INTEGRAMED AMERICA INC
10-Q, 1998-11-16
OFFICES & CLINICS OF DOCTORS OF MEDICINE
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                                  UNITED STATES
                       SECURITIES AND EXCHANGE COMMISSION
                             WASHINGTON, D.C. 20549


                                    FORM 10-Q

              [X] QUARTERLY REPORT PURSUANT TO SECTION 13 OR 15(d)
                     OF THE SECURITIES EXCHANGE ACT OF 1934

                For the quarterly period ended September 30, 1998

                                       OR

             [ ] TRANSITION REPORT PURSUANT TO SECTION 13 OR 15 (d)
                     OF THE SECURITIES EXCHANGE ACT OF 1934

                        For the transition period from to

                           Commission File No. 0-20260
                           Commission File No. 1-11440

                            INTEGRAMED AMERICA, INC.
             (Exact name of Registrant as specified in its charter)


                                    Delaware
         (State or other jurisdiction of incorporation or organization)


                             One Manhattanville Road
                               Purchase, New York
                    (Address of principal executive offices)
                                   06-1150326
                      (I.R.S. employer identification no.)



                                      10577
                                   (Zip code)


                                 (914) 253-8000
              (Registrant's telephone number, including area code)


         Indicate by check mark whether the Registrant (1) has filed all reports
required to be filed by Section 13 or 15(d) of the  Securities  Exchange  Act of
1934  during  the  preceding  12 months  (or for such  shorter  period  that the
Registrant was required to file such reports),  and (2) has been subject to such
filing requirements for the past 90 days.

                                  Yes [X]   No [  ]

         The aggregate number of shares of the Registrant's  Common Stock,  $.01
par value, outstanding on November 1, 1998 was 20,648,369.

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<PAGE>



                            INTEGRAMED AMERICA, INC.
                                    FORM 10-Q

                                TABLE OF CONTENTS


                                                                            PAGE

PART I  -     FINANCIAL INFORMATION

    Item 1.   Financial Statements

                  Consolidated Balance Sheet at September 30, 1998 (unaudited)
                     and December 31, 1997.....................................3

                  Consolidated Statement of Operations for the three and
                     nine-month periods ended September 30, 1998
                     and 1997 (unaudited)......................................4

                  Consolidated Statement of Cash Flows for the nine-month
                     periods ended September 30, 1998 and 1997 (unaudited).....5

                  Notes to Consolidated Financial Statements (unaudited)....6-15

    Item 2.   Management's Discussion and Analysis of Financial Condition
                and Results of Operations..................................16-23

    Item 3.   Quantitative and Qualitative Disclosures About Market Risk......23


PART II -     OTHER INFORMATION

    Item 1.   Legal Proceedings...............................................24

    Item 2.   Changes in Securities...........................................24

    Item 3.   Defaults upon Senior Securities.................................24

    Item 4.   Submission of Matters to a Vote of Security Holders.............24

    Item 5.   Other Information...............................................24

    Item 6.   Exhibits and Reports on Form 8-K................................24


SIGNATURES              ......................................................25

INDEX TO EXHIBITS.............................................................26


                                        2

<PAGE>



PART I  -  FINANCIAL INFORMATION
    Item 1.      Consolidated Financial Statements

<TABLE>
                            INTEGRAMED AMERICA, INC.
                           CONSOLIDATED BALANCE SHEET
                           (all dollars in thousands)
                                     ASSETS
<CAPTION>
                                                                                        September 30,           December 31,
                                                                                        ------------            -----------
                                                                                            1998                    1997        
                                                                                        ------------            -----------
                                                                                         (unaudited)
Current assets:
 <S>                                                                                      <C>                     <C>     
  Cash and cash equivalents ..........................................................    $  5,037                $  1,930
  Patient accounts receivable, less allowance for doubtful accounts of $499 and $180
    in 1998 and 1997, respectively....................................................      10,874                   7,061
 Management fees receivable, less allowance for doubtful accounts of $114 and $214
    in 1998 and 1997, respectively....................................................       1,785                   1,600
  Other current assets ...............................................................       1,450                   1,757
                                                                                           -------                 -------
      Total current assets............................................................      19,146                  12,348
                                                                                           -------                 -------
  Fixed assets, net ..................................................................       5,077                   4,742
  Intangible assets, net..............................................................      19,478                  18,445
  Other assets........................................................................         677                     566
                                                                                           -------                 -------
      Total assets....................................................................     $44,378                 $36,101
                                                                                           =======                 =======
                                             LIABILITIES AND SHAREHOLDERS' EQUITY
Current liabilities:
  Accounts payable....................................................................   $     553                $  1,475
  Accrued liabilities.................................................................       3,400                   2,260
  Due to Medical Practices (see Note 2)...............................................       2,097                   1,745
  Dividends accrued on Preferred Stock................................................         563                     464
  Notes payable and current portion of long-term debt.................................       2,097                     614
  Current portion of exclusive management rights obligation...........................          76                     472
  Patient deposits ...................................................................       2,326                   1,236
                                                                                           -------                 -------
      Total current liabilities.......................................................      11,112                   8,266
                                                                                           -------                 -------
Long-term debt .......................................................................       4,852                     451
Exclusive management rights obligation................................................         454                   1,391
Shareholders' equity
  Preferred Stock, $1.00 par value -
    3,165,644  shares  authorized  in 1998 and 1997,  respectively  -  2,500,000
    undesignated;  665,644 shares designated as Series A Cumulative  Convertible
    of which 165,644 shares were issued and outstanding in 1998 and
    1997, respectively................................................................         166                     166
  Common Stock, $.01 par value - 50,000,000 and 25,000,000 shares authorized;
    21,372,369 and 17,198,616 shares issued and outstanding in 1998 and 1997,
    respectively......................................................................         213                     172
  Capital in excess of par ...........................................................      53,563                  46,471
  Accumulated deficit ................................................................     (25,982)                (20,816)
                                                                                           -------                 -------
      Total shareholders' equity .....................................................      27,960                  25,993
                                                                                           -------                 -------
      Total liabilities and shareholders' equity......................................     $44,378                 $36,101
                                                                                           =======                 =======

        See accompanying notes to the consolidated financial statements.
</TABLE>


                                        3

<PAGE>

<TABLE>


                            INTEGRAMED AMERICA, INC.
                      CONSOLIDATED STATEMENT OF OPERATIONS
              (all amounts in thousands, except per share amounts)

<CAPTION>

                                                                       For the                  For the
                                                                 three-month period       nine-month period
                                                                  ended September 30,     ended September 30,
                                                                 --------------------     -------------------
                                                                   1998         1997       1998         1997
                                                                 -------       ------     ------       ------  
                                                                      (unaudited)             (unaudited)

<S>                                                                <C>        <C>         <C>          <C>    
Revenues, net (see Note 2)......................................   $9,756     $4,956      $27,927      $13,369
Costs of services incurred on behalf of Network Sites:
   Employee compensation and related expenses...................    3,734      1,884       11,050        4,943
   Direct materials.............................................    1,153        302        3,359          929
   Occupancy costs..............................................      725        464        2,120        1,198
   Depreciation.................................................      343        195          976          556
   Other expenses...............................................    1,564        633        3,960        1,926
                                                                   ------     ------      -------       ------
   Total costs of services......................................    7,519      3,478       21,465        9,552

Network Sites' contribution.....................................    2,237      1,478        6,462        3,817
                                                                   ------     ------      -------       ------

General and administrative expenses.............................    1,385      1,005        3,856        3,028
Amortization of intangible assets...............................      234        161          681          349
Interest income.................................................      (24)       (30)         (45)         (98)
Interest expense................................................      126         14          306           48
                                                                   ------     ------      -------       ------
   Total other expenses.........................................    1,721      1,150        4,798        3,327
                                                                   ------     ------      -------       ------

Restructuring and other charges (see Note 8)....................      --         --         2,084         --

Income (loss) from continuing operations before income taxes....      516        328         (420)         490
Provision for income taxes......................................       94         20          245           84
                                                                   ------     ------      -------       ------
Income (loss) from continuing operations........................      422        308         (665)         406

Discontinued operations (see Note 7):
   Loss from operations of discontinued AWM Division (less
      applicable income taxes of $0)............................      --         200          923          249
   (Recapture) loss from disposal of AWM Division...............     (350)       --         3,578          -- 
                                                                   ------     ------      -------       ------
Net income (loss)...............................................      772        108       (5,166)         157
Less: Dividends accrued on Preferred Stock......................       33         33           99           99
                                                                   ------     ------      -------       ------
Net income (loss) applicable to Common Stock....................   $  739     $   75      $(5,265)      $   58
                                                                   ======     ======      =======       ======
Basic and diluted earnings (loss) per share of Common Stock:
   Continuing operations........................................   $ 0.02     $ 0.02      $ (0.04)      $ 0.03
   Discontinued operations......................................     0.01      (0.01)       (0.21)       (0.02)
                                                                   ------     ------      -------       ------
   Net earnings (loss)..........................................   $ 0.03     $ 0.01      $ (0.25)      $ 0.01
                                                                   ======     ======      =======       ======
Weighted average shares - basic.................................   21,372     13,243       20,904       10,790
                                                                   ======     ======      =======       ======
Weighted average shares - diluted...............................   21,619     13,473       20,904       11,020
                                                                   ======     ======      =======       ======

        See accompanying notes to the consolidated financial statements.
</TABLE>


                                        4

<PAGE>

<TABLE>


                                                 INTEGRAMED AMERICA, INC.
                                           CONSOLIDATED STATEMENT OF CASH FLOWS
                                                (all amounts in thousands)

<CAPTION>

                                                                                               For the
                                                                                          nine-month period
                                                                                         ended September 30,  
                                                                                         -------------------    
                                                                                          1998         1997
                                                                                         -------      ------
                                                                                             (unaudited)
Cash flows from operating activities:
<S>                                                                                     <C>          <C>       
  Net (loss) income ..............................................................      $(5,166)     $   157
  Adjustments to reconcile net (loss) income to net cash used in operating activities:
   Depreciation and amortization..................................................        1,938        1,228
   Writeoff of tangible and intangible assets ....................................        5,541           95
   Changes in assets and liabilities-- (Increase) decrease in assets:
        Patient accounts receivable...............................................       (2,733)      (2,237)
        Management fees receivable................................................       (1,075)        (261)
        Other current assets......................................................          199         (108)
        Other assets..............................................................         (111)        (151)
     Increase (decrease) in liabilities:
         Accounts payable.........................................................       (1,222)        (835)
         Accrued liabilities......................................................         (343)         285
         Due to Medical Practices.................................................          352         (164)
         Patient deposits.........................................................          878          434
                                                                                         ------      -------
   Net cash used in operating activities..........................................       (1,742)      (1,557)
                                                                                         ------      -------

  Cash flows (used in) provided by investing activities:
     Proceeds from short term investments.........................................          --         2,000
     Purchase of net liabilities (assets) of acquired businesses..................          487         (661)
     Payments for exclusive management rights and related acquisition costs.......       (3,165)      (9,447)
     Purchase of fixed assets and leasehold improvements..........................       (1,216)        (834)
     Proceeds from sale of fixed assets...........................................          135          139
                                                                                         ------      -------
  Net cash used in investing activities...........................................       (3,759)      (8,803)
                                                                                         ------      -------

  Cash flows provided by (used in) financing activities:
     Proceeds from issuance of Common Stock.......................................        5,500        9,601
     Used for stock issue costs...................................................          (74)      (1,193)
     Proceeds from bank under Credit Facility.....................................        6,000          250
     Principal repayments on debt.................................................       (2,833)        (193)
     Principal repayments under capital lease obligations.........................          (84)         (97)
     Proceeds from exercise of Common Stock options...............................           99           19
                                                                                         ------      -------
Net cash provided by financing activities.........................................        8,608        8,387
                                                                                         ------      -------

Net increase (decrease) in cash and cash equivalents..............................        3,107       (1,973)
Cash and cash equivalents at beginning of period..................................        1,930        3,952
                                                                                         ------      -------


Cash and cash equivalents at end of period........................................       $5,037      $ 1,979
                                                                                         ======      =======

        See accompanying notes to the consolidated financial statements.



</TABLE>

                                        5

<PAGE>



                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS
                                   (unaudited)

NOTE 1 -- INTERIM RESULTS:

     The  accompanying  unaudited  consolidated  financial  statements have been
prepared in accordance with the instructions to Form 10-Q and,  accordingly,  do
not include all of the information and footnotes  required by generally accepted
accounting  principles  for  complete  financial  statements.  In the opinion of
management,  the accompanying unaudited interim financial statements contain all
adjustments  (consisting only of normal recurring accruals) necessary to present
fairly  the  financial  position  at  September  30,  1998,  and the  results of
operations and cash flows for the interim period  presented.  Operating  results
for the interim  period are not  necessarily  indicative  of results that may be
expected  for the year ending  December  31, 1998.  These  financial  statements
should be read in  conjunction  with the financial  statements and notes thereto
included in the Company's Annual Report on Form 10-K for the year ended December
31, 1997.

NOTE 2 -- SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES:

   Basis of consolidation --

     The consolidated  financial  statements comprise the accounts of IntegraMed
America,  Inc. and its wholly owned  subsidiaries,  IVF America (NY),  Inc., IVF
America (MA),  Inc., IVF America (PA), Inc., IVF America (NJ), Inc., IVF America
(MI), Inc., IntegraMed America of Illinois, Inc., Shady Grove Fertility Centers,
Inc. (see Note 6) and the Adult  Women's  Medical  Center,  Inc.  ("AWMC").  All
significant intercompany transactions have been eliminated.  The Company derives
its revenues from management agreements and, with respect to one managed Network
Site and AWMC, from patient service  revenues.  The Company does not consolidate
the results of its managed Network Sites.  Effective August 6, 1998, IVF America
(NY), Inc., IVF America (MA), Inc., IVF America (PA), Inc. and IVF America (MI),
Inc. were merged into IntegraMed America,  Inc. Effective September 1, 1998, the
Company disposed of AWMC via a sale of its operations.

     In  1997,  the  Emerging  Issues  Task  Force of the  Financial  Accounting
Standards  Board (the "EITF") issued EITF No. 97-2. The EITF reached a consensus
concerning certain matters relating to the physician practice management ("PPM")
industry with respect to the consolidation of professional  corporation revenues
and the  accounting  for  business  corporations.  As an interim step before the
consensus, the EITF allowed PPMs to display the revenues and expenses of managed
physician practices in the statement of operations (the "display method") if the
terms  of the  management  agreement  provided  the PPM with a "net  profits  or
equivalent interest" in the medical services furnished by the respective medical
practices. It is the Company's understanding that the EITF did not and would not
object to the use of the display method in PPM financial  statements for periods
ending before December 15, 1998. As the Company does not consolidate its managed
Network Sites, the adoption of EITF 97-2 in 1998 does not have a material impact
on the Company's  financial  position,  cash flows or results of operations.  As
discussed  below,  the Company has  discontinued the display of revenues for its
Long Island and Boston Network Sites due to changes in the respective management
agreements.

     Since  inception  through  December 31,  1997,  the  management  agreements
related to the Long Island and Boston  Network Sites have been  incorporated  in
the Company's  consolidated  financial  statements via the display method as the
Company  believed  that  these  management  agreements  provided  it with a "net
profits or equivalent interest" in the medical services furnished by the Medical
Practices at the Long Island and Boston  Network  Sites.  Consequently,  for the
Long Island and Boston Network Sites, the Company has historically presented the
Medical  Practices'  patient  services  revenue,  less  amounts  retained by the
Medical Practices,  or "Medical Practice retainage",  as "Revenues after Medical
Practice  retainage" in its  consolidated  statement of operations (the "display
method").  Due to changes in the terms of the management  agreements  related to
the Long Island and Boston Network Sites,  effective in October 1997 and January
1998, respectively,  the Company no longer displays the patient services revenue
of the Long Island and Boston  Medical  Practices.  As a result,  the Company no
longer  displays the patient  services  revenue and Medical  Practice  retainage
related to these Network  Sites in the  accompanying  consolidated  statement of
operations  for the periods  prior to January 1, 1998.  The  revised  management
agreements  provide for the Company to receive a specific  management  fee which
the Company has reported in  "Revenues,  net" in the  accompanying  Consolidated
Statement of Operations.


                                        6

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

     These  consolidated  financial  statements are prepared in accordance  with
generally accepted accounting  principles which requires the use of management's
estimates.  The preparation of financial statements in conformity with generally
accepted  accounting  principles  requires  management  to  make  estimates  and
assumptions  that  affect the  reported  amounts of assets and  liabilities  and
disclosure of  contingent  assets and  liabilities  at the date of the financial
statements  and the  reported  amounts  of  revenues  and  expenses  during  the
reporting period. Actual results could differ from those estimates.

   Revenue and cost recognition -

   Reproductive Science Center(R) Division ("RSC Division")

     The Company currently provides comprehensive management services under nine
management agreements.

     Under six of the agreements, including the revised management agreement for
the Boston Network Site, the Company receives as compensation for its management
services a three-part management fee comprised of: (i) a fixed percentage of net
revenues  generally  equal  to 6%,  (ii)  reimbursed  costs of  services  (costs
incurred  in  managing  a Medical  Practice  and any costs paid on behalf of the
Medical  Practice) and (iii) a fixed or variable  percentage  of earnings  after
management  fees  which  is  currently  generally  equal  to  up to  20%,  or an
additional  variable  percentage  of net revenues  generally  ranging from 7% to
9.5%. Under the revised  management  agreement for the Long Island Network Site,
as compensation  for its management  services,  the Company receives a fixed fee
(currently equal to $480,000 per annum), plus reimbursed costs of services.

     Two of the Company's  Network Sites are  affiliated  with medical  centers.
Under  one of  these  management  agreements,  the  Company  primarily  provides
endocrine testing and administrative and finance services for a fixed percentage
of revenues,  equal to 15% of net revenues,  and  reimbursed  costs of services.
Under the second of these  management  agreements,  the  Company's  revenues are
derived from certain ART laboratory services  performed,  and directly billed to
the patients by the Company; out of these patient service revenues,  the Company
pays its direct costs and the remaining balance represents the Company's Network
Site  contribution.  All direct  costs  incurred by the Company are  recorded as
costs of services.

     All management fees are reported as "Revenues,  net" by the Company. Direct
costs incurred by the Company in performing  its  management  services and costs
incurred on behalf of the Medical  Practices are recorded in operating  expenses
incurred on behalf of Network Sites. The physicians  receive as compensation all
remaining earnings after payment of the Company's management fee.

     Prior to January 1, 1998, under another form of management  agreement which
had been in use at the  Long  Island  and  Boston  Network  Sites,  the  Company
recorded all patient  service  revenues and, out of such  revenues,  the Company
paid  the  Medical   Practices'   expenses,   physicians'   and  other   medical
compensation,  direct materials and certain hospital  contract fees. Under these
agreements,  the Company guaranteed a minimum physician compensation based on an
annual  budget  jointly  determined  by the  Company  and  the  physicians.  The
Company's  management  fee was payable only out of remaining  revenues,  if any,
after the  payment  of  physician  compensation  and all  direct  administrative
expenses of the Medical Practice which were recorded as costs of service.  Under
these  arrangements,  the Company had been liable for payment of all liabilities
incurred by the Medical  Practices and had been at risk for any losses  incurred
in the operation thereof. Due to changes in the management agreements related to
the Long Island and Boston Network Sites,  effective in October 1997 and January
1998,  respectively,  the Company no longer displays patient service revenues of
the Long  Island  and  Boston  Medical  Practices  which had been  reflected  in
"Revenues,  net" in the  Company's  consolidated  statement of  operations.  The
revised  management  agreements  provide  for the  Company to receive a specific
management  fee  which  the  Company  will  report  in  "Revenues,  net"  in its
consolidated statement of operations. Under the revised management agreement for
the Long Island Network Site, as compensation for its management  services,  the
Company  receives a fixed fee  (currently  equal to $480,000  per  annum),  plus
reimbursed  costs of services.  Under the revised  management  agreement for the
Boston Network Site, as compensation  for its management  services,  the Company
receives  a  three-part  management  fee  consistent  with the  majority  of the
Company's  existing  management  agreements.  The revised agreements provide for
increased  incentives  and  risk-sharing  for the Company's  affiliated  medical
providers.



                                        7

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

   AWM Division

     In June 1998, the Company  committed  itself to a formal plan to dispose of
the AWM Division.  On September 1, 1998 the Company disposed of the AWM Division
operations  via a sale of certain of its fixed  assets to a third  party and the
third party's assumption of the employees,  building lease,  research contracts,
and medical records. The operating results of the AWM Division for the three and
nine-month  periods  ended  September  30, 1998 and the charges  recorded by the
Company related to its disposal are reflected under "Discontinued Operations" in
the accompanying Consolidated Statement of Operations (See Note 7).

     The AWM  Division's  operations had been comprised of one Network Site with
two locations which were directly owned by the Company and a 51% interest in the
National   Menopause   Foundation   ("NMF"),   a  company  which  had  developed
multifaceted educational programs regarding women's healthcare. The Network Site
had also been involved in clinical trials with major pharmaceutical companies.

     The Company had billed and  recorded  all patient  service  revenues of the
Network Site and had  recorded  all direct costs  incurred as costs of services.
The medical  providers had received a fixed monthly draw which had been adjusted
quarterly by the Company based on the respective Network Site's actual operating
results.

     Revenues  in the AWM  Division  had  also  included  amounts  earned  under
contracts  relating to  clinical  trials  between  the Network  Site and various
pharmaceutical   companies.   The  Network  Site  had   contracted   with  major
pharmaceutical  companies  (sponsors) to perform  women's  medical care research
mainly to determine the safety and efficacy of a medication.  Research  revenues
had been recognized pursuant to each respective contract in the period which the
medical  services  (as  stipulated  by the  research  study  protocol)  had been
performed  and  collection  of such  fees  had  been  considered  probable.  Net
realization  had  been  dependent  upon  final  approval  by  the  sponsor  that
procedures were performed  according to study protocol.  Payments collected from
sponsors in advance for services are included in accrued liabilities,  and costs
incurred  in  performing  the  research  studies  had been  included in costs of
services rendered.

     The  Company's  51%  interest  in NMF had been  included  in the  Company's
consolidated financial statements.  The Company had recorded 100% of the patient
service  revenues and costs of NMF and had reported 49% of any profits of NMF as
minority interest on the Company's consolidated balance sheet. Minority interest
at September 30, 1998 and December 31, 1997 was $0.

   Patient accounts receivable--

     Patient accounts receivable represent receivables from patients for medical
services  provided by the Medical  Practices.  Such  amounts are recorded net of
contractual  allowances  and estimated  bad debts.  As of September 30, 1998 and
December 31, 1997,  of total patient  accounts  receivable  of  $10,874,000  and
$7,061,000,  respectively,  approximately  $10,527,000 and $4,477,000 of patient
accounts  receivable were a function of Network Site revenue (i.e.,  the Company
purchased  the accounts  receivable,  net of  contractual  allowances,  from the
Medical Practice (the "Purchased  Receivables"))  and the remaining  balances of
$347,000 and  $2,584,000,  respectively,  were a function of net revenues of the
Company  (see  --  "Revenue  and  cost  recognition"  above).  Risk  of  loss in
connection with non-collectiblity of Purchased Receivables is partially borne by
the Company in an amount equal to the Company's  proportionate share of revenues
and/or  earnings which are paid to the Company from the Medical  Practice as its
management  fee. Risk of loss in connection with  non-collectibility  of patient
accounts receivable which are a function of net revenues of the Company is borne
by the Company.

   Management fees receivable --

     Management fees receivable represent fees owed to the Company primarily for
repayment  of  advances  by the  Company  to certain  of the  Medical  Practices
pursuant to the respective  management  agreements with these Medical  Practices
(see -- "Revenue and cost recognition" above).



                                        8

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

   Intangible assets --

     Intangible  assets at September 30, 1998 and December 31, 1997 consisted of
the following (000's omitted):

                                                  September 30,   December 31,
                                                  ------------    -----------
                                                      1998            1997    
                                                  ------------    -----------

         Exclusive management rights..............  $20,367          $15,539
         Goodwill.................................       --            3,890
         Trademarks...............................      398              395
                                                    -------          -------
              Total...............................   20,765           19,824
          Less-- accumulated amortization.........   (1,287)          (1,379)
                                                    -------          -------
              Total...............................  $19,478          $18,445
                                                    =======          =======

     Exclusive Management Rights, Goodwill and Other Intangible Assets

     Exclusive management rights, goodwill and other intangible assets represent
costs  incurred by the Company for the right to manage  and/or  acquire  certain
Network Sites and are valued at cost less accumulated  amortization.  During the
nine-month  period ended  September 30, 1998,  the Company  recorded a charge to
earnings  for  the  writeoff  of the  entire  unamortized  portion  of  goodwill
associated  with the AWM Division  which was disposed of effective  September 1,
1998 and recorded an aggregate  exclusive  management right impairment charge of
$1.4 million related to certain of the managed  single-physician  practices (see
Notes 7 and 8).

     Trademarks

     Trademarks  represent  trademarks,  service  marks,  trade  names and logos
purchased by the Company and are valued at cost less accumulated amortization.

     Amortization and recoverability

     The  Company   periodically   reviews  its  intangible   assets  to  assess
recoverability;   any  impairments  would  be  recognized  in  the  consolidated
statement  of  operations  if a permanent  impairment  were  determined  to have
occurred.  Recoverability  of  intangibles is determined  based on  undiscounted
expected  earnings from the related business unit or activity over the remaining
amortization period.  Exclusive management rights are amortized over the term of
the respective management agreement,  usually ten to twenty-five years. Goodwill
and other  intangibles  are amortized  over periods  ranging from three to forty
years.  Trademarks are amortized over five to seven years. The fully depreciated
asset  balances  related  to the AWM  Division  and to  certain  of the  managed
single-physician  practices  were  removed  from  the  Company's  records  as of
September  30, 1998 (see Notes 7 and 8). As of September  30, 1998,  accumulated
amortization  of exclusive  management  rights and  trademarks  was $961,000 and
$326,000,  respectively.  As of December 31, 1997,  accumulated  amortization of
exclusive management rights, goodwill and trademarks was $802,000,  $283,000 and
$294,000, respectively.

   Due to Medical Practices --

     Due to Medical Practices  primarily  represents amounts owed by the Company
to the Medical  Practices  for the medical  providers'  share of the  respective
Medical Practice earnings net of the Company's advances to the Medical Practice,
if any. Due to Medical Practices excludes amounts owed by the Company to Medical
Practices for exclusive management rights.


                                        9

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

   Earnings per share --

     The  Company  determines  earnings  (loss)  per  share in  accordance  with
Financial Accounting Standards No. 128, "Earnings Per Share" (FAS 128) which the
Company adopted in December 1997. All historical  earnings (loss) per share have
been presented in accordance with FAS 128.

NOTE 3 -- SIGNIFICANT MANAGEMENT CONTRACTS:

     For the three and nine-month periods ended September 30, 1998 and 1997, the
Boston, New Jersey, FCI (acquired in mid-August 1997), and Shady Grove (acquired
in mid-March  1998)  Network  Sites  provided  greater than 10% of the Company's
Revenues, net and Network Sites' contribution as follows:
<TABLE>
<CAPTION>

                        Percent of Company       Percent of Network        Percent of Company      Percent of Network
                           Revenues, net         Sites' contribution          Revenues, net        Sites' contribution
                        for the three-month      for the three-month       for the nine-month       for the nine-month
                       period ended Sept. 30,   period ended Sept.  30,   period ended Sept. 30,   period ended Sept. 30,
                       ----------------------   -----------------------   ----------------------   ----------------------
                         1998        1997        1998           1997       1998          1997        1998           1997 
                         ----        ----        ----           ----       ----          ----        ----           ----   

     <S>                 <C>         <C>         <C>           <C>          <C>          <C>         <C>            <C> 
     Boston..........    15.54       28.23       20.80         29.30        16.12        31.74       21.97          36.54
     New Jersey......    12.35       19.19       28.28         40.49        12.44        20.78       28.22          43.54
     FCI.............    25.81       12.22       22.75         13.98        26.73         4.72       26.69           6.08
     Shady Grove.....    18.43          --       11.89            --        13.37           --        8.83             --
</TABLE>

NOTE 4 -- NOTES PAYABLE:

     In September 1998, the Company  obtained from Fleet Bank, N.A.  ("Fleet") a
$13.0  million  credit  facility  (the "New  Credit  Facility").  The New Credit
Facility is comprised of a $4.0 million three-year  working capital revolver,  a
$5.0 million  three-year  acquisition  revolver and a $4.0 million 5.5 year term
loan.  Each component of the New Credit  Facility bears interest by reference to
Fleet's prime rate or LIBOR, at the option of the Company, plus a margin ranging
from  0.00% to 0.25% in the case of  prime-based  loans or 2.75% to 3.00% in the
case of LIBOR-based loans, which margins vary based on a leverage test. Interest
on the prime-based loans is payable monthly and interest on LIBOR-based loans is
payable on the last day of each  interest  period  applicable  thereto  provided
that,  in the case of interest  periods in excess of three  months,  interest is
payable at three-month intervals during such periods.  Borrowings under the term
loan will require only  interest  payments  for the first  twenty  months.  Upon
closing of the New Credit  Facility,  the Company  drew the entire $4.0  million
available  under the term  loan to repay in full its  balance  outstanding  with
First Union National Bank of $2,250,000 and for working  capital and acquisition
purposes. In addition, the Company will utilize a portion of the proceeds of the
term loan to pay part of the consideration to repurchase up to $2 million of the
Company's  outstanding  shares  of  Common  Stock  from time to time on the open
market at prevailing market prices or through privately negotiated transactions.
As of November 1, 1998, the Company had repurchased 724,000 shares of its Common
Stock for an  aggregate  cost of  $476,000.  Unused  amounts  under the  working
capital and  acquisition  revolvers  bear a  commitment  fee of 0.25% and 0.20%,
respectively.  Availability of borrowings under the working capital revolver are
based on eligible  accounts  receivable as defined.  Availability  of borrowings
under  the  acquisition  revolver  will be  based  on  financial  covenants  and
eligibility  criteria with respect to each proposed  acquisition.  Approximately
$4.5 million was available under the working  capital and acquisition  revolvers
as of  September  30,  1998.  The New Credit  Facility  is secured by all of the
Company's assets.

     As part  consideration  for the  acquisition  of the capital stock of Shady
Grove  Fertility  Centers,  Inc.,  the Company issued $1.1 million in promissory
notes which are payable in two equal annual  installments,  due on April 1, 1999
and 2000, respectively, and bear interest at an annual rate of 8.5%.

     Also  included in notes payable is the  Company's  aggregate  obligation of
approximately $1.6 million in the form of cash, stock, and a note to acquire the
balance of the capital stock of Shady Grove  Fertility  Centers,  Inc., in early
1999.


                                       10

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

NOTE 5 -- EQUITY:

     Effective August 31, 1998, the Board of Directors  approved a resolution to
reprice  certain  stock option  agreements  held by each  officer,  director and
employee of the Company, under the 1992 Incentive and Non-Incentive Stock Option
Plan  and/or  the 1998 Stock  Option  Plan.  Per the  resolution,  stock  option
agreements  where the  exercise  price per share was  greater  than  $1.03  were
amended to provide  for an exercise  price per share of $1.03  ("New  Options").
Except for the exercise price of the New Options, all other terms and conditions
of the agreements remain in full force and effect.  Per the resolution,  options
to purchase approximately 1.4 million shares of Common Stock were repriced.

     The Board of Directors has authorized the repurchase of up to $2 million of
the Company's  outstanding  shares of Common Stock from time to time on the open
market at prevailing market prices or through privately negotiated transactions.
The Company will utilize a portion of the term loan proceeds from its new credit
facility  with  Fleet  Bank,  N.A.  to fund a portion  of the price of the stock
repurchases.

     As of September 30, 1998,  dividend  payments of approximately  $563,000 on
the Series A Cumulative  Convertible Preferred Stock (the "Convertible Preferred
Stock") were in arrears. In October 1998, the Company paid all dividend payments
which were in arrears.

     The Board of Directors has authorized a one for four reverse stock split of
its  outstanding  shares of Common Stock  through an amendment to the  Company's
Amended and Restated Certificate of Incorporation.  The reverse stock split will
be submitted for approval by the Company's  stockholders at a Special Meeting of
Stockholders  to be held on November  17,  1998.  If  approved by the  Company's
stockholders, every four shares of Common Stock will be converted into one share
of Common Stock.  On September 21, 1998, the Common Stock had been trading below
$1.00 for 30  consecutive  trading days.  The reverse stock split is intended to
allow  the  Company  to  comply  with the  minimum  $1.00  bid  price  per share
requirement  for continued  listing of the Company's  Common Stock on the Nasdaq
National Market.

     During the first quarter of 1998, the Company consummated an equity private
placement of $5.5 million with entities  affiliated  with Morgan Stanley Venture
Partners  ("Morgan  Stanley")  providing for the purchase of 3,235,294 shares of
the Company's Common Stock at a price of $1.70 per share and 240,000 warrants to
purchase shares of the Company's  Common Stock, at a nominal exercise price. The
Company  used a portion of these  funds to acquire  the  capital  stock of Shady
Grove Fertility Centers, Inc. (see Note 6).

     In March and April 1998,  pursuant to amendments  to the Bay Area,  FCI and
Shady Grove  management  agreements,  the Company issued warrants to purchase an
aggregate of 150,000  shares of Common  Stock,  at a weighted  average  exercise
price of $1.77 per share to the shareholder physicians of the respective medical
practices in exchange for an extension of the term of the  Company's  respective
management agreements from twenty to twenty-five years.

NOTE 6 -- RECENT ACQUISITIONS:

     In January 1998, the Company completed its second in-market merger with the
addition of two  physicians to the FCI practice.  The Company  acquired  certain
assets of Advocate  Medical  Group,  S.C.  ("AMG") and  Advocate  MSO,  Inc. and
acquired the right to manage AMG's infertility practice conducted under the name
Center for Reproductive Medicine ("CFRM"). Simultaneous with the consummation of
this  transaction,  the Company  amended its  management  agreement  with FCI to
include  two of the  three  physicians  practicing  under  the  name  CFRM.  The
aggregate  purchase  price  was  approximately   $1.5  million,   consisting  of
approximately  $1.2  million in cash and  184,314  shares of Common  Stock.  The
majority of the purchase price was allocated to exclusive management rights.

      On March 12, 1998, the Company  acquired the majority of the capital stock
of Shady Grove Fertility  Centers,  Inc. ("Shady  Grove"),  currently a Maryland
business corporation which provides management services, and formerly a Maryland
professional corporation engaged in providing infertility services. Prior to the


                                       11

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

consummation  of the  transaction,  Shady Grove had entered  into a  twenty-year
management  agreement with Levy, Sagoskin and Stillman,  M.D., P.C. (the " Shady
Grove  P.C."),  an  infertility   physician  group  practice  comprised  of  six
physicians and four locations surrounding the greater Washington, D.C. area. The
Company will acquire the balance of the Shady Grove capital stock in early 1999.
The aggregate  purchase  price for all of the Shady Grove capital stock was $5.7
million,  consisting of approximately  $2.8 million in cash,  approximately $1.4
million in Common Stock, and approximately $1.5 million in promissory notes. The
purchase price was allocated to the various assets and  liabilities  assumed and
the balance was allocated to exclusive management rights. On March 12, 1998, the
Closing Date,  the following  consideration  was paid:  (i)  approximately  $1.8
million in cash, (ii)  approximately  $1.2 million in stock or 639,551 shares of
Common Stock,  and (iii)  approximately  $1.1 million in promissory  notes.  The
Company will pay the balance of the aggregate  purchase  price of  approximately
$1.6  million in the form of cash,  stock and a note in early 1999 (the  "Second
Closing Date"), when the balance of the Shady Grove capital stock is transferred
to the Company.  The $1.1 million of promissory notes currently  outstanding are
payable  in two  equal  annual  installments  due on  April 1,  1999  and  2000,
respectively,  and bear interest at an annual rate of 8.5%. The number of shares
of Company Common Stock to be issued on the Second Closing Date, which will have
a fair market value of approximately $200,000, will be determined based upon the
average  closing  price of the  Company's  Common Stock for the ten-day  trading
period prior to the third business day before the Second Closing Date, provided,
however,  that in no event will the price per share exceed $2.00 or be less than
$1.70 for purposes of this calculation.

     The following  unaudited pro forma results of operations  for the three and
nine-month  periods  ended  September  30,  1998 and 1997 have been  prepared by
management  based on the unaudited  financial  information for Shady Grove,  the
Maryland professional corporation, which management arrangement was entered into
in March  1998,  and  Fertility  Centers  of  Illinois,  S.C.  which  management
agreement  was entered  into in August  1997,  adjusted  where  necessary,  with
respect  to  pre-acquisition  periods,  to the basis of  accounting  used in the
historical  financial  statements  of  the  Company.  Such  adjustments  include
modifying  the results to reflect  operations  as if the Shady Grove  management
agreement had been consummated on January 1, 1998 and 1997, respectively, and as
if the FCI  management  agreement,  excluding the in-market  mergers in 1997 and
1998, had been  consummated  on January 1, 1997.  Additional  general  corporate
expenses  which would have been  required to support the  operations  of the new
Network Sites are not included in the pro forma results. The unaudited pro forma
results may not be  indicative  of the results  that would have  occurred if the
management  agreement had been in effect on the dates  indicated or which may be
obtained in the future.

<TABLE>
<CAPTION>
                                                                     For the                For the
                                                                    three-month            nine-month
                                                                   period ended            period ended
                                                                   September 30,           September 30,
                                                                  (000's omitted)         (000's omitted) 
                                                                  ---------------         ---------------    
                                                                  1998       1997         1998       1997
                                                                  ----       ----         ----       ---- 
                                                                    (unaudited)              (unaudited)

<S>                                                               <C>        <C>          <C>       <C>    
Revenues, net.................................................    $9,756     $7,123       $29,433   $20,853
Net income (loss) from continuing operations (1)..............    $  422     $  622       $  (498)  $ 1,414
Basic and diluted earnings (loss) per share of Common Stock
   from continuing operations.................................    $ 0.02     $ 0.04       $ (0.03)  $  0.11

(1)  Pro forma income from continuing  operations before restructuring and other
     charges  for  the   nine-month   period  ended   September   30,  1998  was
     approximately $1.6 million, or $0.07 per share.
</TABLE>

NOTE 7 -- DISCONTINUED OPERATIONS:

     In June 1998, the Company  committed  itself to a formal plan to dispose of
the AWM Division  operations.  On September 1, 1998 the Company  disposed of the
AWM  operations  via a sale of certain of its fixed  assets to a third party and
the  third  party's  assumption  of  the  employees,  building  lease,  research

                                       12

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

contracts,  and  medical  records.  As of  September  30,  1998,  the  Company's
Consolidated Balance Sheet includes  approximately  $30,000 of accounts payable,
$20,000 of accrued  liabilities and $262,500 in notes payable related to the AWM
Division.  During the  nine-month  period ended  September 30, 1998, the Company
reported a loss from the  disposal  of the AWM  Division of  approximately  $3.6
million, which principally represented approximately $3.3 million related to the
write-off of goodwill and $243,000 for  estimated  operating  losses  during the
phase-out  period.  During the three-month  periods ended September 30, 1998 and
1997, the AWM Division recorded revenues of approximately $338,000 and $459,000,
respectively.  During the nine-month  periods ended September 30, 1998 and 1997,
the AWM  Division  recorded  revenues  of  approximately  $1.0  million and $1.7
million, respectively.

NOTE 8 -- RESTRUCTURING AND OTHER CHARGES:

     The Company recorded  approximately $2.1 million in restructuring and other
charges in the  three-month  period ended June 30, 1998.  Such charges  included
approximately  $1.4 million  associated  with its  termination of its management
agreement with the Reproductive Science Center of Greater Philadelphia, a single
physician  Network Site,  effective July 1, 1998,  which primarily  consisted of
exclusive  management right impairment and other asset write-offs.  Such charges
also included  approximately  $700,000 for exclusive management right impairment
losses related to two other single physician Network Sites.

NOTE 9 -- EARNINGS PER SHARE:

     The  reconciliation  of the  numerators and  denominators  of the basic and
diluted EPS  computations  for the three and nine-month  periods ended September
30, 1998 and 1997 is as follows (000's omitted, except for per share amounts):

<TABLE>
<CAPTION>

                                                                  For the                      For the
                                                             three-month period            nine-month period
                                                             ended September 30,           ended September 30,   
                                                            -------------------           -------------------
                                                             1998         1997             1998         1997 
                                                            -----        ------           ------       ------ 
Numerator
<S>                                                         <C>          <C>              <C>         <C>    
Income (loss) from continuing operations..................  $   422      $   308          $  (665)    $   406
Less: Preferred stock dividends accrued...................       33           33               99          99
                                                            -------      -------          -------     -------
Income (loss) from continuing operations
   available to Common stockholders.......................      389          275             (764)        307
Recapture (loss) from discontinued operations.............      350         (200)          (4,501)       (249)
                                                            -------      -------          -------     -------
Net income (loss) available to Common Stockholders........  $   739      $    75          $(5,265)    $    58
                                                            =======      =======          =======     =======

Denominator
Weighted average shares outstanding.......................   21,372       13,243           20,904      10,790
Effect of dilutive options and warrants...................      247          230             --           230
                                                            -------      -------          -------     -------
Weighted average shares and dilutive potential
   Common shares..........................................   21,619       13,473           20,904      11,020
                                                            =======      =======          =======     ======= 

Basic and diluted EPS:
Continuing operations.....................................  $  0.02      $  0.02          $ (0.04)    $  0.03
Discontinued operations...................................     0.01        (0.01)           (0.21)      (0.02)
                                                            -------      -------          -------     -------
Net earnings (loss).......................................  $  0.03      $  0.01          $ (0.25)    $  0.01
                                                            =======      =======          =======     =======
</TABLE>

     The effect of the assumed  exercise  of options to  purchase  approximately
20,000 shares of Common Stock and warrants to purchase  240,000 shares of Common
Stock at exercise prices of $0.625 and of $0.01, respectively,  were included in
computing  the  diluted  per  share  amount  for the  three-month  period  ended
September  30,  1998.  These shares were  excluded in computing  the diluted per
share amount for the  nine-month  period ended  September  30, 1998 as they were
antidilutive due to the Company's net loss during the nine-month period. For the
three and nine-month periods ended September 30, 1998, the effect of the assumed
exercise of options to purchase approximately 1.4 million shares of Common Stock
and  warrants  to  purchase  approximately  313,000  shares of  Common  Stock at


                                       13

<PAGE>


                            INTEGRAMED AMERICA, INC.
                   NOTES TO CONSOLIDATED FINANCIAL STATEMENTS

exercise  prices  ranging  from  $1.00 to $1.03 per share  and  exercise  prices
ranging from $1.25 to $10.34 per share, respectively, were excluded in computing
the diluted per share amount as the  exercise  price of the options and warrants
equaled or exceeded  the average  market  price of the Common Stock during these
periods.  For the  three  and  nine-month  periods  ended  September  30,  1998,
approximately  523,000  shares of Common  Stock from the assumed  conversion  of
Preferred Stock were excluded in computing the diluted earnings per share as the
amount of the  dividend  declared  for these  periods per share of Common  Stock
obtainable on conversion exceeded basic earnings per share.

     The effect of the assumed  exercise  of options to  purchase  approximately
562,000  shares of Common Stock and warrants to purchase  approximately  150,000
shares of Common Stock at exercise  prices ranging from $0.625 to $1.68 and from
$1.25 to $1.81,  respectively,  were included in computing the diluted per share
amount for the three and  nine-month  periods ended  September 30, 1997. For the
three and nine-month periods ended September 30, 1997, the effect of the assumed
exercise of options to purchase approximately 583,000 shares of Common Stock and
warrants to purchase  approximately  233,000  shares of Common Stock at exercise
prices ranging from $2.00 to $3.75 and from $10.34 to  approximately  $14.54 per
share, respectively,  were excluded in computing the diluted per share amount as
the exercise price of the options and warrants exceeded the average market price
of the Common  Stock  during the period.  For the three and  nine-month  periods
ended September 30, 1997,  approximately 414,000 shares of Common Stock from the
assumed  conversion  of Preferred  Stock were  excluded in computing the diluted
earnings per share as the amount of the dividend  declared for these periods per
share of Common Stock  obtainable  on  conversion  exceeded  basic  earnings per
share.

NOTE 10 -- SUPPLEMENTAL DISCLOSURES OF CASH FLOW INFORMATION AND NON-CASH
           TRANSACTIONS:

     In connection  with the Company's  termination of its management  agreement
with the Reproductive Sciences Medical Center, Inc. effective September 1, 1998,
the  Company  was  discharged  from its  remaining  exclusive  management  right
obligation of $650,000.

     In connection  with the Company's  termination of its management  agreement
with the  Reproductive  Science Center of Greater  Philadelphia  and due to this
Network  Site's  historical  operating  losses,  approximately  $583,000  of the
Company's  exclusive  right to  manage  obligation  to the  physician  owner was
applied  against the Company's  receivable  from the physician  owner during the
six-month period ended June 30, 1998.

     In connection with its acquisition of the exclusive right to manage CFRM in
January  1998,  the  Company  issued  184,314  shares  of Common  Stock  with an
aggregate fair value equal to approximately $300,000.

     In connection  with its  acquisition  of the exclusive  right to manage the
Shady Grove P.C., in March 1998,  the Company  issued  639,551  shares of Common
Stock with an  aggregate  fair value  equal to  approximately  $1.2  million and
approximately  $1.1 million in  promissory  notes.  The Company also recorded an
additional  aggregate  obligation of  approximately  $1.6 million in the form of
cash,  stock and a note to acquire  the  balance of the  capital  stock of Shady
Grove, which is anticipated to occur in early 1999.

     In connection  with its  acquisition  of the exclusive  right to manage Bay
Area  Fertility in January 1997,  the Company  issued  333,333  shares of Common
Stock with an aggregate fair value equal to approximately $500,000.

     In March and April 1998,  pursuant to amendments  to the Bay Area,  FCI and
Shady Grove  management  agreements,  the Company issued warrants to purchase an
aggregate  150,000  shares of the Company's  Common Stock at a weighted  average
exercise  price  of  $1.77  per  share  to  the  shareholder  physicians  of the
respective  medical  practices  in exchange  for an extension of the term of the
Company's respective managements agreement from twenty to twenty-five years.

     In the  three-month  period ended  September 30, 1997, the Company  entered
into a capital lease obligation in the amount of $105,000 for medical equipment.

     Accrued dividends on Convertible  Preferred Stock outstanding  increased by
$99,000 to $563,000 and by $99,000 to $430,000,  in the nine-month periods ended
September 30, 1998 and 1997, respectively.

                                       14

<PAGE>




     State  taxes,  which  primarily  reflect  various  state income  taxes,  of
$376,000 and $66,000 were paid in the  nine-month  periods  ended  September 30,
1998 and 1997, respectively.

     Interest paid in cash in the  nine-month  periods ended  September 30, 1998
and 1997 amounted to $306,000 and $48,000,  respectively.  Interest  received in
the nine-month periods ended September 30, 1998 and 1997 amounted to $45,000 and
$168,000 respectively.


                                       15

<PAGE>



Item 2.  Management's Discussion and Analysis of Financial Condition
         and Results of Operations

     The following  discussion and analysis  should be read in conjunction  with
the  consolidated  financial  statements  and  notes  thereto  included  in this
quarterly  report and with the Company's Annual Report on Form 10-K for the year
ended December 31, 1997.

Overview

     IntegraMed  America,  Inc. (the "Company") is a health services  management
company  specializing in fertility and assisted  reproductive  technology  (ART)
services. The Company provides comprehensive management services to a nationwide
network  of medical  providers  currently  consisting  of nine  sites  (each,  a
"Network Site" or "Reproductive  Science  Center").  Each  Reproductive  Science
Center  consists of a location or  locations  where the Company has a management
agreement with a physician group or hospital (each a "Medical  Practice")  which
employs the physicians. The current network of nine Reproductive Science Centers
is comprised of twenty-one locations in nine states and the District of Columbia
and forty-seven  affiliated  physicians,  including  physicians  employed by the
Medical  Practice,  as well as,  physicians who have arrangements to utilize the
Company's facilities.

     The  Company's  objective is to develop,  manage and integrate a nationwide
network of Medical Practices specializing in the provision of high quality, cost
effective fertility health care services.  The primary elements of the Company's
strategy include: (i) establishing additional Reproductive Science Centers, (ii)
increasing  revenue  at  the  Reproductive  Science  Centers,  (iii)  increasing
operating efficiencies at the Reproductive Science Centers and (iv) developing a
nationwide integrated information system.

     Since  inception  through  December 31,  1997,  the  management  agreements
related to the Long Island and Boston  Network Sites have been  incorporated  in
the Company's  consolidated  financial  statements via the display method as the
Company  believed  that  these  management  agreements  provided  it with a "net
profits or equivalent interest" in the medical services furnished by the Medical
Practices at the Long Island and Boston  Network  Sites.  Consequently,  for the
Long Island and Boston Network Sites, the Company has historically presented the
Medical  Practices'  patient  services  revenue,  less  amounts  retained by the
Medical Practices,  or "Medical Practice retainage",  as "Revenues after Medical
Practice  retainage"  in its  consolidated  statement  of  operations  ("display
method"). Due to changes in the management agreements related to the Long Island
and  Boston   Network  Sites   effective  in  October  1997  and  January  1998,
respectively, the Company no longer displays the patient services revenue of the
Long Island and Boston  Medical  Practices.  As a result,  the Company no longer
displays the patient services revenue and Medical Practice  retainage related to
these Network Sites in the accompanying consolidated statement of operations for
the periods prior to January 1, 1998. The revised management  agreements provide
for the  Company to  receive a specific  management  fee which the  Company  has
reported  in  "Revenues,  net" in the  accompanying  consolidated  statement  of
operations.   The  revised  agreements  provide  for  increased  incentives  and
risk-sharing for the Company's affiliated Medical Practices.

     In the nine-month  period ended  September 30, 1998,  the Company  recorded
restructuring  and other charges of approximately  $2.1 million  associated with
its termination of its management agreement with the Reproductive Science Center
of Greater  Philadelphia,  a  single-physician  Network Site,  effective July 1,
1998,  and exclusive  management  right  impairment  losses related to two other
single-physician Network Sites.

     Due to  continued  operating  losses and the  Company's  decision  to focus
exclusively on fertility services, in June 1998, the Company committed itself to
a formal plan to dispose of the operations of the Adult Women's Medical Division
("AWM Division").  The AWM Division  operations were sold effective September 1,
1998.  The  nine-month  period ended  September  30, 1998  reflects an aggregate
charge of  approximately  $4.5 million  related to the operating  losses and the
disposal of the AWM Division.

     During the first quarter of 1998, the Company consummated an equity private
placement of $5.5 million with entities  affiliated  with Morgan Stanley Venture
Partners.  A portion  of these  funds was used by the  Company to  purchase  the
capital stock of Shady Grove  Fertility  Centers,  Inc.  ("Shady Grove") and the
right to manage Levy, Sagoskin and Stillman M.D., P.C. (the "Shady Grove P.C."),
an infertility  physician  group  practice  comprised of six physicians and four
locations in the greater Washington, D.C. area.

                                       16

<PAGE>



     In  September  1998,  the Company  obtained  from Fleet Bank,  N.A. a $13.0
million credit facility to fund acquisitions over  approximately the next one to
two years, to provide working capital,  and to refinance its existing bank debt.
In addition, the Company will utilize a portion of the proceeds of the term loan
from its new credit facility to pay part of the  consideration  to repurchase up
to $2 million of the Company's  outstanding  shares of Common Stock from time to
time on the open  market  at  prevailing  market  prices  or  through  privately
negotiated transactions.

     The Board of Directors has authorized a one for four reverse stock split of
its  outstanding  shares of Common Stock  through an amendment to the  Company's
Amended and Restated Certificate of Incorporation.  The reverse stock split will
be submitted for approval by the Company's  stockholders at a Special Meeting of
Stockholders  to be held on November  17,  1998.  If  approved by the  Company's
stockholders, every four shares of Common Stock will be converted into one share
of Common Stock.  On September 21, 1998, the Common Stock had been trading below
$1.00 for 30  consecutive  trading days.  The reverse stock split is intended to
allow  the  Company  to  comply  with the  minimum  $1.00  bid  price  per share
requirement  for continued  listing of the Company's  Common Stock on the Nasdaq
National Market.

Results of Operations

     The  following  table shows the  percentage of net revenue  represented  by
various expense and other income items  reflected in the Company's  Consolidated
Statement of Operations.

<TABLE>
<CAPTION>
                                                                               For the                  For the
                                                                          three-month period       nine-month period
                                                                          ended September 30,     ended September 30,
                                                                          -------------------     ------------------- 
                                                                            1998       1997         1998       1997  
                                                                          -------     -------     -------     -------
                                                                             (unaudited)              (unaudited)

         <S>                                                                <C>       <C>          <C>        <C>   
         Revenues, net...................................................     100%      100%         100%       100%
         Costs of services incurred on behalf of Network Sites:
              Employee compensation and related expenses.................   38.27%    38.01%       39.57%     36.97%
              Direct materials...........................................   11.82%     6.09%       12.03%      6.95%
              Occupancy costs............................................    7.43%     9.36%        7.59%      8.96%
              Depreciation...............................................    3.52%     3.93%        3.49%      4.16%
              Other expenses.............................................   16.03%    12.78%       14.18%     14.41%
                                                                            -----     -----        -----      -----
              Total costs of services....................................   77.07%    70.17%       76.86%     71.45%
                       
         Network Sites' contribution.....................................   22.93%    29.83%       23.14%     28.55%
         General and administrative expenses.............................   14.20%    20.28%       13.81%     22.65%
         Amortization of intangible assets...............................    2.40%     3.25%        2.44%      2.61%
         Interest income.................................................  (0.24)%   (0.60)%      (0.16)%    (0.73)%
         Interest expense................................................    1.29%     0.28%        1.09%      0.36%
                                                                            -----     -----        -----      -----
              Total other expenses.......................................   17.65%    23.21%       17.18%     24.89%
                                                                            -----     -----        -----      -----
         Restructuring and other charges.................................    0.00%     0.00%        7.46%      0.00%
         Income (loss) from continuing operations before income taxes....    5.28%     6.62%      (1.50)%      3.66%
         Provision for income taxes......................................    0.96%     0.40%        0.88%      0.63%
                                                                            -----     -----        -----      -----
         Income (loss) from continuing operations (a)....................    4.32%     6.22%      (2.38)%      3.03%
         Discontinued operations (recapture) loss........................  (3.59)%     4.04%       16.12%      1.86%
                                                                            -----     -----        -----      -----
             Net income (loss)...........................................    7.91%     2.18%      (18.5)%      1.17%
                                                                            =====     =====        =====      =====

         (a)  Excluding  the effect of the  restructuring  and other  charges in
         1998, income from continuing  operations as a percent of revenues,  net
         would have been 5.08% for the nine months ended September, 30, 1998.

</TABLE>

                                       17

<PAGE>



   Three Months Ended September 30, 1998 Compared to Three Months Ended
     September 30, 1997

     Revenues,  net for the three  months ended  September  30, 1998 (the "third
quarter of 1998") were  approximately  $9.8 million as compared to approximately
$5.0 million for the three months ended  September 30, 1997 (the "third  quarter
of 1997"),  an increase of $4.8  million,  or 96.9%.  The  increase in revenues,
excluding revenues related to the Philadelphia  Network Site agreement which was
terminated  effective  July 1, 1998 and  including  revenues  related to the San
Diego Network Site agreement which was terminated  effective  September 1, 1998,
was approximately  72.5% attributable to new management  agreements entered into
in the  first  quarter  of 1998 and the  second  and third  quarter  of 1997 and
approximately  27.5% attributable to same market growth.  Same market growth was
principally  achieved  via new service  offerings,  the  expansion  of ancillary
services, and increases in patient volume. The aggregate increase in revenue was
comprised  of the  following:  (i)  an  approximate  $4.0  million  increase  in
reimbursed costs of services;  and (ii) an approximate  $760,000 increase in the
Company's  management  fees  derived  from the managed  Medical  Practices'  net
revenue and/or earnings.

     Total costs of services as a percentage of revenue increased by 6.9% in the
third  quarter  of 1998 as  compared  to the  third  quarter  of 1997.  Employee
compensation and related  expenses,  direct  materials,  and other expenses as a
percentage of revenue  increased  primarily due to the factors  attributable  to
increasing revenues. Occupancy costs and depreciation as a percentage of revenue
decreased primarily due to the significant increase in revenues.

     Network  Sites'  contribution  increased  by  approximately  51.4%  to $2.2
million in the third  quarter of 1998 as compared  to $1.5  million in the third
quarter of 1997 due to the factors attributable to increasing revenues.

     General  and  administrative  expenses  for the third  quarter of 1998 were
approximately  $1.4  million as compared to  approximately  $1.0  million in the
third  quarter of 1997,  an  increase of 37.8%.  As a  percentage  of  revenues,
general  and  administrative  expenses  decreased  to  approximately  14.2% from
approximately 20.3% primarily due to the significant increase in revenues.

     Amortization of intangible assets was $234,000 in the third quarter of 1998
as  compared  to  $161,000  in the third  quarter  of 1997.  This  increase  was
attributable to the Company's  acquisitions of new management  agreements in the
first  quarter  of 1998 and the  second and third  quarters  of 1997,  partially
offset by the  absence  of  amortization  related to  certain  single  physician
Network Sites due to exclusive  management  right  impairment  losses which were
recorded in the second quarter of 1998.

     Interest  income for the third  quarter of 1998  decreased  to $24,000 from
$30,000 for the third  quarter of 1997,  due to a lower  invested  cash balance.
Interest  expense  for the third  quarter of 1998  increased  to  $126,000  from
$14,000  in the third  quarter  of 1997,  due to  increases  in bank  borrowings
principally  to  finance  working  capital  and  acquisition  needs and in notes
payable to Medical Providers for exclusive management rights.

     The provision  for income taxes  primarily  reflected  various state income
taxes in both the third quarter of 1998 and the third quarter of 1997.

     Income from continuing  operations was approximately  $422,000 in the third
quarter of 1998 as  compared  to  $308,000  in the third  quarter  of 1997.  The
increase  was   primarily   due  to  the  $759,000   increase  in  Network  Site
contribution,   which  was   partially   offset  by  increases  in  general  and
administrative expenses,  amortization of intangible assets, interest and income
tax expense.

     The  Company  disposed  of the AWM  Division  via a sale of its  operations
effective  September 1, 1998.  Discontinued  operations  in the third quarter of
1998 reflect the recapture of $350,000 of disposal costs which had been recorded
in the second  quarter of 1998.  During the third quarter of 1998 and 1997,  the
AWM Division recorded revenues of $338,000 and $459,000, respectively.


                                       18

<PAGE>



   Nine Months Ended September 30, 1998 Compared to Nine Months Ended
     September 30, 1997

     Revenues,   net  for  the  nine  months  ended   September  30,  1998  were
approximately  $27.9 million as compared to approximately  $13.4 million for the
nine months  ended  September  30,  1997,  an increase  of  approximately  $14.5
million,  or 109%. The increase in revenues,  excluding  revenues related to the
Philadelphia  Network Site agreement which was terminated effective July 1, 1998
and including revenues related to the San Diego Network Site agreement which was
terminated  effective September 1, 1998, was approximately 74.8% attributable to
new  management  agreements  entered  into in the first  quarter of 1998 and the
second and third quarter of 1997 and  approximately  25.2%  attributable to same
market  growth.  Same market  growth was  principally  achieved  via new service
offerings, the expansion of ancillary services, and increases in patient volume.
The  aggregate  increase  in revenue  was  comprised  of the  following:  (i) an
approximate $11.9 million increase in reimbursed costs of services;  and (ii) an
approximate $2.6 million increase in the Company's  management fees derived from
the managed Medical Practices' net revenue and/or earnings.

     Total costs of services as a percentage  of revenue  increased by 5.41% for
the nine months  ended  September  30, 1998 as compared to the nine months ended
September  30,  1997.  Employee   compensation  and  related  expenses,   direct
materials, and other expenses as a percentage of revenue increased primarily due
to  the  factors  attributable  to  increasing  revenues.  Occupancy  costs  and
depreciation  as  a  percentage  of  revenue  decreased  primarily  due  to  the
significant increase in revenues.

     Network  Sites'  contribution  increased  by  approximately  69.3%  to $6.5
million for the nine months ended September 30, 1998 as compared to $3.8 million
for the nine months ended September 30, 1997 due to the factors  attributable to
increasing revenues.

     General and administrative expenses for the nine months ended September 30,
1998 were  approximately  $3.9 million as compared to approximately $3.0 million
for the nine months  ended  September  30,  1997,  an  increase  of 27.3%.  As a
percentage  of  revenues,  general  and  administrative  expenses  decreased  to
approximately  13.8% from  approximately  22.7% primarily due to the significant
increase in revenues.

     Amortization  of  intangible  assets was $681,000 for the nine months ended
September  30, 1998 as compared to $349,000 for the nine months ended  September
30, 1997. This increase was  attributable  to the Company's  acquisitions of new
management  agreements  in the first  quarter  of 1998 and the  second and third
quarters of 1997,  partially  offset by the absence of  amortization  related to
certain  single  physician  Network  Sites  due to  exclusive  management  right
impairment losses which were recorded in the second quarter of 1998.

     Interest  income for the nine months ended  September 30, 1998 decreased to
$45,000  from  $98,000 for the nine months ended  September  30, 1997,  due to a
lower  invested  cash  balance.  Interest  expense  for the  nine  months  ended
September 30, 1998  increased to $306,000 from $48,000 for the nine months ended
September 30, 1997, due to an increase in bank borrowings principally to finance
working capital and acquisition  needs and in notes payable to Medical Providers
for exclusive management rights.

     The provision  for income taxes  primarily  reflected  various state income
taxes in both the nine months ended September 30, 1998 and September 30, 1997.

     Restructuring  and other  charges were  approximately  $2.1 million for the
nine months ended September 30, 1998. Such charges included  approximately  $1.4
million  associated with the Company's  termination of its management  agreement
with the Reproductive Science Center of Greater Philadelphia, a single physician
Network Site,  effective July 1, 1998,  which  primarily  consisted of exclusive
management  right  impairment  and other asset  write-offs.  Such  charges  also
included approximately $700,000 for exclusive management right impairment losses
related to two other single physician Network Sites.

     Income from continuing operations excluding restructuring and other charges
was  approximately  $1.4 million for the nine months ended September 30, 1998 as
compared to $406,000 for the nine months ended  September 30, 1997. The increase
was  primarily  due to the  approximate  $2.6  million  increase in Network Site


                                       19

<PAGE>



contribution,   which   waspartially   offset  by   increases   in  general  and
administrative expenses,  amortization of intangible assets, interest and income
tax expense.

     In June 1998, the Company  committed  itself to a formal plan to dispose of
the AWM Division  operations.  On September 1, 1998 the Company  disposed of the
AWM  Division  operations  via a sale of certain of its fixed  assets to a third
party  and the  third  party's  assumption  of the  employees,  building  lease,
research contracts,  and medical records.  Discontinued  operations for the nine
months ended  September  30, 1998 reflect an aggregate  charge of  approximately
$4.5  million  of  which   $923,000   represented   loss  from   operations  and
approximately  $3.6  million  represented  loss  from  the  disposal  of the AWM
Division.  The loss from  disposal of the AWM Division  principally  represented
approximately $3.3 million related to the write-off of goodwill and $243,000 for
estimated  operating losses during the phase-out period.  During the nine months
ended  September  30,  1998 and 1997,  the AWM  Division  recorded  revenues  of
approximately $1.0 million and $1.7 million, respectively.

Liquidity and Capital Resources

     Historically,  the Company has financed its  operations  primarily  through
sales of equity securities.  More recently, the Company has commenced using bank
financing for working capital and acquisition purposes.  The Company anticipates
that its  acquisition  strategy  will  continue to require  substantial  capital
investment. Capital is needed not only for additional acquisitions, but also for
the effective  integration,  operation  and expansion of the Company's  existing
Network  Sites.  The Medical  Practices may require  capital for  renovation and
expansion and for the addition of medical equipment and technology. In September
1998,  the  Company  obtained  from Fleet  Bank,  N. A. a $13.0  million  credit
facility to fund acquisitions  over  approximately the next one to two years, to
provide working  capital,  and to refinance its existing bank debt. In addition,
the Company will utilize a portion of the proceeds of the term loan from its new
credit facility to pay part of the  consideration to repurchase up to $2 million
of the  Company's  outstanding  shares of Common  Stock from time to time on the
open  market  at  prevailing  market  prices  or  through  privately  negotiated
transactions.

     During the first quarter of 1998, the Company consummated an equity private
placement of $5.5 million with entities  affiliated  with Morgan Stanley Venture
Partners  providing for the purchase of 3,235,294 shares of the Company's Common
Stock at a price of $1.70 per share and 240,000  warrants to purchase  shares of
the Company's  Common Stock,  at a nominal  exercise  price.  A portion of these
funds were used by the Company to purchase the capital  stock of Shady Grove and
the right to manage the Shady Grove P.C.'s  infertility  medical  practice.  The
balance of these funds have been used for working capital purposes.

     At September  30, 1998,  the Company had working  capital of  approximately
$8.0  million,  approximately  $5.0 million of which  consisted of cash and cash
equivalents,  compared  to working  capital  of  approximately  $4.1  million at
December 31,  1997,  approximately  $1.9 million of which  consisted of cash and
cash equivalents.  The net increase in working capital at September 30, 1998 was
principally  due to the $5.5 million  proceeds  received from the equity private
placement with Morgan Stanley and $6.0 million in bank loan proceeds,  partially
offset by  approximately  $3.2  million in  payments  for  exclusive  management
rights,  approximately  $2.8 million in debt repayments and an approximate  $1.9
million  increase in  short-term  debt  related to the Shady Grove  transaction.
Patient accounts  receivable  increased by approximately  $2.7 million.  The net
increase in patient accounts receivables  represented an approximate increase of
$4.9 million in purchased patient accounts receivable, excluding any receivables
acquired  on the day of the  closing of a new  management  agreement,  partially
offset by an approximate decrease of $2.2 million in patient accounts receivable
which were a function of Company revenue.

     During  the  first  quarter  of 1998,  the  Company  completed  its  second
in-market  merger with the  addition of two  physicians  to the FCI practice and
entered into a new management agreement with the Shady Grove, P.C. The aggregate
purchase  price of these  transactions,  exclusive  of  acquisition  costs,  was
approximately  $7.2 million,  consisting of approximately  $4.0 million in cash,
$1.5 million in promissory notes,  823,865 shares of the Company's Common Stock,
and  approximately  an  additional  $200,000 in shares of the  Company's  Common
Stock.  A portion of the  aggregate  purchase  price  related to the Shady Grove
acquisition  will be paid in early 1999 ( the "Second Closing Date") as follows:
approximately   $1.0  million  in  cash,   $403,000  in  promissory   notes  and
approximately $200,000 in shares of the Company's Common Stock. The $1.1 million
of  promissory  notes  currently  outstanding  are  payable in two equal  annual
installments,  due on April 1, 1999 and 2000, respectively, and bear interest at


                                       20

<PAGE>



an annual rate of 8.5%.  The number of shares of Common  Stock of the Company to
be issued in early 1999 will be determined  based upon the average closing price
of the Company's  Common Stock for the ten-day trading period prior to the third
business day before the Second Closing Date, provided, however, that in no event
will the price per share exceed $2.00 or be less than $1.70 for purposes of this
calculation.

     As previously  noted,  in September  1998, the Company  obtained from Fleet
Bank,  N.A.   ("Fleet")  a  $13.0  million  credit  facility  (the  "New  Credit
Facility").  The New Credit  Facility is comprised of a $4.0 million  three-year
working capital revolver,  a $5.0 million three-year  acquisition revolver and a
$4.0 million 5.5 year term loan. Each component of the New Credit Facility bears
interest  by  reference  to Fleet's  prime  rate or LIBOR,  at the option of the
Company,  plus a margin  ranging from 0.00% to 0.25% in the case of  prime-based
loans or 2.75% to 3.00% in the case of  LIBOR-based  loans,  which  margins vary
based on a leverage test.  Interest on the prime-based  loans is payable monthly
and interest on  LIBOR-based  loans is payable on the last day of each  interest
period  applicable  thereto  provided  that, in the case of interest  periods in
excess of three months, interest is payable at three-month intervals during such
periods.  Borrowings under the term loan will require only interest payments for
the first twenty months.  Upon closing of the New Credit  Facility,  the Company
drew the entire $4.0 million  available under the term loan to repay in full its
balance outstanding with First Union National Bank of $2,250,000 and for working
capital and  acquisition  purposes.  In  addition,  the Company  will  utilize a
portion of the  proceeds  of the term loan to pay part of the  consideration  to
repurchase up to $2 million of the Company's  outstanding shares of Common Stock
from time to time on the open  market at  prevailing  market  prices or  through
privately  negotiated  transactions.  As of  November  1, 1998,  the Company had
repurchased  724,000  shares  of its  Common  Stock  for an  aggregate  cost  of
$476,000.  Unused amounts under the working  capital and  acquisition  revolvers
bear  a  commitment  fee of  0.25%  and  0.20%,  respectively.  Availability  of
borrowings  under the working  capital  revolver are based on eligible  accounts
receivable as defined. Availability of borrowings under the acquisition revolver
will be based on financial  covenants and  eligibility  criteria with respect to
each proposed  acquisition.  Approximately  $4.5 million was available under the
working  capital and  acquisition  revolvers as of September  30, 1998.  The New
Credit Facility is secured by all of the Company's assets.

     The Board of Directors has authorized a one for four reverse stock split of
its  outstanding  shares of Common Stock  through an amendment to the  Company's
Amended and Restated Certificate of Incorporation.  The reverse stock split will
be submitted for approval by the Company's  stockholders at a Special Meeting of
Stockholders  to be held on November  17,  1998.  If  approved by the  Company's
stockholders, every four shares of Common Stock will be converted into one share
of Common Stock.  On September 21, 1998, the Common Stock had been trading below
$1.00 for 30  consecutive  trading days.  The reverse stock split is intended to
allow  the  Company  to  comply  with the  minimum  $1.00  bid  price  per share
requirement  for continued  listing of the Company's  Common Stock on the Nasdaq
National Market.

     As of September 30, 1998,  dividend  payments of approximately  $563,000 on
the Series A Cumulative  Convertible Preferred Stock (the "Convertible Preferred
Stock") were in arrears.  In October 1998 the Company paid all dividend payments
which were in arrears.

Year 2000 Issue

     The  Company's  management  has  recognized  the  need to  ensure  that its
operations and  relationships  with its vendors and other third parties will not
be adversely  impacted by software  processing  errors arising from calculations
using the year 2000 and beyond ("Year 2000"). As such, the Company has appointed
a Year 2000 Task Force to  identify  and assess  the risks  associated  with its
information  systems  and  operations,  and its  interactions  with  vendors and
third-party  insurance payors ("the Year 2000 Project").  The five phases of the
Task Force's Year 2000 project are as follows:  1)  identification  of risks, 2)
assessment of risks,  3) development of remediation  and  contingency  plans, 4)
implementation  and 5) testing.  The Company's Year 2000 Task Force is currently
in the  assessment  phase and is scheduled to begin  testing in early 1999.  The
Company has not yet determined  the extent of  contingency  planning that may be
required.

     The  Company  believes  that  the  Year  2000  risks  associated  with  its
information   systems  and  certain   medical   equipment  may  be   potentially
significant.  In nearly all cases,  the  Company is relying on  assurances  from
third party vendors that certain  information systems and medical equipment will
be Year 2000  compliant.  In addition,  in the normal  course of  business,  the
Company  has made  capital  investments  in certain  third  party  software  and
hardware systems to address the financial and operational needs of the business.



                                       21

<PAGE>



These  systems,  which will improve the  efficiencies  and  productivity  of the
replaced systems, have been represented to be Year 2000 compliant by the vendors
and have been or will be installed by November  1999.  The Company plans to test
such third-party systems and equipment, but cannot be sure that its test will be
adequate or that, if problems are identified, they will be addressed in a timely
and satisfactory way.

     The Company is also highly  dependent  upon  receiving  payments from third
party payors for  insurance  reimbursement  for claims  submitted by the managed
Medical  Practices,  and as such,  the ability of such payors to process  claims
submitted by Medical Practices accurately and timely,  constitutes a significant
risk to the Company's cash flow.  Individual  Network Sites have been or will be
in communication  with these payors  throughout the country to insure that these
payors  will be Year 2000  compliant  and will be able to  process  the  Medical
Practices' claims  uninterrupted.  In addition,  the Company deals with numerous
financial institutions, all of whom have indicated that the Year 2000 compliance
issue is being  addressed  proactively  and will not  present a  problem  on the
effective date.

     As the Company and its managed Medical  Practices are primarily  reliant on
third party vendors and payors to be Year 2000  compliant,  the Company does not
anticipate  that it will  incur a  material  incremental  cost  associated  with
addressing Year 2000 problems.  To date, all of the Company's  capital  projects
regarding  information systems were part of its long-term capital strategic plan
and their timing was not accelerated as a result of the Year 2000 issue.

     In the event any third  parties  cannot  timely  provide the  Company  with
information systems, equipment or services that meet the Year 2000 requirements,
the Company's  ability and the ability of its managed Medical Practices to offer
services and to process sales and the  Company's  cash flows could be materially
adversely affected. In addition, if the Company fails to satisfactorily  resolve
Year 2000  issues  related to its  operations  in a timely  manner,  it could be
exposed  to  liability  to third  parties,  particularly,  the  managed  Medical
Practices and their patients.

     Management  believes  that the Company is taking  reasonable  and  adequate
action to address Year 2000 issues.  However, there can be no assurance that the
Company's  information  systems,  medical  equipment  and other  non-information
technology  systems will be Year 2000 compliant on or before  December 31, 1999,
or that  vendors  and  third-party  insurance  payors are, or will be, Year 2000
compliant,  or that the costs  required  to address the Year 2000 issue will not
have a material adverse effect on the Company's business, financial condition or
results of operations.

     Like  virtually  every  company,  and indeed every  aspect of  contemporary
society,  the  Company  is at  risk  for the  failure  of  major  infrastructure
providers to adequately  address  potential Year 2000  problems.  The Company is
highly dependent on a variety of public and private infrastructure  providers to
conduct its business in numerous jurisdictions throughout the country.  Failures
of the banking system, basic utility providers,  telecommunication providers and
other services, as a result of Year 2000 problems, could have a material adverse
effect on the ability of the Company to conduct its business.  While the Company
is cognizant of these risks,  a complete  assessment of all such risks is beyond
the scope of the  Company's  Year 2000  project  or  ability  of the  Company to
address.  The  Company  has  focused its  resources  and  attention  on the most
immediate and controllable Year 2000 risks.

New Accounting Standards

     On June 17, 1998, the FASB issued SFAS No. 133,  "Accounting for Derivative
Instruments  and Hedging  Activities"  (SFAS 133).  The Company does not believe
that  SFAS No.  133 will  have a  material  effect  on the  Company's  financial
position or results of operations.

Fluctuations in Quarterly Results

     The Company's  revenues are typically lower during the first quarter of the
Company's fiscal year. This lower level of revenues is primarily attributable to
the commencement of fertility treatment by the patients of the Medical Practices
at the beginning of the calendar year.  Quarterly results also may be materially
affected by the timing of  acquisitions  and the timing and  magnitude  of costs
related to acquisitions.  Therefore, results for any quarter are not necessarily
indicative of the results that the Company may achieve for any subsequent fiscal
quarter or for a full fiscal year.


                                       22

<PAGE>




Forward Looking Statements

     This Form 10-Q and discussions and/or announcements made by or on behalf of
the Company, contain certain forward-looking  statements regarding events and/or
anticipated  results  within the meaning of the "safe harbor"  provisions of the
Private  Securities  Litigation  Reform  Act of 1995,  the  attainment  of which
involve  various  risks and  uncertainties.  Forward-looking  statements  may be
identified by the use of  forward-looking  terminology  such as, "may,"  "will,"
"expect,"  "believe,"  "estimate,"  "anticipate,"  "continue," or similar terms,
variations of those terms or the negative of those terms.  The Company's  actual
results may differ  materially  from those  described  in these  forward-looking
statements  due to the  following  factors:  the  Company's  ability  to acquire
additional  management  agreements,  including  the  Company's  ability to raise
additional  debt and/or equity  capital to finance  future  growth,  the loss of
significant  management  agreement(s),  the  profitability  or lack  thereof  at
Network Sites managed by the Company,  the Company's  ability to transition sole
practitioners  to group practices,  increases in overhead due to expansion,  the
exclusion of infertility  and ART services from insurance  coverage,  government
laws and regulation  regarding health care, changes in managed care contracting,
the timely development of and acceptance of new infertility,  ART and/or genetic
technologies and techniques and the risks relating to the Year 2000.

Item 3.  Quantitative and Qualitative Disclosures About Market Risk

     Not applicable.

                                       23

<PAGE>



Part II -         OTHER INFORMATION

     Item 1.      Legal Proceedings.

                     On September 1, 1998, the Company and Reproductive Sciences
                     Medical Center,  Inc.  ("RSMC")  entered into a stipulation
                     and settlement agreement, resolving all claims against each
                     other. The management  agreement has been terminated,  RSMC
                     will  lease  the  Company's  assets  over a period of three
                     years, and the parties have entered into mutual  consulting
                     agreements.  Dr.  Samuel H.  Wood  will  serve as a special
                     consultant   to  the  Company   with  respect  to  new  ART
                     technologies  and the Company  shall serve as consultant to
                     RSMC's   Laboratory   Director  on  issues  of   laboratory
                     technology.

                     On  October 9,  1998,  W.F.  Howard,  M.D.,  P.A.,  filed a
                     lawsuit against the Company in the District Court of Denton
                     County,  Texas, seeking to rescind the management agreement
                     related to the Dallas Network Site, or collect damages,  on
                     the ground that its practice has not realized the degree of
                     growth or increases as allegedly  projected by the Company.
                     The  complaint   asserts  alleged   breaches  of  contract,
                     fiduciary  duties and warranties,  as well as a claim under
                     the Texas  Deceptive  Trade  Practices Act, and claims lost
                     profit damages as well as an exemplary award under statute.
                     Litigation  counsel has advised the Company  that it is too
                     early  in  the  litigation  to   meaningfully   assess  the
                     likelihood of success of this lawsuit. Nonetheless, counsel
                     believes  that even an  unfavorable  result will not have a
                     material  adverse  effect on the  Company.  The  management
                     agreement  remains in full operation during the pendency of
                     the lawsuit.

                     There  are a few  other  legal  proceedings  to  which  the
                     Company  is a party.  In the  Company's  view,  the  claims
                     asserted and the outcome of these proceedings will not have
                     a material adverse effect on the financial  position or the
                     results of operations of the Company.

     Item 2.      Changes in Securities.
                     None.

     Item 3.      Defaults Upon Senior Securities.
                     As  of   September   30,   1998,   dividend   payments   of
                     approximately   $563,000   on  the   Series  A   Cumulative
                     Convertible  Preferred  Stock were in  arrears.  In October
                     1998 the Company paid all dividend  payments  which were in
                     arrears.

     Item 4.      Submission of Matters to Vote of Security Holders.
                        None.

     Item 5.      Other Information.
                        Not applicable.

     Item 6.      Exhibits and Reports on Form 8-K.
                        (a) Exhibits.
                            See Index to Exhibits on page 26.
                        (b) Reports on Form 8-K.
                            None.

                                       24

<PAGE>








                                   SIGNATURES


         Pursuant to the  requirements  of the Securities  Exchange Act of 1934,
the  Registrant  has duly  caused  this report to be signed on its behalf by the
undersigned thereunto duly authorized.


                                  INTEGRAMED AMERICA, INC.
                                  (Registrant)




Date: November 16, 1998              By:      /s/ Eugene R. Curcio            
                                              ----------------------------------
                                              Eugene R. Curcio
                                              Vice President and
                                              Chief Financial Officer
                                              (Principal Financial and
                                              Accounting Officer)


                                       25

<PAGE>



                                INDEX TO EXHIBITS


Exhibit
Number                               Exhibit


10.44(c) --   Stipulation  of  Settlement  and  Compromise  of all Claims  Among
              IngetraMed America, Inc. and Assisted  Reproductive  Technologies,
              P.C.,  d/b/a Mainline  Reproductive  Science Center,  Reproductive
              Diagnostics,  Abraham Munabi, M.D., Reproductive Science Center of
              Suburban Philadelphia

10.52(a) --   Agreement  dated  September 1, 1998 By and Among Women's Medical &
              Diagnostic  Center,  Inc.,  IntegraMed  America,  Inc. and Florida
              Medical and Research Institute, P.A.

10.81(b) --   Stipulation  of  Settlement  and  Compromise  of all Claims  Among
              IntegraMed America, Inc. and Reproductive Sciences Medical Center,
              Inc. and Samuel H. Wood, M.D.

10.113(a)--   Loan  Agreement  dated  September  11,  1998  between   IntegraMed
              America, Inc. and Fleet Bank, National Association

27       --    Financial Data Schedule

                                       26


             STIPULATION OF SETTLEMENT AND COMPROMISE OF ALL CLAIMS

                                      AMONG

                            INTEGRAMED AMERICA, INC.

                                       AND

             ASSISTED REPRODUCTIVE TECHNOLOGIES, P.C., d/b/aMAINLINE
             REPRODUCTIVE SCIENCE CENTER, REPRODUCTIVE DIAGNOSTICS,
             ABRAHAM MUNABI, M.D., REPRODUCTIVE SCIENCE CENTER OF
             SUBURBAN PHILADELPHIA


         THIS   STIPULATION   AND  SETTLEMENT   AGREEMENT  dated  July  1,  1998
["Agreement"], by and among (1) IntegraMed America, Inc., a Delaware corporation
with its principal place of business at One Manhattanville Road,  Purchase,  New
York 10577  ["INMD"];  and (2) Assisted  Reproductive  Technologies,  P.C. d/b/a
Reproductive  Science Center of Greater  Philadelphia  ("ART") and  Reproductive
Science Center of Suburban  Philadelphia ("PC"), both Pennsylvania  professional
corporations  with their  principal  place of business at 950 West Valley  Road,
Suite 2401, Wayne Pennsylvania 19087, and Reproductive Diagnostics, Incorporated
("RDI") [RDI and ART  collectively  known as the  "Companies"]  and Dr.  Abraham
Munabi ("Munabi")

                                 R E C I T A L S

         WHEREAS, Companies and INMD are parties to a Management Agreement dated
May 15, 1995 ["Management Agreement"]; and

         WHEREAS,  for the purposes of this Stipulation and Settlement Agreement
["Agreement"], the Companies, PC and INMD accept and adopt the defined terms and
definitions contained in the Management Agreement; and

         WHEREAS, the Companies and INMD are parties to an Asset Purchase
Agreement dated May 15, 1995; and

         WHEREAS,  pursuant to such Management Agreement, the Companies,  Munabi
and INMD have operated a program providing Infertility Services (as such term is
defined  in ss.  1.7 of the  Management  Agreement)  and known as  "Reproductive
Science Center of Greater Philadelphia" [hereinafter "Program"]; and

         WHEREAS the Program was part of the INMD  Reproductive  Science  Center
Division, which consists of a national network of similar Programs; and


                      
                                        1

<PAGE>



         WHEREAS,  pursuant to the Asset Purchase Agreement,  INMD purchased all
of the assets of the  Companies  and, on this date,  is the record tenant of the
office and  laboratory  space of the  Program,  the owner  and/or  lessee of all
equipment,  fixtures and fixed  assets and the employer of all  personnel at the
Program with the exception of physicians; and

         WHEREAS,  pursuant to the Asset  Purchase  Agreement and the Management
Agreement,  INMD was to make certain  payments,  over the term of the Management
Agreement, for the Exclusive Management Right ["RTM Payments"];and

         WHEREAS,  pursuant  to the  Management  Agreement,  INMD  made  certain
Advances to the Companies,  which Advances were to be repaid by the Companies to
INMD; and

         WHEREAS,  Munabi  and  ART  were  parties  to  a  Physician  Employment
Agreement dated May 15, 1995,  pursuant to which Munabi was the medical director
of the Program and obligated to enforce said Management Agreement;

         WHEREAS,  certain disputes have arisen between and among the parties to
this Agreement in which the parties have mutually  served Notices of Termination
and claimed breaches of the various agreements; and

         WHEREAS,  the  parties  desire  to  effectuate  a  termination  of  the
Management  Agreement  in an orderly  fashion,  so as to insure  the  quality of
Infertility  Services at the  Program,  and to settle and  compromise  all their
disputes in order to avoid the expense and the uncertainty of litigation.

         NOW, THEREFORE,  in consideration of the foregoing,  and for other good
and valuable consideration, the parties, intending to be legally bound, agree as
follows:

1.       Termination of Agreements.  INMD and the Companies hereby terminate the
         Asset Purchase Agreement and the Management Agreements,  effective July
         1, 1998 and,  except for the rights and  obligations  contained in this
         Agreement,  all parties are discharged from any  obligations  under the
         Asset Purchase or Management  Agreements,  including but not limited to
         the repayment of Advances,  payment of RTM payments,  and covenants not
         to compete, it being the intention of the parties to accelerate all RTM
         payments  and apply those  accelerated  payments to repay  Advances and
         discharge any remaining Advances' balance.

2.       General Releases.  IntegraMed,  on the one hand, and the Companies, the
         PC and Munabi,  on the other hand, hereby release and forever discharge
         one another  (including  their  subsidiaries,  affiliates,  successors,
         assigns,  agents,  officers,  directors and employees) from any and all
         claims,   suits,  demands,   debts,  causes  of  action,   liabilities,
         indemnities,  obligations,  costs,  losses,  damages  and  expenses  of
         whatsoever  kind or nature,  whether  legal,  equitable  or  statutory,
         liquidated or unliquidated, known or unknown, including but not limited
         to  those  arising  out of the  Management  Agreement,  Asset  Purchase
         Agreement and Physician  Employment  Agreement,  arising from the first
         day of the world until the date of this Settlement Agreement.


                                                                              

                                        2

<PAGE>

       
3.       Continuation  of the Program and  Withdrawal  of INMD.  (a) The parties
         acknowledge and agree that the Program shall,  commencing July 1, 1998,
         be operated solely by Munabi, PC and the Companies, and that INMD shall
         withdraw (except for the INMD  Representative  detailed in paragraph 11
         hereof) and cease to offer any  management,  administrative  or support
         services to the Program.

         (b) Employees. Effective July 1, 1998, at the opening of business, INMD
         shall  terminate the  employment  of all its  employees  located at the
         Program  (other than the INMD  Representative  referred to in paragraph
         11) and the Companies or the PC shall hire such employees.

         (c)  Insurances.  Effective July 1, 1998, INMD shall cancel the general
         liability  insurance policy in effect for the Companies and the Program
         Premises  [as  defined  in   paragraph   7(c)]  and  shall  cancel  the
         professional  liability  insurance  policy in effect for the Companies'
         and PC's staff (including  Munabi).  Munabi covenants and warrants that
         the PC and Munabi  have had  professional  liability  insurance.  in an
         amount  of no  less  than  $1  million  per  claim/$3  million  in  the
         aggregate,  since June 24, 1998 and that the Companies and Munabi shall
         provide INMD, proof of such insurance,  and proof of general  liability
         insurance  for the  Program  Premises  no later than July 8, 1998.  The
         Munabi/Companies/PC obligation to provide proof of such insurance shall
         continue  annually (on the  anniversary  date of the first proof) until
         and unless the Payment  Price,  as defined in  paragraph 5 hereof,  has
         been fully paid to INMD. Munabi hereby acknowledges and agrees that any
         and all health and/or disability  benefits provided by INMD shall cease
         on July 1, 1998.

         (d) Notification of Patients. Munabi, the Companies and PC shall notify
         patients of the Program,  on or before July 10,  1998,  that he and the
         Companies/PC  are no longer  affiliated with INMD. The form and content
         of such  notification  shall  be  previously  approved  by  INMD,  such
         approval not to be unreasonably withheld.

         (e)  Biological Materials.

                  (i) The Companies, PC and Munabi, hereby acknowledge and agree
                  that,  at all times  during the time period of the  Management
                  Agreement, and at all times hereafter,  the Companies,  Munabi
                  and/or  PC have  solely  been the  rightful  custodian  of all
                  biological  materials,  including  but not  limited  to sperm,
                  oocytes  and  embryos   (cryopreserved  or  fresh)["Biological
                  Materials"]  and that they  shall  continue  to  preserve  and
                  protect such Biological Materials as are in their custody.


                                                                            
                                        3

<PAGE>



                  (ii) The  Companies  and PC shall  provide INMD with a list of
                  all patients who (1) have cryopreserved  biological  materials
                  in storage at the Program as of July 1, 1998, and (2) who have
                  had  cryopreserved  biological  materials  in  storage  at the
                  Program from May 15, 1995 through July 1, 1998,  together with
                  information as to and the date as to when storage ceased.

                  (iii)  The  Companies/PC  shall  indemnify,  defend  and  hold
                  harmless INMD against any claims arising out of the custody or
                  storage of Biological Materials on or after July 1, 1998.

         (f)  Removal of  Proprietary  Information.  INMD shall  remove from the
         Program  Premises  any and all copies of  proprietary  information,  as
         listed on Schedule A annexed hereto,  and the Companies,  Munabi and PC
         hereby  covenant  not to copy or utilize  any  consents,  procedure  or
         policy  manuals or proprietary  information  henceforth in operation of
         the Program.

         (g)  Billing  Cooperation.  INMD shall leave at the Program any and all
         documentation  and  equipment  necessary  for the  Program  to bill for
         unbilled Infertility Services and to collect outstanding amounts.  This
         shall include data stored in the computer system at the Program. INMD's
         corporate  staff,  with  the  exception  of  the  INMD   Representative
         described in paragraph 11, shall no longer have modem or network access
         to the Companies/PC's computers at the Program.

4.       Change of name. On or before March 31, 1999, ART, Munabi, PC or any PC,
         fictitious  name and/or  business  entity  through  which  Munabi shall
         practice medicine,  shall cease and desist from utilizing any corporate
         name and/or any fictitious name under which each or any may trade, that
         includes the phrase  "Reproductive  Science Center" and shall cease and
         desist  from  using  any  marketing  materials  that  include  the name
         "Reproductive Science Center".

5.       Payment Price for INMD Withdrawal.  In consideration of the termination
         of the Management  Agreement and Asset  Purchase  Agreement and for the
         withdrawal of INMD from the Program as described  above at paragraph 4,
         PC shall pay the following to INMD:

         (a) The Asset Price as delineated in paragraph 7 below; and

         (b) An amount  ("June Net Costs") equal to the  difference  between (1)
         the Costs of  Services  (as  defined in Section  2.1 of the  Management
         Agreement)  actually  incurred by INMD in the  operation of the Program
         during the time period  June 1 through  June 30,  1998;  and (2) INMD's
         Severance  Cost, such term being defined as the costs and expenses that
         INMD would have incurred had it terminated  all of its employees at the
         Program on July 1, 1998.  The  parties  agree that INMD and PC's agent,
         Cogen & Sklar,  shall,  in good faith,  agree on the foregoing Costs of
         Services and  Severance  Costs,  no later than July 15, 1998,  and that
         INMD shall provide  appropriate backup information and documentation to
         support the calculation thereof.

                                                              
                                        4

<PAGE>



                           

         The  parties  hereto  agree that items (a) and (b),  in the  aggregate,
         represent the total  "Payment  Price" for the assets and  withdrawal of
         INMD.

6.       Payment  of  Payment  Price  and  Covenant  by  Munabi.  Munabi  hereby
         covenants and represents that the obligation for payment of the Payment
         Price is that of the PC, which is the current professional  corporation
         through which he practices medicine. He hereby covenants and represents
         that if, at any time prior to the full payment of the Payment Price, he
         should  establish  another  professional  corporation or entity through
         which he shall practice medicine, he shall do so only if such PC and/or
         sole   proprietorship   or  business  entity   expressly   assumes  the
         obligations of the Payment Price and the obligations of this Agreement.

7.       Purchase  of  Assets.  The PC shall  purchase  the  tangible  assets (a
         tentative schedule of such assets being here attached as Schedule B) at
         a Closing  ("Closing")  to occur at a  mutually  convenient  date on or
         before July 30,  1998.  The  documents  to be exchanged at such closing
         shall be held in escrow by the law firm of  Ledy-Gurren &  Blumenstock,
         LLP  ["LG&B"],  230 Park Avenue,  New York,  New York,  until the first
         installment of the Payment Price has been paid.

         (a) The parties agree that the PC and IntegraMed  shall agree,  in good
         faith, on the accuracy of such schedule on or before July 15, 1998.

         (b) The  purchase  price for such  assets  shall be the net book  value
         thereof  ("Asset  Price") and the parties  agree to utilize  Schedule B
         attached  hereto as a starting point,  and to come to an agreement,  in
         good  faith,as  to the net book value of such  assets.  Such  agreement
         shall occur on or before July 15, 1998.

         (c) The PC shall assume,  as of July 1, 1998,  the lease for the office
         space of the Program  located in Wayne,  PA  ("Program  Premises")  and
         shall indemnify INMD against any claims for rent or payments thereunder
         made by the Landlord.

         (d) The PC shall assume the leases,as of July 1, 1998,  for any and all
         medical  and/or office  equipment  located at the Program  Premises and
         shall indemnify INMD against any claims for rent or payments thereunder
         made by the Lessors thereof.

8.       Payment of Payment Price. The Payment Price shall be paid as follows:

         (a). a down payment  equal to 10% thereof  ["Downpayment"],  payable on
         September 1, 1998.



                                        5

<PAGE>



         (b). the balance thereof due in 16 quarterly  payments,  with the first
         quarterly  payment due on December 1, 1998. The quarterly  payments for
         the  first two  years  ("Year  1" and  "Year  2") shall be eight  equal
         payments which,  together with the Downpayment shall, in the aggregate,
         be in an amount equal to 40% of the total Payment Price,  and those for
         the last 2 years ("Year 3" and "Year 4") shall be eight equal  payments
         which,  in the  aggregate,  shall be in an  amount  equal to 60% of the
         total Payment Price.

         (c). Interest shall accrue on the Payment Price as of September 1, 1998
         at a rate equal to the lesser of INMD's cost of funds (as of  September
         1,  1998) or the  "Prime  Rate" (as of  September  1, 1998) as the same
         shall be  published  in The Wall Street  Journal on  September 2, 1998)
         (hereafter, the "Interest Rate").

         (d)      In the event that the Payment  Price is fully  repaid prior to
                  the end of Year 4, the PC shall be  entitled  to a discount on
                  the remaining balance, as of the date of such pre-payment,  in
                  an amount equal to the then  remaining  balance of the Payment
                  Price multiplied by the Interest Rate.

         (e)      The payment  schedule  detailed  in  sections  (a) through (d)
                  above is specifically subject to paragraph 12 below.

9.       Security. The Payment Price shall be secured as follows:

         (a)      PC shall,  at Closing,  grant and deliver to INMD,  a security
                  interest,  in proper form suitable for filing  pursuant to the
                  Uniform Commercial Code, in the Assets, such security interest
                  to be operative  from the period  beginning at the Closing and
                  ending on  September  1, 2000 and to secure  the  payments  of
                  Years 1 and 2; and

         (b)      Munabi's  shall,  at Closing,  deliver to INMD,  his  personal
                  guaranty, in mutually acceptable form (the parties to use good
                  faith in agreeing to such form) for the payment of the amounts
                  that shall become payable in Years 3 and 4.

         (c)      The securities  granted hereunder shall be fully operative and
                  subject to paragraph 12 below.

10.      Right to Accounts Receivable.  The parties hereby acknowledge and agree
         that, during the operation of the Program,  certain accounts receivable
         were,  and shall  continue to be,  generated.  For the purposes of this
         Agreement,  accounts  receivable are deemed  generated on the date that
         the  medical  or  laboratory  service or  treatment  is  provided  to a
         patient,  irrespective  of the date  (before or after  treatment)  that
         payment is actually received.  The parties hereby agree and acknowledge
         the following rights and interests in accounts receivable of the

                                  
                                        6

<PAGE>



         Program,  it being understood and agreed that any "unapplied  payments"
         (that is, payments as to which,  after  reasonable  inquiry,  it is not
         possible to determine  which medical or  laboratory  service it relates
         to) made by patients  and/or payors shall be prorated,  between May and
         June  Receivables,  based on the percentage of May and June Receivables
         contained in the entire outstanding  balance of the patient at the time
         of the receipt of the unapplied payment.

         (a) Any and all  accounts  receivable  generated on or prior to May 31,
         1998 ("May Receivables") are the sole property of INMD, whether payment
         therefor has, or in the future is, received by INMD, the Companies, the
         PC and/or Munabi.

         (b) Any and all accounts receivable generated on and after June 1, 1998
         ("June Receivables") are the sole property of the Companies and the PC,
         whether payment therefor has been, or in the future is, received by any
         or all of INMD, the Companies, the PC and/or Munabi.

         (c)  The  Companies,  PC  and  Munabi  shall  provide  to  INMD  a full
         accounting  of  payments  received  by them  since  June 1,  1998  ["PC
         Receipts"],   estimated  at  approximately   $20,000  (twenty  thousand
         dollars), by providing all bank statements and records of the PC and/or
         Munabi  relating to such  monies and  identifying  the  patient  names,
         amounts paid and  procedures  performed and the date  thereof,  so that
         INMD may identify such amounts as May Receivables or June  Receivables,
         or a combination  thereof.  It is understood  and agreed that such bank
         records will reveal a deposit of $3300  (thirty-three  hundred dollars)
         to the PC account which represents the personal money of Munabi.

         (d)  INMD  shall  provide  a full  accounting  to the PC of the  amount
         "swept" by INMD on or about June 18, 1998,  estimated at  approximately
         $118,000  ["Swept  Money"],  by identifying the patient names,  amounts
         paid and date of medical treatment  performed,  so that PC can identify
         such amounts as May Receivables or June  Receivables,  or a combination
         thereof.  Further,  INMD shall provide a full  accounting,  in the same
         manner,  to the PC of any  amount  "swept"  by INMD on or after June 1,
         1998.

         (e) In the event there  arises a dispute  between INMD and PC as to the
         nature and  character of the PC Receipts or Swept Money (as May or June
         Receivables),  the parties shall first rely on the date the service was
         rendered,  as shown on the computer records generated by INMD. PC shall
         have the burden of proving such records  erroneous by supplying  copies
         of the patient medical records.

         (f) Escrow monies. Munabi, the PC and the Companies shall promptly, and
         no later than July 6, deliver the PC Receipts to LG&B, to be held in an
         attorney  escrow  account  (non-interest  bearing).  The parties  shall
         agree, in good faith, on the division of such PC Receipts no later than
         July 10, 1998. LG&B shall fax notice of the proposed distribution to PC
         or INMD, as the case shall be, and shall  distribute such escrow money,
         
                                                            

                                        7

<PAGE>



         at the  conclusion of the next  business  day, in accordance  with such
         notice  unless the PC counsel or INMD  notifies LG&B of an intention to
         arbitrate a disagreement with the terms of said proposed distribution.

         INMD shall promptly,  and no later than July 6, deliver the Swept Money
         to  LG&B,  to be  held  in an  attorney  escrow  account  (non-interest
         bearing).  The parties shall agree,  in good faith,  on the division of
         such  Swept  Money by July 10,  1998.  LG&B  shall  fax  notice  of the
         proposed  distribution  to PC or INMD,  as the case shall be, and shall
         distribute  such escrow money,  at the  conclusion of the next business
         day,  in  accordance  with such  notice,  unless the PC counsel or INMD
         notifies  LG&B of an  intention to  arbitrate a  disagreement  with the
         terms of said proposed distribution.

11.      Collection of Accounts Receivable.  A representative of INMD (of INMD's
         choosing) (the "INMD  Representative") shall be on the Program Premises
         for up to and including 120 days,  beginning  July 1, 1998, in order to
         oversee and make efforts for the collection of the accounts  receivable
         of the Program and the PC. Such collection shall be jointly  supervised
         and conducted by the INMD  Representative  and a representative  of the
         Companies/PC designated by Munabi (the "Companies Representative"). The
         INMD and Companies  Representatives  shall have joint and  simultaneous
         access  to the PC's  P.O.  Box at the  Southeastern  PA Post  Office in
         Wayne,  PA.  and  shall  have full and  complete  access to any and all
         billing  information,   data  and  computer  information  necessary  to
         process,  record and document payment of such accounts receivable.  The
         INMD Representative and the Companies Representative shall, jointly and
         in good faith, allocate any and all monies received as being either May
         Receivables or June Receivables.  INMD and the PC shall, in good faith,
         insure  that  the  June  Receivables  are  paid  to the PC and  the May
         Receivables  are paid to INMD.  The PC and Munabi  hereby  covenant  to
         cooperate with the INMD  Representative  in his/her  efforts to collect
         May Receivables and agree not to interfere,  by omission or commission,
         with that  effort.  In the event  that there is a dispute  between  the
         Companies'  Representative and the IntegraMed Representative concerning
         whether  monies  received   constitute  a  May  Receivable  or  a  June
         Receivable,  the  parties  shall  first rely on the date of the service
         rendered,  as shown in the computer  records  generated by INMD and, if
         the Companies' representative disagrees with such records, he/she shall
         produce the patient's  records.  If the parties cannot,  in good faith,
         

                                                                                
                                        8

<PAGE>



         agree to the allocation on the basis of such records,  such collections
         shall be put in escrow until the matter is determined by arbitration or
         agreement.

12.      Acceleration.  The  Payment  Price  shall  be  accelerated  and  become
         immediately due and payable on the occurrence of any of the following::
         (1) Munabi sells his reproductive  science practice,  or a greater than
         49%  interest  therein;  or  (2) if  Munabi,  the  Companies  or the PC
         interfere in the collection of the accounts receivable,  as the same is
         described in Paragraph 11 above; or (3) if a payment is not made within
         fifteen (15) days after written notice by INMD of a default in payment,
         sent by certified mail to the PC.

13.      Waiver of Further Walter Reed Payments.  The parties  acknowledge agree
         that,  during the  operation of the  Management  Agreement,  Munabi has
         received  monthly  payments,  in the nature of a "finder's fee" arising
         out of INMD's management agreement with the U.S. Defense Department and
         Walter Reed  Hospital.  Munabi hereby waives any and all future payment
         or  claim  of any  nature,  to  such  monies  or any  interest  in said
         management agreement or renewal thereof.

14.      Cooperation.  In  the  event  of  any  claims,  suits  or  governmental
         investigations,  arising out of or relating  to the  Program,  in which
         INMD,  Munabi,  the Companies and/or the PC shall be named or involved,
         whether or not pending during the term of the Management Agreement, the
         parties hereto agree to fully  cooperate with each other in the defense
         of such suit, claim or  investigation.  Such cooperation shall include,
         by way of example but not limitation, meeting with defense counsel, the
         production   of  any   documents  in  their   possession   for  review,
         participation in discovery or an investigation by an insurer,  response
         to subpoenae  and the  coordination  of any  individual  defenses  with
         counsel for all parties.  Munabi,  the Companies  and the PC shall,  as
         soon  as  practicable,   deliver  to  INMD  copies  of  any  summonses,
         complaints, suit letters, subpoenae or legal papers of any kind, served
         upon  them or their  attorneys.  This  obligation  to  cooperate  shall
         survive the satisfaction of any payment obligations  hereunder,  or the
         termination of this Agreement for whatever reason,  and nothing in this
         paragraph  shall obligate the parties to pay any legal fees incurred by
         the other.

15.      Non-Disparagement  and  Confidentiality.  The parties  acknowledge that
         this Agreement represents a fully consensual and amicable separation of
         interests  and  that,   hereafter,   each  party   covenants  that,  in
         communicating  with third  parties,  they shall not, by action or word,
         defame,  criticize  or condemn the  actions,  conduct or motives of the
         other.  Each party recognizes that this covenant  represents a material
         obligation  of both parties under this  Agreement,  the breach of which
         may impact  adversely  on the business  interests of the  non-breaching
         party.  The parties further  covenant that they shall keep the terms of
         this Agreement confidential,  except to the extent necessary to enforce
         the terms hereof.


                                                                         

                                        9

<PAGE>



16.      Additional Agreements. The parties anticipate that it will be necessary
         to prepare  various  documents  (including  but not limited to "Bill of
         Sale",  security  agreement and  guaranty) to effectuate  the intent of
         this  Agreement.  They  shall  agree in good faith on the terms of such
         documents.  In addition,  the parties shall  cooperate in good faith to
         carry out the provisions of this Agreement and the intent thereof,  and
         shall  deliver the necessary  documents to effectuate  the intention of
         this Agreement.

17.      Arbitration.  Any dispute arising out of or relating to this Agreement,
         or the  obligations  of the parties to each other,  shall be settled by
         arbitration in accordance  with the Rules of Commercial  Arbitration of
         the American  Arbitration  Association  and  judgement  upon such award
         rendered by the arbitrator  shall be final and binding upon the parties
         and may be  entered  in any  court  having  jurisdiction  thereof.  The
         arbitrator shall be an arbitrator qualified to serve in accordance with
         the rules of the American  Arbitration  Association  who is approved by
         both Munabi and INMD. In the absence of such  approval,  Dr. Munabi and
         INMD each shall designate a person  qualified to serve as an arbitrator
         in accordance  with the rules of the American  Arbitration  Association
         and the two persons so  designated  shall  select the  arbitrator  from
         among those persons  qualified to serve in accordance with the rules of
         the American Arbitration Association.  The arbitration shall be held in
         Philadelphia,  PA. Except as otherwise  provided herein,  the costs and
         expenses of the two  individuals who shall have selected the arbitrator
         and of the  arbitrator  shall be paid by the losing party (who shall be
         specifically designated as such by the arbitrator as part of his or her
         judgment). Notwithstanding the foregoing, the parties shall be entitled
         to obtain an injunction, temporary restraining order or other equitable
         relief from a court of competent jurisdiction.

18.      Governing  Law.  This  Agreement  shall be  governed by the laws of the
         Commonwealth of Pennsylvania,  without  reference to rules of conflicts
         of laws.

19.      Amendment.  No  modification,  amendment or addition to this Agreement,
         nor  waiver  of any of its  provisions,  shall be valid or  enforceable
         unless in writing and signed by all parties.

20.      No  assignment  or  delegation  of this  Agreement  or the  rights  and
         obligations  hereunder  shall be valid without the specific  consent of
         all parties.

21.      No consent or waiver,  express or implied,  by either party hereto,  of
         any  breach or  default by the other  party in the  performance  by the
         other of its obligations  hereunder,  shall be valid unless in writing,
         and no such  consent  or waiver  shall be deemed or  construed  to be a
         consent  or  waiver  to or of  any  other  breach  or  default  in  the
         performance by such other party of the same or any other  obligation of
         such party  hereunder.  Failure on the part of either party to complain
        

                                                                          
                                       10

<PAGE>



         of any act or failure to act of the other party or to declare the other
         party in  default,  irrespective  of how long such  failure  continues,
         shall not constitute a waiver by such party of its rights hereunder.

22.      Any notices, requests, demands and other communications provided for in
         this  Agreement as required  among the parties in  connection  with the
         Agreement shall be in writing and shall be deemed to have been given at
         the time when mailed at any United  States Post Office via  register or
         certified  mail,  prepaid,  or sent  by  overnight  delivery  services,
         addressed  to the party at the  address  set forth  below or such other
         addresses as such party may designate by notice:

         To PC, Companies and/or Munabi:
         Abraham Munabi, M.D.
         950 West Valley Road
         Suite 2401
         Wayne, Pennsylvania 19087



                                                                              
                                       11

<PAGE>


         To IntegraMed America, Inc:

         Donald S. Wood, Ph.D.
         Chief Operating Officer
         Integramed America, Inc.
         One Manhattanville Road
         Purchase, New York 10577

IN WITNESS  WHEREOF,  the parties have set their hands  hereunto this 1st day of
July 1998.


INTEGRAMED AMERICA,INC.                              ART


By:   /s/Donald S. Wood                    By:    /s/Abraham Munabi
      -----------------------                     ----------------------  
         Donald S. Wood, Ph.D.                       Abraham Munabi, M.D.
         Title: Chief Operating Officer       Title: President


RDI                                           REPRODUCTIVE SCIENCE CENTER
                                              OF SUBURBAN PHILADELPHIA



By:      /s/Abraham Munabi                    By:    /s/Abraham Munabi
         -------------------                         --------------------
         Abraham Munabi, M.D.                        Abraham Munabi,M.D.
         Title: President                     Title: President


/s/Abraham Munabi
- --------------------------------------
Abraham Munabi, M.D.

   
                                                        12


                                    AGREEMENT

         THIS AGREEMENT  ("Agreement")  is dated  September 1, 1998 by and among
Women's Medical & Diagnostic Center, Inc., a Florida corporation, with its place
of business at 222 S.W. 36th Terrace, Gainesville,  Florida ("WMDC"), IntegraMed
America,  Inc., a Delaware corporation,  with its principal place of business at
One Manhattanville Road,  Purchase,  New York 10577 ("INMD") and Florida Medical
and Research Institute, P.A., a Florida professional association, with its place
of business at 6440 N.W.  Newberry Road, Suite 204,  Gainesville,  Florida 32605
("FMRI").
                                                     RECITALS:
         WMDC is a wholly-owned subsidiary of INMD conducting a medical practice
in the State of Florida;

         INMD and FMRI have  entered into a Memorandum  of  Understanding  dated
August 24, 1998 ("MOU") pursuant to which,  among other things,  INMD has agreed
to sell certain WMDC accounts receivable to FMRI; and

         WMDC has agreed to assign certain Clinical Research Trials to FMRI.

         NOW THEREFORE,  in  consideration  of the mutual promises and covenants
herein contained, the parties hereto agree as follows:

         1.  RIGHT  TO  CLINICAL   ACCOUNTS   RECEIVABLE.   The  parties  hereby
acknowledge  and agree that,  during the  operation  of WMDC,  certain  accounts
receivable were generated in connection  with medical and/or  clinical  services
rendered by WMDC ("Clinical  Receivables").  For the purposes of this Agreement,
Clinical  Receivables  are deemed  generated on the date that the medical and/or
clinical service or treatment is provided to a patient, irrespective of the date
(before or after  treatment)  that  payment is  actually  received.  The parties
hereby agree and acknowledge the following  rights and interests in the Clinical
Receivables:



<PAGE>


         (a) Any and all  Clinical  Receivables  generated on or prior to August
         31, 1998 ("Pre- Closing Clinical Receivables") are the sole property of
         WMDC,  whether  payment  therefor has, or in the future is, received by
         WMDC or  FMRI.  Any  and all  payments  received  by FMRI on and  after
         September 1, 1998 for Pre-Closing Clinical Receivables will be promptly
         forwarded  to  IntegraMed  America,   Inc.,  One  Manhattanville  Road,
         Purchase,  New  York  10577,   Attention:   John  Kearns,  Director  of
         Accounting (b) Any and all Clinical Receivables  generated on and after
         September 1, 1998 ("Post- Closing Clinical  Receivables")  are the sole
         property of FMRI,  whether  payment  therefor has, or in the future is,
         received by INMD or FMRI.  Any and all payments  received by WMDC on or
         after September 1, 1998 for Post-Closing  Clinical  Receivables will be
         promptly forwarded to FMRI, Attention:  Accounts Receivable Department.
         Nothing contained herein shall be construed to obligate FMRI to collect
         the  Pre-Closing  Clinical  Receivables  generated  by WMDC;  provided,
         however,  FMRI shall give WMDC and INMD access,  from time to time,  as
         reasonably  needed,  to the data  supporting the  Pre-Closing  Clinical
         Receivables,  and,  if  necessary,  give  WMDC or INMD  representatives
         access to FMRI's office at 222 SW 36th Terrance, Gainesville,  Florida,
         on reasonable  notice,  in pursuit of collecting  Pre-Closing  Clinical
         Receivables.  (c) In the event there arises a dispute  between WMDC and
         FMRI as to the nature and  character  of the Clinical  Receivable,  the
         parties shall first rely on the date the service was rendered, as shown
         on the computer  records  generated by WMDC. FMRI shall have the burden
         of proving  such records  erroneous by supplying  copies of the patient
         medical  records.  FMRI shall not be  responsible  for any  refunds due
         patients for services rendered prior to September 1, 1998.


<PAGE>


       
         2. RIGHT TO CLINICAL RESEARCH ACCOUNTS  RECEIVABLE.  The parties hereby
acknowledge  and agree that,  during the  operation  of WMDC,  certain  accounts
receivable were generated in connection with clinical research services rendered
by WMDC ("Research Receivables").  For the purposes of this Agreement,  Research
Receivables  are deemed  generated on the date that the medical and/or  clinical
service, or treatment is provided to a patient, irrespective of the date (before
or after treatment) that payment is actually received.  The parties hereby agree
and  acknowledge  that  any and all  Research  Receivables  generated  prior  to
September  1, 1998 are being  assigned  to FMRI,  and WMDC does  hereby  assign,
transfer  and  convey  such  Research  Receivables  as set forth on  Exhibit  A,
attached  hereto,  to  FMRI in  consideration  for the  payment  of  One-Hundred
Sixty-Five  Thousand  Dollars  ($165,000.00),  the  receipt  of which is  hereby
acknowledged.  To the best of WMDC's knowledge and belief,  Exhibit A represents
Research Receivables as of August 31, 1998.

         3.  CLINICAL  RESEARCH.  Marvin  Heuer,  MD,  Medical  Director of WMDC
("Heuer")  is the  Research  Scientist  or  Principal  Investigator  for various
clinical trials  ("Clinical  Trials") being conducted by WMDC. All such Clinical
Trials  are  hereby   assigned  to  FMRI.   Neither  WMDC  nor  INMD  makes  any
representation  or warranty  that the Clinical  Trials are  assignable or can be
assigned  to FMRI;  however,  WMDC will use its best  efforts to assist with the
assignment of such Clinical Trials to FMRI. WMDC hereby assigns all new research
protocols whichwould have been contractually awarded to WMDC, or to Heuer in his
role as WMDC's  employee,  to FMRI, and will use its best efforts to assist with
any such assignment.

         4. CLINICAL  CHARTS.  Effective  September 1, 1998,  FMRI shall assume
responsibility  for all  patient  charts  maintained  by  WMDC,  other  than the
patients of Drs. Hinshaw, Markle and Sample.


<PAGE>


         5.  FURNISHINGS  AND  EQUIPMENT.  Pursuant to  paragrapgh  8 of the MOU
certain equipment and furnishings  located at the Ocala and Gainesville  offices
are being  conveyed  to FMRI,  effective  the date  hereof.  Attached  hereto as
Exhibit B is a listing of such furnishings and equipment.

         6.  CONFLICT.  Except  as may be  modified  herein,  all the  terms and
conditions of the MOU remain in full force and effect.  In the event any term or
condition  herein is  inconsistent  with or is in  conflict  with the MOU,  this
Agreement shall control.

         7.  INDEMNIFICATION

                  (a) WMDC and INMD agree to indemnify and hold  harmless  FMRI,
its directors,  officers,  employees and agents from any suits, claims, actions,
losses, liabilities or expenses (including reasonable attorneys' fees and costs)
arising out of or in connection with any act or failure to act by either of them
during the  operations of WMDC.  To the best of INMD's and WMDC's  knowledge and
belief,  all  incidents  that  potentiate  a claim have been  reported  to their
professional liability insurer.

                  (b) FMRI agrees to indemnify  and hold harmless WMDC and INMD,
their  respective  officers,  directors,  employees and agents,  from any suits,
claims, actions, losses, liabilities or expenses (including reasonable attorneys
fees and costs)  arising out of or in connection  with any act or failure to act
by it after September 1, 1998.

         8.  PROFESSIONAL  LIABILITY  INSURANCE.  WMDC  agrees  to keep  medical
malpractice  coverage in place for Heuer until such time,  not to exceed 60 days
from September 1, 1998, that Heuer effects such coverage in his own name.




<PAGE>



         9.  COOPERATION.    In   the   event   of   any   claims,    suits   or
governmentalinvestigations, arising out of or relating to the operations of WMDC
in  which  WMDC,  INMD or FMRI or an  individual  of  either  shall  be named or
involved whether occurring or pending prior to this Agreement, the parties agree
to cooperate with each other in the defense of such suit, claim or investigation
by the production of any documents in their  possession for review.  The parties
shall,  as soon as  practical,  deliver to each other  copies of any  summonses,
complaints,  suit letters,  subpoenas or legal papers of any kind, served upon a
party or a party's attorneys. Nothing in this Section shall obligate the parties
to pay any legal fees incurred by the other.

         10. GOVERNING LAW. This Agreement shall be governed by and construed in
accordance with the laws of the State of Florida. Any and all claims,  disputes,
or controversies  arising under, out of, or in connection with this Agreement or
any breach thereof,  shall be determined by binding  arbitration in the State of
Florida, City of Gainesville  (hereinafter  "Arbitration");  provided,  however,
mediation shall be a precursor to Arbitration.  The party seeking  determination
shall  subject  any  such   dispute,   claim  or   controversy   to  either  (i)
JAMS/Endispute or (ii) the American  Arbitration  Association,  and the rules of
commercial  arbitration  of the selected  entity shall govern.  The  Arbitration
shall be  conducted  and  decided by three (3)  arbitrators,  unless the parties
mutually agree, in writing at the time of the Arbitration, to fewer arbitrators.
In reaching a decision,  the arbitrators  shall no authority to change or modify
any provision of this Agreement,  including without  limitation,  any liquidated
damages  provision.  Each party shall bear its own  expenses  and  one-half  the
expenses and costs of the  arbitrators.  Any application to compel  arbitration,
confirm or vacate an arbitral award or otherwise enforce this Paragraph shall be
brought either in the Courts of the State of Florida.




<PAGE>



         11. Notices.  All notices,  requests,  demands and other communications
provided for in this Agreement or required among the parties in connection  with
this Agreement shall be in writingand  shall be deemed to have been given at the
time when  personally  delivered,  mailed at any United  States  Post Office via
certified mail, prepaid, return receipt requested, or sent by overnight delivery
services against receipt,  addressed to the party at the address set forth below
or such other address as such party may designate by notice:

         If to INMD or WMDC:
                  Mr. Jay Higham, Vice President
                  IntegraMed America, Inc.
                  One Manhattanville Road
                  Purchase, New York 10577

         With a Copy to:
                  Claude E. White, General Counsel
                  IntegraMed America, Inc.
                  One Manhattanville Road
                  Purchase, New York 10577

         If to FMRI:
                  Marvin Heuer, MD, President
                  Florida Medical and Research Institute, P.A.
                  6640 N.W. Newberry Road
                  Gainesville, Florida 32605

         With a Copy to:

                  Ellen Gershow, Esq.
                  Dell Graham, P.A.
                  P.O. Box 850
                  203 N.E. 1st Street
                  Gainesville, Florida 32601

         12. SEVERABILITY.  Each  provision in this  Agreement is intended to be
severable,  and may be modified by any court of  competent  jurisdiction  to the
extent  necessary to make such provision valid and  enforceable.  If any term or
provision hereof shall be determined by a court of competent  jurisdiction to be
illegal  or  invalid  for any  reason  whatsoever,  in whole  or in  part,  such
provision shall be severed from this Agreement and shall not effect the validity
of the remainder of this Agreement.


<PAGE>


         13.  INDEPENDENT  STATUS.  The  Parties  agree that FMRI is  purchasing
assets and  certain  receivables  of WMDC and  accepting  assignment  of certain
leases and agreements. Nothing contained herein or with respect to any aspect of
the transaction  shall be construed to constitute FMRI as a related or successor
party-in-interest to WMDC.

         14. TELEPHONE  NUMBERS.  WMDC hereby assigns its right to the telephone
numbers  previously  used  by it to FMRI  and  agrees  to  execute  any  further
documentation necessary to transfer such numbers.

         IN WITNESS  WHEREOF,  the parties have executed this Agreement the date
first above written. WOMEN'S MEDICAL & DIAGNOSTIC CENTER, INC.


By: /s/Jay Higham
    -----------------------------
    Jay Higham, Vice President


FLORIDA MEDICAL AND RESEARCH INSTITUTE, P.A.

By: /s/Marvin Heuer
    ------------------------------
    Marvin Heuer, MD, President



INTEGRAMED AMERICA, INC.


By: /s/Jay Higham
    ------------------------------
    Jay Higham, Vice President


             STIPULATION OF SETTLEMENT AND COMPROMISE OF ALL CLAIMS

                                      AMONG

                            INTEGRAMED AMERICA, INC.

                                       AND

                   REPRODUCTIVE SCIENCES MEDICAL CENTER, INC.
                            AND SAMUEL H. WOOD, M.D.


         THIS STIPULATION AND SETTLEMENT  AGREEMENT  effective September 1, 1998
["Agreement"], by and among (1) IntegraMed America, Inc., a Delaware corporation
with its principal place of business at One Manhattanville Road,  Purchase,  New
York 10577 ["INMD"];  and (2)  Reproductive  Sciences  Medical  Center,  Inc., a
California  professional  corporation,  with its principal  place of business at
4150 Regents Row, Suite 280, La Jolla,  California 92037 ["PC"];  and (3) Samuel
H. Wood, M.D.,  having a post office address at P.O. Box 1208,  Rancho Sante Fe,
California 92067 ["Wood"].

                                 R E C I T A L S

         WHEREAS,  PC and INMD are parties to a Management  Agreement dated June
6, 1997, as amended ["Management Agreement"]; and

         WHEREAS, Wood and INMD are parties to an Asset Purchase Agreement dated
June 6, 1997, as amended ["Asset Agreement"]; and

         WHEREAS,  PC,  Wood and INMD are  parties to a Personal  Responsibility
Agreement   dated  June  6,   1997,   as   amended   ["Personal   Responsibility
Agreement"];and

         WHEREAS, PC and Wood are parties to a Physician-Shareholder  Employment
Agreement dated June 6, 1998, as amended  ["Employment  Agreement"]  pursuant to
which Wood was the medical director of the Program; and

         WHEREAS, the Management Agreement,  Asset Purchase Agreement,  Personal
Responsibility  Agreement and Employment Agreement,  and any Amendments thereto,
are herein collectively referred to as the "Various Agreements"; and

         WHEREAS, for the purposes of this Agreement,  PC, Wood and INMD accept,
adopt and here  utilize  the  defined  terms and  definitions  contained  in the
Management Agreement; and


                                        1

<PAGE>



         WHEREAS,  pursuant to such Management Agreement,  the PC, Wood and INMD
have operated a program providing  Infertility Services (as such term is defined
in ss.1.1.7 of the  Management  Agreement) and known as  "Reproductive  Sciences
Medical Center of San Diego" [hereinafter "Program"]; and

         WHEREAS the  Program is part of the INMD  Reproductive  Science  Center
Division, which consists of a national network of similar Programs; and

         WHEREAS,  pursuant to the Asset  Agreement,  INMD  purchased all of the
assets of Wood used in the  operation  of Wood and PC's  practice  of  providing
Infertility  Services  ["Wood  Practice"]  and Wood, on this date, is the record
tenant of the office and laboratory  space of the Program,  the record tenant of
space at Xi-Med ["Xi-Med Leasehold"]; and

         WHEREAS, INMD is the owner and/or lessee of all equipment, fixtures and
fixed assets and the employer of all personnel at the Program with the exception
of physicians; and

         WHEREAS,  pursuant to the Asset Agreement and the Management Agreement,
INMD was to make certain payments,  during the term of the Management Agreement,
for the assets  and the name  "Reproductive  Sciences  Medical  Center"  ["Asset
Payments"]; and

         WHEREAS, pursuant to the Management Agreement, INMD was to make certain
payments,  over the term of the Management  Agreement and at certain milestones,
to PC, for the Exclusive Management Right ["RTM Payments"]; and

         WHEREAS,  pursuant to the Management  Agreement,  INMD was obligated to
make certain  Advances to the PC, which  Advances if made,  were to be repaid by
the PC to INMD; and

         WHEREAS,  certain disputes have arisen between and among the parties to
this Agreement in which the parties have both served various  Notices of Breach,
claimed breaches of the various  agreements,  as well as fraud in the inducement
and requests for damages and payments; and

         WHEREAS,  on June  12,  1998,  INMD  commenced  an  arbitration  before
JAMS/Endispute  in San Diego,  California ["JAMS  Arbitration"],  against PC and
Wood,  in which INMD seeks  damages  and  recission  and/or  termination  of the
Various Agreements ["INMD Claims"]; and

         WHEREAS,  PC and  Wood  have  interposed  a  counterclaim  in the  JAMS
Arbitration  as  against  INMD,   which  seeks  damages  and  recission   and/or
termination of the Various  Agreements,  and which asserts  various  theories of
recovery,  in both  tort and  contract,  and  which  asserts  the  right to both
compensatory and exemplary damages ["Wood/PC Claims"]; and


                                        2

<PAGE>



         WHEREAS,  the parties desire to effectuate a termination of the Various
Agreements,  and a transition of the management of the Program to Wood and PC in
an orderly fashion,  so as to insure the quality of Infertility  Services at the
Program,  and to settle and  compromise all their disputes in order to avoid the
expense and the uncertainty of litigation.

         NOW, THEREFORE,  in consideration of the foregoing,  and for other good
and valuable  consideration,  the parties,  intending to be legally  bound,  and
without coercion or duress of any kind, hereby agree as follows:

1.       TERMINATION OF AGREEMENTS.  INMD and the PC hereby  terminate the Asset
         Agreement,  the Management Agreement,  the Employment Agreement and the
         Personal Responsibility  Agreement,  effective September 1, 1998. As of
         such date,  except for the rights  and  obligations  contained  in this
         Agreement, all parties are discharged from any obligations arising from
         the Various Agreements,  including but not limited to, the repayment of
         Advances,  payment of RTM  payments,  and  covenants  not to compete or
         solicit employees, and any Lab Build-Out. The parties hereby accelerate
         all  unamortized RTM payments and apply those  accelerated  payments to
         repay Advances and discharge any remaining Advances' balance.

2.       GENERAL  RELEASES.  (a) INMD hereby releases and forever  discharges PC
         and Wood, their  subsidiaries,  affiliates,  successors,  shareholders,
         predecessors, heirs, assigns, agents, officers, directors and employees
         from any and all  claims,  suits,  demands,  debts,  causes of  action,
         liabilities,  indemnities,  obligations,  costs,  losses,  damages  and
         expenses of  whatsoever  kind or nature,  whether  legal,  equitable or
         statutory, liquidated or unliquidated,  known or unknown, including but
         not limited to those  arising out of the  Management  Agreement,  Asset
         Purchase  Agreement,  Personal  Responsibility  Agreement and Physician
         Employment Agreement, and all causes of actions and claims asserted (or
         which could have been asserted) in the JAMS  Arbitration,  arising from
         the first day of the world until the date of this Settlement Agreement.
         It is  expressly  understood  by INMD that the granting of this general
         release to PC and Wood shall  constitute a voluntary and knowing waiver
         of any right to legal recourse as against Wood and PC except such legal
         action that may be necessary to enforce the terms of this Agreement.


         (b)  PC and  Wood  hereby  release  and  forever  discharge  INMD,  its
         subsidiaries,   affiliates,  successors,  shareholders,   predecessors,
         assigns,  agents, officers,  directors and employees,  from any and all
         claims,   suits,  demands,   debts,  causes  of  action,   liabilities,
         indemnities,  obligations,  costs,  losses,  damages  and  expenses  of
         whatsoever  kind or nature,  whether  legal,  equitable  or  statutory,
         liquidated or unliquidated, known or unknown, including but not limited
         to  those  arising  out of the  Management  Agreement,  Asset  Purchase
         Agreement,  Personal Responsibility  Agreement and Physician Employment
         Agreement,  and all causes of actions  and  claims  asserted  (or which
         could have been  asserted)  in the JAMS  Arbitration,  arising from the
         first day of the world until the date of this Settlement Agreement.

                                        3

<PAGE>



         It is  expressly  understood  by PC and Wood that the  granting of this
         general release to INMD shall constitute a voluntary and knowing waiver
         of any right to legal  recourse  as  against  INMD,  except  such legal
         action that may be necessary to enforce the terms of this Agreement.

         (c) Each of Wood, PC and INMD knowingly and voluntarily  waives any and
         all rights  that it has under the  provisions  of  Section  1542 of the
         Civil Code of the State of California, which reads as follows:

                  "A  general  release  does not  extend  to  claims  which  the
                  creditor does not know or suspect to exist in his favor at the
                  time of executing the release, which if known by him must have
                  materially affected his settlement with the debtor."

         Each of the  undersigned  acknowledges  and agrees  that this waiver of
         claims  governed by Section 1542 is an essential  and material  term of
         this Stipulation for Settlement,  without which this document would not
         have been executed.

3.       CONTINUATION  OF THE PROGRAM AND  WITHDRAWAL  OF INMD.  (a) The parties
         acknowledge and agree that the Program shall,  commencing  September 1,
         1998, be operated  solely by PC and Wood,  and that INMD shall withdraw
         (except for the INMD Employee detailed in paragraph 8 hereof) and cease
         to offer any management, administrative,  financial or support services
         to the Program.

         (b) Employees. INMD shall terminate the employment of all its employees
         located  at  the  Program  (other  than  the  Employee  referred  to in
         paragraph  8) and PC and Wood  shall  hire such  employees.  INMD shall
         indemnify Wood and PC for any claims by INMD Employees,  arising out of
         their employment  during the term of the Management  Agreement,  except
         for any and all claims  arising out of the  volitional  or  intentional
         acts of Wood.

         (c) Insurances.  (1) Effective September 1, 1998, INMD shall cancel the
         general  liability  insurance  policy  in  effect  for  the PC and  the
         Facilities [as defined in paragraph 3.2 of the Management Agreement and
         including  the Xi-Med  Leasehold]  and shall  cancel  any  professional
         liability  insurance  policy  in  effect  for  the  PC and  PC's  staff
         (including Wood). Wood and PC covenant and warrant that the PC and Wood
         shall have,  effective no later than  September  1, 1998,  professional
         liability  insurance , insuring all  professional  acts  including  the
         storage of Biological Materials in an amount of no less than $1 million
         per claim/$3  million in the aggregate,  and that the PC and Wood shall
         provide INMD, proof of such insurance,  and proof of general  liability
         insurance  for the  Facilities  no later than  September  1, 1998.  The
         Wood/PC  obligation to provide proof of such  insurance  shall continue
         annually  (on the  anniversary  date of the first  proof) for three (3)
         years.  Wood  hereby  acknowledges  and agrees  that any and all health
         and/or disability benefits provided by INMD shall cease on September 1,
         1998.

                                        4

<PAGE>



         (2)INMD shall continue,  in full force and effect,  "tail  insurance" ,
         covering  the PC and INMD's  prior  employees  for  professional  acts,
         including  the storage of  biological  materials  for claims made after
         September  1, 1998 but  arising  out of  professional  acts or  conduct
         occuring  during  the  term of the  Management  Agreement.  INMD  shall
         provide  PC and  Wood  with  proof  of such  insurance  no  later  than
         September 1, 1998 and shall continue to provide such proof of insurance
         annually (on the anniversary date of the first proof) for three years.

         (d) Notification of Patients.  Wood and PC shall notify patients of the
         Program, on or before October 1, 1998, that he and the PC are no longer
         affiliated with INMD. The form and content of such  notification  shall
         be previously  approved by INMD,  such approval not to be  unreasonably
         withheld or delayed.

         (e)  Biological Materials.

                  (i) The PC and Wood, hereby acknowledge and agree that, at all
                  times during the time period of the Management Agreement,  and
                  at all times hereafter,  the PC and/or Wood have been the sole
                  and rightful custodians of all biological materials, including
                  but not limited to sperm,  oocytes and embryos  (cryopreserved
                  or fresh)["Biological Materials"] and that they shall continue
                  to preserve  and protect such  Biological  Materials as are in
                  their custody.

                  (ii) The PC shall provide INMD with a list of all patients who
                  (1)  currently  have  cryopreserved  biological  materials  in
                  storage at the Program as of  September  1, 1998,  and (2) who
                  have ever had cryopreserved biological materials in storage at
                  the  Program  from June 6, 1997  through  September  1,  1998,
                  together  with  information  as to and  the  date  as to  when
                  storage ceased.


         (f)  Removal of  Proprietary  Information.  INMD shall  remove from the
         Program Premises any and all copies of proprietary  written information
         (as listed on the annexed  Schedule A), and PC and Wood hereby covenant
         not to copy or utilize any  consents,  procedure  or policy  manuals or
         proprietary  information henceforth in operation of the Program, except
         that,  the PC shall,  for a period of ninety days (up to and  including
         November  30,  1998)  be  permitted  to  utilize  the  text of the INMD
         Consents,  now utilized for documenting patient consent,  provided that
         all reference to INMD is redacted or removed therefrom.

         (g)  Billing  Cooperation.  INMD shall leave at the Program any and all
         documentation  and  equipment  necessary  for the  Program  to bill for
         unbilled Infertility Services and to collect outstanding amounts.  This
         shall include data stored in the computer system at the Program.

                                        5

<PAGE>




4.       COVENANT BY WOOD.  Wood hereby  covenants and represents that the PC is
         the  current  professional   corporation  through  which  he  practices
         medicine.  He further  covenants  and  represents  that if, at any time
         prior to the full  payment of the Payment  Price,  he should  establish
         another  professional  corporation  or  entity  through  which he shall
         practice  medicine,  he  shall  do so  only  if  such  PC  and/or  sole
         proprietorship  or business entity expressly assumes the obligations of
         the Payment Price and the obligations of this Agreement.

5.       LEASE OF ASSETS.  The PC shall lease the Program's  tangible assets and
         leasehold  improvements  of the Program on the terms of the Asset Lease
         ["Payment Price"] here annexed as Exhibit A and executed simultaneously
         with this Agreement.

6.       ASSUMPTION OF LEASEHOLD  INTERESTS.  (a) The PC shall assume all future
         lease payments, as of September 1, 1998, the lease for the office space
         of the  Program  located at 4150  Regents  Row,  Suite  280,  La Jolla,
         California  ["Program  Premises"],  and the XiMed  Leasehold  and shall
         indemnify INMD against claims for rent or payments  thereunder  made by
         the Landlord, except as provided in paragraph 11 hereof.

         (b) The PC shall assume the leases,  as of  September 1, 1998,  for any
         and all medical and/or office equipment located at the Program Premises
         except for the  Diagnostic  Products  Corporation  Immulite  Immunology
         Analyzer,  Serial # 5379010  ["Immulite  Analyzer"] and shall indemnify
         INMD  against  any claims for rent or payments  thereunder  made by the
         Lessors thereof. INMD shall assume the lease for the Immulite Analyzer,
         and the parties  shall  cooperate,  in good faith,  in efforts to sell,
         lease, transfer or return such Immulite Analyzer, such sale, leasehold,
         transfer or return not to take place  prior to October 1, 1998.  PC and
         Wood  shall  pay to INMD the  monthly  lease  price of  $1,736.82  (One
         thousand seven hundred and thirty six dollars and eighty-two cents) for
         the use of the Immulite Analyzer for the period September 1, 1998 until
         October 1, 1998  ["Immulite  Payment"].  The Immulite  Payment shall be
         offset,  or  deducted,  from the  first  payment  to be  earned by Wood
         pursuant to Section 9(d)(2) of this Agreement.

7.       RIGHT TO ACCOUNTS RECEIVABLE.  The parties hereby acknowledge and agree
         that,  during the operation of the Program up to and  including  August
         31, 1998,  certain accounts  receivable were, and shall continue to be,
         generated. For the purposes of this Agreement,  accounts receivable are
         deemed generated on the date that the medical or laboratory  service or
         treatment is provided to a patient, irrespective of the date (before or
         after treatment) that payment is actually received.  The parties hereby
         agree and  acknowledge  the following  rights and interests in accounts
         receivable of the Program:

         (a) Any and all  accounts  receivable  generated  prior to September 1,
         1998  ("Pre-  September  Receivables")  are the sole  property of INMD,
         whether  payment  therefor has, or in the future is,  received by INMD,
         the PC and/or Wood.

                                        6

<PAGE>



         

         (b) Any and all accounts receivable generated on and after September 1,
         1998 ("Future Program  Receivables")  shall be the sole property of the
         PC, whether payment therefor has been, or in the future is, received by
         any or all of INMD, the the PC and/or Wood.

         (c) In the event there  arises a dispute  between INMD and PC as to the
         nature and  character  of the Program  Receipts  (as  Pre-September  or
         Future  Receivables),  the  parties  shall  first  rely on the date the
         service was  rendered,  as shown on the computer  records  generated by
         INMD.  PC shall have the burden of proving  such  records  erroneous by
         supplying copies of the patient medical records.

 8.      COLLECTION  OF  ACCOUNTS  RECEIVABLE.  An  employee  of INMD (of INMD's
         choosing)(the  "INMD Employee") shall be on the Program Premises for up
         to and  including  December  31,  1998,  in order to  oversee  and make
         efforts for the  collection  of the accounts  receivable of the Program
         and the PC. Such collection  shall be jointly  supervised and conducted
         by the INMD Employee and a representative  of the PC designated by Wood
         (the "PC  Representative").  The INMD  Employee  and PC  Representative
         shall  have  joint  and  simultaneous  access  to any and  all  billing
         information,   data  and  computer  information  necessary,   provided,
         however,  such  information  be  restricted  to  information  needed to
         process,  record and document payment of such accounts receivable.  The
         INMD  Employee  shall have access to the  Program  Premises at any time
         during  normal  business  hours.  The  INMD  Representative  and the PC
         Representative  shall, jointly and in good faith,  allocate any and all
         monies  received as being either  Pre-September  Receivables  or Future
         Receivables.  INMD and the PC shall,  in good  faith,  insure  that the
         Future Receivables are paid to the PC and the Pre-September Receivables
         are paid to INMD. The PC and Wood hereby covenant to cooperate with the
         INMD Employee in his/her efforts to collect  Pre-September  Receivables
         and  agree not to  interfere,  by  omission  or  commission,  with that
         effort.  In the event that there is a dispute  between  the  Companies'
         Representative  and the IntegraMed  Representative  concerning  whether
         monies  received  constitute  a  Pre-September  Receivable  or a Future
         Receivable,  the  parties  shall  first rely on the date of the service
         rendered,  as shown in the computer  records  generated by INMD and, if
         the Companies' representative disagrees with such records, he/she shall
         produce the patient's  records.  If the parties cannot,  in good faith,
         agree to the allocation on the basis of such records,  such collections
         shall be put in escrow until the matter is determined by arbitration or
         agreement.  The parties  anticipate  that the amount of Pre-  September
         Receivables  to be subject to collection by INMD are the sum of (1) One
         hundred  and  twenty-two  thousand  four  hundred  and  ninety  dollars
         ($122,490.00) and (2) such accounts receivable generated by the Program
         between  August 1 and August 31, 1998 ["August  Receivables"].  Between
         September 1 and  September  30, 1998,  INMD shall account to PC for any
         money collected on behalf of the Program which represented pre-payments
         by patients for medical  services to be performed on or after September
         1, 1998,  including  both "patient  deposits" and  "suspended  credits"
         ["Pre-payments"].The  aggregate  amount of such  Pre-payments  shall be
         paid by INMD to PC no later than October 1, 1998.  Between  September 1
         and  September  30,  1998,  Wood and PC shall  account  to INMD for the
         amount of August Receivables.


                                        7

<PAGE>



                 
9.       ENTITLEMENTS  OF PC AND WOOD. In  consideration  for the  withdrawal of
         INMD from the Program,  the termination of the Various Agreements,  and
         the  obligations  of this  Agreement,  PC and Wood  shall  receive  the
         following:

         (a) Any and all INMD Common Shares ["INMD  Shares"] issued to PC and/or
         Wood upon the signing of the Management  Agreement,  shall no longer be
         subject to the provisions of Section 7.1.7 of the Management Agreement,
         but shall be  subject to all  applicable  Federal  and State law.  INMD
         agrees to provide any documentation or approval  reasonably required by
         PC or Wood in order to sell the INMD Shares in accordance  with law. No
         additional  INMD  Shares  shall be issued to Wood or the PC as a result
         of, or based upon any rights  contained  in,  the  Various  Agreements,
         hereafter.

         (b) INMD shall pay one hundred  percent (100%) of the monthly  payments
         on the  XiMed  Leasehold  for (1) a period  of six  months,  commencing
         September 1, 1998; or (2) until the XiMed  Leasehold is fully sublet to
         another tenant or (3) the  commencement of a Navy contract  between the
         government and the PC or Wood, whichever shall first occur. PC and Wood
         covenant to use commercially  reasonable efforts to sublet the premises
         governed by the XiMed Leasehold.

         (c) INMD shall  Advance  the Costs of Services of the Program up to and
         including  August 31, 1998 and shall be repaid  such money  solely from
         the collected Pre- September Accounts Receivable.

         (d) Consulting  Agreement.  (1) Commencing September 1, 1998, and for a
         period  of  twenty-nine  months  thereafter,  Wood  shall be a  Special
         Consultant  to INMD.  His duties as a Special  Consultant  shall be to,
         upon  request of INMD,  consult and advise INMD with respect to new ART
         technologies,  laboratory  methods,  protocols for new  procedures  and
         results.  It is expressly  understood that INMD shall provide Wood with
         reasonable  notice of such  requests,  but Wood shall also make himself
         reasonably available for such consultation, it being understood between
         the  parties  to this  Agreement  that the time  devoted by Wood to his
         duties as a Special  Consultant shall be not greater than an average of
         10 hours per month.


                                        8

<PAGE>



         (2)  Wood's  compensation  for  performance  of his  duties as  Special
         Consultant shall be $4800 per month ["Consulting Payment"],  payable on
         the 15th day of each  month,  providing  however,  that  INMD  shall be
         entitled to offset the payment  against the Immulite  Payment due under
         Section 6(b) of this  Agreement and any Asset Lease payments due, or to
         become due within 30 days of the date of required payment by INMD.


10.      GOVERNMENT  CONTRACT EFFORT. (a) The parties agree and acknowledge that
         there is a Request  for  Quotation  (RFQ)  issued by the Naval  Medical
         Center  San  Diego  [NMCSD]  which  seeks  an  infertility  program  to
         associate  with  NMSCD  physicians  for the  provision  of  Infertility
         Services to active,  retired  and/or  reservist  US Navy  care-eligible
         personnel   referred  to  NMSCD  for   infertility   treatment   ["Navy
         Contract"].  PC and Wood  desire  to  submit a  proposal  for such Navy
         Contract and desire that INMD, specifically its COO Dr. Donald S. Wood,
         lend  their/his  expertise in preparing  the  necessary  documents  and
         presentation  of such proposal on behalf of PC and Wood.  Wood and INMD
         have evaluated the RFQ and have  determined  that the Scope of Work and
         qualifications listed therein may, in fact, be too narrow to permit the
         PC (and  other  infertility  programs)  to qualify  for  consideration,
         inasmuch as the RFQ may be designed to meet the specific qualifications
         of a  prior  Navy  contractor.  Nonetheless,  both  parties  feel it is
         nonetheless  worthwhile  to prepare  and submit a proposal on behalf of
         PC. In consideration of this Agreement, INMD and Donald S. Wood, hereby
         agree to use commercially  reasonable  efforts to assist PC and Wood in
         the  preparation  and  submission of a proposal for such Navy Contract.
         The parties agree and acknowledge that the deadline for such submission
         is  September 6, 1998,  and that the  preparation  of such  proposal on
         behalf of PC and Wood shall be a  time-consuming  project.  INMD agrees
         that it  shall  use such  efforts  and  shall  devote  such  time as is
         reasonably necessary,  at its own cost and expense, it being understood
         by the parties that whatever the nature of the INMD efforts,  there can
         be no assurance  that Wood or PC will secure the Navy Contract and that
         it shall be impossible  to ascertain the reason  underlying an award of
         the Navy  Contract to an entity other than PC or Wood.  (b) PC and Wood
         agree that the  proposal  for the Navy  Contract  shall not contain any
         description of INMD's future  relationship with PC unless said language
         receives the express  approval of INMD, and such express approval shall
         not be unreasonably withheld or delayed.

         (c) In the event that PC secures the Navy Contract, INMD agrees that it
         shall function as Special  Consultant to the Director of the Laboratory
         of PC.  INMD's duties shall be to, upon request of Wood or the Director
         of the  Laboratory  of  PC,  to  advise  PC  with  respect  to new  ART
         Technologies, laboratory methods, protocols and techniques.

         (d) It is expressly understood among the parties that Wood, in his role
         as  Special  Consultant,  shall  function  purely  as  an  advisor  and
         independent contractor and that conduct of INMD, even if based upon his
         advice and/or recommendation, shall be the sole responsibility of INMD.
         It is also  expressly  understood  among the parties that INMD,  in its
         role as Special  Consultant to PC, shall function  purely as an advisor
         and independent contractor and that the conduct of PC, even if based on
         INMD's advice and/or recommendation shall be the sole responsibility of
         PC.
                                        9

<PAGE>



         

11.      DISCONTINUANCE  OF JAMS  ARBITRATION.  INMD, PC and Wood shall,  within
         seven  (7)  business  days  of  this  Agreement,  write  a  letter  (or
         independent  letters  ) to  JAMS/Endispute,  discontinuing  all  claims
         against  each other with  prejudice.  Each party shall bear its/his own
         costs,  expenses and attorneys fees. The cost of any administrative fee
         assessed by JAMS,  over and above the filing fee  already  paid by INMD
         shall be borne equally between INMD and PC.

12.      COOPERATION.  In  the  event  of  any  claims,  suits  or  governmental
         investigations,  arising out of or relating  to the  Program,  in which
         INMD,  Wood  and/or the PC shall be named or  involved,  whether or not
         pending during the term of the Management Agreement, the parties hereto
         agree to fully  cooperate  with each other in the defense of such suit,
         claim or  investigation.  Such  cooperation  shall  include,  by way of
         example  but  not  limitation,   meeting  with  defense  counsel,   the
         production   of  any   documents  in  their   possession   for  review,
         participation in discovery or an investigation by an insurer,  response
         to subpoenae  and the  coordination  of any  individual  defenses  with
         counsel for all parties. Wood and the PC shall, as soon as practicable,
         deliver to INMD  copies of any  summonses,  complaints,  suit  letters,
         subpoenae  or legal  papers  of any  kind,  served  upon  them or their
         attorneys.  This obligation to cooperate shall survive the satisfaction
         of any  payment  obligations  hereunder,  or the  termination  of  this
         Agreement  for whatever  reason,  and nothing in this  paragraph  shall
         obligate the parties to pay any legal fees incurred by the other.

13.      NON-DISPARAGEMENT  AND  CONFIDENTIALITY.  The parties  acknowledge that
         this Agreement represents a fully consensual and amicable separation of
         interests  and  that,   hereafter,   each  party   covenants  that,  in
         communicating  with third  parties,  they shall not, by action or word,
         defame,  criticize  or condemn the  actions,  conduct or motives of the
         other.  Each party recognizes that this covenant  represents a material
         obligation  of both parties under this  Agreement,  the breach of which
         may impact  adversely  on the business  interests of the  non-breaching
         party.  The parties  further  covenant that the terms of this Agreement
         shall  not  be  disclosed  to any  third  party,except  to  the  extent
         necessary to enforce the terms  hereto,  and except that each party may
         disclose such terms to his/its spouses,  attorneys,  financial advisors
         or in response to judicial process.


                                       10

<PAGE>



14.      ARBITRATION.  Any and all claims,  disputes,  or controversies  arising
         under,  out of, or in  connection  with this  Agreement  or any  breach
         thereof,  shall be  determined by binding  arbitration  in the State of
         California, County of San Diego (hereinafter "Arbitration").  The party
         seeking  determination  shall  subject  any  such  dispute,   claim  or
         controversy  to  either  (i)   JAMS/Endispute   or  (ii)  the  American
         Arbitration Association, and the rules of commercial arbitration of the
         selected entity shall govern.  The  Arbitration  shall be conducted and
         decided by three (3) arbitrators, unless the parties mutually agree, in
         writing  at the  time of the  Arbitration,  to  fewer  arbitrators.  In
         reaching a decision,  the arbitrators shall have no authority to change
         or modify any  provision of this  Agreement.  Each party shall bear its
         own expenses  and  one-half the expenses and costs of the  arbitrators.
         Any  application to compel  arbitration,  confirm or vacate an arbitral
         award or otherwise  enforce this  paragraph  shall be brought either in
         the Courts of the State of  California  or the United  States  District
         Court for the Southern  District of California,  to whose  jurisdiction
         for such  purposes  PC,  Wood and INMD hereby  irrevocably  consent and
         submit.

15.      GOVERNING  LAW.  This  Agreement  shall be  governed by the laws of the
         State of California, without reference to rules of conflicts of laws.

16.      AMENDMENT.  No  modification,  amendment or addition to this Agreement,
         nor  waiver  of any of its  provisions,  shall be valid or  enforceable
         unless in writing and signed by all parties.

17.      No  assignment  or  delegation  of this  Agreement  or the  rights  and
         obligations  hereunder  shall be valid without the specific  consent of
         all parties.

18.      No consent or waiver,  express or implied,  by either party hereto,  of
         any  breach or  default by the other  party in the  performance  by the
         other of its obligations  hereunder,  shall be valid unless in writing,
         and no such  consent  or waiver  shall be deemed or  construed  to be a
         consent  or  waiver  to or of  any  other  breach  or  default  in  the
         performance by such other party of the same or any other  obligation of
         such party  hereunder.  Failure on the part of either party to complain
         of any act or failure to act of the other party or to declare the other
         party in  default,  irrespective  of how long such  failure  continues,
         shall not constitute a waiver by such party of its rights hereunder.

19.      Any notices, requests, demands and other communications provided for in
         this  Agreement as required  among the parties in  connection  with the
         Agreement shall be in writing and shall be deemed to have been given at
         the time when mailed at any United  States Post Office via  register or
         certified  mail,  prepaid,  or sent  by  overnight  delivery  services,
         addressed  to the party at the  address  set forth  below or such other
         addresses as such party may designate by notice:

         

                                       11

<PAGE>

         To PC or Wood at:

         Reproductive Sciences Medical Center, Inc.
         4150 Regents Park Row, Suite 280
         La Jolla, CA 92037
         Attention:  Samuel H. Wood, M.D., P.C.

         With Copy to:

         David J. Hirsch, Esq.
         9460 Wilshire Boulevard
         Suite 830
         Beverly Hills, California 90212

         To IntegraMed America, Inc:

         Donald S. Wood, Ph.D.
         Chief Operating Officer
         Integramed America, Inc.
         One Manhattanville Road
         Purchase, New York 10577

         The  failure  of any party to claim  such  notice,  or the  refusal  of
         delivery, shall not alter the effectiveness of said notice.

20.      This Agreement is the result of arms-length and deliberate negotiations
         and each party has consulted with counsel. Should this Agreement be the
         subject of  interpretation,  it shall be deemed to have been drafted by
         all of the parties equally.

21.      This Agreement may be executed in any number of separate  counterparts,
         each of  which  shall be  deemed  to be an  original,  but all of which
         together shall constitute one and the same  instrument.  This Agreement
         shall be effective  upon the receipt by each party of facsimile  copies
         of the  signature  page,  with the original,  executed  documents to be
         exchanged within seven (7) business days thereafter.

IN  WITNESS  WHEREOF,  the  parties  have set  their  hands  hereunto  as of the
effective date herein written.

INTEGRAMED AMERICA, INC.                      REPRODUCTIVE SCIENCES
                                              MEDICAL CENTER, INC.


By:    /s/Donald S. Wood                        By:  /s/Samuel H. Wood
       ------------------------------                ------------------------
       Donald S. Wood, Ph.D.                         Samuel H. Wood, M.D.
Title: Chief Operating Officer                Title: President


       ------------------------------
       Samuel H. Wood, M.D.

                                       12




         Loan  Agreement  dated as of  September  11,  1998  between  INTEGRAMED
AMERICA,  INC., a Delaware  corporation  with its chief place of business at One
Manhattanville  Road,  Purchase,  New York 10577-2100 (the "Borrower") and FLEET
BANK,  NATIONAL  ASSOCIATION,  a national banking  association,  244 Westchester
Avenue, White Plains, New York 10604 (the "Bank").

         The parties hereto hereby agree as follows:

1.       DEFINITIONS.

1.1      Defined  Terms.  As used  herein  the  following  terms  shall have the
following meanings:

         "Accounts"  shall mean those  accounts  (i)  arising out of the sale or
lease of goods or the rendition of services by the Borrower, or (ii) acquired by
the Borrower from another Person.

         "Account  Debtor" shall mean the person who is obligated on or under an
Account.

         "Acquisition"  shall mean with  respect to any Person,  the purchase or
other acquisition by such Person, by any means whatsoever  (including  through a
merger, amalgamation,  dividend or otherwise and whether in a single transaction
or in a series of related  transactions),  of (i) any Capital Stock of any other
Person  if,  immediately  thereafter,  such  other  Person  would  be  either  a
Subsidiary  of such Person or otherwise  under the control of such Person,  (ii)
any business, going concern or division or segment of any other Person, or (iii)
any Property of any other Person other than in the ordinary  course of business,
provided, however, that no acquisition of all or substantially all of the assets
of such other Person  shall be deemed to be in the ordinary  course of business.
Acquisition  shall  exclude  Capital   Expenditures  (as  hereinafter   defined)
otherwise  permitted  by  this  agreement.  For  purposes  of  this  definition,
"Acquisition"  shall take the form of the Borrower's  entering into a Management
Agreement and the  Borrower's  acquisition of certain fixed assets in connection
therewith.

         "Acquisition  Cost" shall mean with respect to any  Acquisition  by any
Person,  the sum of (i) all cash consideration paid or agreed to be paid by such
Person to make such  Acquisition  (inclusive  of  payments by such Person of the
seller's  professional  fees and expenses and other out-of-  pocket  expenses in
connection  therewith),  plus  (ii)  the  fair  market  value  of  all  non-cash
consideration paid by such Person in connection therewith,  plus (iii) an amount
equal to the principal or stated amount of all  liabilities  assumed or incurred
by such Person in  connection  therewith.  The principal or stated amount of any
liability  assumed or incurred  by a Person in  connection  with an  Acquisition
which is a contingent liability shall be an amount equal to the stated amount of
such liability or, if the same is not stated, the maximum reasonably anticipated
amount payable by such Person in respect thereof as determined by such Person in
good faith.

                                      

                                       1
<PAGE>


         "Adjusted Net Income" shall mean,  with respect to the Borrower and its
Subsidiaries on a consolidated basis for any period, the net income (or loss) of
the  Borrower  and its  Subsidiaries  on a  consolidated  basis for such period,
excluding extraordinary items, as determined in accordance with GAAP.

         "Affiliate"  as  applied  to any  Person  shall  mean any other  Person
directly  or  indirectly  through  one  or  more   intermediaries   controlling,
controlled  by, or under common control with,  that Person.  For the purposes of
this  definition,  "control"  (including with  correlative  meanings,  the terms
"controlling",  "controlled by" and "under common control with"),  as applied to
any Person, means the possession, directly or indirectly, of the power to direct
or cause the direction of the  management  and policies of that Person,  whether
through the ownership of voting securities or by contract or otherwise.

         "Agreement"  shall mean this Loan  Agreement,  as the same from time to
time may be amended, supplemented or modified.

         "Applicable Margin" shall mean:

         (a)  with  respect  to the  unpaid  principal  balance  of  Facility  A
Revolving  Credit Loans that consist of Fluctuating  Rate Loans and LIBOR Loans,
in each case at all times during which the  applicable  Pricing  Level set forth
below is in effect,  the  percentage  set forth below next to such Pricing Level
and under the applicable column:

                                  Applicable Margin (Type of Loan)
                                  --------------------------------

                                  Fluctuating 
         Pricing Level             Rate Loan       LIBOR Loan
         -------------             ---------       ----------

         Pricing Level I              0.25%           3.00%
         Pricing Level II             0.00%           2.75%
         Pricing Level III            0.00%           2.25%

         (b)  with  respect  to the  unpaid  principal  balance  of  Facility  B
Revolving Credit Loans and Term Loans that consist of Fluctuating Rate Loans and
LIBOR Loans, in each case at all times during which the applicable Pricing Level
set forth  below is in  effect,  the  percentage  set forth  below  next to such
Pricing Level and under the applicable column:

                                  Applicable Margin (Type of Loan)
                                  --------------------------------

                                  Fluctuating 
         Pricing Level             Rate Loan       LIBOR Loan
         -------------             ---------       ----------

         Pricing Level I             0.00%            2.75%
         Pricing Level II            0.00%            2.50%
         Pricing Level III           0.00%            2.25%


                                       2
<PAGE>

         In each of the above cases,  changes in the Applicable Margin resulting
from  a  change  in  a  Pricing   Level  shall  be  based  upon  the   financial
statements/certificate  most recently  delivered  pursuant to Sections 5.2(a)(i)
and 5.2(b) and shall become  effective on the date such financial  statements or
certificate,  as applicable, are delivered to the Bank in the format required by
this  Agreement.  Notwithstanding  anything to the  contrary  contained  in this
definition,  (i) if, at any time and from time to time, the Borrower shall be in
Default of its  obligations  under  Section 5.2,  Pricing  Level I (as increased
pursuant to Section  2.11(c)) shall apply until such Default is cured,  and (ii)
Pricing  Level I shall apply  during the period  commencing  on the date of this
Agreement  and  ending  on the  date of  delivery  thereafter  of the  financial
statements/certificate  covering  the fiscal  period of the  Borrower  ending on
March 31, 1999.

         "Borrowing Base" shall mean at any time 50% of the Borrower's  Eligible
Accounts Receivable at such time.

         "Borrowing Base Certificate" shall mean a certificate  substantially in
the form of Exhibit D hereto.

         "Business Day" shall mean a day other than a Saturday,  Sunday or other
day on which  commercial  banks in New York are  required or permitted by law to
remain  closed,  except that  "Business  Day" in the context of a specific  city
shall mean any date on which commercial banks are open for business in that city
and relative to the date of (i) making or continuing any Loans as, or converting
any Loans from or into,  LIBOR Loans,  (ii) making any payment or  prepayment of
principal  of or payment of interest on any portion of the  principal  amount of
any Loans being  maintained as LIBOR Loans,  or (iii) the Borrower's  giving any
notice  (or the number of  Business  Days to elapse  prior to the  effectiveness
thereof) in connection with any matter  referred to in the foregoing  clause (i)
or (ii),  any day on which  dealings in Dollars are carried on in the  interbank
eurodollar market in London, England.

         "Capital  Expenditures"  shall mean for any period,  the  additions  to
property,  plant and equipment and other capital expenditures of such Person for
such period as the same are or would be set forth in a consolidated statement of
cash flows of such  Person for such  period (or the notes  thereto)  prepared in
accordance with generally  accepted  accounting  principles,  excluding any such
additions which are attributable to an Acquisition.

         "Capitalized Lease" shall mean any lease the obligations to pay rent or
other amounts under which constitute Capitalized Lease Obligations.

         "Capitalized  Lease  Obligations"  shall  mean  as to any  Person,  the
obligations  of such  Person to pay rent or other  amounts  under a lease of (or
other agreement  conveying the right to use) real and/or personal property which
obligations are required to be capitalized  under GAAP and, for purposes of this
Agreement,  the  amount  of such  obligations  shall be the  capitalized  amount
thereof, determined in accordance with GAAP.


                                       3
<PAGE>
   
        "Capital  Stock"  shall mean as to any Person,  all shares,  interests,
partnership  interests,  limited  liability company  interests,  participations,
rights in or other  equivalents  (however  designated)  of such Person's  equity
(however  designated) and any rights,  warrants or options  exchangeable  for or
convertible into such shares, interests, participations, rights or other equity.

         "Cash  Equivalents" means (a) securities with maturities of one year or
less from the date of acquisition  issued or fully  guaranteed or insured by the
United States  Government or any agency thereof,  (b) certificates of deposit or
eurodollar  time deposits  with  maturities of one year or less from the date of
acquisition and overnight bank deposits of any commercial bank having capital in
excess of  $200,000,000,  (c)  repurchase  obligations  of any  commercial  bank
satisfying the requirements of clause (b) of this definition,  having a term not
more than seven days with respect to  securities  issued or fully  guaranteed or
insured by the United  States  Government,  (d)  commercial  paper of a domestic
issuer rated at least A-1 or the equivalent thereof by Standard & Poor's Ratings
Group ("S&P") or P-1 or the equivalent  thereof by Moody's  Investors  Services,
Inc.  ("Moody's")  and in either case maturing  within one year from the date of
acquisition, (e) securities with maturities of one year or less from the date of
acquisition  issued or fully guaranteed by any state,  commonwealth or territory
of the United States,  by any political  subdivision or taxing  authority of any
such  state,  commonwealth  or  territory  or by  any  foreign  government,  the
securities  of which  state,  commonwealth,  territory,  political  subdivision,
taxing authority or foreign government (as the case may be) are rated at least A
by S&P or A by Moody's,  (f) securities with maturities of one year or less from
the date of  acquisition  backed by  standby  letters  of  credit  issued by any
commercial bank satisfying the  requirements of clause (b) of this definition or
(g) shares of money market mutual or similar funds which invest  exclusively  in
assets   satisfying  the  requirements  of  clauses  (a)  through  (f)  of  this
definition.

         "Change in  Control"  shall mean that after the date of this  Agreement
the ownership of the Borrower's outstanding Capital Stock shall change such that
any one  Person  or any  one  group  of  Affiliated  Persons  owns  directly  or
beneficially  more than 50% of the issued and  outstanding  Capital Stock of the
Borrower.

         "Cleanup  Laws"  shall  mean any  federal,  state or local  statute  or
regulation  relating to hazardous or toxic wastes or  substances  or the removal
thereof.

         "Collateral"  shall mean the collateral  described in Section 9 of this
Agreement.

         "Commitment" shall mean the Facility A Commitment and/or the Facility B
Commitment.

         "Commitment  Letter"  shall  mean  the  letter  agreement  between  the
Borrower and the Bank dated July 16, 1998.

         "Commitment  Period" shall mean the Facility A Commitment Period and/or
the Facility B Commitment Period.

                                       4
<PAGE>

         "Consolidated"  or  "consolidated"  shall  mean  the  Borrower  and its
Subsidiaries on a consolidated basis in accordance with GAAP.

         "Consolidated  Adjusted  EBITDA" shall mean,  for any period,  (i) with
respect  to  Network  Sites  owned  by the  Borrower  for more  than 12  months,
Consolidated EBITDA and (ii) with respect to Network Sites owned by the Borrower
for less than 12 months, the sum of (A) Consolidated  EBITDA for each full month
the  Network  Site was owned by the  Borrower  for  which the Bank has  received
financial statements,  plus (B) pro forma Consolidated EBITDA for that number of
months immediately prior to the Borrower's  acquisition equal to 12 months minus
the number of months the Network Site was owned by the Borrower as calculated by
the Borrower in good faith and in a manner reasonably  satisfactory to the Bank,
plus (C) any adjustments reasonably satisfactory to the Bank.

         "Consolidated  Debt Service" shall mean for any period,  the sum of (i)
Consolidated Interest Expense for such period and (ii) all scheduled payments of
principal on  Consolidated  Funded Debt during such period,  including  payments
made on account of Capitalized Leases.

         "Consolidated  EBITDA" shall mean, with respect to the Borrower and its
Subsidiaries for any period,  the sum of (i) Adjusted Net Income,  (ii) Interest
Expense,  (iii)  depreciation,  amortization and other non-cash charges and (iv)
provision  for  Federal,  state  and  local  income  taxes,  in each case of the
Borrower and its Subsidiaries on a consolidated basis for such period,  computed
in accordance with GAAP.

         "Consolidated   Effective   Net  Worth"  shall  mean  at  any  date  of
determination,  the sum of  capital  surplus,  earned  surplus  (or  accumulated
deficit),  the par value of each class of capital stock multiplied by the number
of outstanding shares of such class of capital stock, additional paid-in capital
and  Subordinated  Debt of the Borrower and its  Subsidiaries  on a Consolidated
basis.

         "Consolidated Funded Debt" shall mean at any date of determination, the
aggregate  funded  indebtedness  (as determined in accordance  with GAAP) of the
Borrower and its Subsidiaries,  determined on a Consolidated basis in accordance
with GAAP, on such date.

         "Consolidated  Interest  Expense"  shall  mean,  with  respect  to  the
Borrower  and  its  Subsidiaries  for the  applicable  period  of  determination
thereof,  the interest expense of the Borrower and its Subsidiaries  during such
period determined on a consolidated basis in accordance with GAAP.

         "Consolidated   Senior   Funded   Debt"  shall  mean  at  any  date  of
determination,  the aggregate funded  indebtedness of the Borrower that does not
constitute  Subordinated Debt,  determined on a Consolidated basis in accordance
with GAAP, on such date.

         "Consolidating"  or  "consolidating"  shall mean the  Borrower  and its
Subsidiaries each taken separately.

                                       5
<PAGE>

         "Continuation/Conversion Notice" is defined in Section 2.9.

         "Contractual Obligations" shall mean as to any Person, any provision of
any  security  issued  by  such  Person  or  of  any  agreement,  instrument  or
undertaking  to  which  such  Person  is a party  or by  which  it or any of its
property is bound.

         "Controlled" and "Control" shall mean any  partnership,  corporation or
other entity of which the Borrower, alone, or the Borrower and/or one or more of
its Subsidiaries,  either has the power to direct the management or the power to
direct at least a majority of the voting interests.

         "Cost of Funds" means the per annum rate of interest  which the Bank is
required to pay, or is offering to pay, for wholesale liabilities,  adjusted for
reserve  requirements and such other  requirements as may be imposed by federal,
state or local government and regulatory agencies, as determined by the Bank.

         "Default"  shall mean any of the  events  specified  in this  Agreement
under  "Events of  Default",  whether or not any  requirement  for the giving of
notice, the lapse of time, or both, has been satisfied.

         "Dollars"  and "$" shall mean dollars in lawful  currency of the United
States of America.

         "Eligible  Accounts  Receivable  shall mean those Accounts (i) which do
not remain unpaid for more than 90 days from the original  date of invoice,  and
(ii) have been validly assigned to the Bank and, are subject to a first priority
Lien in  favor  of the  Bank  and  comply  with  all of the  terms,  conditions,
warranties  and  representations  made to the Bank under this  Agreement and the
other Loan Documents;  but Eligible  Accounts  Receivable  shall not include the
following:  (a) Accounts with respect to which the Account Debtor is an officer,
director,  employee,  or agent of the  Borrower or an  Affiliate;  (b)  Accounts
arising  from a sale of goods  which are  placed on  consignment,  or subject to
guaranteed sale,  bill-and-hold,  repurchase or return, or other terms by reason
of which the  payment of the Account  Debtor may be  conditional;  (c)  Accounts
arising from invoices for deposits,  and rebills of amounts previously  credited
to the  extent of  credits  issued  more than  fifteen  (15) days  prior to such
rebill;  (d) Accounts with respect to which the Account  Debtor is not domiciled
in the  United  States of America  unless  such  Account is fully  secured by an
irrevocable  letter of credit acceptable to the Bank and in favor of or assigned
to the Bank;  (e) Accounts  with respect to which the sale is on an  installment
sale,  lease or other extended payment basis; (f) Accounts with respect to which
the Account Debtor is a federal,  state, local or foreign governmental authority
unless  such  governmental  authority  is the  United  States of  America or any
department,  agency or  instrumentality  of the Untied States,  and the Borrower
complies  with the  Assignment  of Claims  Act of 1940,  as  amended  (31 U.S.C.
Section 203 et seq.;  (g) Accounts with respect to which the Account Debtor is a
Subsidiary  of,  Affiliate  of, or has common  officers  or  directors  with the
Borrower;  (h)  Accounts  with respect to which the Bank does not for any reason
have a perfected  first  priority  Lien;  (i) Accounts with respect to which the
Borrower  is or may  become  liable to the  Account  Debtor  for  goods  sold or
services  rendered by the Account  Debtor to the Borrower,  to the extent of the
Borrower's  existing or potential liability to such Account Debtor; (j) Accounts
with  respect to which the Account  Debtor has disputed  any  liability,  or the
Account  is  otherwise  subject  to any right of  setoff,  deduction,  breach of
warranty or other  defense,  dispute or  counterclaim  by the Account Debtor but
such Account shall be ineligible only to the extent of the disputed or otherwise
disallowed  amount;  (k) that  portion of any Accounts  representing  late fees,
service  charges  or  interest,  but only to the  extent  of such  portion;  (l)
Accounts of an Account  Debtor where the Account Debtor is located in New Jersey
or Minnesota  unless the Borrower (1) with respect to such state, has received a
Certificate  of Authority to do business and is in good  standing in such state,
or (2) has filed a Notice of  Business  Activities  Report  with the New  Jersey
Division of Taxation or the Minnesota Department of Revenue, as applicable,  for
the  then  current  year;  (m)  Accounts  owed by any  Account  Debtor  which is
insolvent or is the subject of an insolvency proceeding; (n) that portion or any
Accounts  represented  by an instrument,  or chattel paper;  and (o) any and all
Accounts of an Account Debtor whose  creditworthiness is not satisfactory to the
Bank in its reasonable  credit  judgment  based on information  available to the
Bank.  References to  percentages  of all Accounts are based on dollar amount of
Accounts, and not number of Accounts.

                                       6
<PAGE>

         "Environmental Laws" shall mean any federal,  state or local statute or
regulation  relating to hazardous or toxic wastes or  substances  or the removal
thereof.

         "ERISA" shall mean the Employee Retirement Income Security Act of 1974,
as amended from time to time.

         "Event of  Default"  shall  mean any of the  events  specified  in this
Agreement  under  "Events of Default",  provided  that any  requirement  for the
giving of notice,  the lapse of time, or both, or any other condition,  has been
satisfied.

         "Facility A Commitment"  shall mean the  obligation of the Bank to make
Facility  A  Revolving  Credit  Loans to the  Borrower  during  the  Facility  A
Commitment  Period  pursuant to the terms hereof as such Commitment is described
in Section  2.1(a)  hereof and as subject to  reduction in  accordance  with the
terms hereof.

         "Facility A Commitment Period" shall mean the period from and including
the date hereof to and including the Facility A Termination Date or such earlier
date as the Facility A Commitment shall terminate as provided herein.

         "Facility B Commitment"  shall mean the  obligation of the Bank to make
Facility  B  Revolving  Credit  Loans to the  Borrower  during  the  Facility  B
Commitment  Period  pursuant to the terms hereof as such Commitment is described
in Section  2.1(a)  hereof and as subject to  reduction in  accordance  with the
terms hereof.

         "Facility B Commitment Period" shall mean the period from and including
the date hereof to and including the Facility B Termination Date or such earlier
date as the Facility B Commitment shall terminate as provided herein.

         "Facility A Revolving  Credit Loan" shall mean a Loan made  pursuant to
Section 2.1(a) hereof.

         "Facility A Revolving  Credit Note" shall mean the Note  referred to in
Section 2.2(a) hereof.

         "Facility B Revolving  Credit Loan" shall mean a Loan made  pursuant to
Section 2.1(b) hereof.

         "Facility B Revolving  Credit Note" shall mean the Note  referred to in
Section 2.2(b) hereof.

                                       7
<PAGE>

         "Facility A Termination Date" shall mean September 11, 2001 or, if such
date is not a Business Day, the Business Day next succeeding such date.

         "Facility B Termination Date" shall mean September 11, 2001 or, if such
date is not a Business Day, the Business Day next succeeding such date.

         "Fixed  Charge  Coverage  Ratio"  shall  be  determined  on  a  rolling
four-quarter  basis and shall mean, for any such four-quarter  period, the ratio
of (A)  Consolidated  Adjusted  EBITDA for such period  minus the sum of Capital
Expenditures  during such period that have not been financed  (excluding amounts
paid in connection with Permitted Acquisitions),  and cash dividends paid during
such period and income  taxes paid during such period to (B)  Consolidated  Debt
Service for such period.

         "Fluctuating  Rate Loans" shall mean Loans hereunder that bear interest
at a rate of interest based upon the Prime Rate plus the Applicable  Margin,  if
any.

         "GAAP" shall mean generally accepted accounting principles applied in a
manner  consistent  with  that  employed  in the  preparation  of the  financial
statements described in Section 3.1.

         "Governmental Authority" shall mean any nation or government, any state
or  other  political  subdivision  thereof,  any  entity  exercising  executive,
legislative,  judicial,  regulatory or administrative functions of or pertaining
to government,  and any corporation or other entity owned or controlled (through
stock or capital ownership or otherwise) by any of the foregoing.

         "Guarantees" shall mean the guarantees to be executed by the Guarantors
substantially in the form of Exhibit F hereto.

         "Guarantors" shall mean each and every present and future Subsidiary of
the Borrower that the Bank in its reasonable discretion deems to be a "material"
Subsidiary of the Borrower.

         "Indebtedness"  shall mean (without  duplication),  with respect to any
Person, (a) all obligations of such Person for borrowed money or with respect to
deposits or advances of any kind, (b) all  obligations of such Person  evidenced
by bonds, debentures, notes or other similar instruments, (c) all obligations of
such Person for the  deferred  purchase  price of property or  services,  except
accrued  expenses  arising in the ordinary course of business,  current accounts
payable  arising in the ordinary  course of business and not overdue beyond such
period as is commercially reasonable for such Person's business,  amounts due to
medical  providers and patient deposits (d) all obligations of such Person under
conditional  sale or other  title  retention  agreements  relating  to  property
purchased  by such  Person,  (e) all  payment  obligations  of such  Person with
respect to interest rate or currency protection agreements , (f) all obligations
of such  Person as an account  party under any letter of credit or in respect of
bankers' acceptances, (g) all obligations of any third party secured by property
or assets of such Person (regardless of whether or not such Person is liable for
repayment of such  obligations),  (h) all  guarantees  of such  Person,  (i) all
Capitalized Lease Obligations of such Person and (j) the redemption price of all
redeemable  preferred  stock of such Person (but not  accrued  dividends  on any
preferred  stock),  but only to the extent that such stock is  redeemable at the
option of the holder or requires  sinking  fund or similar  payments at any time
prior to the Termination Date.

                                       8
<PAGE>

         "Installment  Payment  Date"  shall  mean any date on which  all or any
portion of the principal amount of the Term Loan is due and payable.

         "Interest  Period"  shall  mean any  period  during  which a Loan bears
interest at a fixed rate as elected by the Borrower in accordance with the terms
of this Agreement.

         (a) If any Interest  Period would otherwise end on a day which is not a
Business  Day,  that  Interest  Period shall be extended to the next  succeeding
Business  Day  unless  the  result of such  extension  would be to  extend  such
Interest Period into another calendar month, in which event such Interest Period
shall end on the immediately preceding Business Day.

         (b) No Interest Period shall extend beyond a stated Maturity Date.

         (c) No portion of the Term Loan shall be continued as or converted into
a Libor Loan with an Interest Period which extends beyond an Installment Payment
Date if, after giving  effect to the  continuation  or  conversion of such Libor
Loan, the amount payable on any Installment Payment Date would exceed the sum of
(i) the aggregate  principal amount of the outstanding  portion of the Term Loan
constituting  Libor Loans with Interest Periods ending prior to such Installment
Payment  Date  and (ii)  the  aggregate  outstanding  portion  of the Term  Loan
constituting Fluctuating Rate Loans.

         (d) If such Interest  Period  commences on a day for which there exists
no  numerically  corresponding  day in the final month of such Interest  Period,
such Interest Period shall end on the last Business Day of such month.

         "Leverage Ratio" shall mean at any date of determination,  the ratio of
(i) Consolidated  Senior Funded Debt as of such date to (ii) Consolidated EBITDA
for the four fiscal  quarter  period ending on such date or, if such date is not
the last day of a fiscal  quarter,  for the  immediately  preceding  four fiscal
quarter period.

         "LIBOR" shall mean, as applicable to any LIBOR Loan, the rate per annum
(rounded upward, if necessary, to the nearest 1/32 of one percent) as determined
on the basis of the offered rates for deposits in U.S. dollars,  for a period of
time  comparable  to the  interest  period  applicable  to such LIBOR Loan which
appears on the Telerate  page 3750 as of 11:00 a.m.  London time on the day that
is two London  Business  Days  preceding  the first day of the  interest  period
applicable to such LIBOR Loan;  provided,  however,  if the rate described above
does not appear on the Telerate System on any applicable interest  determination
date, the LIBOR rate shall be the rate (rounded  upwards as described  above, if
necessary)  for  deposits  in dollars  for a period  substantially  equal to the
interest  period on the  Reuters  Page "LIBO" (or such other page as may replace
the LIBO Page on that service for the purpose of displaying  such rates),  as of
11:00 a.m.  (London Time), on the day that is two (2) London Business Days prior
to the  beginning  of such  Interest  Period.  If both the  Telerate and Reuters
system are  unavailable,  then the rate for that date will be  determined on the
basis of the offered  rates for  deposits  in U.S.  dollars for a period of time
comparable  to the  interest  period  applicable  to such  LIBOR  Loan which are
offered by four  major  banks in the London  interbank  market at  approximately
11:00  a.m.  London  time,  on the  day  that is two (2)  London  Business  Days
preceding the first day of the interest period  applicable to such LIBOR Loan as
selected  by the Bank.  The  principal  London  office of each of the four major
London banks will be requested to provide a quotation of its U.S. dollar deposit
offered rate. If at least two such  quotations  are provided,  the rate for that
date will be the arithmetic mean of the quotations. If fewer than two quotations
are  provided as  requested,  the rate for that date will be  determined  on the
basis of the rates quoted for loans in U.S.  dollars to leading  European  banks
for a period of time comparable to the interest period  applicable to such LIBOR
Loan  offered by major banks in New York City at  approximately  11:00 a.m.  New
York City time, on the day that its two London Business Days preceding the first
day of such  LIBOR  Loan.  In the event  that Bank is unable to obtain  any such
quotation as provided  above,  it will be deemed that LIBOR  pursuant to a LIBOR
Loan  cannot be  determined.  In the event  that the Board of  Governors  of the
Federal  Reserve System shall impose a Reserve  Percentage with respect to LIBOR
deposits of the Bank then for any period  during which such  Reserve  Percentage
shall apply,  LIBOR shall be equal to the amount  determined above divided by an
amount equal to 1 minus the Reserve Percentage.

                                       9
<PAGE>

         "LIBOR  Loans" shall mean Loans  hereunder  that bear  interest for the
Interest Period  applicable  thereto at a rate of interest based upon LIBOR plus
the Applicable Margin.

         "Lien"   shall   mean  any   mortgage,   pledge,   security   interest,
hypothecation,  assignment,  deposit  arrangement,  encumbrance,  or preference,
priority or other security agreement or preferential  arrangement of any kind or
nature whatsoever which has the practical effect of creating a security interest
(including,  without  limitation,  any conditional sale or other title retention
agreement,  any financing lease having substantially the same economic effect as
any of the  foregoing,  and the  filing  of any  financing  statement  under the
Uniform Commercial Code or comparable law of any jurisdiction).

         "Loan" or "Loans"  shall mean any loan made by the Bank to the Borrower
hereunder  whether a Facility A  Revolving  Credit  Loan,  Facility B  Revolving
Credit Loan or the Term Loan.

         "Loan Documents" shall mean this Agreement and each document, agreement
and instrument  executed in connection herewith or pursuant hereto together with
each document,  agreement and  instrument  made by the Borrower or any Guarantor
with or in favor of or owing to the Bank.

         "Management Agreement" shall mean an agreement entered into between the
Borrower and a Practice Group pursuant to which the Borrower provides management
and  administrative  services to such Practice Group and furnishes such Practice
Group with facilities, equipment, personnel and supplies.

         "Maturity  Date"  shall  mean the date  that  all or a  portion  of the
outstanding principal balance of a Loan is due and payable pursuant to the terms
hereof  which shall  include  without  limitation  (i) with respect to Revolving
Credit Loans, the applicable Termination Date, and (ii) with respect to the Term
Loan,  each  Installment  Payment Date and the final  Maturity  Date of the Term
Loan.

         "Network  Site" means each  location  with  respect to which a Practice
Group has entered into a single Management Agreement with the Borrower.

         "Notes" shall mean  collectively  the Facility A Revolving  Credit Note
referred to in Section  2.2(a)  hereof,  the  Facility B  Revolving  Credit Note
referred to in Section  2.2(b)  hereof and the Term Note  referred to in Section
2.8 hereof.

         "Notice of Borrowing" is defined in Section 2.3.

         "Obligations"  shall  mean  any and  all  sums  owing  under  the  Loan
Documents and all other  obligations,  direct or contingent,  joint,  several or
independent,  of the Borrower now or hereafter existing due or to become due to,
or held or to be  held by the  Bank  pursuant  to the  Loan  Documents,  whether
created directly or acquired by assignment or otherwise.

         "Permitted  Acquisition" shall mean an Acquisition permitted by Section
7.2.

         "Person" shall mean any  individual,  corporation,  partnership,  joint
venture,  limited liability company, trust,  unincorporated  organization or any
other  juridical  entity,  or a  government  or state or any agency or political
subdivision thereof.

         "Plan" shall mean any plan of a type  described  in Section  4021(a) of
ERISA in respect of which the  Borrower is an  "employer"  as defined in Section
3(5) of ERISA.

         "Practice  Group"  means  one  or  more  physicians  or a  professional
corporation  or  professional  association  owned by physicians or a hospital or
medical center.

         "Post-Default  Rate" shall mean at any time a rate of interest equal to
4% per annum in excess of the rate that would then be applicable to  Fluctuating
Rate Loans based upon the Pricing Level therefor.

         "Pricing Level" shall mean Pricing Level I, Pricing Level II or Pricing
Level III, as applicable.

         "Pricing Level I" shall mean the  applicable  Pricing Level at any time
when the Leverage Ratio is greater than 1.50:1.00.

                                       10
<PAGE>

         "Pricing Level II" shall mean the applicable  Pricing Level at any time
when the  Leverage  Ratio is greater  than  1.00:1.00  but less than or equal to
1.50:1.00.

         "Pricing Level III" shall mean the applicable Pricing Level at any time
when the Leverage Ratio is less than or equal to 1.00:1.00.

         "Prime  Rate"  shall mean the  variable  per annum rate of  interest so
designated  from time to time by the Bank as its prime rate. The Prime Rate is a
reference rate and does not necessarily  represent the lowest or best rate being
charged to any customer.

         "Property" shall mean all types of real, personal, tangible, intangible
or mixed property.

         "Real  Property"  shall mean any real  property  owned or leased by the
Borrower or any of its Subsidiaries or any Guarantor or any of its Subsidiaries.

         "Reportable  Event"  shall  mean any of the events set forth in Section
4043(b) of ERISA or the regulations thereunder.

         "Requirements  of Law" shall mean as to any Person,  the certificate of
incorporation and by-laws or other organizational or governing documents of such
Person,  and  any  law,  treaty,  rule or  regulation,  or  determination  of an
arbitrator or a court or other Governmental  Authority,  in each case applicable
to or binding upon such Person or any of its property or to which such Person or
any of its property is subject.

         "Revolving Credit Loan" shall mean any Facility A Revolving Credit Loan
and/or any Facility B Revolving Credit Loan made pursuant to Section 2.1 hereof.

         "Revolving Credit Note" shall mean any Facility A Revolving Credit Note
and/or any Facility B Revolving Credit Note referred to in Section 2.2. hereof.

         "Security Agreement" shall mean the Security  Agreement(s)  referred to
in this  Agreement,  certain  or all of which are  substantially  in the form of
Exhibit G hereto.

         "Specified  Person"  shall  mean  either  the  Borrower  or  any of its
Subsidiaries or any Guarantor or any of its Subsidiaries.

         "Subordinated  Debt" shall mean all Indebtedness  owing by the Borrower
to any  Person  that  is  completely  subordinated  to  all  of  the  Borrower's
Obligations  to the  Bank  pursuant  to a  subordination  agreement  in form and
substance satisfactory to the Bank.

         "Subsidiary" or "Subsidiaries" of any Person shall mean any corporation
or  corporations  of which the Person alone, or the Person and/or one or more of
its  Subsidiaries,  owns,  directly  or  indirectly,  at least a majority of the
securities having ordinary voting power for the election of directors.

                                       11
<PAGE>

         "Term Loan" shall mean the Loan made pursuant to Section 2.8 hereof.

         "Term Note" shall mean the Note referred to in Section 2.8 hereof.

         "Type" refers to whether a Loan is a  Fluctuating  Rate Loan or a Libor
Loan.

         "Year 2000 Issue" shall mean failure of computer software, hardware and
firmware systems and equipment  containing  embedded  computer chips to properly
receive, transmit, process,  manipulate,  store, retrieve,  retransmit or in any
other way utilize data and information due to the occurrence of the year 2000 or
the inclusion of dates on or after January 1, 2000.

         1.2 Accounting  Terms.  As used herein and in any  certificate or other
document made or delivered  pursuant  hereto,  accounting terms not specifically
defined herein shall have the respective  meanings given to them under generally
accepted accounting principles.


2.       AMOUNT AND TERMS OF REVOLVING CREDIT COMMITMENT AND TERM NOTE.

         2.1 Revolving Credit Commitments.

         (a) Subject to the terms and conditions hereof, the Bank agrees to make
revolving credit loans to the Borrower (the "Facility A Revolving Credit Loans")
from  time to time  during  the  Facility  A  Commitment  Period  the  aggregate
principal  amount  of which at any one time  outstanding  shall not  exceed  the
lesser of the  Borrowing  Base or  $4,000,000,  as such amount may be reduced as
provided in this Agreement (the "Facility A Commitment").  During the Facility A
Commitment  Period the Borrower may use the  Commitment  for obtaining  Loans by
borrowing,  prepaying in whole or in part and reborrowing on a revolving  basis,
all in accordance with the terms and conditions hereof.

         (b) Subject to the terms and conditions hereof, the Bank agrees to make
revolving credit loans to the Borrower (the "Facility B Revolving Credit Loans")
from  time to time  during  the  Facility  B  Commitment  Period  the  aggregate
principal  amount  of  which  at any  one  time  outstanding  shall  not  exceed
$5,000,000,  as such amount may be reduced as provided  in this  Agreement  (the
"Facility B Commitment").  During the Facility B Commitment  Period the Borrower
may use the Facility B Commitment for obtaining Loans by borrowing, prepaying in
whole or in part and  reborrowing on a revolving  basis,  all in accordance with
the terms and conditions hereof.

         2.2 Revolving Credit Notes.

         (a) The  Facility  A  Revolving  Credit  Loans  made by the Bank to the
Borrower  pursuant to Section  2.1(a)  hereof shall be evidenced by a promissory
note  of the  Borrower  substantially  in the  form of  Exhibit  A  hereto  with
appropriate  insertions (the "Facility A Revolving Credit Note"), payable to the
order of the Bank and  representing  the  obligation  of the Borrower to pay the
lesser of (a) the amount of the  Facility  A  Commitment  or, (b) the  aggregate
unpaid  principal  amount of all  Facility A Revolving  Credit Loans made by the
Bank to the  Borrower,  with interest  thereon as  hereinafter  prescribed.  The
Facility A  Revolving  Credit Note shall (i) be dated the date  hereof,  (ii) be
stated to mature on the Facility A Termination Date and (iii) bear interest with
respect to the unpaid principal balance thereof from time to time outstanding at
a rate per annum to be elected by the  Borrower  in  accordance  with the notice
provisions  set forth in Section 2.3 hereof,  and in the case of LIBOR Loans for
the  Interest  Period  therein  specified,  equal to either  (1) LIBOR  plus the
Applicable  Margin,  or (2) the Prime  Rate plus the  Applicable  Margin  (which
interest  rate will  change  when and as the Prime Rate  changes).  In all cases
interest  shall be  computed  on the basis of a  360-day  year for  actual  days
elapsed and shall be payable as provided in this Agreement.  After any stated or
accelerated  maturity,  the Facility A Revolving Credit Note shall bear interest
at the rate set forth in this Agreement.

                                       12
<PAGE>

         (b) The  Facility  B  Revolving  Credit  Loans  made by the Bank to the
Borrower  pursuant to Section  2.1(b)  hereof shall be evidenced by a promissory
note  of the  Borrower  substantially  in the  form of  Exhibit  B  hereto  with
appropriate  insertions (the "Facility B Revolving Credit Note"), payable to the
order of the Bank and  representing  the  obligation  of the Borrower to pay the
lesser of (a) the amount of the  Facility  B  Commitment  or, (b) the  aggregate
unpaid  principal  amount of all  Facility B Revolving  Credit Loans made by the
Bank to the  Borrower,  with interest  thereon as  hereinafter  prescribed.  The
Facility B  Revolving  Credit Note shall (i) be dated the date  hereof,  (ii) be
stated to mature on the Facility B Termination Date and (iii) bear interest with
respect to the unpaid principal balance thereof from time to time outstanding at
a rate per annum to be elected by the  Borrower  in  accordance  with the notice
provisions  set forth in Section 2.3 hereof,  and in the case of LIBOR Loans for
the  Interest  Period  therein  specified,  equal to either  (1) LIBOR  plus the
Applicable  Margin,  or (2) the Prime  Rate plus the  Applicable  Margin  (which
interest  rate will  change  when and as the Prime Rate  changes).  In all cases
interest  shall be  computed  on the basis of a  360-day  year for  actual  days
elapsed and shall be payable as provided in this Agreement.  After any stated or
accelerated  maturity,  the Facility B Revolving Credit Note shall bear interest
at the rate set forth in this Agreement.

         2.3  Procedure  for  Borrowings.  The  Borrower  may  borrow  under the
applicable  Commitment  during the applicable  Commitment Period on any Business
Day by giving the Bank  irrevocable  notice (each a "Notice of  Borrowing") of a
request  for a Facility A  Revolving  Credit  Loan and/or a Facility B Revolving
Credit Loan  hereunder (a) in the case of LIBOR Loans three Business Days before
a proposed  borrowing or  continuation  or conversion and (b) in the case of all
other Loans not less than one nor more than five Business Days before a proposed
borrowing or  continuation  or  conversion,  setting forth (i) the amount of the
Loan  requested,  which  shall not be less  than  $100,000,  (ii) the  requested
borrowing date or Interest Period  commencement  date, as the case may be, (iii)
whether the Loan shall be a LIBOR Loan,  Fluctuating  Rate Loan or a combination
thereof,  and (iv) if  entirely or  partially  a LIBOR  Loan,  the length of the
Interest Period therefor,  which shall be one, two, three or six months,  as the
Borrower shall elect. As used in this Section 2.3,  "conversion"  shall mean the
conversion  of a Loan from one Type to another  Type as more fully  described in
this Agreement. Such notice shall be written (including, without limitation, via
facsimile  transmission)  and shall be  sufficient  if received by l p.m. on the
date on  which  such  notice  is to be  given.  If any such  request  is sent by
facsimile  it shall be  confirmed  in writing  sent by the  Borrower to the Bank
within two Business Days thereafter.  Unless notification is otherwise furnished
by the Borrower to the Bank (in a manner  consistent  with the  requirements  of
this Section),  Loans will be made by credits to the  Borrower's  demand deposit
account  maintained with the Bank. If the Borrower  furnishes such notice but no
election is made as to the Type of Loan or the Interest  Period to be applicable
thereto,  the Loan will  automatically  then be made as a Fluctuating  Rate Loan
until such required information is furnished pursuant to the terms hereof.

         2.4 [Reserved].

         2.5 Commitment Fees.

         (a) As  additional  compensation  for the Facility A Commitment  on the
revolving  basis  provided  for herein,  the  Borrower  agrees to pay the Bank a
commitment  fee for the  Facility  A  Commitment  Period at the rate of .25% per
annum  on the  average  daily  unused  portion  of  the  Facility  A  Commitment
hereunder.  Such commitment fee shall be payable  quarterly,  on the last day of
each March, June September and December during the Facility A Commitment Period,
commencing  September 30, 1998,  and on the Facility A Termination  Date. If the
Borrower  fails to pay any such  amount to the Bank when due the  amount of such
defaulted  payment  shall  bear  interest  from the date  when  due  until  (but
excluding) the date when paid at the Post-Default Rate. The obligation so to pay
interest  shall  not be  construed  so as to waive  the  requirement  to pay the
commitment fees as hereinabove set forth.

         (b) As  additional  compensation  for the Facility B Commitment  on the
revolving  basis  provided  for herein,  the  Borrower  agrees to pay the Bank a
commitment  fee for the  Facility  B  Commitment  Period at the rate of .20% per
annum  on the  average  daily  unused  portion  of  the  Facility  B  Commitment
hereunder.  Such commitment fee shall be payable  quarterly,  on the last day of
each March, June September and December during the Facility B Commitment Period,
commencing  September 30, 1998,  and on the Facility B Termination  Date. If the
Borrower  fails to pay any such  amount to the Bank when due the  amount of such
defaulted  payment  shall  bear  interest  from the date  when  due  until  (but
excluding) the date when paid at the Post-Default Rate. The obligation so to pay
interest  shall  not be  construed  so as to waive  the  requirement  to pay the
commitment fees as hereinabove set forth.

                                       13
<PAGE>

         2.6  Regulatory  Changes in Capital  Requirements.  If as a result of a
change in any  existing,  or the  imposition of any future,  law,  regulation or
guideline  or the  interpretation  thereof  by any  court or  administrative  or
governmental authority charged with the administration thereof, or compliance by
the Bank with any request or directive  (whether or not having the force of law)
of any such authority,  imposes,  modifies,  deems  applicable or results in the
application of, any capital  maintenance,  capital ratio or similar  requirement
against loan  commitments  made by the Bank (or  participations  therein) or the
Bank in anticipation of the  effectiveness of any capital  maintenance,  capital
ratio or similar  requirement takes reasonable action to enable itself to comply
therewith,  and the result  thereof is to impose upon the Bank or  increase  any
capital  requirement  applicable  as a result of the  making or  maintenance  of
either or both  Commitments or  participations  therein (which  imposition of or
increase in capital  requirements  may be  determined  by the Bank's  reasonable
allocation of the aggregate of such capital impositions or increases) then, upon
demand by the Bank, the Borrower shall  immediately pay to the Bank from time to
time as specified by the Bank such  additional  amount as shall be sufficient to
compensate   the  Bank  for  such   impositions   of  or  increases  in  capital
requirements.  Any such amount not paid  within one  Business  Day after  demand
being made by the Bank shall be paid together with interest at the  Post-Default
Rate from the date demanded until payment in full thereof. A certificate setting
forth in reasonable  detail the amounts  necessary to  compensate  the Bank as a
result of an imposition of or increase in capital requirements  submitted by the
Bank to the Borrower shall be conclusive, absent manifest error or bad faith, as
to the amount  thereof.  For purposes of this  Section,  all  references  to the
"Bank" shall be deemed to include any corporation controlling the Bank. The Bank
will  promptly  notify  the  Borrower  of any  event of  which it has  knowledge
occurring after the date hereof which will entitle it to  compensation  pursuant
to  this  Section  and  will  designate  a  different  lending  office  if  such
designation  will  avoid  the need  for,  or  reduce  the  amount  of,  any such
additional amounts which may thereafter accrue and would not, in the judgment of
the Bank, be otherwise disadvantageous to the Bank.

         2.7 Termination or Reduction of Commitment. The Borrower shall have the
right,  upon not less than three Business Days'  irrevocable  written notice, to
terminate either  Commitment or, from time to time, to reduce the amount of such
Commitment,  provided  that (a) any such  reduction  (i) shall be in the minimum
amount of $500,000 or an integral  multiple of $100,000 in excess thereof,  (ii)
shall reduce permanently the amount of such Commitment then in effect, and (iii)
shall be  accompanied  by prepayment of the  applicable  Revolving  Credit Loans
outstanding to the extent,  if any, that the Loans then  outstanding  exceed the
amount of such Commitment as then reduced, together with accrued interest on the
amount so prepaid to and  including  the dates of each such  prepayment  and any
amounts payable pursuant to Section 2.14 in connection therewith and the payment
of any  unpaid  commitment  fee  applicable  to  such  commitment  then  accrued
hereunder,  and (b) any such termination of such Commitment shall be accompanied
by prepayment in full of the  applicable  Revolving  Credit Loans  together with
accrued interest thereon to and including the date of prepayment and any amounts
payable pursuant to Section 2.14 in connection  therewith and the payment of any
unpaid commitment fee applicable to such commitment then accrued hereunder.

         2.8 Term Loan.  The Bank  hereby  agrees to make a 66-month  $4,000,000
term loan (the "Term  Loan") to the  Borrower.  The Term Loan shall be made as a
Fluctuating  Rate Loan  unless  and until the  Borrower  furnishes  the  notices
required by this Agreement to convert all or a portion of such Loan to a Loan of
another  Type.  The Term Loan shall be  evidenced  by a  promissory  note of the
Borrower  substantially  in the  form  of  Exhibit  C  hereto  with  appropriate
insertions (the "Term Note") and dated the date of such Term Loan. The principal
amount of the Term Note shall be payable in sixteen (16)  consecutive  quarterly
installments  each of which  shall be in an amount  equal to Two  Hundred  Fifty
Thousand  Dollars  and  00/100  ($250,000.00),  payable on the first day of each
January,  March,  June and  September  commencing  June 1, 2000 until the entire
unpaid  principal  balance of the Term Note shall be paid in full. The Term Note
shall bear  interest on the unpaid  principal  amount  thereof from time to time
outstanding  at a rate per annum,  to be elected  pursuant to the  provisions of
this Agreement equal to either (i) LIBOR plus the Applicable Margin, or (ii) the
Prime Rate plus the Applicable Margin (which interest rate shall change when and
as the Prime Rate changes). In all cases interest shall be computed on the basis
of a 360-day  year for actual  days  elapsed and shall be payable as provided in
this Agreement.  After any stated or accelerated maturity thereof, the Term Note
shall bear interest at the increased rate set forth in this Agreement.


                                       14
<PAGE>

         2.9  Continuation  and Conversion of Loans. The Borrower shall have the
right at any time on prior  irrevocable  written or telex  notice to the Bank as
specified in this  Agreement  (i) to continue any LIBOR Loan as a Libor Loan for
the same or a different  Interest  Period  (specifying the Interest Period to be
applicable thereto), (ii) to convert any LIBOR Loan into a Fluctuating Rate Loan
and (iii) to convert any Fluctuating Rate Loan into a LIBOR Loan (specifying the
Interest   Period   to   be   applicable   thereto)   (each   such   notice,   a
"Continuation/Conversion Notice"), subject to the following:

         (a) in the case of a  conversion  of less  than all of the  outstanding
Loans, the aggregate  principal amount of Loans converted shall not be less than
$100,000 and shall be an integral multiple thereof;

         (b) no LIBOR Loan shall be  converted at any time other than at the end
of an Interest Period applicable thereto; and

         (c) any  portion of a Loan  maturing  or required to be prepaid in less
than one month may not be converted into or continued as a LIBOR Loan.

         In the event that the  Borrower  shall not give notice to continue  any
LIBOR Loan into a  subsequent  Interest  Period or convert  any such Loan into a
Loan of another type, on the last day of the Interest Period thereof,  such Loan
(unless prepaid) shall  automatically be converted into a Fluctuating Rate Loan.
The Interest Period  applicable to any Libor Loan resulting from a conversion or
continuation  shall be  specified  by the  Borrower  in the  irrevocable  notice
delivered by the Borrower pursuant to this Agreement;  provided,  however, that,
if such notice does not specify  either the type of Loan or the Interest  Period
to be applicable  thereto,  the Loan shall  automatically  be converted into, or
continued  as, as the case may be, a  Fluctuating  Rate Loan until such required
information is furnished pursuant to the terms hereof.  Notwithstanding anything
to the contrary  contained above, if an Event of Default shall have occurred and
is continuing,  no Libor Loan may be continued into a subsequent Interest Period
and no Fluctuating Rate Loan may be converted into a Libor Loan.

         2.10 Prepayment.

         (a)  Voluntary.  The Borrower may prepay any  Fluctuating  Rate Loan in
whole or in part  without  premium  or  penalty;  provided,  however,  that each
partial prepayment on account of any Fluctuating Rate Loan shall be in an amount
not less than  $100,000 or an integral  multiple of $100,000 in excess  thereof.
Except as provided otherwise in this Agreement,  the Borrower may not prepay any
Libor Loan prior to the last day of the  Interest  Period  therefor.  Any amount
prepaid on account of a Revolving  Credit Loan may be  reborrowed  in accordance
with the  provisions of Section 2.1 hereof.  Any partial  prepayment of the Term
Loan shall be applied to the last maturing installments thereof in inverse order
of their respective maturities.

                                       15
<PAGE>

         (b)  Mandatory.  If, at any time, the aggregate  outstanding  principal
balance of Facility A Revolving  Credit  Loan(s)  exceeds  the  Borrowing  Base,
within five days of the first day there exists such excess,  the Borrower  shall
make  payment to the Bank in an amount  equal to such excess  together  with any
amounts payable pursuant to Section 2.14 in connection  therewith.  Such payment
shall be applied to reduce the aggregate unpaid principal  balance of Facility A
Revolving Credit Loans then outstanding by first applying such payment to reduce
Fluctuating  Rate  Loans and then to reduce  LIBOR  Loans.  Notwithstanding  the
foregoing,  the  Borrower  may  direct  by  written  notice to the Bank that any
prepayment or repayment be applied first, to the principal amount of LIBOR Loans
if such  prepayment or repayment is made on the last day of the Interest  Period
applicable thereto.

         Each prepayment shall be made together with payment of accrued interest
on the amount prepaid to and including the date of prepayment.

         2.11  Interest  Payments;  Manner  of  Payments;  Rate  After  Default;
Schedule to Note.

         (a)   Interest   accrued  on  each  Loan  shall  be  payable,   without
duplication, on:

                (i) the Maturity Date of such Loan  (excluding  any  Installment
Payment Date unless  interest  would  otherwise  be payable on such  Installment
Payment Date pursuant to subsections (ii) - (v) below);

                (ii) with  respect to any  portion of any Loan repaid or prepaid
pursuant to this  Agreement,  the date of such repayment or  prepayment,  as the
case may be;

                (iii) with respect to that portion of the outstanding  principal
amount of all Loans  maintained as Fluctuating Rate Loans, the first day of each
month  commencing  with the first such date  following the date of the making of
such Loans;

                (iv) with respect to that portion of the  outstanding  principal
amount  maintained  as LIBOR  Loans,  the last day of each  applicable  Interest
Period (and, if such Interest Period shall exceed three months,  on the last day
of each three-month  period occurring  during such Interest  Period),  but in no
event more frequently than monthly;

                (v) with  respect to that portion of the  outstanding  principal
amount  converted  into  Fluctuating  Rate  Loans or  Libor  Loans on a day when
interest would not otherwise have been payable pursuant to Subsections  (a)(iii)
or (a)(iv), the date of such conversion.

         (b) All payments (including  prepayments) to be made by the Borrower on
account of principal or interest  with respect to any Loan or on account of fees
or any other  obligations of the Borrower to the Bank hereunder shall be made to
the Bank at the office of the Bank set forth in Section  10.1  hereof or at such
other  place as the Bank may from time to time  designate  in  writing in lawful
money of the United States of America in  immediately  available  funds.  If the
entire  amount of any  required  principal  and/or  interest is not paid in full
within ten (10) days after the same is due, the Borrower shall pay to the Bank a
late fee equal to five percent (5%) of the required payment. The Borrower hereby
authorizes and directs the Bank to charge any account of the Borrower maintained
at any office of the Bank for any such  payments.  Subject to the  provisions of
subparagraph  (a) in the definition of Interest  Period set forth in Section 1.1
hereof, if any payment to be so made hereunder,  or under any Note,  becomes due
and payable on a day other than a Business  Day,  such payment shall be extended
to the next succeeding  Business Day and, to the extent  permitted by applicable
law,  interest  thereon shall be payable at the then applicable rate during such
extension.

                                       16
<PAGE>

         (c) Upon and following an Event of Default,  all Loans, and any and all
accrued  and unpaid  interest,  fees or  amounts  due  hereunder,  to the extent
permitted by applicable law, shall bear interest (payable on demand,  and in any
event  on the last  day of each  month,  and  computed  daily on the  basis of a
360-day year for actual days elapsed) (i) in all cases other than Libor Loans at
the  Post-Default  Rate until paid and (ii) in the case of Libor Loans at a rate
which shall be the greater of the Post-Default Rate or 4% per annum in excess of
the rate  applicable to such Libor Loan (based upon the Pricing Level  therefor)
until the  expiration of the Interest  Period  applicable to such Loan, at which
time the Loan will  automatically  be converted into a Fluctuating Rate Loan and
until paid shall bear interest at the Post-Default  Rate. In no event,  however,
shall  interest  payable  hereunder be in excess of the maximum rate of interest
permitted  under  applicable  law. The  obligation  so to pay interest  upon any
obligation of the Borrower to the Bank shall not be construed so as to waive the
requirement for payment on the date that payment is due to the Bank as set forth
in this Agreement.

         (d) The Borrower hereby expressly  authorizes the Bank to record on the
schedule  attached  to each  Revolving  Credit  Note the amount and date of each
Revolving Credit Loan, the rate of interest thereon, the date and amount of each
payment of principal and the unpaid principal balance;  provided,  however, that
the failure of the Bank to make any such notation shall not in any manner affect
the  obligation of the Borrower to repay any Loan in  accordance  with the terms
hereof. All such notations shall be presumed to be correct.

         2.12 Use of Proceeds.

         (a) The proceeds of Facility A Revolving  Credit Loans shall be used to
finance working capital requirements of the Borrower.

         (b) The proceeds of Facility B Revolving  Credit Loans shall be used by
the Borrower for Acquisitions within the limitations of this Agreement.

         (c) The proceeds of the Term Loan hereunder  shall be used to refinance
existing  Indebtedness of the Borrower owing to First Union National Bank and to
finance  a portion  of the costs  associated  with the  Borrower's  Acquisitions
within the limitations of this Agreement.

         2.13 Increased  Costs.  If the Bank  determines  that the effect of any
applicable   law  or   government   regulation,   guideline   or  order  or  the
interpretation   thereof  by  any  Governmental   Authority   charged  with  the
administration  thereof  (such as, for  example,  a change in  official  reserve
requirements  which the Bank is  required  to  maintain  in  respect of loans or
deposits or other funds procured for funding such loans) is to increase the cost
to the Bank of making or  continuing  Libor  Loans  hereunder  or to reduce  the
amount of any payment of principal or interest  receivable  by the Bank thereon,
then the Borrower will pay to the Bank on demand such additional  amounts as the
Bank may  determine to be required to  compensate  the Bank for such  additional
costs or reduction.  Any additional  payment under this section will be computed
from the effective date at which such  additional  costs have to be borne by the
Bank.  A  certificate  as to any  additional  amounts  payable  pursuant to this
Section setting forth the basis and method of determining  such amounts shall be
conclusive, absent manifest error, as to the determination by the Bank set forth
therein if made reasonably and in good faith. The Borrower shall pay any amounts
so  certified  to it by  the  Bank  within  10  days  of  receipt  of  any  such
certificate. The Bank will promptly notify the Borrower of any event of which it
has  knowledge  occurring  after  the  date  hereof  which  will  entitle  it to
compensation  pursuant to this  Section and will  designate a different  lending
office if such designation will avoid the need for, or reduce the amount of, any
such  additional  amounts  which may  thereafter  accrue and would  not,  in the
judgment of the Bank, be otherwise  disadvantageous to the Bank. For purposes of
this  Section,  all  references  to the "Bank"  shall be deemed to  include  any
participant in any Commitment and/or Loans.

                                       17
<PAGE>

         2.14 Yield  Maintenance.  If, at any time (i) any Loan is a Libor Loan,
and (ii) the Bank in its sole  discretion  should  determine that current market
conditions  can  accommodate a prepayment  request,  the Borrower shall have the
right at such time and from time to time to prepay  such Loan in whole  (but not
in part),  and the Borrower shall pay to the Bank a yield  maintenance fee in an
amount  computed  as  follows:  The  current  rate for  United  States  Treasury
securities (bills on a discounted basis shall be converted to a bond equivalent)
with a maturity date closest to the maturity date of the term chosen pursuant to
the Fixed Rate Election as to which the prepayment is made,  shall be subtracted
from the Cost of Funds  component  of the  fixed  rate in  effect at the time of
prepayment.  If the result is zero or a negative number, there shall be no yield
maintenance  fee.  If the  result  is a  positive  number,  then  the  resulting
percentage  shall be  multiplied  by the amount of the  principal  balance being
prepaid.  The  resulting  amount shall be divided by 360 and  multiplied  by the
number of days remaining in the term chosen  pursuant to the Fixed Rate Election
as to which the  prepayment  is made.  Said  amount  shall be reduced to present
value  calculated by using the number of days remaining in the  designated  term
and using the  above-referenced  United  States  Treasury  security rate and the
number of days remaining in the term chosen  pursuant to the Fixed Rate Election
as to which the  prepayment  is made.  The  resulting  amount shall be the yield
maintenance  fee  due to the  Bank  upon  prepayment  of the  Libor  Loan.  Each
reference in this paragraph to "Fixed Rate Election"  shall mean the election by
the Borrower pursuant to Section 2.3 of this Agreement.

         If by reason of an Event of Default the Bank elects to declare any Loan
to be  immediately  due and payable,  then the foregoing  amount with respect to
such Loan shall become due and payable in the same manner as though the Borrower
had exercised such right of prepayment.

         A certificate as to any  additional  amounts  payable  pursuant to this
Section setting forth the basis and method of determining  such amounts shall be
conclusive, absent manifest error, as to the determination by the Bank set forth
therein if made reasonably and in good faith. The Borrower shall pay any amounts
so  certified  to it by  the  Bank  within  10  days  of  receipt  of  any  such
certificate. For purposes of this Section, all references to the "Bank" shall be
deemed to include any participant in any Commitment and/or Loans.

         2.15  Alternate Rate of Interest.  In the event,  and on each occasion,
that on the day two  Business  Days prior to the  commencement  of any  Interest
Period for a LIBOR Loan, the Bank shall have determined (i) that dollar deposits
in the  amount of the  requested  principal  amount of such  LIBOR  Loan are not
generally  available in the London Interbank Market, (ii) that the rate at which
such dollar  deposits are being offered will not  adequately  and fairly reflect
the cost to the Bank of  making or  maintaining  such  LIBOR  Loan  during  such
Interest  Period,  or (iii) that reasonable  means do not exist for ascertaining
the LIBOR,  the Bank shall, as soon as practicable  thereafter,  give written or
telex notice of such  determination  to the  Borrower.  In the event of any such
determination,  until the  circumstances  giving  rise to such  notice no longer
exist,  (i) no LIBOR Loans will be made  hereunder (ii) each  outstanding  LIBOR
Loan shall be converted into a Fluctuating Rate Loan on the last day of the then
current  Interest  Period  applicable  thereto  and (iii)  unless  the  Borrower
notifies the Bank at least two  Business  Days prior to the date of any proposed
borrowing of a LIBOR Loan for which a Notice of Borrowing  has  previously  been
given that it elects not to borrow on such date, such Loan shall instead be made
as a Fluctuating Rate Loan.

         Promptly upon becoming aware that the circumstances giving rise to such
notice no  longer  exist,  the Bank  shall use its best  efforts  to notify  the
Borrower  that its  obligation  to make LIBOR Loans and convert Loans into LIBOR
Loans has been reinstated, but its failure to do so shall impose no liability on
the Bank. Each  determination  by the Bank hereunder shall be conclusive  absent
manifest error.

                                       18
<PAGE>

         2.16 Change in Legality.

         (a) Notwithstanding  anything to the contrary herein contained,  if any
change  in  any  law  or  regulation  or in the  interpretation  thereof  by any
governmental authority charged with the administration or interpretation thereof
shall make it unlawful for the Bank to make or maintain any LIBOR Loan, then, by
written notice to the Borrower, the Bank may:

                (i) declare that LIBOR Loans will not  thereafter be made by the
Bank hereunder, whereupon the Borrower shall be prohibited from requesting LIBOR
Loans from the Bank hereunder unless such declaration is subsequently withdrawn;
and

                (ii)  require  that all  outstanding  LIBOR  Loans made by it be
converted  to  Fluctuating  Rate Loans,  in which event (x) all such LIBOR Loans
shall be  automatically  converted to Fluctuating Rate Loans as of the effective
date of such notice as provided in paragraph  (b) below and (y) all payments and
prepayments  of principal  which would  otherwise have been applied to repay the
converted  LIBOR Loans shall  instead be applied to repay the  Fluctuating  Rate
Loans resulting from the conversion of such LIBOR Loans.

         (b) For purposes of this Section,  a notice to the Borrower by the Bank
pursuant to paragraph  (a) above shall be  effective  with respect to each LIBOR
Loan, if lawful,  on the last day of the then current  Interest  Period for such
LIBOR Loan;  in all other  cases,  such notice  shall be effective on the day of
receipt by the Borrower and (ii) all references to the "Bank" shall be deemed to
include any participant in any Commitment and/or the Loans.

         Promptly upon becoming aware that the circumstances giving rise to such
notice no  longer  exist,  the Bank  shall use its best  efforts  to notify  the
borrower  that its  obligation  to make LIBOR Loans and convert Loans into LIBOR
Loans has been reinstated, but its failure to do so shall impose no liability on
the Bank.


3.       REPRESENTATIONS AND WARRANTIES.

         In order to induce  the Bank to enter into this  Agreement  and to make
the financial accommodations herein provided for, the Borrower hereby covenants,
represents and warrants to the Bank that:

         3.1 Financial Condition. The consolidated balance sheet of the Borrower
and the  Guarantors  as at  December  31,  1997,  and the  related  consolidated
statements  of  operations  and retained  earnings and cash flows for the fiscal
year  ended on such  date,  certified  by Price  Waterhouse  LLP copies of which
certified  statements  have  heretofore been furnished to the Bank, are complete
and correct and present fairly the financial  condition of the Borrower and each
such Guarantor as at such date, and the results of its operations and changes in
financial  position  for the fiscal year then ended.  Such  certified  financial
statements,  including  schedules  and  notes  thereto,  have been  prepared  in
accordance with generally accepted accounting  principles.  Neither the Borrower
nor  any  Guarantor  has  any  material   contingent   obligations,   contingent
liabilities or liabilities  for taxes,  long-term  leases or unusual  forward or
long-term  commitments,  which  are not  reflected  in the  foregoing  certified
statements  or in the  notes  thereto.  Except  as set  forth  in the  Company's
Quarterly  Reports on Form 10-Q for the  quarters  ended March 31, 1998 and June
30,  1998,  respectively,   since  the  date  of  the  aforementioned  financial
statements,   there  has  been  no  material  adverse  change  in  the  business
operations,  assets or  financial  or other  condition  of the  Borrower  or any
Guarantor.

                                       19
<PAGE>

         3.2  Corporate  Existence;  Compliance  with Law.  The  Borrower,  each
Guarantor and each of their Subsidiaries (a) is duly organized, validly existing
and in good standing under the laws of the  jurisdiction  of its  incorporation,
(b) has the corporate power and authority and the legal right to own and operate
its property,  and to conduct the business in which it is currently engaged, (c)
is duly qualified as a foreign  corporation  and in good standing under the laws
of each jurisdiction where its ownership or operation of property or the conduct
of its business  require such  qualification,  and (d) is in compliance with all
Requirements  of Law;  except to the extent  that the failure to so qualify as a
foreign  corporation as required by clause (c) of this Section or to comply with
all  Requirements of Law as required by clause (d) of this Section could not, in
the  aggregate,  have a material  adverse  effect on the  business,  operations,
property or  financial  or other  condition  of any such  Person,  and could not
materially  adversely  affect the  ability of (i) the  Borrower  to perform  its
obligations under this Agreement,  the Notes and its Security  Agreement or (ii)
any  Guarantor  to perform its  obligations  under its  Guarantee  and  Security
Agreement, if any.

         3.3  Corporate  Power;  Authorization;   Enforceable  Obligations.  The
Borrower  has the  corporate  power and  authority  and the legal right to make,
execute,  deliver and perform its obligations under this Agreement, its Security
Agreement  and the Notes,  and to borrow  hereunder  and has taken all necessary
corporate action to authorize the borrowings on the terms and conditions of this
Agreement,  its Security Agreement and the Notes and to authorize the execution,
delivery and  performance  of this  Agreement,  its Security  Agreement  and the
Notes.  No consent  or  authorization  of,  filing  with,  or other act by or in
respect  of any other  Person  (including  stockholders  and  creditors  of such
Borrower) or any  Governmental  Authority,  is required in  connection  with the
borrowings hereunder or with the execution, delivery,  performance,  validity or
enforceability of this Agreement,  its Security  Agreement or the Notes,  except
for the filing of financing statements required to perfect the security interest
intended to be granted by the Security Agreement.  This Agreement,  its Security
Agreement  and the Notes will be duly  executed  and  delivered on behalf of the
Borrower and this Agreement, its Security Agreement and the Notes, when executed
and delivered, will each constitute a legal, valid and binding obligation of the
Borrower  enforceable  against the Borrower in accordance with its terms, except
as  enforceability  may  be  limited  by  applicable   bankruptcy,   insolvency,
reorganization,   moratorium  or  similar  laws  affecting  the  enforcement  of
creditors' rights generally and equitable  principles of general  applicability,
regardless of whether  enforcement is sought in an action at law or a proceeding
in equity.

         3.4 Power,  Authorization,  Enforceable Obligations of Guarantors. Each
Guarantor has the power and  authority and the legal right to make,  deliver and
perform its Guarantee and Security  Agreement and the transactions  contemplated
thereby and has taken all necessary corporate action to authorize the execution,
delivery and performance of its Guarantee and Security Agreement.  No consent or
authorization of, filing with, or other act by or in respect of any other Person
(including  stockholders  and creditors of the  Guarantors) or any  Governmental
Authority is required in connection with the execution,  delivery,  performance,
validity or enforceability of such Guarantee or Security  Agreement,  except for
the filing of financing  statements  required to perfect the  security  interest
intended to be granted by the Security Agreement.  Each individual and corporate
Guarantee and each Security  Agreement  have been duly executed and delivered by
the  respective  parties  thereto,  and each such document  constitutes a legal,
valid and binding  obligation of the respective  Guarantor  enforceable  against
such Guarantor in accordance  with its terms,  except as  enforceability  may be
limited by  applicable  bankruptcy,  insolvency,  reorganization,  moratorium or
similar laws  affecting  the  enforcement  of  creditor's  rights  generally and
equitable principles of general applicability, regardless of whether enforcement
is sought in an action at law or a proceeding in equity.

                                       20
<PAGE>

         3.5 No Legal Bar.  The  execution,  delivery  and  performance  of this
Agreement, the Security Agreement and the Notes and the borrowings hereunder and
the use of the proceeds thereof by the Borrower and the execution,  delivery and
performance  of  the  Guarantees  by  the  Guarantors,   will  not  violate  any
Requirement  of  Law or  any  Contractual  Obligation  of  the  Borrower  or the
Guarantors,  and will not result in, or require,  the creation or  imposition of
any Lien on any of its properties or revenues pursuant to any Requirement of Law
or Contractual Obligation except those in favor of the Bank provided herein.

         3.6 No Material Litigation. No litigation,  investigation or proceeding
of or before any arbitrator or  Governmental  Authority is pending by or against
any  Specified  Person or against any of their  properties  or revenues (a) with
respect to this Agreement,  the Security Agreement,  Notes, or the Guarantees or
any of the  transactions  contemplated  hereby or thereby,  or (b) except as set
forth in the Company's  Quarterly Report on Form 10-Q for the quarter ended June
30, 1998, which if adversely determined, would have a material adverse effect on
the  business,  operations,  property or  financial  or other  condition  of the
Borrower and its Subsidiaries or of the Guarantors.

         3.7 No Default. No Specified Person is in default under or with respect
to any Contractual  Obligation in any respect which could be materially  adverse
to the  business,  operations,  property or financial or other  condition of the
Borrower  or any of  its  Subsidiaries  or of the  Guarantors,  or  which  could
materially  and adversely  affect the ability of (i) the Borrower to perform its
obligations under this Agreement,  its Security Agreement, the Notes or any Loan
Document  to which  it is a  party,  or (ii) the  Guarantors  to  perform  their
obligations  under the  Guarantees.  No Default or Event of Default has occurred
and is continuing.

         3.8  No  Burdensome  Restrictions.  No  Contractual  Obligation  of any
Specified  Person and no  Requirement of Law materially  adversely  affects,  or
insofar as the  Borrower may  reasonably  foresee may so affect,  the  business,
operations,  property or  financial  or other  condition  of any such  Specified
Person.

         3.9 Taxes.  The Borrower and the Guarantors  have filed or caused to be
filed all tax returns  which to the knowledge of the Borrower are required to be
filed, and have paid all taxes shown to be due and payable on said returns or on
any assessments made against them or any of their property.

         3.10  Federal  Regulations.  The  Borrower  is not  engaged nor will it
engage,  principally or as one of its important  activities,  in the business of
extending  credit for the  purpose of  "purchasing"  or  "carrying"  any "margin
stock"  within  the  respective  meanings  of each  of the  quoted  terms  under
Regulation U of the Board of Governors of the Federal  Reserve System as now and
from time to time  hereafter  in effect.  No part of the  proceeds  of any Loans
hereunder  will be used for  "purchasing"  or  "carrying"  "margin  stock" as so
defined or for any purpose which violates,  or which would be inconsistent with,
the provisions of the Regulations of such Board of Governors.

                                       21
<PAGE>

         3.11 Environmental Matters.

         (a) None of the Real Property contains, or to the best knowledge of the
Borrower  has  previously  contained,  (i)  any  hazardous  or  toxic  waste  or
substances in amounts or  concentrations  which (A)  constitute or constituted a
violation of or (B) could reasonably be expected to give rise to liability under
any  applicable  environmental  law,  except  in  either  case  insofar  as such
violation  or  liability  could not  reasonably  be  expected to have a material
adverse  effect  on the  business,  operations  or  financial  condition  of the
Borrower and the Guarantors or (ii) any underground  storage tanks,  except such
as  have  been  removed  or  remediated  in  accordance   with  all   applicable
environmental laws.

         (b) The Real Property is in  compliance  in all material  respects with
all applicable federal, state and local environmental standards and requirements
affecting such Real Property, and there are no environmental conditions of which
Borrower has knowledge which could  interfere in any material  respects with the
continued use of the Real Property.

         (c) Neither the Borrower nor any of its  Subsidiaries nor any Guarantor
has received any notices of violations or advisory action by regulatory agencies
regarding environmental control matters or environmental permit compliance.

         (d)  Hazardous  waste  has not  been  transferred  from any of the Real
Property to any other  locations  except in compliance in all material  respects
with all applicable environmental laws, regulations or permit requirements.

         (e)  With  respect  to the Real  Property,  there  are no  proceedings,
governmental  administrative  actions or judicial proceedings pending or, to the
best knowledge of the Borrower,  contemplated under any federal,  state or local
law regulating the discharge of hazardous or toxic  materials or substances into
the environment,  to which the Borrower or any of its Subsidiaries is named as a
party.

         3.12. Year 2000 Issue. The Borrower and its Subsidiaries  have reviewed
the  effect  of the Year  2000  Issue on the  computer  software,  hardware  and
firmware systems and equipment  containing embedded microchips owned or operated
by or for the  Borrower  and its  Subsidiaries  or  used or  relied  upon in the
conduct of their business (including systems and equipment supplied by others or
with  which  such  computer   systems  of  the  Borrower  and  its  Subsidiaries
interface).  The costs to the Borrower and its Subsidiaries of any reprogramming
required as a result of the Year 2000 Issue to permit the proper  functioning of
such systems and equipment and the proper processing of data, and the testing of
such reprogramming,  and of the reasonably foreseeable  consequences of the Year
2000 Issue to the Borrower or any of its Subsidiaries  (including  reprogramming
errors  and the  failure of systems or  equipment  supplied  by others)  are not
reasonably  expected  to result in a Default  or Event of  Default  or to have a
material  adverse  effect on the  business,  assets,  operations,  prospects  or
condition (financial or otherwise) of the Borrower or any of its Subsidiaries.


                                       22
<PAGE>

4.       CONDITIONS PRECEDENT.

         4.1 Conditions to Initial  Extensions of Credit.  The obligation of the
Bank to make the  initial  extension  of credit  to the  Borrower  hereunder  is
subject to the satisfaction of the following conditions precedent:

                  (a) Notes and  Agreements.  The Bank shall have  received  the
Facility A Revolving  Credit Note, the Facility B Revolving  Credit Note and the
Term  Note,  conforming  to the  requirements  hereof and duly  executed  by the
Borrower.

                  (b)  Guarantees.  The Bank shall have received the  Guarantees
substantially in the form of Exhibit F hereto duly executed by each Guarantor.

                  (c) Security  Agreements.  The Bank shall have  received (i) a
Security  Agreement  from the Borrower and each Guarantor  substantially  in the
form of Exhibit G hereto,  together with UCC-1 financing  statements executed by
each such entity in favor of the Bank.

                  (d) Borrower Pledge Agreement.  The Bank shall have received a
Borrower Pledge Agreement from the Borrower substantially in the form of Exhibit
H hereto duly executed by the Borrower.

                  (e) Borrowing Base  Certificate.  The Bank shall have received
and satisfactorily reviewed a Borrowing Base Certificate as set forth in Section
5.2(c) hereof.

                  (f) Legal Opinion.  The Bank shall have received an opinion of
counsel to the Borrower and each Guarantor  substantially in the form of Exhibit
E hereto.  Such  opinion  shall also cover such other  matters  incident  to the
transactions  contemplated  by this Agreement and the Loan Documents as the Bank
shall reasonably require.

                  (g)  Origination  Fees.  The Bank  shall  have  been  paid the
aggregate  $50,000 balance of the  origination  fees described in the Commitment
Letter.

                  (h) Certificates and Resolutions. The Bank shall have received
(i)  copies  of the  resolutions  of the  board  of  directors  of the  Borrower
authorizing  the execution,  delivery and  performance of this Agreement and the
Loan  Documents  certified by the  Secretary  or an Assistant  Secretary of such
corporation  and like  resolutions of each Guarantor  authorizing the execution,
delivery and performance of its respective Guarantee and Security Agreement,  if
any, certified  respectively by the Secretary or an Assistant  Secretary of each
such corporation;  (ii) a certificate of the Secretary or an Assistant Secretary
of the Borrower and each Guarantor  certifying the names and true  signatures of
the officers of each such  corporation  authorized to sign any and all documents
to be  delivered  by  each  such  corporation  or as  required  or  contemplated
hereunder;  and  (iii)  good  standing  certificates  issued  by the  applicable
Governmental Authority.

                  (i) Lien Searches. The Bank shall have received the results of
searches of Uniform  Commercial  Code and other Lien filings with respect to the
Borrower  in each state  where it  conducts  business  and such  searches  shall
disclose no Liens on any assets  encumbered,  except for Liens  permitted  under
Section 7.4, or if unpermitted Liens are disclosed, the Bank shall have received
satisfactory evidence of release of such Liens.

                                       23
<PAGE>

                  (j) Commitment  Letter.  The Borrower shall have satisfied all
the terms and conditions of the Commitment Letter.

                  (k) Legal  Structure.  The Bank  shall be  satisfied  with the
corporate and legal  structure  and  capitalization  of the Company,  including,
without limitation,  the charter and bylaws of the Company and each agreement or
instrument relating thereto.

                  (l) Examination.  The Bank shall have conducted an examination
of the  Company's  books and  records  and the books and  records of the Network
Sites  (subject  to  applicable  laws  and   regulations   relating  to  patient
confidentiality),  at the Company's expense, by an examiner  satisfactory to the
Bank and such  examination  shall be in form and substance  satisfactory  to the
Bank.

                  (m) Consents.  All governmental  and third-party  consents and
approvals   necessary  in  connection  with  each  aspect  of  the  transactions
contemplated by this Agreement shall have been obtained  (without the imposition
of any  conditions  that are not  acceptable  to the Bank)  and shall  remain in
effect;  all applicable waiting periods shall have expired or been terminated or
waived  without  any  adverse  action  being  taken  by  any  authority   having
jurisdiction;  and no law or  regulation  shall be applicable in the judgment of
the Bank that restrains,  prevents or imposes material  adverse  conditions upon
any aspect of the transactions contemplated by this Agreement.

                  (n) Compliance.  The intended use of the proceeds of the Loans
shall  be in full  compliance  with  all  applicable  laws,  including,  without
limitation,  Regulations  G, T, U and X of the Board of Governors of the Federal
Reserve System.

                  (o) Additional Matters.  All other documents and legal matters
in connection  with the  transactions  contemplated  by this Agreement  shall be
satisfactory in form and substance to the Bank and its counsel.

         4.2 Conditions to All Extensions of Credit.  The obligation of the Bank
to make any Loan  (including  the initial  Loans) to be made by it  hereunder is
subject to the satisfaction of the following conditions precedent:

                  (a)  Representations  and Warranties.  The representations and
warranties   made  by  the  Borrower  herein  or  which  are  contained  in  any
certificate,  document or financial or other written statement  furnished at any
time  under  or in  connection  herewith,  shall  be  correct  on  and as of the
borrowing  date for such  extension  of credit as if made on and as of such date
except to the extent any such  representation or warranty expressly speaks as of
a specific date.

                  (b) No  Default  or Event of  Default.  No Default or Event of
Default shall have occurred and be continuing on the date an extension of credit
is to be made or after  giving  effect to the  extension of credit to be made on
such date.

                                       24
<PAGE>

                  (c) Compliance with Borrowing Base. As to Facility A Revolving
Credit Loans only,  after  taking into  account the Facility A Revolving  Credit
Loan to be made, all outstanding Facility A Revolving Credit Loans together with
the  requested  Facility A Revolving  Credit Loan shall not exceed the Borrowing
Base.

                  (d)  Compliance  with  Section 7.2. As to Facility B Revolving
Credit Loans only,  the Borrower  shall be in full  compliance  with each of the
provisions set forth in Section 7.2.

         Each   borrowing  by  the  Borrower   hereunder   shall   constitute  a
representation  and  warranty  by the  Borrower  as of the  date  of  each  such
borrowing  that the  conditions in clauses (a), (b), (c) and (d) of this Section
have been satisfied.


5.       AFFIRMATIVE COVENANTS.

         The Borrower  hereby agrees that, so long as any Commitment  remains in
effect, any Note remains outstanding and unpaid, or any other amount is owing to
the Bank  hereunder,  the Borrower will and will cause each Specified  Person as
applicable to:

         5.1 Corporate Existence and Qualification.  Take the necessary steps to
preserve its corporate existence and its right to conduct business in all states
in which the  nature of its  business  requires  qualification  to do  business,
except where the failure so to qualify could not  reasonably by expected to have
a material adverse effect on the business,  operations or financial condition of
the Borrower or the Guarantors.

         5.2 Financial Information and Compliance Certificates.

                  (a)  Keep  its  books  of  account  in  accordance  with  good
accounting  practices  and furnish to the Bank within 90 days after the last day
of each of its fiscal years, (i) the consolidated balance sheets of the Borrower
and its  Subsidiaries  as at such last day of the fiscal year and  statements of
income and retained  earnings and cash flows for such fiscal year each  prepared
in accordance with GAAP consistently applied and certified without qualification
by a firm of independent certified public accountants reasonably satisfactory to
the  Bank;  and  within  (ii) 45 days  after  the  close  of each  fiscal  month
consolidated balance sheets, statements of income and retained earnings and cash
flows of the  Borrower and its  Subsidiaries  as of the last day of and for such
month  and for the  period  of the  fiscal  year  ended  as of the  close of the
particular month, all such monthly  statements to be in reasonable  detail,  and
certified by the chief financial or accounting officer of the Borrower as having
been  prepared in  accordance  with GAAP  (exclusive of footnotes and subject to
year-end  adjustments).  The Borrower  will also,  with  reasonable  promptness,
furnish such other data as may be  reasonably  requested by the Bank and will at
all  times  and  from  time to time  permit  the Bank by or  through  any of its
officers,  agents,  employees,  attorneys  or  accountants  to inspect  and make
extracts from such Borrower's books and records.

                                       25
<PAGE>

                  (b)  Within 45 days  after the close of each  fiscal  quarter,
deliver a certificate  of the  president  and the chief  financial or accounting
officer  of the  Borrower  evidencing  a  computation  of  compliance  with  the
provisions  of Section 6 hereof and a  computation  of the Leverage  Ratio (each
including supporting detail of each applicable  calculation) and stating that in
each case  except as  disclosed  in such  certificate,  the person  making  such
certificate has no knowledge of any Default or Event of Default.

                  (c) Within 30 days after the last day of each  month,  deliver
to the Bank an accounts receivable agings report accompanied by a Borrowing Base
Certificate  indicating a computation  of the Borrowing Base and executed by the
chief  financial  or  accounting  officer of the  Borrower,  covering the period
ending the last day of the immediately preceding month.

                  (d) Promptly after the same are sent,  copies of all financial
statements  and  reports  which  the  Borrower  sends to its  stockholders,  and
promptly  after the same are  filed,  copies  of all  financial  statements  and
reports  which  the  Borrower  may  make  to,  or file  with,  any  Governmental
Authority, agency, commission, board or bureau.

                  (e) Within five days of any officer of the Borrower  obtaining
knowledge of any Default,  if such Default is then  continuing,  Borrower  shall
furnish to the Bank a certificate of the chief  financial or accounting  officer
of the  Borrower  setting  forth the details  thereof  and the action  which the
Borrower is taking or proposes to take with respect thereto.

         5.3  Insurance.  Maintain  insurance  with  responsible  and  reputable
insurance  companies or  associations in such amounts and covering such risks as
are  usually  carried by  companies  engaged in  similar  businesses  and owning
similar  properties in the same general areas in which the Borrower operates and
naming the Bank as an additional insured or loss payee (as appropriate)  thereon
as its interest may appear.

         5.4  Preservation  of  Properties;  Compliance  with Law.  Maintain and
preserve all of its properties which are used or which are useful in the conduct
of its  business in good working  order and  condition,  ordinary  wear and tear
excepted and comply in all material respects with all Requirements of Law .

5.5 Taxes. Duly pay and discharge all taxes or other claims which might become a
lien upon any of its property except to the extent that any thereof are being in
good faith appropriately contested with adequate reserves provided therefor.

         5.6 Maintain Operating Accounts.  Maintain all of its primary operating
accounts  with the Bank,  unless  the  Borrower  shall  have  provided  evidence
reasonably  satisfactory to the Bank that for geographical  purposes or in order
to comply with  applicable  Requirements of Law such accounts are required to be
maintained elsewhere.

                                       26
<PAGE>

         5.7 Notice of  Litigation.  Promptly  notify the Bank in writing of any
litigation,  legal  proceeding  or dispute,  other than disputes in the ordinary
course of  business  or,  whether  or not in the  ordinary  course of  business,
involving amounts in excess of $50,000, affecting the Borrower or any Subsidiary
whether or not fully covered by insurance,  and regardless of the subject matter
thereof  (excluding,  however,  any actions  relating  to workers'  compensation
claims or negligence claims relating to use of motor vehicles,  if fully covered
by insurance, subject to deductibles).

         5.8 Indemnity (Environmental  Matters).  Indemnify the Bank against any
liability,  loss,  cost,  damage,  or expense  (including,  without  limitation,
reasonable  attorneys'  fees) arising from (i) the  imposition or recording of a
lien by any  local,  state,  or federal  government  or  governmental  agency or
authority  pursuant to any  Cleanup  Laws;  (ii)  claims of any private  parties
regarding  violations of Cleanup Laws; and (iii) costs and expenses  (including,
without  limitation,  reasonable  attorneys'  fees  and fees  incidental  to the
securing of  repayment  of such costs and  expenses)  incurred by any  Specified
Person or the Bank in connection with compliance by any Specified  Person or the
Bank with any statute,  regulation or order issued  pursuant to any Cleanup Laws
by any local, state or federal government or governmental agency or authority.

         5.9 Year 2000 Issue.  Take, and shall cause each of its Subsidiaries to
take,  all  necessary  action to complete in all material  respects by March 31,
1999, the reprogramming of computer software,  hardware and firmware systems and
equipment  containing  embedded  microchips  owned  or  operated  by or for  the
Borrower  and its  Subsidiaries  or used or relied  upon in the conduct of their
business  (including systems and equipment supplied by others or with which such
systems of the  Borrower  or any of its  Subsidiaries  interface)  required as a
result of the Year 2000 Issue to permit the proper  functioning of such computer
systems and other equipment and the testing of such systems and equipment, as so
reprogrammed.  At the request of the Bank, the Borrower shall provide, and shall
cause each of its Subsidiaries to provide,  to the Bank reasonable  assurance of
its compliance with the preceding sentence.

         5.10 Material  Subsidiaries.  Cause each direct and indirect Subsidiary
of the  Borrower to become a Guarantor  (unless  the Bank has  provided  written
notice to the Borrower  that such  Subsidiary  is not, in the Bank's  reasonable
judgment, a "material"  Subsidiary of the Borrower) and take any action as shall
be  necessary to grant the Bank a first  priority  perfected  security  interest
(subject to liens  permitted by Section  7.4) in all the issued and  outstanding
Capital  Stock  and  all  the  personal  property  and  fixtures  of  each  such
Subsidiary.

         5.11 Reserved.

         5.12 After-Acquired Stock. Deliver to the Bank any After-Acquired Stock
(as defined in Section 7.3  hereof) and a stock power in  connection  therewith,
substantially  in the form of Exhibit I hereto,  executed by the Borrower,  such
delivery  to occur not more than 10 days  after the  acquisition  of such  After
Acquired Stock.

                                       27
<PAGE>

6.       FINANCIAL COVENANTS.

         The Borrower  hereby agrees that, so long as any Commitment  remains in
effect, any Note remains outstanding and unpaid, or any other amount is owing to
the Bank hereunder,  the Borrower and its  Subsidiaries on a consolidated  basis
will:

         6.1 Fixed Charge  Coverage  Ratio.  Maintain as at the last day of each
fiscal quarter a Fixed Charge Coverage Ratio of not less than 1.2 to 1.0.

         6.2  Consolidated  Effective Net Worth.  Maintain as at the last day of
each fiscal quarter Consolidated  Effective Net Worth in an amount not less than
$26,750,000,  plus 50% of the  Consolidated  Adjusted Net Income of the Borrower
and its Subsidiaries,  on a cumulative basis, commencing with June 30, 1998, for
the fiscal quarter then ending (provided,  that,  notwithstanding the definition
of Adjusted Net Income, there shall not be any reduction for any net loss), plus
80% of the net  proceeds,  on a  cumulative  basis,  received by the Borrower in
connection  with any issuance of  securities  (whether for cash or otherwise) by
the Borrower during the fiscal quarter then ending.

         6.3 Adjusted Leverage Ratio. Maintain as at the last day of each fiscal
quarter a ratio of  Consolidated  Senior  Funded Debt to  Consolidated  Adjusted
EBITDA of not more than 2.5 to 1.0.

7.       NEGATIVE COVENANTS.

         The Borrower  hereby agrees that, so long as any Commitment  remains in
effect, any Note remains outstanding and unpaid, or any other amount is owing to
the Bank  hereunder it will not, nor will it permit any of its  Subsidiaries  or
any Guarantor or any of its Subsidiaries to:

         7.1  Indebtedness  for Borrowed Money.  Incur, or permit to exist,  any
Indebtedness  for borrowed money except (i)  Indebtedness  incurred  pursuant to
borrowings  hereunder  and  under  any  other  loans  made  by the  Bank  in its
discretion to the Borrower or any Subsidiary,  (ii) Indebtedness existing on the
date hereof and reflected in the financial statements referred to in Section 3.1
hereof,  (iii)  Indebtedness  incurred  after the date of this  Agreement  in an
aggregate  amount not in excess of $1,125,000 in any fiscal year (except for the
period from the date hereof  through  December  31, 1998 such  aggregate  amount
shall be $750,000)  and not in excess of $3,000,000 in the aggregate at any time
outstanding; provided, that, same is incurred in connection with the acquisition
of fixed assets  within the  limitations  of Section 7.8 hereof,  (iv)  purchase
money  Indebtedness  incurred in connection with Permitted  Acquisitions and (v)
Indebtedness  of a Person which is the subject of a Permitted  Acquisition or to
which any assets or business  acquired in a  Permitted  Acquisition  are subject
provided that, in each case, such  Indebtedness  existed at the time of, and was
not created in anticipation of, such Permitted Acquisition.

7.2      Mergers, Acquisitions and Sales of Assets.
        
         (a) Enter  into any merger or  consolidation  or  liquidate,  windup or
dissolve  itself or sell,  transfer or lease or otherwise  dispose of all or any
substantial  part of its assets  (other than (i) sales of inventory and obsolete
equipment  in the  ordinary  course  of  business  and (ii) the  disposition  of
Reproductive Science Associates,  Inc. and Reproductive Science Center of Dallas
by means of the sale of the Management Contract relating to such practice to the
physician/owner  of such practice  except that any  Subsidiary may merge into or
consolidate  with any other Subsidiary which is wholly-owned by the Borrower and
any  Subsidiary  which  is  wholly-owned  by the  Borrower  may  merge  with  or
consolidate  into the  Borrower  provided  that the  Borrower  is the  surviving
corporation.

                                       28
<PAGE>

         (b) Make any  Acquisition  other than as  provided  in  Section  7.2(a)
unless  each  of  the  following  conditions  shall  have  been  satisfied  (any
Acquisition  permitted  by  Section  7.2(a)  or  whereby  each of the  following
conditions shall have been satisfied shall be referred to herein as a "Permitted
Acquisition"):

                  (i) the  Acquisition  Cost in respect thereof shall not exceed
(i) $8,000,000 with respect to any individual Acquisition;  and (ii) $20,000,000
in the aggregate during any fiscal year;

                  (ii) no Default or Event of Default  shall  exist  immediately
before or after giving effect thereto;

                  (iii) the Person,  business or assets  acquired in  connection
with such  Acquisition are related to the infertility and assisted  reproductive
technology services business;

                  (iv) the Borrower  shall have  delivered to the Bank, not less
than 10 days prior to the consummation of such Acquisition, (i) a certificate of
a financial officer of the Borrower, in all respects reasonably  satisfactory to
the  Bank  and  dated  the  date of such  consummation,  attaching  a  pro-forma
compliance  certificate  (in a format  satisfactory  to the Bank)  after  giving
effect to such  Acquisition  and based on the most recent  financial  statements
delivered to the Bank pursuant to this Agreement and (ii) copies of the purchase
or merger agreement or any other material  documents executed in connection with
the Acquisition;

                  (v) immediately  after giving effect to each such Acquisition,
all of the representations  and warranties  contained in Section 3 shall be true
and  correct as if then made  except to the extent  any such  representation  or
warranty expressly speaks of a specific date;

                  (vi) the  Acquisition  shall have the  approval  of the target
company's board of directors (or similar governing body);

                  (vii) the Bank shall have received such other  information  or
documents  as it  shall  have  reasonably  requested  in  connection  with  such
Acquisition.

                  (viii)  the  acquisition   shall  have  been   consummated  in
accordance  with the  definitive  acquisition  agreement,  without any waiver or
amendment of any term or condition  therein not  consented to by the Bank and in
compliance with all applicable laws and all necessary approvals;

                                       29
<PAGE>

                  (ix) the Bank shall be satisfied that any otherwise applicable
state takeover law and any applicable  supermajority  charter provisions are not
applicable  to  the   Acquisition  or  that  any  conditions  to  avoiding  such
restrictions have been satisfied;

                  (x) all  governmental  and third-party  consents and approvals
necessary  in  connection  with each aspect of the  Acquisition  shall have been
obtained  (without the imposition of any  conditions  that are not acceptable to
the Bank) and shall remain in effect;  all applicable waiting periods shall have
expired or been  terminated or waived  without any adverse action being taken by
any authority having jurisdiction;  and no law or regulation shall be applicable
in the judgment of the Bank that restrains, prevents or imposes material adverse
conditions upon any aspect of the Acquisition; and

                  (xi) any Acquisition  with a total  Acquisition Cost in excess
of $1,000,000 or any Acquisition  occurring after the Borrower has paid,  during
any twelve-month period, in excess of $3,000,000 in Acquisition Costs in respect
of all such  Acquisitions  during such  period,  will require the consent of the
Bank.

         7.3 Lending, Advances and Investments. Lend or advance money, credit or
property to or invest in (by capital contribution,  loan, purchase or otherwise)
any  firm,  corporation,   or  other  Person  except  (i)  investments  in  Cash
Equivalents,  (ii) accounts  receivable arising out of sales of inventory or the
rendering of services in the ordinary course of business (iii) loans or advances
not in excess of  $1,500,000  in the  aggregate at any one time  outstanding  to
Practice Groups who have executed a Management Agreement with the Borrower, (iv)
purchases of accounts receivable pursuant to Management  Agreements to which the
Borrower or any  Subsidiary  is party;  provided same is existing as of the date
hereof or  arises  out of a  Permitted  Acquisition,  (v) a loan in a  principal
amount of up to $50,000 to Gerardo Canet and a loan in a principal  amount of up
to $15,000 to Donald Wood to enable each to exercise  options to purchase  stock
of the Borrower, (vi) loans to officers, directors and employees in an aggregate
amount at any one time outstanding not to exceed $500,000, (vii) the purchase of
537 shares of Shady Grove  Fertility  Centers,  Inc. not presently  owned by the
Borrower,  from Robert J.  Stillman,  M.D.  ("After-Acquired  Stock") and (viii)
payroll advances to employees which are to be repaid through payroll deduction.

         7.4 Liens.  Create,  assume or permit to exist,  any Lien on any of its
property or assets now owned or hereafter  acquired except (i) Liens in favor of
the Bank;  (ii) other Liens  incidental  to the  conduct of its  business or the
ownership of its property and assets which were not incurred in connection  with
the  borrowing of money or the  obtaining of advances or credit and which do not
materially impair the use thereof in the operation of its business;  (iii) Liens
for taxes or other  governmental  charges which are not  delinquent or which are
being  contested  in  good  faith  and for  which  a  reserve  shall  have  been
established in accordance with generally accepted  accounting  principles;  (iv)
purchase  money Liens granted to secure the unpaid  purchase  price of any fixed
assets  purchased  within the  limitations  of Section 7.8 hereof;  (v) judgment
Liens in existence  less than 30 days after the entry thereof or with respect to
which execution has been stayed;  (vi) any interest or title of a lessor secured
by a lessor's  interest under any lease permitted by this  Agreement;  and (vii)
leases or subleases  granted to others not  interfering in any material  respect
with the business of such Person..

                                       30
<PAGE>

         7.5 Contingent Liabilities. Assume, endorse, be or become liable for or
guarantee the obligations of any Person excluding  however,  (i) the endorsement
of negotiable  instruments  for deposit or collection in the ordinary  course of
business;  (ii) the  Guarantees and (iii) the assumption of leases in connection
with an Acquisition.

         7.6  Dividends.  (a) Declare or pay any dividends on its Capital Stock,
except (i) dividends  payable solely in shares of its own common stock,  (ii) as
long as no Default or Event of Default has occurred and is continuing, dividends
in connection  with the Borrower's  outstanding  preferred stock in an aggregate
amount not in excess of  $133,000  in any fiscal  year and (iii) any  Subsidiary
wholly owned by the Borrower may declare and pay dividends to the  Borrower,  or
(b) purchase,  redeem,  retire or otherwise  acquire any of its Capital Stock at
any time  outstanding  (other than in connection with the surrender of shares of
the  Borrower's  Series  A  Cumulative  Convertible  Preferred  Stock  upon  its
conversion into shares of the Borrower's Common Stock).

         7.7  Sales  of  Receivables;  Sale  -  Leasebacks.  Sell,  discount  or
otherwise  dispose of notes,  accounts  receivable or other obligations owing to
the Borrower, with or without recourse,  except for the purpose of collection in
the ordinary course of business; or sell any asset pursuant to an arrangement to
thereafter lease such asset from the purchaser thereof.

         7.8 Capital Expenditures; Capitalized Leases. Expend or agree to expend
in the aggregate for the Borrower and all  Subsidiaries  in excess of $1,500,000
in any fiscal year for Capital  Expenditures  including  assets  acquired  under
Capitalized  Leases,   excluding  amounts  paid  in  connection  with  Permitted
Acquisitions.

         7.9 Lease  Payments.  Expend in the  aggregate for the Borrower and all
Subsidiaries in excess of $2,000,000 in any fiscal year for the lease, rental or
hire of real or personal  property  pursuant to any rental  agreement  therefor,
whether an operating lease, capitalized lease or otherwise.

         7.10 Nature of Business.  Materially  alter the nature of its business.

         7.11 Stock of Subsidiaries. Sell or otherwise dispose of any Subsidiary
(except in connection  with a merger or  consolidation  of a Subsidiary into the
Borrower or another  Subsidiary)  or permit a Subsidiary to issue any additional
shares of its capital stock except pro rata to its stockholders.

         7.12  ERISA.  (i)  Terminate  any Plan so as to result in any  material
liability to the Pension Benefit Guaranty  Corporation  established  pursuant to
Subtitle  A of Title IV of ERISA  (the  "PBGC"),  (ii)  engage in or permit  any
person under its control to engage in any "prohibited  transaction"  (as defined
in Section 406 of ERISA or Section 4975 of the Internal Revenue Code of 1954, as
amended)  involving any Plan which would subject a Borrower to any material tax,
penalty  or other  liability,  (iii)  incur or  suffer  to  exist  any  material
"accumulated  funding deficiency" (as defined in Section 302 of ERISA),  whether
or not waived, involving any Plan, or (iv) allow or suffer to exist any event or
condition,  which presents a material risk of incurring a material  liability to
the PBGC by reason of termination of any Plan.

                                       31
<PAGE>

         7.13  Accounting  Changes.  Make, or permit any  Subsidiary to make any
change in its accounting  treatment or financial  reporting  practices except as
required or permitted by GAAP in effect from time to time.

         7.14 Transactions with Affiliates. Except for the Management Agreements
and  as  otherwise  specifically  set  forth  in  this  Agreement,  directly  or
indirectly  purchase,  acquire or lease any property from, or sell,  transfer or
lease any property to, or enter into any other  transaction,  with any Affiliate
except in the  ordinary  course of business  and at prices and on terms not less
favorable  to it than those  which would have been  obtained in an  arm's-length
transaction with a non-affiliated third party.


8.       EVENTS OF DEFAULT.

         Upon the occurrence and during the  continuance of any of the following
events (each an Event of Default):

         (a) Borrower  shall fail to pay principal of any of the Notes when due,
or shall fail to pay any interest,  or other amount payable hereunder within two
Business Days after the same becomes due; or

         (b) Any  representation or warranty made or deemed made by the Borrower
herein or which is contained in any certificate,  document or financial or other
written  statement  furnished  at any time  under  or in  connection  with  this
Agreement shall prove to have been false in any material respect on or as of the
date made or deemed made; or

         (c) Borrower  shall  default in the  observance or  performance  of any
covenant or provision contained in Section 6 or 7 hereof; or

         (d) Borrower  shall  default in the  observance or  performance  of any
other provision  contained in this Agreement or any other Loan Document and such
default  shall  continue  unremedied  with respect to other  provisions  of this
Agreement for a period of 10 days after written  notice  thereof is given to the
Borrower  by the  Bank and  with  respect  to other  Loan  Documents  after  the
expiration of any applicable grace or cure periods; or

         (e) Any Specified  Person shall (i) default in any payment in excess of
$10,000 in the aggregate  with respect to any  Indebtedness  for borrowed  money
(other than the Notes) in excess of $50,000 beyond the period of grace,  if any,
provided  in the  instrument  or  agreement  under which such  Indebtedness  was
created; or (ii) default in the observance or performance of any other agreement
or condition relating to any such indebtedness or contained in any instrument or
agreement  evidencing,  securing  or  relating  thereto or any other event shall
occur or  condition  exist,  in each case the  effect of which  default or other
event  or  condition  is to  cause or  permit  the  holder  or  holders  of such
Indebtedness  (or a trustee  or agent on behalf of such  holder or  holders)  to
cause such Indebtedness to become due prior to its stated maturity; or

                                       32
<PAGE>

         (f) (i) Any  Specified  Person shall  commence any case,  proceeding or
other action (A) under any existing or future law of any jurisdiction,  domestic
or foreign,  relating to  bankruptcy,  insolvency,  reorganization  or relief of
debtors,  seeking to have an order for  relief  entered  with  respect to it, or
seeking to  adjudicate it a bankrupt or  insolvent,  or seeking  reorganization,
arrangement,  adjustment, winding-up, liquidation,  dissolution,  composition or
other relief with respect to it or its debts,  or (B) seeking  appointment  of a
receiver,  trustee, custodian or other similar official for it or for all or any
substantial  part of its assets,  or any  Specified  Person shall make a general
assignment  for the benefit of its  creditors;  or (ii) there shall be commenced
against any  Specified  Person any case,  proceeding or other action of a nature
referred  to in clause (i) above  which (A) results in the entry of an order for
relief or any such  adjudication  or  appointment  or (B)  remains  undismissed,
undischarged  or  unbonded  for a period  of 60 days;  or (iii)  there  shall be
commenced  against any  Specified  Person any case,  proceeding  or other action
seeking  issuance of a warrant of  attachment,  execution,  distraint or similar
process against all or any  substantial  part of its assets which results in the
entry of an  order  for any  such  relief  which  shall  have not been  vacated,
discharged,  or stayed or bonded  pending  appeal  within 30 days from the entry
thereof;  or (iv) any Specified  Person shall take any action in furtherance of,
or indicating its consent to, approval of, or  acquiescence  in, any of the acts
set  forth  in  clause  (i),  (ii) or  (iii) of this  Section  8(f);  or (v) any
Specified  Person shall  generally not, or shall be unable to, or shall admit in
writing its inability to, pay its debts as they become due; or

         (g)  (i)  any  Specified   Person  shall  engage  in  any   "prohibited
transaction"  (as defined in Section  406 of ERISA or Section  4975 of the Code)
involving any Plan,  (ii) any  "accumulated  funding  deficiency" (as defined in
Section 302 of ERISA),  whether or not waived,  shall exist with  respect to any
Plan, (iii) a Reportable Event shall occur with respect to, or proceedings shall
commence  to have a trustee  appointed,  or a  trustee  shall be  appointed,  to
administer or to terminate,  any Plan,  which Reportable Event or institution of
proceedings is, in the reasonable  opinion of the Bank,  likely to result in the
termination of such Plan for purposes of Title IV of ERISA,  and, in the case of
a Reportable  Event, the continuance of such Reportable Event unremedied for ten
days after notice of such Reportable Event pursuant to Section  4043(a),  (c) or
(d) of ERISA is given or the continuance of such  proceedings for ten days after
commencement  thereof,  as the case may be,  (iv) any Plan shall  terminate  for
purposes  of Title IV of ERISA,  and in each case in clauses  (i)  through  (iv)
above, such event or condition could subject the Borrower to any tax, penalty or
other  liabilities  in the  aggregate  material  in  relation  to the  business,
operations or property of the Borrower; or

         (h)  the  rendition  by any  court  of a  final  judgment  against  any
Specified Person in excess of $50,000 (to the extent not covered by insurance as
to  which  the  insurer  has   acknowledged   liability)   which  shall  not  be
satisfactorily  stayed,  discharged,  vacated or set aside within 60 days of the
making thereof;  or the attachment of any property of any Specified Person which
has not been released or provided for to the reasonable satisfaction of the Bank
within 60 days after the making thereof; or

         (i) any Guarantee of any Guarantor  shall cease to be in full force and
effect  (other than by reason of a  transaction  permitted by Section  7.2(a) of
this Agreement); or

                                       33
<PAGE>

         (j) any of the Liens  created  and  granted  pursuant  to the  Security
Agreement(s) shall fail to be valid, first,  perfected Liens subject to no prior
or equal Lien except as permitted by this Agreement; or

         (k) a Change of Control shall occur; or

         (l) the Bank shall have  determined in its reasonable  discretion  that
there has occurred a material  adverse  change in the  business,  properties  or
financial condition of the Borrower;

then, in any such event,  any or all of the following  actions may be taken: (i)
the Bank may, at its option,  declare either or all Commitments to be terminated
forthwith,  whereupon such Commitment(s) and all obligations of the Bank to make
Revolving Credit Loans shall  immediately  terminate;  (ii) the Bank may, at its
option,  declare the Loans  hereunder  (with accrued  interest  thereon) and all
other amounts owing under this Agreement and the Notes to be due and payable and
the same,  and all interest  accrued  thereon,  shall  forthwith  become due and
payable without presentment, demand, protest or notice of any kind, all of which
are hereby waived, anything contained herein or in any instrument evidencing the
Loans to the contrary notwithstanding.


9.       COLLATERAL SECURITY.

         9.1 General Loan and Collateral  Agreement.  As collateral security for
the payment of the Obligations,  the Borrower and each Guarantor hereby grant to
the Bank a lien on and security  interest in and right of setoff with respect to
any and all deposits or other sums at any time  credited by or due from the Bank
or any Affiliate of the Bank to the Borrower  and/or any Guarantor,  whether now
existing or hereafter arising, whether in regular or special depository accounts
or otherwise, and any and all monies, credit,  collateral,  securities and other
property of the Borrower and/or any Guarantor, whether now existing or hereafter
arising,  and the proceeds  thereof,  now or hereafter held or received by or in
transit to the Bank or any Affiliate of the Bank from or for the Borrower and/or
any  Guarantor,   whether  for  safekeeping,   custody,  pledge,   transmission,
collection or otherwise. At any time, without demand or notice, the Bank may set
off the same or any part thereof and apply the same to any of the Obligations of
the Borrower  and/or any Guarantor  even though  unmatured and regardless of the
adequacy  of any other  collateral  securing  the  Loans.  ANY AND ALL RIGHTS TO
REQUIRE THE BANK TO EXERCISE  ITS RIGHTS OR REMEDIES  WITH  RESPECT TO ANY OTHER
COLLATERAL  WHICH  SECURES THE  OBLIGATIONS,  PRIOR TO  EXERCISING  ITS RIGHT OF
SETOFF WITH RESPECT TO SUCH DEPOSITS,  CREDITS OR OTHER PROPERTY OF THE BORROWER
OR ANY GUARANTOR, ARE HEREBY KNOWINGLY, VOLUNTARILY AND IRREVOCABLY WAIVED.

         9.2  Additional  Collateral  Security.  In addition  to the  collateral
described in Section 9.1 hereof, payment of the Obligations is also secured by a
first priority (subject to Liens permitted by this Agreement)  security interest
in (i) all personal  property  and fixtures of the Borrower and each  Guarantor,
(ii) assignments of all financing statements in favor of the Borrower and/or the
Guarantors in connection with its (their) purchase of accounts receivable, (iii)
all the issued  and  outstanding  Capital  Stock of each  Subsidiary  that is or
becomes a Guarantor, and (iv) all proceeds and products of the forgoing, whether
now owned or hereafter acquired, as provided in a Security Agreement executed or
to be executed and delivered by the Borrower and each Guarantor to the Bank.


                                       34
<PAGE>

10.      MISCELLANEOUS.

         10.1  Notices.  All  notices,  requests  and  demands  to or  upon  the
respective  parties hereto to be effective shall be in writing unless  otherwise
expressly  provided  herein  and shall be deemed to have been duly given or made
when delivered by hand or by nationally recognized overnight courier service, or
by telegram or telecopy,  or when deposited in the mail addressed as follows, or
to such  address as may be  hereafter  notified  in  writing  by the  respective
parties hereto and any future holders of any Note:

         The Borrower:        IntegraMed America, Inc.
                              One Manhattanville Road
                              Purchase, New York 10577-2100
                              Att: Eugene R. Curcio, Vice President Finance and
                              Chief Financial Officer
                              Telecopy No.: 914-253-8008

         with a copy to:      Bachner, Tally, Polevoy & Misher LLP
                              380 Madison Ave.
                              New York, New York 10017
                              Attn: Sheldon E. Misher, Esq.
                              Telecopy No.: 212-682-5729

         The Bank:            Fleet Bank, National Association
                              244 Westchester Avenue
                              White Plains, New York 10604
                              Att: Thomas G. Carley, Vice President
                              Telecopy No.: 914-681-5045

         with a copy to:      Richard M. Skoller, Esq.
                              Emmet, Marvin & Martin, LLP
                              120 Broadway
                              New York, New York 10271
                              Telecopy No.: 212-238-3100

         10.2 No Waiver;  Cumulative  Remedies.  No failure to  exercise  and no
delay in  exercising,  on the part of the  Bank,  any  right,  remedy,  power or
privilege  hereunder shall operate as a waiver thereof;  nor shall any single or
partial exercise of any right, remedy, power or privilege hereunder preclude any
other or further exercise thereof or the exercise of any other right.

                                       35
<PAGE>

         10.3 Survival of Representations  and Warranties.  All  representations
and  warranties  made  hereunder and in any document,  certificate  or statement
delivered pursuant hereto or in connection  herewith shall survive the execution
and delivery of this Agreement and the Notes.

         10.4 Payment of Expenses; Examination.

         (a) The Borrower  agrees to pay or reimburse the Bank for all its costs
and expenses (including, without limitation, the reasonable fees and expenses of
attorneys  for the Bank)  incurred in  connection  with (i) the  enforcement  or
preservation  of any rights  under this  Agreement or any Note or any other Loan
Document  or any  other  instrument  or  agreement  entered  into in  connection
herewith or therewith  including,  without  limitation,  the reasonable fees and
disbursements  of attorneys for the Bank;  (ii) any claim or action  threatened,
made or brought  against  the Bank  arising  out of or relating to any extent to
this  Agreement,  the  Security  Agreement,  any Note or Loan  Documents  or any
instrument  or  agreement  entered  into in  connection  with  the  transactions
contemplated hereby or thereby; (iii) the perfection of any security interest in
the Collateral or in the  maintenance of the  Collateral;  (iv) any amendment or
modification  of any Loan  Document;  (v) the  payment  of any tax,  assessment,
recording fee or similar  charge imposed on or with respect to the Collateral or
the filing or  recording of any Loan  Document;  (vi) any waiver of any right of
the Bank under any Loan Document and (vii) the reasonable fees and disbursements
of any counsel to the Bank  incurred  from time to time in  connection  with the
transactions contemplated by this Agreement.

         (b) The Borrower agrees that at any time and from time to time the Bank
may conduct an examination of the Borrower's books and records and the books and
records  of each  Network  Site  (subject  to  applicable  laws and  regulations
relating to patient  confidentiality).  The cost of one such examination in each
calendar year shall be borne by the Borrower; provided, that, should at any time
a Default or Event of Default shall have occurred and be continuing, the cost of
all such  examinations  shall  thereafter  be borne by the  Borrower  until such
Default or Event of Default shall have been cured or waived. The obligations set
forth in this  Section  10.4 shall be in  addition to any other  obligations  or
liabilities of the Borrower to the Bank hereunder or at common law or otherwise.
The  provisions  of this Section 10.4 shall survive the payment of the Notes and
the termination of this Agreement.

         10.5 WAIVER OF JURY TRIAL,  SET-OFF AND COUNTERCLAIM.  THE BORROWER AND
THE BANK MUTUALLY  HEREBY  KNOWINGLY,  VOLUNTARILY AND  INTENTIONALLY  WAIVE THE
RIGHT TO A TRIAL BY JURY,  AND THE BORROWER  WAIVES THE RIGHT TO  INTERPOSE  ANY
SETOFF OR  COUNTERCLAIM,  IN EACH CASE IN  RESPECT  OF ANY CLAIM  BASED  HEREON,
ARISING OUT OF,  UNDER OR IN  CONNECTION  WITH THIS  AGREEMENT OR ANY OTHER LOAN
DOCUMENTS  CONTEMPLATED  TO BE EXECUTED IN CONNECTION  HEREWITH OR ANY COURSE OF
CONDUCT, COURSE OF DEALINGS,  STATEMENTS (WHETHER VERBAL OR WRITTEN ) OR ACTIONS
OF ANY PARTY.  THIS WAIVER  CONSTITUTES  A MATERIAL  INDUCEMENT  FOR THE BANK TO
ACCEPT THIS AGREEMENT AND MAKE THE LOANS.

                                       36
<PAGE>

         10.6 WAIVER OF AUTOMATIC  STAY. THE BORROWER  AGREES THAT, IN THE EVENT
THAT THE BORROWER,  ANY GUARANTOR OR ANY OF THE PERSONS OR PARTIES  CONSTITUTING
THE  BORROWER  OR ANY  GUARANTOR  SHALL  (i) FILE WITH ANY  BANKRUPTCY  COURT OF
COMPETENT  JURISDICTION  OR BE THE SUBJECT OF ANY PETITION UNDER TITLE 11 OF THE
U.S. CODE, AS AMENDED  ("BANKRUPTCY CODE"), (ii) BE THE SUBJECT OF ANY ORDER FOR
RELIEF  ISSUED UNDER THE  BANKRUPTCY  CODE,  (iii) FILE OR BE THE SUBJECT OF ANY
PETITION SEEKING ANY  REORGANIZATION,  ARRANGEMENT,  COMPOSITION,  READJUSTMENT,
LIQUIDATION,  DISSOLUTION, OR SIMILAR RELIEF UNDER ANY PRESENT OR FUTURE FEDERAL
OR STATE ACT OR LAW  RELATING TO  BANKRUPTCY,  INSOLVENCY,  OR OTHER  RELIEF FOR
DEBTORS,  (iv) HAVE SOUGHT OR CONSENTED TO OR ACQUIESCED IN THE  APPOINTMENT  OF
ANY TRUSTEE, RECEIVER,  CONSERVATOR, OR LIQUIDATOR, OR (v) BE THE SUBJECT OF ANY
ORDER,  JUDGMENT,  OR  DECREE  ENTERED  BY ANY COURT OF  COMPETENT  JURISDICTION
APPROVING  A  PETITION   FILED  AGAINST  SUCH  PARTY  FOR  ANY   REORGANIZATION,
ARRANGEMENT,  COMPOSITION,  READJUSTMENT,  LIQUIDATION,  DISSOLUTION, OR SIMILAR
RELIEF  UNDER ANY  PRESENT  OR FUTURE  FEDERAL OR STATE ACT OR LAW  RELATING  TO
BANKRUPTCY,  INSOLVENCY,  OR RELIEF FOR  DEBTORS,  THE BANK SHALL  THEREUPON  BE
ENTITLED AND THE BORROWER  IRREVOCABLY  CONSENTS TO IMMEDIATE AND  UNCONDITIONAL
RELIEF FROM ANY AUTOMATIC STAY IMPOSED BY SECTION 362 OF THE BANKRUPTCY CODE, OR
OTHERWISE,  ON OR AGAINST  THE  EXERCISE  OF THE RIGHTS AND  REMEDIES  OTHERWISE
AVAILABLE TO THE BANK AS PROVIDED FOR HEREIN,  IN ANY NOTE, OTHER LOAN DOCUMENTS
DELIVERED  IN  CONNECTION  HEREWITH  AND AS  OTHERWISE  PROVIDED BY LAW, AND THE
BORROWER HEREBY  IRREVOCABLY  WAIVES ANY RIGHT TO OBJECT TO SUCH RELIEF AND WILL
NOT CONTEST ANY MOTION BY THE BANK SEEKING  RELIEF FROM THE  AUTOMATIC  STAY AND
THE BORROWER WILL COOPERATE WITH THE BANK, IN ANY MANNER  REQUESTED BY THE BANK,
IN ITS EFFORTS TO OBTAIN RELIEF FROM ANY SUCH STAY OR OTHER PROHIBITION.

         10.7 LIMITATION OF LIABILITY. NO CLAIM MAY BE MADE BY THE BORROWER, ANY
GUARANTOR,  ANY SPECIFIED  PERSON,  OR ANY OTHER PERSON  AGAINST THE BANK OR THE
AFFILIATES,  DIRECTORS, OFFICERS, EMPLOYEES, ATTORNEYS OR AGENTS OF THE BANK FOR
ANY  SPECIAL,  INDIRECT  OR  CONSEQUENTIAL  DAMAGES  OR, TO THE  FULLEST  EXTENT
PERMITTED BY LAW,  FOR ANY PUNITIVE  DAMAGES IN RESPECT OF ANY CLAIM OR CAUSE OF
ACTION  (WHETHER  BASED ON CONTRACT,  TORT,  STATUTORY  LIABILITY,  OR ANY OTHER
GROUND)  BASED  ON,  ARISING  OUT OF OR  RELATED  TO ANY  LOAN  DOCUMENT  OR THE
TRANSACTIONS  CONTEMPLATED  HEREBY  OR  THEREBY  OR ANY ACT,  OMISSION  OR EVENT
OCCURRING IN CONNECTION THEREWITH, AND THE BORROWER (FOR ITSELF AND ON BEHALF OF
EACH  GUARANTOR AND EACH SPECIFIED  PERSON)  HEREBY WAIVES,  RELEASES AND AGREES
NEVER TO SUE UPON ANY CLAIM FOR ANY SUCH DAMAGES,  WHETHER SUCH CLAIM NOW EXISTS
OR HEREAFTER  ARISES AND WHETHER OR NOT IT IS NOW KNOWN OR SUSPECTED TO EXIST IN
ITS FAVOR.

                                       37
<PAGE>

         10.8  Modification  and Waiver.  No  modification or waiver of, or with
respect  to any  provision  of this  Agreement  or any  document  or  instrument
delivered in connection  therewith shall be effective  unless and until it shall
be in writing and signed by the Bank, and then such modification or waiver shall
be effective only in the specific  instance and for the purpose for which given.
No notice to or demand on the Borrower in any case shall, of itself,  entitle it
to any other or further notice or demand in similar or other circumstances.

         10.9  Successors and Assigns.  (a) This Agreement shall be binding upon
and inure to the benefit of the Borrower,  the Bank,  all future  holders of the
Notes and their respective successors and assigns,  except that the Borrower may
not assign or transfer any of its rights under this Agreement  without the prior
written  consent of the Bank.  The term "Bank" as used herein shall be deemed to
include the Bank and its successors, endorsees and assigns.

         (b) The Bank shall have the unrestricted right at any time or from time
to time,  and  without  Borrower's  or any  Guarantor's  consent,  to assign any
portion  (equivalent  to an  initial  Commitment  and/or  Loans of not less than
$1,000,000 in principal  amount) of its rights and obligations  hereunder to one
or more banks or other  financial  institutions  (each,  an "Assignee")  and the
Borrower  and  each  Guarantor  agree  that it  shall  execute,  or  cause to be
executed,  such  documents,  including  without  limitation,  amendments to this
Agreement and to any other  documents,  instruments  and agreements  executed in
connection herewith as the Bank shall deem necessary to effect the foregoing. In
addition,  at the request of the Bank and any such Assignee,  the Borrower shall
issue one or more new promissory notes, as applicable, to any such Assignee and,
if the Bank has retained any of its rights and obligations  hereunder  following
such  assignment,  to the Bank,  which new  promissory  notes shall be issued in
replacement  of,  but  not in  discharge  of,  the  liability  evidenced  by the
promissory  note held by the Bank prior to such assignment and shall reflect the
amount of the  respective  commitments  and loans held by such  Assignee and the
Bank after giving effect to such assignment.  Upon the execution and delivery of
appropriate  assignment  documentation,  amendments and any other  documentation
required  by the Bank in  connection  with such  assignment,  and the payment by
Assignee of the purchase price agreed to by the Bank,  and such  Assignee,  such
Assignee shall be a party to this Agreement and shall have all of the rights and
obligations  of the Bank  hereunder  (and  under any and all  other  guaranties,
documents,  instruments and agreements  executed in connection  herewith) to the
extent that such rights and obligations  have been assigned by the Bank pursuant
to the assignment documentation between the Bank and such Assignee, and the Bank
shall  be  released  from  its   obligations   hereunder  and  thereunder  to  a
corresponding  extent.  Notwithstanding  the  foregoing,  no  Assignee  or other
transferee  of any rights of the Bank shall be  entitled  to receive any greater
payment  under  Section  2.6 or 2.13 than the Bank would have been  entitled  to
receive with respect to the rights transferred, unless such transfer was made at
a time when the circumstance giving rise to such greater payment did not exist.

         (c) The Bank  shall  have the  unrestricted  right at any time and from
time to time,  and  without  the  consent  of or notice to the  Borrower  or any
Guarantor,  to grant to one or more banks or other financial institutions (each,
a  "Participant")  participating  interests  in the  Bank's  obligation  to lend
hereunder  and/or  any or all of the Loans  held by the Bank  hereunder.  In the
event  of  any  such  grant  by  the  Bank  of  a  participating  interest  to a
Participant,  whether or not upon notice to the Borrower,  the Bank shall remain
responsible for the  performance of its  obligations  hereunder and the Borrower
shall continue to deal solely and directly with the Bank in connection  with the
Bank's rights and  obligations  hereunder.  The Bank may furnish any information
concerning  the  Borrower  in its  possession  from time to time to  prospective
Assignees  and  Participants,  provided  that the Bank  shall  require  any such
prospective  Assignee  or  Participant  to  agree in  writing  to  maintain  the
confidentiality of such information. Notwithstanding the foregoing, the Bank and
any  Participants  shall not be entitled to receive  any greater  payment  under
Section  2.6 or 2.13 than the Bank would have been  entitled  to receive  had no
participating interests been granted.

                                       38
<PAGE>

         10.10 Governing Law; Consent to Jurisdiction. This Agreement, the Notes
and any documents and instruments delivered in connection herewith and therewith
and the rights and  duties of the  parties  hereunder  and  thereunder  shall be
governed by, and construed and  interpreted  in accordance  with, the law of the
State of New York and the Borrower consents to the jurisdiction of the courts of
the State of New York in any action  brought  to enforce  any rights of the Bank
under this Agreement and any document or instrument related hereto.

         10.11  Entire  Agreement.  This  Agreement  and any  other  agreements,
documents and  instruments  executed and delivered  pursuant to or in connection
with the Obligations  contain the entire agreement  between the parties relating
to the subject matter hereof and thereof.  The Borrower  expressly  acknowledges
that  the  Bank  has not  made  and the  Borrower  is not  relying  on any  oral
representations, agreements or commitments of the Bank or any officer, employee,
agent or representative thereof.

         10.12  Interest   Adjustment.   All  agreements  between  Borrower  and
Guarantors and the Bank are hereby  expressly  limited so that in no contingency
or event  whatsoever,  whether  by reason of  acceleration  of  maturity  of the
indebtedness  evidenced hereby or otherwise,  shall the amount paid or agreed to
be paid to the Bank for the use or the forbearance of the indebtedness evidenced
hereby exceed the maximum  permissible under applicable law. As used herein, the
term  "applicable  law"  shall  mean the law in  effect  as of the  date  hereof
provided,  however, that in the event there is a change in the law which results
in a higher  permissible  rate of  interest,  then the Loan  Documents  shall be
governed  by such  new law as of its  effective  date.  In  this  regard,  it is
expressly  agreed  that  it is the  intent  of  Borrower  and  the  Bank  in the
execution,  delivery  and  acceptance  of this  Agreement  to contract in strict
compliance  with the laws of the State of New York from time to time in  effect.
If, under or from any  circumstances  whatsoever,  fulfillment  of any provision
hereof  or of any of the  Loan  Documents  at the  time of  performance  of such
provision  shall be due, shall involve  transcending  the limit of such validity
prescribed  by  applicable  law,  then  the  obligation  to be  fulfilled  shall
automatically  be reduced to the limits of such  validity,  and if under or from
circumstances  whatsoever  the Bank should ever  receive as interest  and amount
which would exceed the highest lawful rate, such amount which would be excessive
interest shall be applied to the reduction of the principal balance evidenced by
a Note (in such manner as the Bank may determine in its sole discretion) and not
to the payment of interest.  This provision  shall control every other provision
of all agreements between the Borrower, Guarantors and the Bank.

         10.13 Pledge to Federal Reserve. The Bank may at any time pledge all or
any portion of its rights under the loan documents  including any portion of the
promissory  note to any of the twelve (12) Federal Reserve Banks organized under
Section 4 of the Federal  Reserve Act, 12 U.S.C.  Section 341. No such pledge or
enforcement  thereof  shall release Bank from its  obligations  under any of the
loan documents.

         10.14 Lost Notes.  Upon  receipt of an  affidavit  of an officer of the
Bank as to the loss,  theft,  destruction or mutilation of any Note or any other
security  document which is not of public  record,  and, in the case of any such
loss, theft, destruction or mutilation,  upon surrender and cancellation of such
Note or other security  document,  the Borrower will issue,  in lieu thereof,  a
replacement Note or other security document in the same principal amount thereof
and otherwise of like tenor.

         10.15  Counterparts.  This  Agreement  may be signed  in any  number of
counterparts  with the same effect as if the signatures  thereto and hereto were
upon the same instrument.

         IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be
duly  executed  and  delivered  in New York,  New York by their  proper and duly
authorized officer as of the day and year first above written.

                            INTEGRAMED AMERICA, INC.

                             By:    /s/Eugene R. Curcio
                                    ---------------------------
                             Name:  Eugene R. Curcio
                             Title: Vice President, Finance and
                                    Chief Financial Officer


                        FLEET BANK, NATIONAL ASSOCIATION

                             By:   /s/Thomas G. Carley
                                   -----------------------------
                             Name: Thomas G. Carley
                            Title: Vice President


<PAGE>



                                    EXHIBIT A


                    FORM OF FACILITY A REVOLVING CREDIT NOTE



<PAGE>


                        FACILITY A REVOLVING CREDIT NOTE

$4,000,000.00                                            White Plains, New York
                                                         September 11, 1998

         INTEGRAMED AMERICA, INC., a Delaware corporation (the "Borrower"),  for
value  received,  hereby  promises to pay to the order of FLEET  BANK,  NATIONAL
ASSOCIATION  (the  "Bank")  on  September  11,  2001,  at the office of the Bank
specified in Section 10.1 of the Loan Agreement  dated as of September 11, 1998,
between the Borrower  and the Bank,  as amended from time to time (as so amended
the  "Agreement";  terms  defined in the  Agreement  shall  have  their  defined
meanings  when used in this  Note),  in  lawful  money of the  United  States of
America and in immediately  available funds the principal amount of FOUR MILLION
and 00/100 DOLLARS  ($4,000,000.00)  or, if less than such principal amount, the
aggregate  unpaid principal amount of all Loans made by the Bank to the Borrower
pursuant to Section 2.1(a) of the Agreement.  The Borrower  further  promises to
pay  interest  in like money on the unpaid  principal  balance of this Note from
time to time outstanding at an annual rate as selected by the Borrower  pursuant
to the terms of Section 2.2 of the Agreement.  Interest shall be computed on the
basis of a 360-day year for actual days elapsed and shall be payable as provided
in the  Agreement.  All Loans made by the Bank pursuant to subsection  2.1(a) of
the Agreement  and all payments of the principal  thereon may be endorsed by the
holder of this Note on the schedule annexed hereto,  to which the holder may add
additional  pages.  The  aggregate  net unpaid amount of Loans set forth in such
schedule shall be presumed to be the principal balance hereof.  After the stated
or any  accelerated  maturity  hereof,  this  Note  shall  bear  interest  at an
increased rate as set forth in the Agreement, payable on demand, but in no event
in excess of the maximum rate of interest permitted under applicable law.

         This Note is the  Facility A Revolving  Credit Note  referred to in the
Agreement,  and is entitled to the benefits  thereof and may be prepaid,  and is
required to be prepaid,  in whole or in part (subject to the indemnity  provided
in the Agreement) as provided therein. Upon the occurrence of any one or more of
the Events of Default  specified in the  Agreement,  all amounts then  remaining
unpaid  on this  Note may be  declared  to be  immediately  due and  payable  as
provided in the Agreement.  This Note is secured by the collateral  described in
each Security Agreement.

         This Note shall be  construed  in  accordance  with and governed by the
laws of the State of New York.

                                       INTEGRAMED AMERICA, INC.


                                        By:  /s/Eugene R. Curcio
                                             ---------------------------
                                      Name:  Eugene R. Curcio
                                     Title:  Vice President Finance and
                                             Chief Financial Officer

<PAGE>




                                    EXHIBIT B


                    FORM OF FACILITY B REVOLVING CREDIT NOTE




<PAGE>


                        FACILITY B REVOLVING CREDIT NOTE

$5,000,000.00                                             White Plains, New York
                                                          September 11, 1998

         INTEGRAMED AMERICA, INC., a Delaware corporation (the "Borrower"),  for
value  received,  hereby  promises to pay to the order of FLEET  BANK,  NATIONAL
ASSOCIATION  (the  "Bank")  on  September  11,  2001,  at the office of the Bank
specified in Section 10.1 of the Loan Agreement  dated as of September 11, 1998,
between the Borrower  and the Bank,  as amended from time to time (as so amended
the  "Agreement";  terms  defined in the  Agreement  shall  have  their  defined
meanings  when used in this  Note),  in  lawful  money of the  United  States of
America and in immediately  available funds the principal amount of FIVE MILLION
and 00/100 DOLLARS  ($5,000,000.00)  or, if less than such principal amount, the
aggregate  unpaid principal amount of all Loans made by the Bank to the Borrower
pursuant to Section 2.1(b) of the Agreement.  The Borrower  further  promises to
pay  interest  in like money on the unpaid  principal  balance of this Note from
time to time outstanding at an annual rate as selected by the Borrower  pursuant
to the terms of Section 2.2 of the Agreement.  Interest shall be computed on the
basis of a 360-day year for actual days elapsed and shall be payable as provided
in the  Agreement.  All Loans made by the Bank pursuant to subsection  2.1(b) of
the Agreement  and all payments of the principal  thereon may be endorsed by the
holder of this Note on the schedule annexed hereto,  to which the holder may add
additional  pages.  The  aggregate  net unpaid amount of Loans set forth in such
schedule shall be presumed to be the principal balance hereof.  After the stated
or any  accelerated  maturity  hereof,  this  Note  shall  bear  interest  at an
increased rate as set forth in the Agreement, payable on demand, but in no event
in excess of the maximum rate of interest permitted under applicable law.

         This Note is the  Facility B Revolving  Credit Note  referred to in the
Agreement,  and is entitled to the benefits  thereof and may be prepaid,  and is
required to be prepaid,  in whole or in part (subject to the indemnity  provided
in the Agreement) as provided therein. Upon the occurrence of any one or more of
the Events of Default  specified in the  Agreement,  all amounts then  remaining
unpaid  on this  Note may be  declared  to be  immediately  due and  payable  as
provided in the Agreement.  This Note is secured by the collateral  described in
each Security Agreement.

         This Note shall be  construed  in  accordance  with and governed by the
laws of the State of New York.

                                       INTEGRAMED AMERICA, INC.


                                        By:  Eugene R. Curcio
                                             ----------------------------
                                      Name:  Eugene R. Curcio
                                     Title:  Vice President Finance and
                                             Chief Financial Officer


<PAGE>




                                    EXHIBIT C

                                FORM OF TERM NOTE




<PAGE>


                                    TERM NOTE


$4,000,000.00                                          White Plains, New York
                                                       September 11, 1998


                INTEGRAMED   AMERICA,   INC.,   a  Delaware   corporation   (the
"Borrower"),  for value  received,  hereby promises to pay to the order of FLEET
BANK, NATIONAL  ASSOCIATION (the "Bank") at its office specified in Section 10.1
of the Loan  Agreement  dated as of September  11, 1998 between the Borrower and
the Bank,  as amended  from time to time (as so amended the  "Agreement";  terms
defined in the  Agreement  shall have their  defined  meanings when used in this
Note) in lawful money of the United States and in immediately  available  funds,
the principal sum of FOUR MILLION AND 00/100 DOLLARS  ($4,000,000.00) payable in
sixteen (16)  consecutive  quarterly  installments  in the amount of $250,000.00
each and the last  and  final  installment  equal to the then  unpaid  principal
balance of this Note payable on the first day of each , January, March, June and
September,  commencing  June 1,  2000.  The  Borrower  further  promises  to pay
interest  at said office in like money on the unpaid  principal  balance of this
Note from time to time outstanding  (computed on the basis of a 360 day year for
actual days  elapsed) at an annual rate as selected by the Borrower  pursuant to
the terms of Section 2 of the  Agreement.  Interest shall be payable as provided
in the  Agreement.  Whenever  the entire  unpaid  principal  amount of this Note
becomes due and payable (whether at the stated maturity hereof,  by acceleration
or otherwise) interest hereon shall thereafter be payable on demand at a rate as
set forth in the  Agreement,  but in no event in excess of the  maximum  rate of
interest permitted under any applicable law.

                This Note is the Term Note referred to in the Agreement,  and is
entitled to the benefits and subject to the terms  thereof and may be prepaid in
whole  or in part  (subject  to the  indemnity  provided  in the  Agreement)  as
provided  therein.  This Note is secured  by the  Collateral  described  in each
Security Agreement.

                Upon the  occurrence of any one or more of the Events of Default
specified in the Agreement,  all amount then remaining unpaid under the Note may
be declared immediately due and payable as provided in the Agreement.

                This Note shall be construed in accordance  with and governed by
the laws of the State of New York.

                                               INTEGRAMED AMERICA, INC.


                                         By:  /s/Eugene R. Curcio
                                              ----------------------------
                                       Name:  Eugene R. Curcio
                                      Title:  Vice President Finance and
                                              Chief Financial Officer


<TABLE> <S> <C>


<ARTICLE>                     5


<MULTIPLIER>                                   1,000

       
<S>                                            <C>
<PERIOD-TYPE>                                  9-mos
<FISCAL-YEAR-END>                              Dec-31-1998
<PERIOD-START>                                 Jan-01-1998
<PERIOD-END>                                   Sep-30-1998
<CASH>                                         5,037
<SECURITIES>                                   0
<RECEIVABLES>                                  13,272
<ALLOWANCES>                                   613
<INVENTORY>                                    0
<CURRENT-ASSETS>                               19,146
<PP&E>                                         5,077 <F1>
<DEPRECIATION>                                 0
<TOTAL-ASSETS>                                 44,378
<CURRENT-LIABILITIES>                          11,112
<BONDS>                                        0
                          0
                                    166
<COMMON>                                       213
<OTHER-SE>                                     27,581
<TOTAL-LIABILITY-AND-EQUITY>                   44,378
<SALES>                                        27,927
<TOTAL-REVENUES>                               27,927
<CGS>                                          21,465
<TOTAL-COSTS>                                  21,465
<OTHER-EXPENSES>                               2,084 <F2>
<LOSS-PROVISION>                               0
<INTEREST-EXPENSE>                             306
<INCOME-PRETAX>                                (420)
<INCOME-TAX>                                   245
<INCOME-CONTINUING>                            (665)
<DISCONTINUED>                                 4,501
<EXTRAORDINARY>                                0
<CHANGES>                                      0
<NET-INCOME>                                   (5,166)
<EPS-PRIMARY>                                  (0.25)
<EPS-DILUTED>                                  (0.25)

<FN>
<F1>
PP&E is net of accumulated depreciation.
<F2>
Represents restructuring and other charges.
</FN>

        



</TABLE>


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