.

IV.  Incentive Awards

     The Plan is an annual incentive program, running coincident with the
     Company's fiscal (calendar) year, providing opportunities for participants
     to earn cash and stock awards based on overall Company performance and, to
     a more limited extent, individual performance during a given operating
     period. The goal of the Plan is to be simple and predictable, yet to
     provide significant monetary incentives to participants. The Plan is
     designed to allow participants to share in the Company's success by
     providing additional annual cash compensation for participants and serving
     as a vehicle for building longer-term financial security.

V.   Establishment Criteria for Annual Incentive Awards

     Prior to the first meeting of the PAGI Board of Directors in each calendar
     year, the Committee will, after consulting with the President, adopt and
     recommend to the Board criteria which will establish for that year (i) the
     amount of compensation available under the Plan, (ii) the amount of the
     President's discretionary pool available for distribution under the Plan,
     (iii) the date during the immediately next succeeding calendar year when
     such compensation is payable (the "Payment Date"), (iv) the allocation of
     compensation payable under the Plan, (v) the individuals entitled to
     participate in the Plan, and (vi) such other matters related to the
     operation of the Plan for that year as the Committee considers appropriate
     or necessary. A copy of the criteria applicable to the current year (the
     "Key Parameters") is attached as Exhibit 1. Upon approval by the PAGI Board
     and by the Company's Board of Directors, the Key Parameters shall define
     and establish the terms of the Plan for the applicable calendar year.

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VI.  Distribution of Incentive Awards

     1.   Determination of Incentive Award

          Annually, before the payment date, the President (as to all
          participants other than himself) and the Committee (as to the
          President) will make a determination of the corporate performance
          against the criteria established under and applying all relevant
          factors outlined in the Key Parameters, and calculate the appropriate
          award for each participant.

     2.   Distribution of Incentive Award

          Subject to provisions below relating to deferred payments, all
          compensation payable under the Plan shall be paid on or before the
          Payment Date in a lump sum distribution, subject to tax withholding
          and other regular payroll deductions. Compensation payable in stock of
          PAGI (the "Stock") will be distributed for no consideration, but may
          be subject to conditions or restrictions imposed by the Committee. The
          Plan will limit securities that can be awarded annually to an amount
          not in excess of one percent of the number of shares of PAGI stock
          outstanding at the beginning of the fiscal year to which the award
          relates. As awards of securities under the Plan would be defined as
          participant-directed transactions pursuant to Section 16b-3(d)1(ii) of
          the Act, disinterested administration of the Plan is not required, nor
          is the six month holding period normally associated with grant and
          award transactions designed to meet the exemption requirements of
          Section 16 of the Act.

     3.   Active Employee Contingency

          Participants must be actively employed with the Company on the last
          day of the Plan year to qualify for receipt of an incentive award.

VII. Miscellaneous Provisions

     Decisions on all matters affecting the implementation, operation,
     continuation, modification, or termination of the Plan shall be made to the
     sole discretion of the Committee or its delegate(s). If any provision of
     this Plan is determined to be invalid or unenforceable, said invalid or
     unenforceable provision shall be deemed null and void, this Plan shall
     continue and shall be construed in all respect to the extent possible to
     fulfill the purposes of the Plan as if such invalid or unenforceable
     provision was omitted.EXHIBIT 10.18

                     SECOND AMENDMENT AND CONSENT AGREEMENT

     This Second Amendment and Consent Agreement ("Amendment") is made as of the
20th day of November, 2000 by and among the lending institutions listed in Annex
I to the Loan Agreement (as defined  below) (each a "Lender" and,  collectively,
the "Lenders"),  FLEET CAPITAL  CORPORATION,  a Rhode Island corporation with an
office at 200 Glastonbury  Boulevard,  Glastonbury,  CT 06033, as administrative
agent for Lenders  ("Agent"),  and GENTIVA  HEALTH  SERVICES,  INC.,  a Delaware
corporation  with its chief  executive  office at 3  Huntington  Quadrangle  2S,
Melville, NY 11747 ("Company"), OLSTEN HEALTH SERVICES HOLDING CORP., a Delaware
corporation  with its chief  executive  office at 3  Huntington  Quadrangle  2S,
Melville,  NY 11747 ("OHS") and each of the  SUBSIDIARY  BORROWING  CORPORATIONS
listed on the signature  pages hereto (each of Company,  OHS and each Subsidiary
Borrowing Corporation is a "Borrower" and, collectively, "Borrowers").

                                   BACKGROUND

     A.  Borrower,  Agent and Lenders are parties to a certain Loan and Security
Agreement  dated  March 13,  2000 (as it has been,  may herein or  hereafter  be
modified, amended, restated or replaced from time to time, the "Loan Agreement")
pursuant to which Borrowers  established  certain  financing  arrangements  with
Lenders.  The Loan  Agreement  and all  instruments,  documents  and  agreements
executed in  connection  therewith  or related  thereto  are  referred to herein
collectively  as the "Loan  Documents."  All  capitalized  terms  not  otherwise
defined herein shall have the meaning ascribed thereto in the Loan Agreement.

     B.  Borrowers  have  requested and Agent and Lenders have agreed to certain
modifications  and  amendments  to the Loan  Agreement  subject to the terms and
conditions of this Amendment.

     NOW, THEREFORE, with the foregoing background incorporated by reference and
made a part hereof,  and  intending to be legally  bound,  the parties  agree as
follows:

     1.  Waiver.  Borrowers  hereby  acknowledge  and  confirm  that an Event of
Default has occurred under the Loan Agreement as a result of Borrowers'  failure
to comply with the minimum  Tangible  Net Worth  covenant  contained  in Section
8.3.2 on  Schedule  8.3 of the Loan  Agreement  ("Existing  Default").  Upon the
effectiveness  of this  Amendment,  Agent  and  Lenders  shall be deemed to have
waived the Existing  Default provided that such waiver shall not be deemed to be
a waiver of any subsequent violations of the minimum Tangible Net Worth covenant
or a waiver of any other Events of Default which may have occurred but which are
not specifically referred to herein.

     2.  Amendment  to Loan  Agreement.  Section  8.3.2  of the  Loan  Agreement
contained on Schedule 8.3 of the Loan  Agreement is hereby  amended and restated
in its entirety as follows:

     8.3.2.   Minimum  Tangible  Net  Worth.   Borrowers  shall  maintain  on  a
     Consolidated   basis  a  minimum  Tangible  Net  Worth  of  not  less  than
     $325,000,000, at the end of each fiscal quarter of Borrowers, provided that
     beginning with the fiscal quarter ending March 31,

                                    1

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     2001,  this amount  shall be  permanently  increased  by an amount equal to
     fifty percent (50%) of  Borrowers'  Consolidated  Net Income (to the extent
     positive) for fiscal quarter.

     3. Representations and Warranties. Each Borrower represents and warrants as
follows:

     a) The  execution  and  delivery  by such  Borrower of this  Amendment  and
performance by such Borrower of the transactions herein contemplated (i) are and
will be within such Borrower's  corporate  powers,  (ii) have been authorized by
all  necessary  corporate  action,  and  (iii)  are  not  and  will  not  be  in
contravention of any order of any court or other agency or government, of law or
any other indenture,  agreement or undertaking to which such Borrower is a party
or by which the  property of any  Borrower is bound,  or in  conflict  with,  or
result in a breach of or  constitute  (with due notice  and/or  lapse of time) a
default  under any such  indenture,  agreement or  undertaking  or result in the
imposition of any lien,  charge or incumbrance of any nature on such Property of
any Borrower.

     b) This  Amendment  and any other  agreements,  instruments  and  documents
executed  and/or  delivered in connection  herewith shall be valid,  binding and
enforceable against such Borrower in accordance with their respective terms.

     c) After  giving  effect to this  Amendment,  (i) the  representations  and
warranties  contained  herein,  in the Loan  Agreement  and in each  other  Loan
Document and  certificate  or other writing  delivered to Agent or Lenders on or
prior to the date  hereof  shall be correct  and  accurate on and as of the date
hereof  as though  made on and as of such date  (subject  to the  provisions  of
Section 7.2 of the Loan Agreement); and (ii) other than the Existing Default, no
Default or Event of Default has occurred and is continuing on the date hereof or
would  result from this  Amendment  becoming  effective in  accordance  with its
terms.

     d) No  authorization  or approval  or other  action by, and no notice to or
filing with, any governmental  authority or other regulatory body is required in
connection with the due execution,  delivery and performance by such Borrower of
this  Amendment or the  performance by such Borrower of the Loan  Agreement,  as
amended hereby.

     4.  Effectiveness  Conditions.  This  Amendment  shall  be  effective  upon
completion of the following  conditions  precedent  (all documents to be in form
and substance reasonably  satisfactory to Agent and Lenders and their counsel in
their sole discretion):

     a) Execution and delivery to Agent by all signatories of this Amendment;

     b) Other than the Existing  Default,  no Default or Event of Default  shall
have occurred and remain outstanding under the Existing Loan Documents;

     c)  Completion  of  Agent's   collateral  field  audit,  with  the  results
satisfactory to Agent (in its sole but reasonable business judgment); and

     d) Payment of all costs and  expenses of Agent as provided for in Section 9
below.

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     5.  Continued  Effectiveness  of the Loan and Security  Agreement  and Loan
Documents.  Each Borrower hereby (a) confirms and agrees that each Loan Document
to which it is a party is,  and shall  continue  to be, in full force and effect
and is hereby  ratified and  confirmed in all respects  except that on and after
the date  hereof  (i) all  references  in the Loan  Agreement  to "this Loan and
Security Agreement", this "Agreement",  "hereof", "hereto", "hereunder" or words
of like import  referring to the Loan Agreement,  and (ii) all references in any
other Loan Document to "the Loan and Security  Agreement," the "Loan Agreement,"
"thereto,"  "thereof,"  "thereunder,"  or words of like import  referring to the
Loan and  Security  Agreement  shall  mean the Loan and  Security  Agreement  as
amended by this  Amendment;  and (b) confirms and agrees that to the extent that
any such Loan  Document  purports  to  assign or pledge to Agent,  or to grant a
security  interest in or lien on, any collateral as security for the obligations
of Borrowers from time to time existing in respect of the Loan Agreement and the
Loan Documents is hereby ratified and confirmed in all respects.  Nothing herein
contained  is intended to in any manner  affect,  impair or limit the  validity,
priority and extent of Agent's existing  security interest in and Liens upon the
Collateral.

     6. No Waiver.  Other than as specified  herein with respect to the Existing
Default,  each  Borrower  hereby  acknowledges  and agrees that Lenders have not
waived any  Default or Event of  Default  now  existing  or  hereafter  arising.
Accordingly,  this Amendment is without prejudice to Agent and Lenders and Agent
and  Lenders  reserve all of their  rights  under the Loan  Agreement,  the Loan
Documents, at law and otherwise regarding any Default or Event of Default (other
than the Existing  Default) that may exist or hereafter arise.  Without limiting
the generality of the foregoing,  Lenders' making any future extension of credit
to Borrowers  shall not be deemed a waiver by Lenders of any of their rights and
remedies  under the Loan  Agreement and the Existing Loan  Documents and Lenders
expressly  reserve  their  right to require,  as a condition  to any such future
extension of credit,  that Borrowers  fully comply with all terms and conditions
of the Loan Agreement and the other Loan Documents as amended hereby.

     7. Amendment as Loan Document. Each Borrower hereby acknowledges and agrees
that this  Amendment  constitutes a "Loan  Document"  under the Loan  Agreement.
Accordingly, it shall be an Event of Default under the Loan Agreement if (i) any
representation  or warranty made by Borrowers  under or in connection  with this
Amendment  shall have been untrue,  false or misleading in any material  respect
when made, or (ii) Borrowers shall fail to perform or observe any term, covenant
or agreement contained in this Amendment.

     8.  Governing  Law.  This  Agreement  shall be governed by,  construed  and
enforced in accordance with the substantive laws of the State of New York.

     9.  Expenses.  Borrowers  will pay on demand all  reasonable  out-of-pocket
costs and expenses of the Agent in connection  with the  preparation,  execution
and delivery of this Amendment,  and each other  agreement or document  executed
and delivered in connection herewith.

     10.  Counterparts.  This  Amendment  may  be  executed  in  any  number  of
counterparts,  each of which when so executed shall be deemed to be an original,
and such  counterparts  together shall  constitute  one and the same  respective
agreement. Counterparts by facsimile shall bind the parties hereto.

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<PAGE>

     11. Waiver of Trial by Jury. EACH BORROWER,  THE AGENT AND EACH LENDER EACH
HEREBY IRREVOCABLY WAIVE ALL RIGHT TO TRIAL BY JURY IN ANY ACTION, PROCEEDING OR
COUNTERCLAIM  (WHETHER BASED ON CONTRACT,  TORT OR OTHERWISE)  ARISING OUT OF OR
RELATING  TO THIS  AMENDMENT  OR THE  ACTIONS OF THE AGENT OR THE LENDERS IN THE
NEGOTIATION, ADMINISTRATION, PERFORMANCE OR ENFORCEMENT HEREOF.

                          SIGNATURES ON FOLLOWING PAGES

                                       4

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                              SUBSIDIARY BORROWING
                              CORPORATIONS:

                              New York Healthcare Services, Inc.
                              OHS Service Corp.
                              Olsten Certified HealthCare Corp.
                              Olsten Health Services (Certified), Inc.
                              Olsten Health Services (Infusion), Inc.
                              Olsten Health Services (Quantum) Corp.
                              Olsten Health Services (USA), Inc.
                              Olsten Network Management, Inc.
                              Olsten Network Management (Area One) Corp.
                              Olsten Network Management (Area Two) Corp.
                              Olsten Network Management (Area Three) Corp.
                              Olsten Services of New York, Inc.
                              QC-Medi New York, Inc.
                              Quality Care - USA, Inc.
                              Quality Managed Care, Inc.
                              The I.V. Clinic, Inc.
                              The I.V. Clinic III, Inc.

                              By:  /s/ John Collura
                                   ---------------------------------------------
                                   Print Name:  John Collura
                                   Title:  Exec VP

                    {SIGNATURES CONTINUED ON FOLLOWING PAGE}

                                       S-1

<PAGE>

                            AGENT:

                            FLEET CAPITAL CORPORATION

                            By:  /s/ Frank J. Galle
                                 ------------------------------------

                            Print name:    Frank J. Galle
                                         -----------------------------

                            Title:  Senior Vice President
                                    ----------------------------------

                            LENDERS:

                            FLEET CAPITAL CORPORATION

                            By:  /s / Frank J. Galle
                                 -------------------------------------

                            Print name:    Frank J. Galle
                                         -----------------------------

                            Title:  Senior Vice President
                                    ----------------------------------

                            GMAC COMMERCIAL CREDIT LLC

                            By:  /s / Frank Imperato
                                 -----------------------------------

                            Print name:    Frank Imperato
                                         ----------------------------

                            Title:  Senior Vice President
                                    ----------------------------------

                            U.S. BANK NATIONAL ASSOCIATION

                            By:  /s/ Robert W. Josephson
                                 -----------------------------------

                            Print name:    Robert W. Josephson
                                         ----------------------------

                            Title:  Vice President
                                    ---------------------------------

                    {SIGNATURES CONTINUED ON FOLLOWING PAGE}

                                       S-1

<PAGE>

                            debis FINANCIAL SERVICES, INC.

                            By:  /s/ James M. Vandervalk
                                 -----------------------------------

                            Print name:    James M. Vandervalk
                                         ----------------------------

                            Title:  President - ABL
                                    ---------------------------------

                            DIME COMMERCIAL CORP.

                            By:  /s/ James A. Fisher
                                 -----------------------------------

                            Print name:    James A. Fisher
                                         ----------------------------

                            Title:  Senior Vice President
                                    ----------------------------------

                            IBJ WHITEHALL BUSINESS CREDIT CORPORATION

                            By:  /s/ Dan Bueno
                                 ---------------------------------

                            Print name:  Dan Bueno
                                         --------------------------

                            Title:  Assistant Vice President
                                    -----------------------------------

                            NATIONAL BANK OF CANADA

                            By:  /s/ Michael F. McIntyre /s/ Gaeteon R. Frasina
                                 -----------------------------------------------

                            Print name:  Michael F. McIntyre  Gaeton R. Frasina
                                         ---------------------------------------

                            Title:       AVP                  VP & Mgr.
                                    ----------------------------------

                            SIEMENS CREDIT CORPORATION

                            By:  /s/ Frank Amodio
                                 ---------------------------------

                            Print name:    Frank Amodio
                                         --------------------------

                            Title:  Vice President - Credit
                                    -----------------------------------

                               S-1

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