ADVANCED MEDICAL INC
SC 13D/A, 1995-12-05
SURGICAL & MEDICAL INSTRUMENTS & APPARATUS
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                                  UNITED STATES
                       SECURITIES AND EXCHANGE COMMISSION
                             Washington, D.C. 20549

                                  SCHEDULE 13D

                    Under the Securities Exchange Act of 1934
                                (Amendment No. 13)*

                             Advanced Medical, Inc.
                                (Name of Issuer)

                          Common Stock, $.01 par value
                         (Title of Class of Securities)

                                  00754 C 10 1
                                 (CUSIP Number)

                              Barry D. Shalov, Esq.
                  Gordon Altman Butowsky Weitzen Shalov & Wein
                         114 West 47th Street, 20th Floor
                             New York, New York 10036
                                 (212) 626-0800

           (Name, Address and Telephone Number of Person Authorized to
                        Receive Notices and Communications)

                                December 4, 1995
             (Date of Event which Requires Filing of this Statement)

If the filing person has previously  filed a statement on
Schedule 13G to report the  acquisition  which is the
subject of this  Schedule 13D, and is filing this schedule
because of Rule 13d-1(b)(3) or (4), check the following box
//.

Check the  following box if a fee is being paid with the
statement //. (A fee is not required only if the reporting
person:  (1) has a previous statement on file reporting 
beneficial  ownership  of more  than  five  percent  of the 
class of securities  described  in Item 1;  and (2) has 
filed  no  amendment  subsequent thereto reporting 
beneficial  ownership of five percent or less of such
class.) (See Rule 13d-7).

     NOTE: Six copies of this statement, including all
exhibits, should be filed with the  Commission.  See Rule
13d-1(a) for other parties to whom copies are to be sent.

*The  remainder of this cover page shall be filled out for a
reporting  person's initial filing on this form with respect
to the subject class of securities, and for  any  subsequent 
 amendment   containing   information  which  would  alter
disclosures provided in a prior cover page.

The information required on the remainder of this cover page
shall not be deemed to be "filed" for the purpose of Section
18 of the  Securities  Exchange  Act of 1934 ("Act") or
otherwise  subject to the liabilities of that section of the
Act but  shall be  subject  to all other  provisions  of the
Act  (however,  see the Notes).

                       Page 1 of   Pages
                   List of Exhibits is on Page

<PAGE>

                            SCHEDULE 13D

CUSIP No. 00754 C 10 1                    Page 2 of    Pages


1     NAME OF REPORTING PERSON
            Jeffry M. Picower

      S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON


2     CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*      
         See Items 2 and 6 hereof.                                  
                                                (a) /x/
                                                (b) //

3     SEC USE ONLY

4     SOURCE OF FUNDS*


5     CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO
       ITEMS 2(d) or 2(e)                           //

6     CITIZENSHIP OR PLACE OF ORGANIZATION
            United States

       NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH:

7     SOLE VOTING POWER
            2,277,764.905

8     SHARED VOTING POWER
           27,966,612.67

9     SOLE DISPOSITIVE POWER
            2,277,764.905

10    SHARED DISPOSITIVE POWER
           27,966,612.67

11    AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
            30,244,377.575

12    CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES*
             //

13    PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)     
       71.16%

14    TYPE OF REPORTING PERSON*
            IN


<PAGE>
                          SCHEDULE 13D

CUSIP No. 00754 C 10 1                   Page 3 of    Pages


1     NAME OF REPORTING PERSON
            Decisions Incorporated

      S.S. OR I.R.S. IDENTIFICATION NO. OF ABOVE PERSON


2     CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP*      
          See Items 2 and 6 hereof.                                  
                                               (a) /x/
                                               (b) //

3     SEC USE ONLY

4     SOURCE OF FUNDS*
            WC

5     CHECK BOX IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO
      ITEMS 2(d) or 2(e)                
                                                //

6     CITIZENSHIP OR PLACE OF ORGANIZATION
            Delaware

       NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH:

7     SOLE VOTING POWER
            -0-

8     SHARED VOTING POWER
           27,966,612.67

9     SOLE DISPOSITIVE POWER
            -0-

10    SHARED DISPOSITIVE POWER
           27,966,612.67

11    AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
           27,966,612.67

12    CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES*
             //

13    PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)     
       65.80%

14    TYPE OF REPORTING PERSON*
            CO



<PAGE>


                 SCHEDULE 13D - AMENDMENT NO. 9


     This statement  ("Statement")  constitutes Amendment
No. 13 to the Schedule 13D filed with the  Securities and
Exchange  Commission  (the  "Commission")  on April 7, 1989
(the  "Original  Filing"),  as amended by (i) Amendment No.
1 (the "First Amendment") filed with the Commission on June
5, 1989; (ii) Amendment No. 2 (the "Second  Amendment") 
filed with the  Commission  on May 18, 1990;  (iii)
Amendment No. 3 (the "Third  Amendment")  filed with the 
Commission on March 1, 1991; (iv) Amendment No. 4 (the
"Fourth Amendment") filed with the Commission on April 12, 
1991;  (v)  Amendment  No. 5 (the "Fifth  Amendment")  filed
with the Commission on November 27, 1991;  (vi)  Amendment
No. 6 (the "Sixth  Amendment") filed with the Commission on
April 12, 1993; (vii) Amendment No. 7 (the "Seventh
Amendment") filed with the Commission on January 4, 1994,
(viii) Amendment No. 8 (the  "Eighth  Amendment")  filed
with the  Commission  on June 29,  1994;  (ix) Amendment 
No. 9 filed  with the  Commission  on August  19,  1994 
(the  "Ninth Amendment");  (x)  Amendment  No. 10 filed with
the  Commission on September 14, 1994 (the "Tenth
Amendment"); (xi) Amendment No. 11 filed with the Commission
on October 26, 1994 (the "Eleventh  Amendment");  and (xii) 
Amendment No. 12 filed with the  Commission on February 3,
1995 (the "Twelfth  Amendment"),  concerning the  common 
stock,  par value  $.01 per share  ("Common  Stock"),  of 
Advanced Medical,  Inc., a Delaware corporation (the
"Issuer").  The Original Filing, the First  Amendment,  the
Second  Amendment and the Third  Amendment  were filed on
behalf of Jeffry M. Picower,  April C. Freilich and 
Decisions  Incorporated,  a Delaware corporation 
("Decisions").  The Fourth Amendment, the Fifth Amendment,
the  Sixth  Amendment,  Seventh  Amendment,  the  Eighth 
Amendment,  the  Ninth Amendment,  the  Tenth  Amendment, 
the  Eleventh  Amendment,  and  the  Twelfth Amendment 
were,  and this  Statement  is, filed on behalf of Mr. 
Picower,  Ms. Freilich,  Decisions  and JA Special  Limited 
Partnership,  a Delaware  limited partnership ("JA Special", 
and collectively with Mr. Picower,  Ms. Freilich and
Decisions, "Registrants").

     This Statement hereby amends the Items identified 
below, or the particular paragraphs of such Items which are
identified below, to reflect the execution of a letter
agreement between Mr. Picower and the Issuer.


<PAGE>



Item 3.     Source and Amount of Funds or Other Consideration

            Item 3 is hereby amended to add the following:

            As more fully  described in Item 4, the funds
used by Decisions  for the $25,000,000 loan to the Issuer
under the Note (as hereinafter  defined) were derived from
the working capital of Decisions.


Item 4.     Purpose of the Transaction

            Item 4 is hereby amended to add the following:

            On October 12, 1995,  Decisions  Incorporated, 
a corporation wholly owned by Picower  ("Decisions") agreed
to lend and on December 4, 1995 loaned to the Issuer the
principal amount of $25,000,000  (the "Loan"),  and, in
exchange, the Issuer issued to Decisions a promissory  note
(the "Note"),  a copy of which is attached hereto as Exhibit
26 and incorporated herein by reference.  The Note provides, 
among other things, that: (i) interest on the principal
amount of the Loan shall  accrue at a rate of 7% per annum; 
(ii)  interest  on the  principal amount of the $25,000,000 
Note shall be due and payable on October 11, 1996 and
thereafter on June 30 and December 31 of each  calendar 
year;  (iii)  principal (together with accrued and unpaid
interest  thereon) shall be payable on January 4, 2001; 
(iv) the  Issuer's  obligations  under the  $25,000,000 
Note shall be secured  by a  first  priority  security 
interest  in all of the  Corporation's assets,  subject to
certain senior liens previously  granted to General Electric
Capital Corporation  ("GECC"),  provided,  however,  that
until such time as the Issuer has obtained GECC's consent, 
the first priority  security  interest will not  apply  to 
assets  of the  Issuer  on which  GECC  has a lien;  and (v)
the principal  portion of the $25,000,000  Note may be, at
the option of the holder, converted into up to 9,523,809 
shares of the  Corporation's  common stock,  par value  $.01
per share,  at a  conversion  price of $2.625 per share, 
subject to anti-dilution protection, which was the closing
price of the Common Stock on the day immediately prior to
the date on which Decisions agreed to provide the Loan.

      The  source of the  funds,  used by  Decisions  to
extend  the Loan to the Issuer was Decisions working
capital.


<PAGE>


Item 5.     Interest in Securities of the Issuer

            Item 5(a) is hereby amended to add the
following:

            (a) As of the close of business on December 4,
1995, Registrants may be deemed to have direct beneficial
ownership of the following amounts of Common Stock:

                                                Approximate  
                                              Percentage of
Name              Number of Shares              Outstanding
Shares(1)

Mr. Picower         2,277,764.905(2)                   5.36%


- ------------------------------- 

(1) The  percentage  of  outstanding  shares of Common Stock 
calculated is based upon the number of shares of Common
Stock  outstanding on October 13, 1995 (the "Common Stock
Outstanding")  (i.e.,  14,069,261),  as reported on the
cover page of the Issuer's  Quarterly  Report on Form 10-Q
for the fiscal period ended September 30, 1995. For purposes
of calculating  the  percentages of outstanding shares of
Common Stock owned by Mr. Picower, Decisions and JA Special
the shares of Common  Stock  issuable  upon  conversion  of
their  respective  holdings  of Convertible  Preferred 
Stock were added to the Common Stock  Outstanding.  Also
included in such calculation with respect to Decisions were
the 6,030,151 shares of Common Stock which are issuable to
Decisions upon  conversion of a promissory note owned by
Decisions (the "$6,000,000 Note"), the 10,534,846 shares of
Common Stock which are issuable to Decisions upon conversion
of a promissory note owned by Decisions (the "6,500,000 
Note"),  and the 9,523,809  shares of Common Stock which are
issuable to Decisions  upon  conversion of the Note.  

(2) For  purposes of  calculating  the number of shares of
Common  Stock of which Mr. Picower, Decisions and JA Special
are the direct beneficial owners, an additional 141,401.905
shares of Common Stock, 25,720.158 shares of Common Stock
and  115,386.513  shares of Common  Stock,  respectively, 
were included in such calculations.  Such  additional 
amounts of Common Stock are  issuable  upon the conversion 
by  such  persons  of  their  respective  holdings  of the 
Issuer's convertible  preferred stock, par value $.01 per
share  ("Convertible  Preferred Stock").  Also included in
such  calculation  with respect to Decisions were the
6,030,151 shares of Common Stock which are issuable to
Decisions upon conversion the $6,000,000 Note, the
10,534,846 shares of Common Stock which are issuable to
Decisions upon  conversion of the 6,500,000  Note,  and the
9,523,809  shares of Common Stock which are issuable to
Decisions upon conversion of the Note.


<PAGE>


Decisions            27,494,125.1582                  64.69%
JA Special              472,487.5132                   1.11%
Ms. Freilich                1,000                    less than 0.1%

            Mr. Picower may, by virtue of his controlling 
shareholder  interest in Decisions and his position as the
sole  director of  Decisions,  be deemed to beneficially own
(as contemplated by Rule 13d-3 ("Rule 13d-3") promulgated
under the  Securities  Exchange Act of 1934, as amended) the
shares of Common Stock of which Decisions and JA Special
possess direct beneficial ownership. Ms. Freilich may,  by 
virtue  of her  position  as  President  of  Decisions,  be 
deemed to beneficially  own (as  contemplated by Rule 13d-3)
the shares of Common Stock of which Decisions and JA Special
possess direct  beneficial  ownership.  Decisions may,  by
virtue of its  position  as general  partner of JA Special
be deemed to beneficially  own (as  contemplated by Rule
13d-3) the shares of Common Stock of which JA  Special 
possesses  direct  beneficial  ownership.  Mr.  Picower, 
Ms. Freilich  and  Decisions  disclaim  beneficial 
ownership of such shares for all other purposes.


Item 6.     Contracts, Arrangements, Understandings
            or Relationships With Respect to
            Securities of the Issuer

            Item 6 is hereby amended to add the following:

            As more fully  described  in Item 4, the  Issuer 
issued the Note to Decisions.


Item 7.  Material to be Filed as Exhibits

Exhibit 26.       Promissory Note dated as of              At Page ___
                  October 12, 1995, issued to
                  Decisions.

<PAGE>

                                   SIGNATURES

     After  reasonable  inquiry and to the best of my 
knowledge  and belief,  I certify that the information  set
forth in this statement is true,  complete and correct.

Dated:  December 4, 1995



                                    /s/  Jeffry M. Picower   
                                       Jeffry M. Picower



                                    /s/  April C. Freilich   
                                       April C. Freilich


                                    DECISIONS INCORPORATED



                                    By: /s/ April C. Freilich
                                           April C. Freilich
                                           President


                                    JA SPECIAL LIMITED PARTNERSHIP


                                    By:  Decisions Incorporated
                                          General Partner


                                    By: /s/ April C. Freilich
                                           April C. Freilich
                                           President



<PAGE>




     This Note and any shares  acquired  upon the exercise of this Note have not
been  registered  under the Securities  Act of 1933, as amended,  and may not be
transferred,  sold or otherwise  disposed of except while such a registration is
in effect or pursuant to an exemption from registration under said Act.


                                 PROMISSORY NOTE


$25,000,000                                              As of October 12, 1995
                                                              New York, New York




     FOR VALUE RECEIVED,  the undersigned,  Advanced  Medical,  Inc., a Delaware
corporation (the "Company"), hereby promises to pay to Decisions Incorporated, a
Delaware  corporation  (the  "Noteholder"),  the  principal  sum of Twenty  Five
Million  ($25,000,000)  Dollars, with interest on the unpaid balance hereof from
December 4, 1995 (the "Funding  Date") at a rate of seven (7%) percent per annum
compounded  semi-annually (the "Interest Rate"). The principal amount hereof and
all  accrued  and  unpaid  interest  thereon  shall be due and  payable at noon,
Eastern  Standard  Time,  on  January 4, 2001,  and all the  accrued  and unpaid
interest  under the Note shall be due and payable in arrears on October 11, 1996
and  thereafter  on the 30th day of June  and the 31st day of  December  of each
calendar year.

     Both  principal  and  interest  shall be paid in lawful money of the United
States of America to the  Noteholder  at the  address  set forth in Section  6.4
hereof or at such other address as the Noteholder  shall  designate by notice in
writing to the Company, in immediately available funds.

     This Note may not be prepaid at any time (except that principal  under this
Note shall be reduced from time to time as contemplated in Article V hereof).

     In the event that the Company  fails to pay the  principal  under this Note
when due,  interest or deemed interest on the entire unpaid balance of this Note
from the due date of such unpaid  principal until payment is made, shall (to the
extent  legally  enforceable)  accrue  at a rate  of 15%  per  annum  compounded
annually (the "Late Rate") and shall be payable on demand.

     In the event the Late Rate or the Interest Rate exceeds the maximum rate of
interest permitted by applicable law, the Late Rate or the Interest Rate, as the
case may be, shall be reduced to the maximum rate  permitted by applicable  law.
Nothing herein or in any other document related to this Note or the indebtedness
evidenced hereby ("Related Document") shall entitle the Noteholder


<PAGE>



to collect  interest in excess of the maximum  interest  permitted by applicable
law (the "Legal  Maximum"),  and nothing herein or in any Related Document shall
obligate  the  Company to pay  interest in excess of the Legal  Maximum.  If any
interest is charged in excess of the Legal Maximum,  any such charge will result
from bona fide error,  and the excess amount shall be applied or credited to the
indebtedness  of the  Company  hereunder  or returned  to the  Company.  For the
purpose of determining whether any excess amount of interest has been contracted
for, charged, or received by the Noteholder, all interest at any time contracted
for,  charged,  or received by the Noteholder in connection with this Note shall
be amortized,  prorated,  allocated, and spread in equal parts during the entire
term of this Note. The terms of this paragraph  shall govern in the event of any
inconsistency in any other provision of this Note or any Related Document.

     If any part of this Note is  determined  to be  illegal,  unenforceable  or
against  public  policy,  then the same shall be deemed  deleted  from this Note
without affecting or impairing any other part hereof.

     The Company  agrees to reimburse  the  Noteholder,  on demand,  for (i) all
costs (including reasonable attorneys' fees and disbursements actually incurred)
in  connection  with  the  enforcement  of this  Note by the  Noteholder  or the
protection  of the  rights  of the  Noteholder  hereunder,  and (ii) all fees in
connection with any filing of a Notification and Report Form ("Hart-Scott Form")
under the  Hart-Scott-Rodino  Antitrust Improvement Act of 1976, as amended from
time to time ("Hart-Scott") as contemplated by Section 5.13 hereof.

     The Company hereby waives presentment,  demand, notice of dishonor, protest
and all other notices whatsoever.


                                    ARTICLE I

                               CERTAIN DEFINITIONS

     SECTION 1.1.  Definitions.  As used herein,  the following terms shall have
the meanings set forth below:

     "Additional  Shares of  Common  Stock"  shall  mean all  shares  (including
treasury  shares) of Common Stock issued or sold (or,  pursuant to Section 5.2.3
or 5.2.4  hereof,  deemed to be issued) by the  Company  after the date  hereof,
whether or not subsequently reacquired or retired by the Company, other than the
shares of Common Stock issued upon the exercise of the Conversion Right and



                                       -2-

<PAGE>



     other than  shares of Common  Stock  issued  upon the  exercise  of options
granted pursuant to the Company's  existing  employee or non- employee  director
Stock Option Plan and Stock  Purchase Plan, as the same may be amended from time
to time.

     "Affiliate" shall mean any first Person which,  directly or indirectly,  is
controlled by a second Person.  Control shall be deemed to exist when the second
Person  beneficially  owns,  directly or  indirectly,  the  securities  or other
interests (a) having voting power under ordinary circumstances to elect at least
a majority of the directors  (or persons  performing  similar  functions) of the
first  Person or (b)  representing  a majority  in interest of the equity of the
first Person.

     "Book  Value"  shall mean,  in respect of any share of Common  Stock on any
date herein specified, the quotient of (a) the amount by which (i) the Company's
consolidated  total  assets  exceeds  (ii)  the  Company's   consolidated  total
liabilities,  in each case  determined (A) as of the last day of the most recent
fiscal year of the Company  ended prior to such date,  or (B) as of the last day
of the most recent calendar month ended prior to such date, whichever is higher,
divided by (b) the number of Fully Diluted Outstanding shares of Common Stock.

     "Business  Day" shall  mean any day other than a Saturday  or a Sunday or a
day  on  which  commercial  banking  institutions  in New  York,  New  York  are
authorized by law to be closed.  Any reference to "days"  (unless  Business Days
are specified) shall mean calendar days.

     "Collateral"  shall  mean the  collateral  pledged  by the  Company  to the
Noteholder or in which the Company  granted the  Noteholder a security  interest
pursuant  to or under the  Pledge  Provision  as  security  for its  obligations
hereunder.

     "Commission" shall mean the Securities and Exchange Commission or any other
federal agency at the time administering the Securities Act.

     "Common Stock" shall mean the common stock, $.01 par value, of the Company,
such term to include  any stock into which  such  Common  Stock  shall have been
changed or any stock resulting from any  reclassification  of such Common Stock,
and all other stock of any class or classes (however  designated) of the Company
the  shareholders  of which have the  right,  without  limitation  as to amount,
either to all or to a share of the balance of current  dividends and liquidating
dividends  after the  payment  of  dividends  and  distributions  on any  shares
entitled to preference.



                                       -3-

<PAGE>




     "Company" shall mean Advanced  Medical,  Inc., and such term to include any
corporation  which  shall  succeed to or assume the  obligations  of the Company
hereunder in compliance with Section 5.3 hereof.

     "Convertible  Securities" shall mean any evidences of indebtedness,  shares
of stock (other than Common  Stock) or other  securities  directly or indirectly
convertible into or exchangeable for Additional Shares of Common Stock.

     "Current Market Price" shall mean on any date specified herein, the average
daily Market Price during the period of the most recent 20 days,  ending on such
date, on which the national securities  exchanges were open for trading,  except
that if no class of the Common  Stock is then  listed or  admitted to trading on
any national securities exchange or quoted in the  over-the-counter  market, the
Current Market Price shall be the Market Price on such date; provided,  however,
that  in the  event  that  the  Company  has  entered  into  a  firm  commitment
underwriting agreement with an underwriter (i) pursuant to which the Company and
such  underwriter have determined an offering price for the sale of Common Stock
in a public offering as a result of arms length  negotiations  within the 20 day
period  described  above or (ii) relating to the public  offering of Convertible
Securities  then,  in the case of (i),  the  Current  Market  Price of shares of
Common  Stock  issued and sold in such public  offering  shall be such  offering
price and in the case of (ii),  the Current  Market  Price shall be the lower of
Current Market Price or Market Price on the date immediately  preceding the date
the offering price of such  Convertible  Securities was determined in connection
with the  filing  of the  Registration  Statement  which is  declared  effective
covering such Convertible Securities filed pursuant to the Securities Act.

     "Decisions  Notes" shall mean the principal of, premium (if any),  interest
on and any other  amounts due in respect of all  Indebtedness  of the Company to
Decisions Incorporated  ("Decisions") which is the subject of (i) the Promissory
Note  dated as of January 4, 1994 ( as amended  and  modified  through  the date
hereof),  between  the  Company  and  Decisions,  in  the  principal  amount  of
$6,000,000, and (ii) the Promissory Note dated as of August 12, 1994 (as amended
and modified through the date hereof), between the Company and Decisions, in the
principal  amount of  $6,500,000,  in each case as the same may be modified  and
amended by agreement of the Company and  Decisions  from time to time,  provided
that the principal amount of such Indebtedness  shall not exceed the outstanding
principal amount thereof immediately prior to such amendment or modification.




                                       -4-

<PAGE>



     "Debentures"  shall  mean the  Company's  7-1/4%  Subordinated  Convertible
Debentures due 2002 and the Company's 15% Subordinated Debentures due 1999.

     "Debenture  Notes"  shall mean  those  notes  issued to the  holders of the
Company's 7-1/4% Subordinated  Convertible  Debentures due 2002 in consideration
of the conversion by such holders of the Company's 7-1/4% Subordinated
Convertible Debentures due 2002 held by them.

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

     "Fidata  Reorganization  Event"  shall  mean the  occurrence  of any  event
contemplated in clause (1) through (5) of Section 4.1(e) hereof, with respect to
Fidata  Trust  Company  New York or any  other  immaterial  direct  or  indirect
subsidiary of Fidata Corporation.

     "Fully Diluted Outstanding" when used with reference to Common Stock, shall
mean at any date as of which the number of shares  thereof is to be  determined,
all  shares of Common  Stock  outstanding  at such date and all shares of Common
Stock issuable in respect of the Conversion Right on such date and other options
or warrants to purchase, or securities  convertible into, shares of Common Stock
outstanding on such date which would be deemed  outstanding  in accordance  with
generally  accepted  accounting  principles  as from time to time in effect  for
purposes of deeming book value or net income per share.

     "GECC Loan Agreement" shall mean the Loan Agreement, dated August 12, 1994,
between IMED  Corporation  ("IMED")  and General  Electric  Capital  Corporation
("GECC").

     "GECC  1994  Intercreditor   Agreement"  shall  mean  the  inter-  creditor
agreement dated as of August 12, 1994, between the Initial Noteholder and GECC.

     "Indebtedness"  shall mean all debt for borrowed money and similar monetary
obligations evidenced by bonds, notes, debentures, capitalized lease obligations
or otherwise.

     "Initial  Noteholder"  shall  mean  Decisions   Incorporated,   a  Delaware
corporation.




                                       -5-

<PAGE>



     "Market  Price"  shall mean on any date  specified  herein,  the amount per
share of Common Stock equal to (a) the last sale price of Common Stock,  regular
way, on such date or, if no such sale takes  place on such date,  the average of
the  closing  bid and  asked  prices  thereof  on  such  date,  in each  case as
officially  reported  on the  principal  national  securities  exchange on which
Common  Stock is then listed or admitted to trading,  or (b) if Common  Stock is
not then listed or admitted to trading on any national  securities  exchange but
is designated as a national market system security by the NASD, the last trading
price of Common  Stock on such date,  or (c) if there shall have been no trading
on such date or if Common Stock is not so designated, the average of the closing
bid and asked prices of Common Stock on such date as shown by the NASD automated
quotation  system,  or (d) if Common  Stock is not then  listed or  admitted  to
trading on any national exchange or quoted in the  over-the-counter  market, the
higher of (x) Book Value per share or (y) the fair value  thereof  determined in
good faith by the Board of Directors of the Company as of a date which is within
15 days of the date as of which the determination is to be made.

     "NASD" shall mean the National Association of Securities Dealers, Inc.

     "Note"  shall  mean  this  promissory  note  in  the  principal  amount  of
$25,000,000.

     "Options" shall mean rights, options or warrants to subscribe for, purchase
or otherwise  acquire  either  Additional  Shares of Common Stock or Convertible
Securities  other  than  options  granted  pursuant  to the  Company's  existing
employee Stock Option Plan as the same may be amended from time to time.

     "Other Securities" shall mean any stock (other than Common Stock) and other
securities  of the Company or any other Person which the  Noteholder at any time
shall be entitled to receive,  or shall have received,  upon the exercise of the
Conversion  Right,  in lieu of or in addition to Common  Stock,  or which at any
time  shall  be  issuable  or shall  have  been  issued  in  exchange  for or in
replacement of Common Stock or Other  Securities  pursuant to Section 5.3 hereof
or otherwise.

     "Person"  shall mean a  corporation,  an  association,  a  partnership,  an
organization or a business in whatever form.

     "Pledge Provision" shall mean Sections 3.2 through 3.9 of this Agreement.




                                       -6-

<PAGE>



     "Registration   Rights  Agreement"  shall  mean  the  Registration   Rights
Agreement, dated August 12, 1994, between the Company and the Initial Noteholder
(and/or any Affiliate thereof).

     Repurchase  Obligation"  shall mean the obligations of the Company pursuant
to Section 5.13 hereof.

     "Restricted  Securities"  shall mean any  shares of Common  Stock (or Other
Securities) which have been issued upon the exercise of the Conversion Right and
which are  evidenced by a certificate  or  certificates  bearing the  applicable
legend or legends referred to herein.

     "Sale  of the  Company"  shall  mean the  sale by the  shareholders  of the
Company in one or more  transactions  of a majority of the capital  stock of the
Company,  the  merger or  consolidation  of the  Company  with or into any other
Person,  or the sale of assets of the Company  (excluding sales of inventory and
other  assets  in the  ordinary  course of  business  and  consistent  with past
practices of the Company and its  predecessors)  aggregating  50% or more of the
book value of the Company's assets as of the date hereof.

     "Securities  Act" shall mean the  Securities  Act of 1933,  or any  similar
federal statute, and the rules and regulations of the Commission thereunder, all
as the same shall be in effect at the time.

                                   ARTICLE II

                               RANKING OF THE NOTE

     SECTION 2.1.  Ranking.  Any  Indebtedness of the Company  evidenced by this
Note shall be senior in right to payment of any of the  Company's  Indebtedness,
including, without limitation, the Debentures and the Debenture Notes, provided,
however,  that  Indebtedness  of  the  Company  evidenced  by  this  Note  shall
constitute  Indebtedness  ranking pari passu with the  Indebtedness  outstanding
under the Decisions Notes; and provided further,  however, that so long as there
exists no Event of Default  hereunder  and no event  which,  with the passage of
time or the giving of notice or both would result in the  occurrence of an Event
of Default,  the Company  may make (i) any  payment on any  Indebtedness  of the
Company  outstanding as of the date hereof in accordance with and subject to the
terms  thereof;  and (ii) any payment of regularly  scheduled  interest upon any
other  Indebtedness,  when the same is due and  payable in  accordance  with and
subject to the terms thereof.




                                       -7-

<PAGE>



     SECTION 2.2.  Acceleration Right. The Company shall, not less than ten (10)
days prior to the date of the payment of any principal  portion of any Debenture
Note (including, without limitation, any prepayment or redemption thereof or any
similar  payment  thereunder,  other  than the  payment of  regularly  scheduled
interest  thereon),  deliver  written  notice  thereof  to the  Noteholder  (the
"Payment  Notice"),  which notice shall  specify the date upon which the Company
intends to make such payment.  For a period of five (5) days  following the date
of receipt of the  Payment  Notice by the  Noteholder  (the  "Exercise  Period")
Decisions will have the right (the  "Acceleration  Right") to declare all or any
portion  of the  outstanding  interest  and  principal  under  this  Note  to be
immediately  due and  payable,  such right to be exercised by delivery of notice
thereof (the  "Acceleration  Notice") by the  Noteholder to the Company prior to
the expiration of the Exercise Period.

     Any other  provision of this Note to the contrary  notwithstanding,  in the
event of the  exercise of the  Acceleration  Right by the  Noteholder,  all such
outstanding  amounts so specified by the Noteholder in the  Acceleration  Notice
(the  "Accelerated  Amounts") under this Note shall  immediately  become due and
payable and the  Company  shall  thereafter  make no further  payment  under the
Debenture Notes or the Debentures  until the Accelerated  Amounts have been paid
in full.

                                   ARTICLE III

                    COVENANTS OF THE COMPANY/PLEDGE/DIVIDENDS

     SECTION 3.1.  Creation of  Indebtedness.  So long as this Note shall remain
outstanding  the Company shall not,  without  having  obtained the prior written
consent of the Noteholder,  create, incur, assume or guarantee any Indebtedness:
(i) which is secured by any lien, claim,  security interest or other encumbrance
on any assets,  property or rights of the Company or any Affiliate,  or upon the
income  derived  therefrom;  or (ii) the  principal  portion  of which is due or
payable prior to payment in full of the Indebtedness evidenced by this Note: (x)
in each case,  other than those arising with respect to the GECC Loan Agreement;
and (y) in the case of clause (ii), other than the Debenture Notes.

     SECTION  3.2.  Pledge.   The  payment  and  performance  of  the  Company's
obligations under this Note will at all times be secured as follows:

     (a)  Security  Interest.  Subject  and on par with the rights of  Decisions
under the Decisions  Notes and the agreements and  instruments  related  thereto
(the "Parity Rights"); and subject



                                       -8-

<PAGE>



to and subordinate to the prior rights of GECC under the GECC Loan Agreement and
the agreements and instruments related thereto (the "Prior Rights"), as security
for the due and punctual  performance  and payment of the Company's  obligations
under this Note, the Company hereby pledges to and creates in, and hereby agrees
from time to time hereafter to pledge to and create in, the Noteholder,  for its
benefit,  a security interest in all of the Company's right,  title and interest
in all of the Company's  assets whether now owned or hereafter  acquired and all
products  and  proceeds  thereof  (all such assets and all products and proceeds
thereof  being  referred  to herein  as the  "Collateral"),  including,  without
limitation:  (i) all of the shares of Common Stock, par value $.01 per share and
all other securities of IMED Corporation  ("IMED") held by the Company,  whether
now owned or  hereafter  acquired;  (ii) all of the  shares  of Common  Stock of
Alteon,  Inc., a Delaware  corporation,  held by the Company  ("Alteon  Stock"),
whether now owned or hereafter acquired,  and (iii) all patents,  trademarks and
other  intellectual  property  rights owned by the Company,  including,  without
limitation,   those  licensed  by  the  Company  to  IMED.  Notwithstanding  the
foregoing,  to the extent that GECC has Prior  Rights with respect to any of the
Collateral  (all such Collateral  referred to herein as the "GECC  Collateral"),
the  Company  shall not be deemed to have  granted  the  Noteholder  a  security
interest in any the GECC Collateral  until such time as the Company has obtained
GECC's consent to the Company granting to the Noteholder of a security  interest
therein.

     SECTION 3.3.  Representations,  Warranties  and  Covenants  with Respect to
Collateral. The Company hereby represents, warrants and covenants that:

     (a) The Collateral which constitutes  securities (the "Pledged Collateral")
is and shall be at all times duly  authorized,  validly  issued,  fully paid and
nonassessable.  Subject to the Prior Rights and the Parity  Rights,  the Company
will  deliver to the  Noteholder  certificates  representing  all of the Pledged
Collateral  accompanied  by a  stock  transfer  power  executed  in  blank  with
signature  guaranteed,  all in the  form and  manner  to the  Noteholder  or its
counsel.

     (b) All Collateral shall be free and clear of any liens and restrictions on
the transfer  thereof  except for (i) the Prior Rights and Parity  Rights,  (ii)
restrictions  on  transfer  of the  Collateral  imposed  by  state  and  federal
securities laws and (iii) restrictions imposed herein.

     (c) The Company shall use its reasonable  business  efforts to, as promptly
as  practicable  following  the date  hereof,  obtain the consent of GECC to the
Company granting to the



                                       -9-

<PAGE>



Noteholder a lien on and security interest in the GECC Collateral as provided in
the  Company in Section 3.2 hereof;  provided,  however,  that at the request of
GECC,  the  Noteholder  will  enter  into  an  subordination  and  intercreditor
agreement  with GECC  substantially  in the form of the GECC 1994  Intercreditor
Agreement.


     SECTION 3.4.  Perfection of Security  Interest.  Before the issuance of the
Note at the Closing and upon the Noteholder's  written request from time to time
thereafter, the Company will make, execute, acknowledge and deliver, and deliver
to the  Noteholder  for filing and  recording in the proper filing and recording
places,  all  such  instruments,   including,  without  limitation,  appropriate
financing statements,  and take all such action as the Noteholder or its counsel
may reasonably  deem necessary or advisable to carry out the intent and purposes
of this Note,  or for assuring and  confirming  to the  Noteholder  the security
interest  in  the  Collateral  provided  for  hereunder.  Without  limiting  the
generality of the foregoing  sentence,  the Company will, from time to time upon
the  Noteholder's  request,  cause its accounting books and records to be marked
with such legends or  segregated in such manner as the  Noteholder  may specify,
and take or cause to be taken such other action and adopt such procedures as the
Noteholder  may  specify,  to give notice of or better to assure the lien on the
Collateral intended to be created hereby.

     SECTION 3.5.  Indemnity.  The Company will  indemnify and save and hold the
Noteholder  harmless  from  and  against  any and  all  claims,  damages,  loss,
liability or judgments  which may be incurred or sustained by the  Noteholder or
asserted against the Noteholder,  directly or indirectly, in connection with the
existence of or the exercise of any of the liens with respect to the Collateral;
provided,  however,  that the  foregoing  shall  not  extend to  actions  of the
Noteholder which are grossly negligent or constitute willful misconduct or which
are not taken in good faith by the Noteholder,  and any action or failure to act
in accordance  with an opinion of legal counsel  shall  conclusively  be deemed,
insofar as addressed by the legal  conclusions set forth in such opinion,  to be
without gross  negligence  or willful  misconduct  and to be in good faith.  The
covenants  contained in this Section 3.5 shall  survive the  termination  of the
other provisions of this Note.

     SECTION 3.6.  Administration  of Collateral.  The Noteholder shall have all
rights  afforded a secured  party under the  uniform  commercial  code.  Without
limiting the foregoing,  subject to the Prior Rights and the Parity Rights,  the
following provisions shall govern the administration of the Pledged Collateral:




                                      -10-

<PAGE>



     (a) Until there shall be an Event of Default hereunder,  the Company shall:
(i) be entitled to receive all cash  dividends and other cash  distributions  or
cash payments on or with respect to the Pledged Collateral; and (ii) be entitled
to vote or consent  with  respect to the  Pledged  Collateral  in any manner not
inconsistent  with the terms of this Note.  Subject to the Prior  Rights and the
Parity  Rights,  and to the preceding  sentence all  distributions  constituting
Pledged  Collateral  made or paid on the Pledged  Collateral will be retained by
the  Noteholder  (or if received by the Company or a  subsidiary  of the Company
shall be held by such Person in trust and shall be forthwith  delivered by it to
the Noteholder in the original form received, endorsed in blank) and held by the
Noteholder as a part of the Collateral.

     (b) If there  shall  have  occurred  an Event of Default  hereunder,  then,
subject  to  the  Prior  Rights  and  Parity  rights,  all  dividend  and  other
distributions  and  payments  with  respect to the Pledged  Collateral  shall be
retained by the Noteholder (or if received by the Company or a subsidiary of the
Company  shall be held by such Person in trust and shall be forthwith  delivered
by it to the  Noteholder in the original form  received,  endorsed in blank) and
held by the Noteholder as part of the Collateral or applied by the Noteholder to
the  payment  of the Note in such  manner  as it may  determine  in its sole and
absolute  discretion,  and, if to the extent that the Noteholder shall so notify
the Company in writing, only the Noteholder shall be entitled to vote or consent
or to take any other  action  with  respect to the Pledged  Collateral  (and the
Company or the  appropriate  subsidiary  of the Company  will,  if so requested,
execute or cause to be executed  appropriate  proxies therefor).  If there shall
have occurred an Event of Default hereunder,  the Noteholder at its option shall
at all times have the right to transfer into its name or that of its nominee any
or all of the Collateral, subject to any applicable laws governing such transfer
and to the Prior Rights and Parity Rights.

     SECTION 3.7. Right to Realize upon Collateral.  Subject to the Prior Rights
and Parity  Rights,  except to the extent  prohibited  by  applicable  law which
cannot be waived the following provisions shall govern the Noteholder's right to
realize  upon the  Collateral  if an  Event  of  Default  hereunder  shall  have
occurred, in addition to any rights and remedies available at law or in equity:

     (a)  Marshaling,  etc.  The  Noteholder  shall not be  required to make any
demand  upon or pursue or exhaust  any of its  rights or  remedies  against  the
Company or others with respect to the payment of the Company's  obligations with
respect to the Note,  or to pursue or exhaust any of its rights or remedies with
respect to any of the Collateral therefor. The Noteholder shall not be



                                      -11-

<PAGE>



required to marshal the Collateral in any particular order and all of its rights
hereunder  shall be  cumulative.  The Company  agrees to waive,  and does hereby
absolutely  and  irrevocably  waive and relinquish the benefit and advantage of,
and does hereby  covenant not to assert against the  Noteholder,  any valuation,
stay,  appraisement,  extension  or  redemption  laws now  existing or which may
hereafter exist which,  but for this provision,  might be applicable to any sale
made under the judgment,  order or decree of any court,  or privately  under the
power of sale conferred by this Note or otherwise  based on this Note in respect
of any Collateral. Without limiting the generality of the foregoing, the Company
hereby agrees that it will not invoke or utilize any law which might cause delay
in, or impede the  enforcement of the rights of the Noteholder  under this Note,
and hereby waives the same. In addition,  the Company hereby waives any right to
prior notice (except to the extent expressly  provided in this Note) or judicial
hearing in connection  with the taking  possession or the  disposition of any of
the Collateral,  including  without  limitation any such right which the Company
would otherwise have under the Constitution of the United States of America,  or
any state or territory thereof.

     (b) Sales of Collateral. Any item of the Collateral may be sold for cash or
other  value in any number of lots at public or  private  sale  without  demand,
advertisement  or notice  (excepting  only that the  Noteholder  shall  give the
Company five (5) days prior  written  notice of the time and place of any public
sale,  or the time after which a private sale may be made,  which notice each of
the Company and the Noteholder  hereby agrees to be reasonable).  At any sale or
sales of the Collateral (except to the extent prohibited by applicable law which
cannot be waived) the Noteholder or any of its officers  acting on its behalf or
its  assigns may bid for the  purchase of the whole or any part of the  property
and  rights  so sold and upon  compliance  with the terms of such sale may hold,
exploit  and  dispose  of such  property  and  rights  so sold  without  further
accountability to the Company except for the proceeds of such sale or sales. The
Company will execute and deliver,  or cause to be executed and  delivered,  such
instruments,  documents,  assignments,  waivers, certificates and affidavits and
supply or cause to be supplied  such further  information  and take such further
action as the Noteholder shall require in connection with such sale.

     (c)  Application  of Proceeds.  After the occurrence of an Event of Default
hereunder,  and subject to the Prior Rights and the Parity Rights,  the proceeds
of all sales and collections, and any other moneys (including any cash contained
in the  Collateral)  the  application of which is not otherwise  herein provided
for, shall be applied as follows:



                                      -12-

<PAGE>




          First,  to the payment of the costs and expenses of such sale or sales
     and the reasonable compensation of the Noteholder and its counsel.

          Second,  any surplus then  remaining  to the payment of the  Company's
     obligations in respect of the Note secured by such Collateral in such order
     and manner as the Noteholder may in its sole discretion determine.

          Third, any surplus then remaining shall be deposited in the account of
     the  Company,  subject,  however,  to the  rights of the holder of any then
     existing lien of which the Noteholder has actual notice.

     (d) Sale without  Registration.  The Company  recognizes that  registration
under  the  Securities  Act of  1933,  as  amended  (the  "Securities  Act")  of
securities  included in the Collateral or compliance  with the  requirements  of
Rule 144 might be  required  to effect  any  public  sale  thereof  and that the
Noteholder may desire to effect one or more private or other sales not requiring
such  registration to avoid the attendant  delays and  uncertainty.  The Company
therefore  agrees that if, at any time when the  Noteholder  shall  determine to
exercise  such  right  to sell  all or part of the  securities  included  in the
Collateral  pursuant to this Section 3.7, and the securities in questions  shall
not be effectively  registered  under the Securities Act, the Noteholder may, in
its sole and absolute discretion,  sell such securities by private or other sale
not requiring such registration in such manner and in such  circumstances as the
Noteholder  may deem  necessary  or  advisable  in order  that  such sale may be
effected  without such  registration.  Without  limiting the  generality  of the
foregoing, in any event the Noteholder may, in its sole and absolute discretion:
(i) approach and negotiate  with one or more possible  purchasers to effect such
sale;  and (ii) restrict such sale to one or more  purchasers  each of whom will
represent and agree that such purchaser is purchasing  for its own account,  for
investment and not with a view to the  distribution or sale of such  securities.
The  Company  hereby  agrees  that such manner of  disposition  is  commercially
reasonable,  that it will  upon  the  request  of the  Noteholder  give any such
purchaser  access to such information as would be necessary if such sale were by
the issuer seeking to effect  compliance  with Regulation D under the Securities
Act, and that the Noteholder  shall incur no  responsibility  for selling all or
part of the  securities  constituting  Collateral at a private or other sale not
requiring such registration notwithstanding the possibility that a substantially
higher  price  might  be  realized  if  the  sale  were  deferred   until  after
registration  or were made in compliance  with Rule 144 or other  exemption from
the registration provisions under the



                                      -13-

<PAGE>



Securities Act. The Company acknowledges that there is no adequate remedy at law
for failure by it to comply  with the  provisions  of this  Section 3.7 and that
such failure would not be adequately  compensable in damages,  therefore  agrees
that its agreements contained in this Section 3.7 may be specifically enforced.

     (e)  Registration  of  Securities.  If, in the  opinion of counsel  for the
Noteholder,  registration under the Securities Act of securities included in the
Collateral  or  compliance  with the  requirements  of Rule 144 is  required  in
connection  with a proposed sale of any security  included in the Collateral and
there is no exemption  from  registration  under the  Securities  Act which,  if
utilized,  would give the Noteholder materially similar benefits from such sale,
the  Company  will use its  reasonable  efforts  to  cause  the  issuer  of such
security, as expeditiously as possible and at its expense (including the expense
of  printing  such  reasonable  number of  prospectuses  as the  Noteholder  may
specify),  to cause such security to be registered  under the  Securities Act or
any similar federal statute then in effect and cause such registration to remain
effective, and to cause such security to be and remain qualified under the "Blue
Sky" or securities laws of any states  designated by the Noteholder in each case
for a period not to exceed nine (9) months; and provided, further, that only one
effective registration shall be required hereunder.

     SECTION 3.8.  Custody of Collateral.  Except to the extent  provided by the
mandatory  requirements of applicable law which cannot be waived, the Noteholder
shall not have any duty as to the custody and protection of the Collateral,  the
collection of any part thereof or any income thereon,  or as to the preservation
or exercise of any rights pertaining  thereto,  including,  without  limitation,
rights  against  the prior  parties,  beyond the use of  reasonable  care in the
custody and physical preservation of any Collateral actually in the Noteholder's
possession.

     SECTION  3.9.  Alteon  Stock.  If  there  shall  not have  occurred  and be
continuing an Event of Default  hereunder,  the Company will be entitled to sell
the Alteon Stock. Upon any such sale, the Noteholder's security interest and the
security  interest  granted by the Decision Notes in the shares sold (but not in
the  proceeds  thereof  (the  "Alteon  Proceeds"))  shall  terminate;   and  the
Noteholder agrees to return any certificates  evidencing such securities held by
it and to execute such documents and instruments  necessary to allow the Company
to transfer  such  securities  free of any  interest of the  Noteholder  created
hereunder.

     Following any such sale, at the Noteholder's request, the Company shall (i)
establish a segregated bank account (the "Bank



                                      -14-

<PAGE>



Account")  solely for the purpose of holding,  and into which the Company  shall
deposit, the Alteon Proceeds, and (ii) take all steps required in order to cause
the bank at which the Bank  Account is  established  to record the  Noteholder's
security  interest in the Bank Account and the funds held  therein.  The Company
agrees that,  without the prior written consent of the  Noteholder,  the Company
shall only  withdraw and use the funds held in the Bank  Account:  (x) after the
Company has exhausted all of its other cash reserves; and (y) once so withdrawn,
solely for working  capital and not for the purpose of making any redemptions or
paying any dividends, distributions, interest or capital expenditures.

     SECTION 3.10. Dividends and Use of Proceeds. From and after the date hereof
and while this Note is  outstanding,  without the prior  written  consent of the
Initial Noteholder,  which may be withheld in its sole and absolute  discretion,
the  Company  shall not:  (i)  declare or pay any cash  dividends  on its common
stock;  or (ii)  utilize  the  proceeds of the loan  evidenced  by this Note (or
permit or suffer any such  utilization  to occur or exist) for any purpose other
than:  (w) the payment of  principal  and  interest on this Note or on any other
indebtedness of the Company to the Initial Noteholder or its Affiliates;  (x) to
acquire or assist any of the  Company's  Affiliates  to acquire any  business or
line of  business;  (y) to  invest in or  acquire  any  securities  (or right to
acquire any securities) of IMED, any other Affiliate of the Company or any other
entity  (other than the  Company);  or (z) to pay any and all costs and expenses
incurred in connection with the foregoing activities.

                                   ARTICLE IV

                                EVENTS OF DEFAULT

     SECTION 4.1. Events of Default.  If any of the following events ("Events of
Default") shall occur and be continuing:

     (a) the Company  shall fail to pay the  principal  of this Note when due or
shall fail to pay interest on this Note when due; or

     (b) the Company shall fail to perform or observe any covenant  contained in
this  Note and such  failure  shall  continue  for a  period  of three  (3) days
following notice thereof from the Noteholder to the Company;

     (c) there shall occur an event of default under any  instrument  evidencing
Indebtedness  the principal  amount of which exceeds  $500,000 of the Company or
any Affiliate (including IMED)



                                      -15-

<PAGE>



and the holder of such Indebtedness shall accelerate the maturity
thereof;

     (d) a final judgment which, in the aggregate with other  outstanding  final
judgments against the Company or any of its Affiliates (including IMED), exceeds
$500,000  shall  be  rendered  against  the  Company  or any  of its  Affiliates
(including IMED) if, within 30 days after entry thereof, such judgment shall not
have  been  discharged  or  stayed  pending  appeal,  or  within  30 days  after
expiration of such stay such judgment shall not have been discharged; or

     (e) the Company or any of its  Affiliates  (including  IMED)  (other than a
Fidata Reorganization Event) shall:

          (1) commence a voluntary case under Title 11 of the United States Code
          as  from  time  to  time  in  effect,  or  authorize,  by  appropriate
          proceedings of its board of directors,  or other  governing  body, the
          commencement of such a voluntary case;

          (2) have filed against it a petition  commencing  an  involuntary
          case under said Title 11;

          (3) seek relief as a debtor under any applicable  law, other than said
          Title  11,  of  any  jurisdiction   relating  to  the  liquidation  or
          reorganization  of debtors or to the modification or alteration of the
          rights of creditors, or consent to or acquiesce in such relief;

          (4)  have  entered  against  it any  order  by a  court  of  competent
          jurisdiction (i) finding it to be bankrupt or insolvent, (ii) ordering
          or approving its  liquidation,  reorganization  or any modification or
          alteration of the rights of its creditors,  or (iii) assuming  custody
          of,  or  appointing  a  receiver  or  other  custodian  for,  all or a
          substantial part of its property; or

          (5) make an assignment for the benefit of, or enter into a composition
          with,  its  creditors,  or appoint or consent to the  appointment of a
          receiver  or  other  custodian  for all or a  substantial  part of its
          property;





                                      -16-

<PAGE>



then,  the Noteholder  may, by notice to the Company,  declare the entire unpaid
principal amount of this Note, and all interest  accrued and unpaid thereon,  to
be forthwith due and payable,  whereupon this Note and all such accrued interest
and all such  amounts  shall become and be  forthwith  due and payable,  without
presentment,  demand,  protest or further  notice of any kind,  all of which are
hereby expressly waived by the Company.


                                    ARTICLE V

                                   CONVERSION

     The  Noteholder  is entitled to purchase  from the Company by conversion of
the  principal  portion of this Note  pursuant to the terms hereof (which may be
converted  in whole or in part at any time or from  time to time  following  the
Commencement  Date (as  hereinafter  defined))  (the  "Conversion  Right") up to
9,523,809 duly authorized,  validly issued,  fully paid and nonassessable shares
of Common Stock, par value $.01 per share (the "Common  Stock"),  of the Company
at the purchase price per share of $2-5/8 of such principal amount (the "Initial
Purchase  Price"),  at any time or from time to time from and after the  earlier
of: thirty (30) days  following the Funding Date or the date on which the Common
Stock issuable upon exercise hereof is first approved for listing, upon official
notice of issuance,  on the American Stock Exchange (the  "Commencement  Date"),
and  prior to 5:00  p.m.,  Eastern  Standard  time,  on  January  4,  2001  (the
"Expiration  Date"),  all subject to the terms,  conditions and  adjustments set
forth below.

     SECTION 5.1. Conversion of Note.

     5.1.1.  Exercise.  The Conversion  Right may be exercised by the Noteholder
hereof,  in whole or in part, from time to time, during normal business hours on
any  Business  Day  from  and  after  the  Commencement  Date  and  prior to the
Expiration Date, by delivery to the Company at its office maintained pursuant to
Section  5.12.2(a)  hereof,  a subscription in  substantially  the form attached
hereto as  Exhibit  A, or a  reasonable  facsimile  thereof  (the  "Subscription
Notice") duly executed by such  Noteholder,  in which event the principal amount
of the Note  shall be  reduced  by an amount  equal to the  amount  obtained  by
multiplying  (a) the number of shares of Common Stock (without  giving effect to
any  adjustment  thereof)  designated  in such  subscription  by (b) the Initial
Purchase Price,  and such Noteholder  shall thereupon be entitled to receive the
number of duly authorized,  validly issued,  fully paid and nonassessable shares
of Common  Stock (or Other  Securities)  determined  as provided in Sections 5.2
through 5.4 hereof.



                                      -17-

<PAGE>




     5.1.2. When Exercise Effective. Each exercise of the Conversion Right shall
be deemed to have been  effected  immediately  prior to the close of business on
the Business Day on which the  Subscription  Notice shall have been delivered to
the Company as provided in Section 5.1.1 hereof,  and at such time the Person or
Persons in whose name or names any  certificate  or  certificates  for shares of
Common  Stock (or Other  Securities)  shall be  issuable  upon such  exercise as
provided in Section  5.1.3  hereof shall be deemed to have become the holders of
record thereof.

     5.1.3.  Delivery of Stock  Certificates,  etc. As soon as practicable after
the delivery of the  Subscription  Notice and in any event within five  Business
Days thereafter,  the Company at its expense (including the payment by it of any
applicable  issue taxes) will cause to be issued in the name of and delivered to
the Noteholder  hereof,  or, subject to Section 5.9 hereof,  as such  Noteholder
(upon payment by such Noteholder of any applicable  transfer taxes) may direct a
certificate or certificates for the number of duly  authorized,  validly issued,
fully paid and  nonassessable  shares of Common Stock (or Other  Securities)  to
which such Noteholder  shall be entitled upon such exercise plus, in lieu of any
fractional share to which such Noteholder  would otherwise be entitled,  cash in
an  amount  equal to the same  fraction  of the  Market  Price  per share on the
Business Day next preceding the date of such exercise.

     5.1.4.  Company to Reaffirm  Obligations.  The Company will, at the time of
each  exercise  of the  Conversion  Right,  upon the  request of the  Noteholder
hereof,  acknowledge  in writing  its  continuing  obligation  to afford to such
Noteholder all rights (including  without limitation any rights to registration,
pursuant to the Registration Rights Agreement,  of the shares of Common Stock or
Other  Securities  issued upon such  exercise)  to which such  Noteholder  shall
continue to be entitled after such exercise in accordance with the terms hereof;
provided,  however,  that if the Noteholder shall fail to make any such request,
such failure shall not affect the continuing obligation of the Company to afford
such rights to such Noteholder.

     5.2. Adjustment of Common Stock Issuable Upon Exercise.

     5.2.1. General; Number of Shares; Conversion Price. The number of shares of
Common  Stock  which the  Noteholder  shall be  entitled  to  receive  upon each
exercise of the Conversion  Right shall be determined by multiplying  the number
of shares of Common Stock which would  otherwise (but for the provisions of this
Section 5.2) be issuable upon such  exercise,  as  designated by the  Noteholder
hereof pursuant to Section 5.1.1 hereof, by the fraction



                                      -18-

<PAGE>



of which (a) the numerator is the Initial Purchase Price and (b) the denominator
is the Conversion Price in effect on the date of such exercise.  The "Conversion
Price" (i) shall initially be the Initial Purchase Price, (ii) shall be adjusted
and  readjusted  from time to time as provided in this Section 5.2 and, (iii) as
so adjusted or readjusted,  shall remain in effect until a further adjustment or
readjustment thereof is required by this Section 5.2.

     5.2.2.  Adjustment of Conversion  Price. In case the Company at any time or
from time to time after the date hereof shall issue or sell Additional Shares of
Common Stock  (including  Additional  Shares of Common Stock deemed to be issued
pursuant  to  Section  5.2.3 or 5.2.4  hereof)  without  consideration  or for a
consideration per share less than the greater of the Current Market Price or the
Conversion Price in effect immediately prior to such issue or sale, then, and in
each such case, subject to Section 5.2.7 hereof,  such Conversion Price shall be
reduced,  concurrently  with such issue or sale, to a price  (calculated  to the
nearest .001 of a cent)  determined by multiplying  such  Conversion  Price by a
fraction:

               (a) the  numerator  of which shall be (i) the number of shares of
          Common Stock outstanding  immediately prior to such issue or sale plus
          (ii) the  number  of  shares  of  Common  Stock  which  the  aggregate
          consideration  received by the  Company  for the total  number of such
          Additional  Shares of Common Stock so issued or sold would purchase at
          the greater of such Current  Market Price and such  Conversion  Price;
          and

               (b) the  denominator  of which  shall be the  number of shares of
          Common Stock outstanding immediately after such issue or sale.

     5.2.3. Treatment of Options and Convertible Securities. In case the Company
at any time for from time to time after the date hereof shall issue, sell, grant
or assume,  or shall fix a record date for the  determination of shareholders of
any  class of  securities  entitled  to  receive,  any  Options  or  Convertible
Securities, then, and in each such case, the maximum number of Additional Shares
of Common Stock (as set forth in the instrument relating thereto, without regard
to any provisions  contained therein for a subsequent  adjustment of such number
the purpose of which is to protect  against  dilution) at any time issuable upon
the  exercise of such  Options  or, in the case of  Convertible  Securities  and
Options therefor,  the conversion or exchange of such Convertible Securities and
Options therefor, shall be deemed to be Additional Shares of Common Stock issued
as of the time of such  issue,  sale,  grant or  assumption  or,  in case such a
record date



                                      -19-

<PAGE>



shall have been  fixed,  as of the close of business on such record date (or, if
the  Common  Stock  trades on an  ex-dividend  basis,  on the date  prior to the
commencement of ex-dividend  trading);  provided,  however, that such Additional
Shares of Common  Stock  shall not be  deemed  to have been  issued  unless  the
consideration  per share  (determined  pursuant to Section 5.2.5 hereof) of such
shares  would be less  than  the  greater  of the  Current  Market  Price or the
Conversion  Price in effect on the date of and immediately  prior to such issue,
sale, grant or assumption or immediately  prior to the close of business on such
record date (or, if the Common Stock trades on an ex-dividend basis, on the date
prior to the  commencement  of  ex-dividend  trading),  as the case may be;  and
provided, further, that:

          (a) whether or not an adjustment of the  Conversion  Price is required
     in connection  with the issuance,  sale grant or assumption of such Options
     or  Convertible  Securities,  no  adjustment  or further  adjustment of the
     Conversion  Price shall be made as a result of the exercise of such Options
     or the  conversion  or  exchange  of such  Convertible  Securities  and the
     consequent  issue or sale of  Convertible  Securities  or  shares of Common
     Stock;

          (b) in any case in which Additional  Shares of Common Stock are deemed
     to be issued,  if such  Options or  Convertible  Securities  by their terms
     provide,  with the passage of time or  otherwise,  for any  increase in the
     consideration  payable  to  the  Company,  or  decrease  in the  number  of
     Additional Shares of Common Stock issuable,  upon the exercise,  conversion
     or exchange thereof (by change of rate or otherwise),  the Conversion Price
     computed on the original issue,  sale, grant or assumption thereof (or upon
     the  occurrence  of the record date, or date prior to the  commencement  of
     ex-dividend  trading,  as the case may be, with respect  thereof),  and any
     subsequent  adjustments  based  thereon,  shall,  upon any such increase or
     decrease  becoming  effective,  be  recomputed  to reflect such increase or
     decrease insofar as it affects such Options, or the rights of conversion or
     exchange under such Convertible  Securities,  which are outstanding at such
     time;

          (c) in any case in which Additional  Shares of Common Stock are deemed
     to be  issued,  upon  the  expiration  (or  purchase  by  the  Company  and
     cancellation  or  retirement) of any such Options which shall not have been
     exercised,  or the expiration of any rights of conversion or exchange under
     any such Convertible  Securities the rights of conversion or exchange under
     which shall not have been exercised, the



                                      -20-

<PAGE>



     Conversion  Price  computed  upon  the  original  issue,   sale,  grant  or
     assumption  thereof (or upon the  occurrence  of the record  date,  or date
     prior to the commencement of ex-dividend  trading, as the case may be, with
     respect thereto), and any subsequent adjustments based thereon, shall, upon
     (and effective as of) such expiration (or such  cancellation or retirement,
     as the case may be), be recomputed as if:

               (i) in the case of Options or  Convertible  Securities,  the only
          Additional  Shares of Common Stock issued or sold were the  Additional
          Shares  of  Common  Stock,  if any,  actually  issued or sold upon the
          exercise  of  such  Options  or the  conversion  or  exchange  of such
          Convertible Securities and the consideration received therefor was the
          consideration  actually received by the Company upon such exercise, or
          for the issue or sale of all such  Convertible  Securities  which were
          actually converted or exchanged, plus the additional consideration, if
          any,  actually  received  by  the  Company  upon  such  conversion  or
          exchange, and

               (ii) in the case of Options for Convertible Securities,  only the
          Convertible  Securities,  if any,  actually  issued  or sold  upon the
          exercise of such Options  were issued at the time of the issue,  sale,
          grant or assumption of such Options, and the consideration received by
          the Company for the  Additional  Shares of Common Stock deemed to have
          then  been  issued  was the  consideration  actually  received  by the
          Company for the issue,  sale, grant or assumption of all such Options,
          whether or not exercised,  plus the consideration  deemed to have been
          received by the Company  (pursuant to Section  5.2.5  hereof) upon the
          issue or sale of such  Convertible  Securities  with  respect to which
          such Options were actually exercised; and

          (d) no  readjustment  pursuant  to  clause  (b) or (c)  above  (either
     individually or cumulatively  together with all prior readjustments as made
     in respect of such Options or Convertible Securities) shall have the effect
     of  increasing  the  Conversion  Price  by a  proportion  (relative  to the
     Conversion  Price in  effect  immediately  prior to such  readjustment)  in
     excess of the inverse of the aggregate proportional adjustment thereof made
     in respect of the  issue,  sale,  grant or  assumption  of such  Options or
     Convertible  Securities  or the  fact  that  such  Options  or  Convertible
     Securities  were  outstanding  at the time  other  shares of Common  Stock,
     Options or Convertible Securities were issued.



                                      -21-

<PAGE>




If the consideration provided for in any Option or the additional consideration,
if any,  payable upon the  conversion  or exchange of any  Convertible  Security
shall  be  reduced,  or the rate at  which  any  Option  is  exercisable  or any
Convertible  Security is convertible  into or exchangeable  for shares of Common
Stock  shall be  increased,  at any time under or by reason of  provisions  with
respect  thereto  designed  to  protect  against   dilution,   then,   effective
concurrently  with each such change,  the Conversion  Price then in effect shall
first be adjusted to  eliminate  the effects (if any) of the issuance (or deemed
issuance) of such Option or  Convertible  Security on the  Conversion  Price and
then readjusted as if such Option or Convertible Security had been issued on the
date of such change with the terms in effect after such change, but only if as a
result of such  adjustment  the  Conversion  Price then in effect  hereunder  is
thereby reduced.

     5.2.4. Treatment of Stock Dividends, Stock Splits, etc. In case the Company
at any time or from time to time after the date hereof shall  declare or pay any
dividend  on the  Common  Stock  payable  in  Common  Stock,  or shall  effect a
subdivision of the  outstanding  shares of Common Stock into a greater number of
shares of Common Stock (by  reclassification  or otherwise  than by payment of a
dividend in Common  Stock),  then, and in each such case,  Additional  Shares of
Common  Stock  shall be deemed to have been  issued  (a) in the case of any such
dividend,  immediately  after the close of  business  on the record date for the
determination  of  shareholders  of any class of securities  entitled to receive
such  dividend,  or (b) in the case of any  such  subdivision,  at the  close of
business  on the day  immediately  prior to the day upon  which  such  corporate
action becomes effective.

     5.2.5. Computation of Consideration. For the purposes of this Section 5.2:

               (a) the  consideration  for the  issue or sale of any  Additional
          Shares of Common Stock shall, irrespective of the accounting treatment
          of such consideration:

                    (i)  insofar as it  consists  of cash,  be  computed  at the
               amount  of  cash  actually  received  by the  Company  net of any
               expenses  paid or incurred by the Company or any  commissions  or
               compensation   paid  or  concessions  or  discounts   allowed  to
               underwriters,  dealers or others  performing  similar services in
               connection with such issue or sale;

                    (ii)   insofar  as  it  consists   of  property   (including
               securities) other than cash actually received



                                      -22-

<PAGE>



               by the Company, be computed at the fair value thereof at the time
               of such issue or sale,  as  determined in good faith by the Board
               of Directors of the Company;

                    (iii)  insofar as it  consists  neither of cash nor of other
               property, be computed as having no value; and

                    (iv) in case Additional Shares of Common Stock are issued or
               sold  together  with other stock or securities or other assets of
               the Company for a consideration which covers both, be the portion
               of such  consideration  so  received,  computed  as  provided  in
               clauses (i), (ii) and (iii) above,  allocable to such  Additional
               Shares of Common  Stock,  all as  determined in good faith by the
               Board of Directors of the Company;

          (b)  Additional  Shares of  Common  Stock  deemed to have been  issued
     pursuant to Section  5.2.3 hereof shall be deemed to have been issued for a
     consideration per share determined by dividing:

                    (i) the total  amount of cash and  other  property,  if any,
               received and  receivable  by the Company as direct  consideration
               for the  issue,  sale,  grant or  assumption  of the  Options  or
               Convertible  Securities in question,  plus the minimum  aggregate
               amount  of  additional   consideration   (as  set  forth  in  the
               instruments  relating  thereto,  without  regard to any provision
               contained   therein   for  a   subsequent   adjustment   of  such
               consideration   the  purpose  of  which  is  to  protect  against
               dilution)  payable to the  Company  upon the  exercise in full of
               such Options or the  conversion  or exchange of such  Convertible
               Securities or, in the case of Options for Convertible Securities,
               the exercise of such Options for  Convertible  Securities and the
               conversion or exchange of such  Convertible  Securities,  in each
               case  computing such  consideration  as provided in the foregoing
               clause (a),

         by

                    (ii) the  maximum  number of shares of Common  Stock (as set
               forth in the instruments relating thereto,  without regard to any
               provision  contained therein for a subsequent  adjustment of such
               number  the  purpose  of which is to  protect  against  dilution)
               issuable  upon the exercise of such Options or the  conversion or
               exchange of such Convertible securities; and



                                      -23-

<PAGE>




          (c)  Additional  Shares of  Common  Stock  deemed to have been  issued
     pursuant to Section 5.2.4 hereof shall be deemed to have been issued for no
     consideration.

     5.2.6. Adjustments for Combinations, etc. In case the outstanding shares of
Common  Stock  shall  be  combined  or  consolidated,   by  reclassification  or
otherwise,  into a lesser number of shares of Common Stock, the Conversion Price
in  effect  immediately  prior  to  such  combination  or  consolidation  shall,
concurrently  with the  effectiveness of such combination or  consolidation,  be
proportionately increased.

     5.2.7.  Minimum  Adjustment  of  Conversion  Price.  If the  amount  of any
adjustment of the Conversion  Price required  pursuant to this Section 5.2 would
be less than  one-tenth  (1/10) of one percent (1%) of the  Conversion  Price in
effect at the time such  adjustment  is otherwise  so required to be made,  such
amount shall be carried  forward and adjustment with respect thereto made at the
time of and together with any subsequent  adjustment  which,  together with such
amount and any other amount or amounts so carried  forward,  shall  aggregate at
least one tenth (1/10) of one percent (1%) of such Conversion Price.

     5.2.8. Shares Deemed  Outstanding.  For all purposes of the computations to
be  made  pursuant  to this  Section  5.2:  (i)  there  shall  be  deemed  to be
outstanding  all shares of Common  Stock  issuable  pursuant to the  exercise of
Options and  conversion of  Convertible  Securities  outstanding at the close of
business on the date hereof, including,  without limitation,  (a) this Note, (b)
the  Decisions  Notes,  and (c) the Warrant to purchase  25,000 shares of common
stock, dated July 29, 1991, issued to Montgomery Medical Ventures II, L.P., (ii)
immediately  after any Additional Shares of Common Stock are deemed to have been
issued pursuant to Section 5.2.3 or 5.2.4 hereof,  such Additional  Shares shall
be deemed to be  outstanding;  (iii)  treasury  shares shall not be deemed to be
outstanding;  and (iv) no adjustment  shall be made in the Conversion Price upon
the  issuance of shares of Common  Stock  pursuant  to Options  and  Convertible
Securities so deemed to be outstanding, but this Section 5.2.8 shall not prevent
other  adjustments in the Conversion Price arising by virtue of such outstanding
Options or  Convertible  Securities  pursuant to the provisions of Section 5.2.3
hereof; provided,  however, that, for purposes of calculating adjustments to the
Conversion  Price,  there shall be deemed to be  outstanding  immediately  after
giving effect to any issuance of shares of Common Stock,  Options or Convertible
Securities  all shares of Common Stock issuable upon the exercise of Options and
conversion  of  Convertible   Securities  then  outstanding  (including  without
limitation this Note) after giving effect to the



                                      -24-

<PAGE>



antidilution   provisions   contained  in  all  such  outstanding   Options  and
Convertible  Securities  which  cause an  adjustment  in the number of shares of
Common Stock so issuable,  either by virtue of such issuance of shares of Common
Stock,  Options or Convertible  Securities or by virtue of the operation of such
antidilution provisions.

     5.3. Consolidation, Merger, etc.

     5.3.1.   Adjustments   for   Consolidation,   Merger,   Sale   of   Assets,
Reorganization,  etc.  In case the  Company  after  the date  hereof  (a)  shall
consolidate  with or merge into any other Person and shall not be the continuing
or surviving  corporation of such  consolidation or merger,  or (b) shall permit
any other Person to  consolidate  with or merge into the Company and the Company
shall be the  continuing  or  surviving  Person  but,  in  connection  with such
consolidation  or merger,  the Common Stock or Other Securities shall be changed
into or exchanged  for stock or other  securities of any other Person or cash or
any  other  property,  or (c) shall  transfer  all or  substantially  all of its
properties  or  assets  to any  other  Person,  or (d)  shall  effect a  capital
reorganization  or  reclassification  of the  Common  Stock or Other  Securities
(other than a capital reorganization or reclassification to the extent that such
capital  reorganization or  reclassification  results in the issue of Additional
Shares of Common Stock for which  adjustment in the Conversion Price is provided
in  Section  5.2.2.  hereof),  then,  and in the case of each such  transaction,
proper  provision shall be made so that, upon the basis and the terms and in the
manner provided herein the Noteholder, upon the exercise of the Conversion Right
at any time after the  consummation  of such  transaction,  shall be entitled to
receive  (at the  aggregate  Conversion  Price  in  effect  at the  time of such
consummation  for all  Common  Stock  or Other  Securities  issuable  upon  such
exercise immediately prior to such consummation), in lieu of the Common Stock or
Other  Securities  issuable upon such exercise prior to such  consummation,  the
greatest  amount of securities,  cash or other property to which such Noteholder
would  actually have been entitled as a shareholder  upon such  consummation  if
such Noteholder had exercised the Conversion  Right  immediately  prior thereto,
subject to adjustments (subsequent to such consummation) as nearly equivalent as
possible to the  adjustments  provided for in Sections  5.2, 5.3 and 5.4 hereof;
provided however,  that if a purchase,  tender or exchange offer shall have been
made to and  accepted by the  shareholders  of more than 50% of the  outstanding
shares of Common Stock, and if the Noteholder so designates in a notice given to
the  Company  on or  before  the  date  immediately  preceding  the  date of the
consummation of such  transaction,  the Noteholder  shall be entitled to receive
the greatest amount of securities, cash or other property to which



                                      -25-

<PAGE>



such  Noteholder  would  actually  have been  entitled as a  shareholder  if the
Noteholder  had exercised the  Conversion  Right prior to the expiration of such
purchase,  tender  or  exchange  offer  and  accepted  such  offer,  subject  to
adjustments  (from  and  after  the  consummation  of such  purchase,  tender or
exchange offer) as nearly equivalent as possible to the adjustments provided for
in Sections 5.2, 5.3 and 5.4 hereof.

     5.3.2. Assumption of Obligations. Notwithstanding anything contained in the
Note to the  contrary,  the  Company  will not  effect  any of the  transactions
described in clauses (a) through (d) of Section  5.3.1 hereof  unless,  prior to
the  consummation  thereof,  each person  (other than the Company)  which may be
required to deliver any stock, securities, cash or property upon the exercise of
the  Conversion  Right as provided  herein shall assume,  by written  instrument
delivered  to,  and  reasonably   satisfactory  to,  the  Noteholder,   (a)  the
obligations  of the  Company  hereunder  (and if the Company  shall  survive the
consummation of such  transaction,  such assumption shall be in addition to, and
shall not release the Company from,  any  continuing  obligations of the Company
hereunder),  (b) the  obligations of the Company under the  Registration  Rights
Agreement,  and (c) the obligation to deliver to such  Noteholder such shares of
stock,  securities,  cash or  property  as,  in  accordance  with the  foregoing
provisions of this Section 5.3, such Noteholder may be entitled to receive,  and
such Person  shall have  similarly  delivered to such  Noteholder  an opinion of
counsel for such Person, which counsel shall be reasonably  satisfactory to such
Noteholder,  stating that this Note shall thereafter  continue in full force and
effect and the terms hereof (including  without limitation all of the provisions
of this  Section  5.3) shall be  applicable  to the stock,  securities,  cash or
property  which such Person may be required to deliver  upon any exercise of the
Conversion Right or the exercise of any rights pursuant hereto.

     5.4. Other Dilutive  Events.  In case any event shall occur as to which the
provisions  of Section  5.2 or 5.3 hereof are not  strictly  applicable  but the
failure to make any  adjustment  would  not,  in the  reasonable  opinion of the
Noteholder,  fairly protect the purchase Conversion Right in accordance with the
essential  intent and principles of such  Sections,  then, in each such case, at
the request of such Noteholder,  the Company shall appoint a firm of independent
investment  bankers of recognized  national standing (which shall be independent
of the Company and shall be  satisfactory to the  Noteholder),  which shall give
their  opinion  upon the  adjustment,  if any,  on a basis  consistent  with the
essential  intent and  principles  established  in Sections  5.2 and 5.3 hereof,
necessary to preserve,  without dilution,  the Conversion Right. Upon receipt of
such opinion, the Company will promptly



                                      -26-

<PAGE>



mail a copy  thereof to the  Noteholder  and shall make the  adjustments
described therein.

     5.5. No Dilution or  Impairment.  The Company will not, by amendment of its
certificate   of   incorporation   or   through   any   consolidation,   merger,
reorganization,  transfer of assets, dissolution, issue or sale of securities or
any other voluntary action, avoid or seek to avoid the observance or performance
of any of the terms of this Note,  but will at all times in good faith assist in
the  carrying  out of all such terms and in the taking of all such action as may
be  necessary or  appropriate  in order to protect the  Conversion  Right of the
Noteholder against dilution or other impairment. Without limiting the generality
of the foregoing, the Company (a) will not permit the par value of any shares of
stock  receivable upon the exercise of the Conversion Right to exceed the amount
payable  therefor  upon such  exercise,  (b) will take all such action as may be
necessary or appropriate in order that the Company may validly and legally issue
fully paid and  nonassessable  shares of stock on the exercise of the Conversion
Right from time to time outstanding,  (c) will not take any action which results
in any  adjustment  of the  Conversion  Price if the  total  number of shares of
Common Stock (or Other  Securities)  issuable after the action upon the complete
exercise  of the  Conversion  Right for all  shares of Common  Stock that may be
acquired  hereunder  would exceed the total number of shares of Common Stock (or
Other Securities) then authorized by the Company's  certificate of incorporation
and  available  for the  purpose of issue upon such  exercise,  and (d) will not
issue any capital stock of any class which is preferred as to dividends or as to
the   distribution   of  assets  upon  voluntary  or  involuntary   dissolution,
liquidation  or  winding-up,  unless the rights of the holder  thereof  shall be
limited  to a fixed  sum or  percentage  of par  value  or a sum  determined  by
reference to a formula based on a published index of interest rates, an interest
rate publicly  announced by a financial  institution  or a similar  indicator of
interest  rates in respect of  participation  in dividends and to a fixed sum or
percentage of par value in any such distribution of assets.

     5.6. Accountants' Report as to Adjustments.  In each case of any adjustment
or  readjustment  in the shares of Common Stock (or Other  Securities)  issuable
upon the  exercise of the  Conversion  Right,  the  Company at its expense  will
promptly  compute such  adjustment or  readjustment in accordance with the terms
hereof and cause  independent  certified public accounts of recognized  national
standing  (which may be the  regular  auditors of the  Company)  selected by the
Company to verify such computation (other than any computation of the fair value
of  property  as  determined  in good  faith by the  Board of  Directors  of the
Company) and prepare a



                                      -27-

<PAGE>



report setting forth such adjustment or  readjustment  and showing in reasonable
detail  the  method  of  calculation  thereof  and the  facts  upon  which  such
adjustment  or  readjustment  is  based,   including  a  statement  of  (a)  the
consideration  received or to be  received  by the  Company  for any  Additional
Shares of Common  Stock  issued or sold or deemed to have been  issued,  (b) the
number of shares of Common Stock  outstanding or deemed to be  outstanding,  and
(c) the Conversion Price in effect  immediately  prior to such issue or sale and
as  adjusted  and  readjusted  (if  required  by Section  5.2 hereof) on account
thereof.  The  Company  will  forthwith  mail a copy of each such report to each
Noteholder  and will,  upon the written  request at any time of any  Noteholder,
furnish to such  Noteholder a like report setting forth the Conversion  Price at
the time in effect and showing in reasonable  detail how it was calculated.  The
Company  will also keep  copies of all such  reports  at its  office  maintained
pursuant to Section 5.12.2(a) hereof and will cause the same to be available for
inspection at such office during normal  business hours by any Noteholder or any
prospective purchaser thereof designated by the Noteholder thereof.

     5.7. Notices of Corporate Action. In the event of

          (a) any  taking by the  Company  of a record  (or  establishment  of a
     record date) of the shareholders of any class of securities for the purpose
     of  determining  the  shareholders  thereof who are entitled to receive any
     dividend or other distribution,  or any right to subscribe for, purchase or
     otherwise  acquire any shares of stock of any class or any other securities
     or property, or to receive any other right, or

          (b) any capital  reorganization  of the Company,  reclassification  or
     recapitalization  of the capital stock of the Company or any  consolidation
     or merger involving the Company and any other Person or any transfer of all
     or substantially all the assets of the Company to any other Person, or

          (c)  any  voluntary  or   involuntary   dissolution,   liquidation  or
     winding-up of the Company, or

          (d) any issuance of any Common Stock,  Convertible  Security or Option
     by the Company,

     the Company will mail to each  Noteholder a notice  specifying (i) the date
or  expected  date on which any  record is to be taken for the  purpose  of such
dividend,  distribution or right, and the amount and character of such dividend,
distribution or right, (ii) the



                                      -28-

<PAGE>



date or  expected  date on  which  any  such  reorganization,  reclassification,
recapitalization,  consolidation,  merger, transfer, dissolution, liquidation or
winding-up is to take place,  the time,  if any such time is to be fixed,  as of
which the Noteholders of record of Common Stock (or Other  Securities)  shall be
entitled to exchange their shares of Common Stock (or Other  Securities) for the
securities   or   other   property   deliverable   upon   such   reorganization,
reclassification,    recapitalization,    consolidation,    merger,    transfer,
dissolution, liquidation or winding-up and a description in reasonable detail of
the transaction and (iii) the date of such issuance, together with a description
of the  security  so  issued  and  the  consideration  received  by the  Company
therefor. Such notice shall be mailed at least 45 days prior to the date therein
specified.

     5.8.  Registration  of Common Stock. If any shares of Common Stock required
to be  reserved  for  purposes  of  exercise  of the  Conversion  Right  require
registration with or approval of any governmental authority under any federal or
state law (other than the Securities  Act) before such shares may be issued upon
exercise, the Company will, at its expense and as expeditiously as possible, use
its best efforts to cause such shares to be duly registered or approved,  as the
case may be.  The shares of Common  Stock (or Other  Securities)  issuable  upon
exercise of the Conversion  Right shall  constitute  Registrable  Securities (as
such term is defined in the  Registration  Rights  Agreement).  Each  Noteholder
shall be  entitled  to all of the  benefits  afforded  to a  holder  of any such
Registrable   Securities  under  the  Registration  Rights  Agreement  and  such
Noteholder,  by its acceptance of the Note,  agrees to be bound by and to comply
with the terms and conditions of the Registration Rights Agreement applicable to
such  Noteholder  as a holder of such  Registrable  Securities.  As  promptly as
practicable  following  the  date  hereof  and,  in any  event  within  30  days
thereafter,  the Company  will,  at its expense,  arrange for the listing on the
American  Stock  Exchange,  upon official  notice of issuance,  of the shares of
Common Stock issuable upon exercise hereof.  At any such time as such shares are
listed on any other  national  securities  exchange,  the Company  will,  at its
expense,  obtain  promptly  and  maintain  the approval for listing on each such
exchange,  upon  official  notice of  issuance,  of the  shares of Common  Stock
issuable upon exercise of the Conversion Right, and maintain the listing of such
shares after their issuance.

     5.9. Restrictions on Transfer.

     5.9.1.  Restrictive Legend. Except as otherwise permitted by this Section
5.9, each  certificate  for Common Stock (or Other  Securities)  issued upon the
exercise of the Conversion Right



                                      -29-

<PAGE>



and each  certificate  issued upon the direct or  indirect  transfer of any such
Common Stock (or Other  Securities),  this Note and each Note issued upon direct
or indirect  transfer or in substitution  for this Note pursuant to Section 5.12
hereof  shall  bear the  legend  set forth on the face of this Note and shall be
transferable only upon satisfaction of the conditions  specified in this Section
5.9.

     5.9.2.  Notice of  Proposed  Transfer,  Opinion  of  Counsel.  Prior to any
transfer  of this Note or any  Restricted  Securities  which are not  registered
under  an  effective  registration  statement  under  the  Securities  Act,  the
Noteholder  will  give  written  notice  to the  Company  of  such  Noteholder's
intention to effect such transfer and to comply in all other  respects with this
Section 5.9.2.  Each such notice (a) shall describe the manner and circumstances
of the proposed  transfer,  and (b) shall  designate  counsel for the Noteholder
giving such notice. The Noteholder giving such notice will submit a copy thereof
to the counsel  designated in such notice.  The following  provisions shall then
apply:

          (a) If in the opinion of such  counsel the  proposed  transfer  may be
     effected without  registration of such Note or Restricted  Securities under
     the Securities Act, such Noteholder shall thereupon be entitled to transfer
     such Note or  Restricted  Securities  in  accordance  with the terms of the
     notice  delivered by such Noteholder to the Company.  Except as provided in
     Section  5.9.3  hereof,  each  certificate  representing  the Note and such
     Restricted Securities issued upon or in connection with such transfer shall
     bear the restrictive legends required by Section 5.9.1 hereof.

          (b) If in the opinion of such  counsel the  proposed  transfer may not
     legally be effected  without  registration  under the  Securities Act (such
     opinion to state the basis of the legal conclusions reached therein),  such
     Noteholder  shall not be  entitled  to  transfer  such  Note or  Restricted
     Securities until either (x) receipt by the Company of a further notice from
     such Noteholder pursuant to the foregoing  provisions of this Section 5.9.2
     and  fulfillment  of the  provisions  of  clause  (a) and (y) such  Note or
     Restricted Securities have been effectively registered under the Securities
     Act.

The Company will pay the reasonable  fees and  disbursements  of counsel for any
Noteholder  and of counsel  for the  Company  in  connection  with all  opinions
rendered by them  pursuant to this Section  5.9.2 and pursuant to Section  5.9.3
hereof.  Notwithstanding  any other provision of this Section 5.9, no opinion of
counsel shall be necessary for a transfer of the Note or



                                      -30-

<PAGE>



Restricted  Securities  by  the  Noteholder  thereof  to an  affiliate  of  such
Noteholder,  if the  transferee  agrees in  writing  to be  subject to the terms
hereof to the same  extent as if such  transferee  were the  Initial  Noteholder
hereof.

     5.9.3.  Termination  of  Restrictions.  The  restrictions  imposed  by this
Section 5.9 upon the  transferability  of Restricted  Securities shall cease and
terminate as to any particular  Restricted  Securities (a) when such  Restricted
Securities shall have been  effectively  registered under the Securities Act, or
(b) when, in the opinions of both counsel for the Noteholder thereof and counsel
for the Company,  such  restrictions  are no longer  required in order to insure
compliance with the Securities Act. Whenever such  restrictions  shall cease and
terminate as to any  Restricted  Securities,  the  Noteholder  thereof  shall be
entitled to receive from the Company,  without  expense  (other than  applicable
transfer taxes, if any), new securities of like tenor not bearing the applicable
legends required by Section 5.9.1 hereof.

     5.10.  Availability  of  Information.  If the  Company  shall  have filed a
registration  statement  pursuant to the  requirements  of the Exchange Act or a
registration  statement  pursuant to the requirements of the Securities Act, the
Company will comply with the reporting  requirements of Sections 13 and 15(d) of
the  Exchange Act and will comply with all other  public  information  reporting
requirements of the Commission (including Rule 144 promulgated by the Commission
under  the  Securities  Act) from time to time in  effect  and  relating  to the
availability  of an  exemption  from  the  Securities  Act for  the  sale of any
Restricted  Securities.  The Company will also cooperate with each holder of any
Restricted Securities in supplying such information as may be necessary for such
holder  to  complete  and file any  information  reporting  forms  presently  or
hereafter  required by the Commission as a condition to the  availability  of an
exemption from the Securities Act for the sale of any Restricted Securities. The
Company will furnish to each Noteholder, promptly upon their becoming available,
copies of all financial statements,  reports,  notices and proxy statements sent
or made available  generally by the Company to its  stockholders,  and copies of
all  regular  and  periodic   reports  and  all   registration   statements  and
prospectuses  filed by the  Company  with any  securities  exchange  or with the
Commission.

     5.11.  Reservation of Stock, Etc. The Company will at all times reserve and
keep available, solely for issuance and delivery upon exercise of the Conversion
Right, the number of shares of Common Stock of each class (or Other  Securities)
from time to time issuable upon the complete  exercise of the  Conversion  Right
for all shares that may be acquired hereunder. All shares of



                                      -31-

<PAGE>



Common Stock (or Other  Securities)  issuable  upon  exercise of the  Conversion
Right shall be duly  authorized  and, when issued upon such  exercise,  shall be
validly issued and, in the case of shares,  fully paid and nonassessable with no
liability on the part of the holders thereof.

     5.12. Ownership, Transfer and Substitution of Notes.

     5.12.1.  Ownership. The Company may treat the person in whose name the Note
is  registered  on the  register  kept at the office of the  Company  maintained
pursuant to Section 5.12.2(a) hereof as the owner and Noteholder thereof for all
purposes,  notwithstanding any notice to the contrary,  except that, if and when
the Note is  properly  assigned  in blank,  the  Company  may (but  shall not be
obligated  to)  treat  the  bearer  thereof  as the  owner  of the  Note for all
purposes,  notwithstanding  any notice to the  contrary.  Subject to Section 5.9
hereof, the Note, if properly assigned, may be exercised by a new Noteholder.

     5.12.2. Office; Transfer and Exchange of Note.

          (a) The  Company  will  maintain  an  office  (which  may be an agency
     maintained  at a bank) in New York City (which is  currently  the office of
     Fidata   Corporation)   and/or  San  Diego,   California   where   notices,
     presentations  and  demands in respect of this Note may be made upon it and
     shall notify the Noteholders of any change of location of such office.

          (b) The  Company  shall  cause  to be kept  at its  office  maintained
     pursuant to Section  5.12.2(a)  hereof a register for the  registration and
     transfer of the Note. The names and addresses of Noteholders, the transfers
     thereof and the names and  addresses  of  transferees  of the Note shall be
     registered in such register.  The Person in whose name any Note shall be so
     registered shall be deemed and treated as the owner and Noteholder  thereof
     for all  purposes,  and the Company  shall not be affected by any notice or
     knowledge to the contrary.

          (c)  Upon  the  surrender  of  this  Note,   properly  endorsed,   for
     registration  of  transfer  or for  exchange  at the office of the  Company
     maintained pursuant to Section 5.12.2(a) hereof, the Company at its expense
     will (subject to compliance with Section 5.9 hereof, if applicable) execute
     and  deliver to or upon the order of the  Noteholder  thereof a new Note or
     Notes of like tenor,  in the name of such  Noteholder or as such Noteholder
     (upon payment by such  Noteholder  of any  applicable  transfer  taxes) may
     direct, calling in the aggregate on the



                                      -32-

<PAGE>



     face or faces  thereof for  conversion  into the number of shares of Common
     Stock called for in the Notes so surrendered.

     5.12.3.   Replacement  of  Notes.  Upon  receipt  of  evidence   reasonably
satisfactory to the Company of the loss, theft, destruction or mutilation of any
Note, upon delivery of indemnity reasonably  satisfactory to the Company in form
and amount or, in the case of any such  mutilation,  upon surrender of such Note
for  cancellation  at the office of the Company  maintained  pursuant to Section
5.12.2(a) hereof,  the Company at its expense will execute and deliver,  in lieu
thereof, a new Note of like tenor and dated the date hereof.

     5.12.4. Additional Restrictions. Any transfer of this Note shall be subject
to the additional restrictions and provisions of Section 6.1 hereof.

     5.13.  Repurchase by the Company of Note. In the event that, at any time or
from  time to time  prior to the  Expiration  Date,  the  Initial  Holder or any
Affiliate  thereof  desires to exercise the Conversion  Right and is required by
any of the provisions the Hart-Scott,  to file a Hart-Scott Form with the United
States  Federal Trade  Commission  and/or the United States  Justice  Department
prior to the  conversion  of all or any  portion  of this Note  pursuant  to the
Conversion  Right;  and (ii)  such  person,  with  due  care and in good  faith,
proceeds with such filing (the "Filing")  but,  within sixty (60) days following
the date on which such person  makes a Filing,  the  Noteholder  is prevented or
otherwise   restricted  by  the  provision  of  Hart-Scott  and  the  rules  and
regulations  thereunder from converting all or any portion of this Note pursuant
to the Conversion  Right,  then upon written notice thereof from the Noteholder,
the Company shall, within ten (10) business days following the Company's receipt
of such notice,  repurchase  from the  Noteholder  the portion of this Note that
such holder was prohibited or otherwise  restricted (the "Restricted  Portion"),
pursuant  to  the  provisions  of  Hart-Scott  and  the  rules  and  regulations
thereunder, from converting, for a price equal to the product of: (x) the number
of shares of Common  Stock  for  which the  Restricted  Portion  of this Note is
convertible but for the provisions of Hart-Scott; and (y) the difference between
the Current  Market Price per share of Common Stock as of the date of the Filing
and the current Conversion Price per share of Common Stock as of the date of the
Filing.

     5.14.  Remedies.  The Company  stipulates  that the  remedies at law of the
Noteholder in the event of any default or  threatened  default by the Company in
the  performance of or compliance with any of the terms of this Note are not and
will not



                                      -33-

<PAGE>



be adequate and that, to the fullest extent  permitted by law, such terms may be
specifically  enforced by a decree for the specific performance of any agreement
contained  herein or by an  injunction  against a violation  of any of the terms
hereof or otherwise.

     5.15. No Rights or Liabilities as  Stockholder.  Nothing  contained in this
Note shall be construed as conferring upon the Noteholder hereof any rights as a
stockholder of the Company or as imposing any  obligation on such  Noteholder to
purchase any securities or as imposing any  liabilities on such  Noteholder as a
stockholder of the Company,  whether such obligation or liabilities are asserted
by the Company or by creditors of the Company.


                                   ARTICLE VI

                                  MISCELLANEOUS

     SECTION  6.1.  Transfer  and  Exchange.  In addition to the  provisions  of
Section 5.12 hereof,  at the option of the Noteholder  hereof,  this Note may be
transferred  or  exchanged  for  other  notes  of any  denomination  which is an
integral  multiple  of $1,000 and of a like  aggregate  principal  amount.  Upon
surrender hereof to the Company,  the Company shall execute and deliver,  in the
name of such Noteholder,  or the new transferee or transferees,  as the case may
be,  one or more  new  notes,  in such  authorized  denominations  as  shall  be
designated  by the  Noteholder  hereof and dated the most  recent  date to which
interest has been paid on the surrendered note, or if no interest has been paid,
then dated the date  hereof.  All notes  issued  under this Section 6.1 shall be
valid obligations of the Company,  evidencing the same indebtedness and entitled
to the same benefits as the note surrendered.  Upon presentation for transfer or
exchange,  this Note shall be  accompanied  by an  executed  form of  assignment
satisfactory to the Company. No service charge shall be made for the transfer or
exchange of this Note.

     SECTION  6.2. No Waiver;  Cumulative  Remedies.  No failure or delay on the
part of the Noteholder in exercising any right,  power or remedy under this Note
shall operate as a waiver thereof;  nor shall any single or partial  exercise of
any such right,  power or remedy preclude any other or further  exercise thereof
or the  exercise  of any other  right,  power or remedy  right,  power or remedy
preclude  any other or further  exercise  thereof or the  exercise  of any other
right,  power or remedy under this Note. The remedies  provided in this Note are
cumulative and not exclusive of any remedies provided by law.




                                      -34-

<PAGE>



     SECTION 6.3. Amendments, Etc. No amendment,  modification,  termination, or
waiver of any provision of this Note nor consent to any departure by the Company
therefrom,  shall in any event be effective  unless the same shall be in writing
and signed by the Noteholder, and then such waiver or consent shall be effective
only in the specific  instance and for the specific  purpose for which given. No
notice or demand on the  Company in any case shall  entitle  the  Company to any
other or further notice or demand in similar or other circumstances.

     SECTION 6.4. Addresses for Notices,  Etc. All notices,  requests,  demands,
directions  and other  communications  provided  for under this Note shall be in
writing  (including  telegraphic  communication)  and mailed or delivered to the
applicable party at the addresses indicated below:

                  If to the Company:

                  Advanced Medical, Inc.
                  9775 Businesspark Avenue
                  San Diego, California  92131
                  Attention: President

                  If to the Noteholder:

                  Decisions Incorporated
                  22 Saw Mill River Road
                  Hawthorne, New York 10532
                  Attention: President

or, as to each party, at such other address as shall be designated by such party
in a written notice to each other party  complying as to delivery with the terms
of this  Section.  All such notices,  requests,  demands,  directions  and other
communications shall, when mailed or telegraphed, be effective when deposited in
the mails or  delivered to the  telegraph  company,  respectively,  addressed as
aforesaid.

     SECTION 6.5. Payment on Non-Business Days.  Whenever any payment to be made
under  this Note  shall be stated  to be due on a  Saturday,  Sunday or a public
holiday under the laws of the State of New York or the State of California  such
payment may be made on the next  succeeding  business day, and such extension of
time shall in such case be  included in the  computation  of payment of interest
under this Note.

     SECTION 6.6.  Binding Effect;  Assignment.  This Note shall be binding upon
and inure to the benefit of such parties and



                                      -35-

<PAGE>



their respective successors and assigns, except that, the Company shall not have
the right to assign its rights  hereunder or any interest or  obligation  herein
without the prior written consent of the Noteholder.

     SECTION 6.7.  Governing  Law. This Note shall be governed by, and construed
in accordance  with,  the laws of the State of New York  applicable to contracts
made and to be performed wholly within such State.

     SECTION 6.8. Severability of Provisions.  Subject to the fifth paragraph of
this Note,  any provision of this Note which is prohibited or  unenforceable  in
any jurisdiction shall, as to such jurisdiction, be ineffective to the extent of
such  prohibition  or  unenforceability   without   invalidating  the  remaining
provisions  hereof or affecting the validity or enforceability of such provision
in any other jurisdiction.

     SECTION  6.9.  Headings.  Article  and  Section  headings  in this Note are
included  herein for  convenience  of reference  only and shall not constitute a
part hereof for any other purpose.

     SECTION 6.10 Consent of the Noteholder.  Except to the extent  specifically
provided herein, to the extent that the consent of the Noteholder is required in
accordance  with the terms of this Note,  such  consent  may be  withheld in the
Noteholder's sole discretion.

     SECTION 6.11.  Debentures and Debenture Notes.  The Indebtedness  hereunder
constitutes "Senior Indebtedness" within the meaning ascribed to such term under
the indentures creating the Debentures and the Debenture Notes.



                                      -36-

<PAGE>



     IN WITNESS WHEREOF,  the Company has caused this Note to be executed by its
proper  corporate  officer  thereunto duly authorized as of the date first above
written.

                                          ADVANCED MEDICAL, INC.



                                          By: /s/ Joseph Kuhn, President




The signature of the undersigned below evidences its agreement to and acceptance
of the provisions of Article II hereof.


DECISIONS INCORPORATED


By: /s/ April Freilich, President



                                      -37-

<PAGE>


                                    EXHIBIT A


                              FORM OF SUBSCRIPTION

             [To be executed only upon exercise of Conversion Right]



To Advanced Medical, Inc.



     The  undersigned  registered  Noteholder  of  the  promissory  note  in the
original  principal amount of $6,500,000  issued to Decisions on _______,  1995,
hereby  irrevocably  exercises the  Conversion  Right thereof for, and purchases
thereunder * shares of the Common Stock through application of $_____________ of
the principal  amount of the Note as purchase price therefor,  and requests that
the  certificates  for such  shares be issued in the name of, and  delivered  to
____________________________ , whose address is __________________
- ----------------------.


Dated:
                                            (Signature must conform in all
                                            respects to name of Noteholder)




                                                         (Street Address)



                                            (City)   (State)     (Zip Code)

- --------
*Insert here the number of shares called for in the first paragraph of Article V
of the Note (or, in the case of a partial  exercise,  the portion  thereof as to
which the Conversion  Right is being  exercised),  in either case without making
any adjustment for Additional Shares of Common Stock or any other stock or other
securities or property or cash which,  pursuant to the adjustment  provisions of
Article V of the Note, may be delivered upon exercise.



<PAGE>





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