EXHIBIT 10.17
(FORM OF MED SECURITY INTEREST ASSIGNMENT AGREEMENT)
ASSIGNMENT OF COLLATERAL
FOR VALUABLE CONSIDERATION, Med Diversified, Inc., a corporation organized
and existing under the laws of the State of Nevada (the "Assignor"), having its
principal office at 000 Xxxxxxxxxx Xxxxxx, Xxxxx 000, Xxxxxxx, Xxxxxxxxxxxxx
00000, hereby assigns, grants, sells and transfers to Private Investment Bank
Limited, Nassau, Bahamas, a bank and trust company organized and existing under
the laws of The Bahamas (the "Assignee"), having its principal office at
Xxxxxxxxxx Xxxxx, Xxxxx Xxxxxx, X.X. Xxx X-0000, and the Assignee's successors,
transferees and assigns forever, all of the right, title and interest of the
Assignor in and to the "Collateral" identified on Attachment A to that certain
UCC Financing Statement, filed in the State of Delaware with the Delaware
Department of State ("Delaware Department of State") on April 3, 2002 (" Med
UCC"), against American Reimbursement, LLC, a Delaware limited liability
company, as debtor, in favor of Assignor, as secured party. Concurrently with
the execution of this Assignment, Assignor shall file that certain UCC Financing
Statement Amendment with the Delaware Department of State, in substantially the
form attached hereto as Exhibit A, evidencing the assignment to Assignee, as the
new secured party under the Med UCC, of all of Assignor's right, title and
interest in and to the "Collateral" identified on Attachment A to the Med UCC.
IN WITNESS WHEREOF, the undersigned have executed this Assignment as of the
14th day of August, 2002.
ASSIGNOR:
Med Diversified, Inc.,
a Nevada corporation
By:
------------------------------
Name:
Title:
ASSIGNEE:
Private Investment Bank Limited,
Nassau, Bahamas
By:
------------------------------
Name:
Title:
PAGE 1
EXHIBIT A
UCC FINANCING STATEMENT AMENDMENT
PAGE A-1
[UCC FINANCING STATEMENT AMENDMENT LOGO]
FOLLOW INSTRUCTIONS (front and back) CAREFULLY
A. NAME & PHONE OF CONTACT AT FILER [optional]
B. SEND ACKNOWLEDGMENT TO: (Name and Address)
THE ABOVE SPACE IS FOR FILING OFFICE USE ONLY
1a. INITIAL FINANCING STATEMENT FILE # 1b. This FINANCING STATEMENT AMENDMENT is
20833834 / / to be filed [for record] (or recorded) in the
REAL ESTATE RECORDS.
2. / / TERMINATION: Effectiveness of the Financing Statement identified above is
terminated with respect to security interest(s) of the Secured Party
authorizing this Termination Statement.
3. / / CONTINUATION: Effectiveness of the Financing Statement identified above
with respect to security interest(s) of the Secured Party authorizing
this Continuation Statement is continued for the additional period
provided by applicable law.
4. /X/ ASSIGNMENT (full or partial): Give name of assignee in item 7a or 7b and
address of assignee in item 7c; and also give name of assignor in item 9.
5. AMENDMENT (PARTY INFORMATION): This Amendment affects / / Debtor OR
/ / Secured Party of record. Check only ONE of these two boxes.
Also check ONE of the following three boxes AND provide appropriate
information in items 6 and/or 7.
/ / CHANGE name and/or address: Give current record name in item 6a or 6b;
also give new name (if name change) in item 7a or 7b and/or new address
(if address change) in item 7c.
/ / DELETE name: Give record name to be deleted in item 6a or 6b.
/ / ADD name: Complete item 7a or 7b, and also item 7c; also complete items
7d-7g (if applicable).
6. CURRENT RECORD INFORMATION:
6a. ORGANIZATION'S NAME
OR
6b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
7. CHANGED (NEW) OR ADDED INFORMATION:
7a. ORGANIZATION'S NAME
Private Investment Bank Limited
OR
7b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
7c. MAILING ADDRESS CITY STATE POSTAL CODE COUNTRY
Deyonshire House
Queen Street P.O. Box N-3918 Nassau Bahamas
7d. TAX ID #: SSN OR EIN ADD'L INFO RE 7e. TYPE OF ORGANIZATION 7f. JURISDICTION OF ORGANIZATION 7G. ORGANIZATIONAL ID #,
ORGANIZATION if any
DEBTOR / / NONE
8. AMENDMENT (COLLATERAL CHANGE): check only ONE box.
Describe collateral / / deleted or / / added, or give entire
/ / restated collateral description, or describe collateral / / assigned.
9. NAME OF SECURED PARTY OF RECORD AUTHORIZING THIS AMENDMENT (name of
assignor, if this is an Assignment). If this is an Amendment authorized by a
Debtor which adds collateral or adds the authorizing Debtor, or if this is a
Termination authorized by a Debtor, check here / / and enter name of DEBTOR
authorizing this Amendment.
9a. ORGANIZATION'S NAME
Med Diversified, Inc.
OR
9b. INDIVIDUAL'S LAST NAME FIRST NAME MIDDLE NAME SUFFIX
10.OPTIONAL FILER REFERENCE DATA
DE SOS
FILING OFFICE COPY -- NATIONAL UCC FINANCING STATEMENT AMENDMENT (FORM UCC3)
(REV. 07/29/98)
