1 Exhibit 10.19 AGREEMENT THIS AGREEMENT, made and entered into this day of April, 1996, is between National Benefit Resources, Inc. ("NBR") and Birman Managed Care, Inc. (the "Company"). R E C I T A L S A. Pursuant to that certain Subscription Agreement of even date herewith (the "Subscription Agreement"), between the Company and NBR, NBR has agreed to acquire newly issued shares (the "Acquired Shares") of the common stock of the Company ("Common Stock"). B. By letter dated April 4, 1996 (the "April 4 Letter") incorporated herewith as Exhibit "A" and made a part hereof as though fully set forth herein from BMC Health Plans, Inc., a wholly-owned subsidiary of the Company ("BMC"), NBR and BMC have agreed that NBR would seek to manage and provide fronting carriers which would issue excess risk, fully-insured, provider excess and other ancillary insurance products, including group life and accidental death and disability (collectively "Covered Products") to managed care plans and/or their respective participants (collectively "Covered Plans") as to which BMC has provided services with respect to plan delivery, system formation, development or implementation, or ongoing operations, marketing and management services (collectively "Covered Services"). C. As a condition to its execution and performance of the Subscription Agreement, incorporated herewith as Exhibit "B" and made a part hereof as though fully set forth herein NBR requires that the Company enter into this Agreement, and the Company is willing to do so. NOW, THEREFORE, in consideration of the mutual covenants and agreements contained herein, the parties to this Agreement agree as follows: ARTICLE I DIRECTOR DESIGNATION AND OTHER RIGHTS 1.1 BOARD DESIGNEES. Throughout the five (5) year term of the April 4 Letter (the "Term"), the Company agrees that it shall cause: (a) one or more individuals designated by NBR to be elected to serve as a director of each affiliate of the Company which is engaged in the provision of Covered Services (each an "Affiliated Service Provider"), it being agreed that NBR shall be entitled to designate no more than one director for each Affiliated Service Provider; 2 (b) the maintenance in office of each such designee until such designee is removed pursuant to this Section 1.1 or shall no longer be serving by reason of resignation, incapacity, retirement, or death; and (c) the removal from office of any such designee upon the written request of NBR. 1.2 DIRECTORS AND OFFICERS LIABILITY COVERAGE. Company shall use its reasonable efforts to acquire and maintain or cause its Affiliated Service Provider(s) to use reasonable efforts to acquire and maintain directors and officers liability insurance at all times while an NBR designee is serving as a director of Affiliated Service Provider(s) written on a claims occurrence basis with a single occurrence limit of not less than one million dollars ($1,000,000) and a general aggregate limit of not less than one million dollars ($1,000,000). 1.3 COVERED PRODUCTS. Throughout the Term, if any Covered Plan shall desire to obtain any Covered Product, the Company agrees to cause each Affiliated Service Provider to use its best efforts and relationships to cause such Covered Plan to obtain such Covered Product through NBR on terms substantially similar to those contemplated by the April 4 Letter; provided that the Covered Products to which NBR has access and which are available to such Covered Plan are reasonably responsive to the requirements of the Covered Plan and reasonably price competitive. 1.4 FINANCIAL INFORMATION. Throughout the Term, the Company shall deliver to NBR each of the following: (a) within fifteen (15) days after the end of each calendar month such regular monthly consolidated financial information as is prepared for review by management of the Company; (b) within forty-five (45) days after the end of each calendar quarter (except for the last quarter of each fiscal year), an unaudited consolidated balance sheet of the Company as of the end of such quarter and related unaudited consolidated statement of operations, statement of cash flow, and statement of changes in stockholders' equity, setting forth in each case in comparative form the consolidated figures for the corresponding period in the previous fiscal year; (c) within fifteen (15) days after it files them with the Securities and Exchange Commission (the "Commission") copies of the annual report and of information, documents and other reports which the Company is required to file with the Commission pursuant to Section 13 or 15(d) of the Securities Exchange Act of 1934 as amended (the "SEA"); 2 3 (d) within ninety (90) days after the end of each fiscal year, an audited consolidated balance sheet of the Company as of the end of such fiscal year and related audited consolidated statement of operations, statement of cash flow, and statement of changes in stockholders' equity for such fiscal year, setting forth in each case in comparative form the consolidated figures for the corresponding period in the previous fiscal year accompanied by the report thereon prepared by independent auditors selected by the Company's board of directors; and (e) with reasonable promptness, such other available financial reports, information, and data with respect to the Company, any of its affiliates as NBR may reasonably request from time to time, including without limitation budgets, forecasts, cash flow projections and statements and information relative thereto. All such statements, reports, forms, information and data shall be provided without cost to NBR and all such financial statements shall be prepared in accordance with GAAP and shall fairly present the information contained therein, subject, in the case of financial information other than that set forth in Section 1.4(d) above, to normal year-end audit adjustments. ARTICLE II CONFIDENTIALITY, RESTRICTIONS ON ACCESS 2.1 USE OF COMPANY CONFIDENTIAL INFORMATION. NBR shall use commercially reasonable efforts to maintain in confidence from other than its agents and employees and to refrain, and to cause its agents and its employees to refrain, from disclosing any information obtained by it pursuant to Section 1.4 hereof which is proprietary to the Company ("Company Confidential Information") without the prior written consent of the Company. NBR shall exercise the same degree of care to safeguard the secrecy and prevent the unauthorized disclosure of Company Confidential Information as it uses with respect to its own proprietary information, but in no event less than reasonable care. 2.2 EXCEPTIONS. The obligations of confidentiality set forth in Section 2.1 above shall not apply to Company Confidential Information which NBR can reasonably demonstrate: (a) was already known to NBR prior to receipt thereof from the Company; (b) was developed by employees of NBR having no access to such Company Confidential Information; (c) has become public knowledge through no breach of this Agreement; 3 4 (d) has been made available to NBR by a third party without any breach of confidence on its part; (e) is material to any litigation or arbitration proceeding initiated by any party to this Agreement in connection with a dispute arising out of this Agreement; or (f) is required to be disclosed by order of a governmental agency or court having jurisdiction over such Holder or by any law, rule or regulation or pursuant to any listing agreement with or the rules of any stock exchange or upon the request of any stock exchange. 2.3 RESTRICTIONS ON ACCESS. The Company shall not be obligated to prepare or furnish any document or report which would disclose any information that the Company is at that time precluded from disclosing to NBR by reason of government regulation, contractual obligation, or other restrictions arising by operation of law. During the Term, the Company shall not enter into any contractual obligation (other than a contractual obligation concerning information which is the subject of the immediately following sentence) that limits the Company's freedom to disclose Company Confidential Information to NOR; provided, however, that the Company may enter into any initial confidentiality agreements as it may reasonably determine are necessary to evaluate a potential transactions with third parties and which precludes it from disclosing to those not having a need to know information and data concerning such third party. ARTICLE III REGISTRATION RIGHTS 3.1 PIGGYBACK REGISTRATIONS RIGHT TO PIGGYBACK. If at any time (whether or not during the Term), prior to the expiration of the Company's holding period under 144(k), the Company proposes to cause a registration statement (a "Registration") under the Securities Act of 1933 as amended (the "Securities Act") to become effective with respect to any shares of its Common Stock (other than a Registration statement on Form S-4 or S-8 or any successor or similar forms), and the Registration form to be used may be used for a secondary offering of Common Stock (a "Piggyback Registration") and at the time thereof NBR or any transferee thereof which has acquired all of the Acquired Shares (herein a "Holder") continues to hold any Acquired Shares which have not then previously been the subject of a Registration, the Company will give written notice of such determination to the Holder, not less than ten (10) business days prior to the projected filing of a Registration statement with the Commission, and if a Piggyback Registration is requested by written notice from the Holder to the Company within ten (10) business days after receipt of the aforesaid notice, the Company, to the extent permitted by law, 4 5 and subject to any underwriter cutbacks which will be enforced pro rata against all persons holding piggyback rights shall include in such Registration all Acquired Shares held thereby. 3.2 REGISTRATION PROCEDURES. If and whenever the Company effects a Registration which is to include a Piggyback Registration, the Company will as expeditiously as reasonably possible: (a) prepare and file with the Commission a registration statement on the appropriate form with respect to the shares proposed to be registered and use its reasonable commercial efforts to cause such registration statement to become effective (provided that before filing a registration statement or prospectus or any amendments or supplements thereto, the Company shall furnish to the counsel selected by Holder copies of all such documents proposed to be filed including all drafts thereof, which documents shall be subject to the prior review of such counsel reasonably prior to such filing); (b) prepare and file with the Commission such amendments and supplements to such registration statement and the prospectus used in connection therewith as may be necessary to keep such registration statement effective for a period of the lesser of sixty (60) calendar days or the completion of the plan of distribution described in such prospectus and comply with the provisions of the Securities Act with respect to the disposition of all shares covered by such registration statement during such period in accordance with the intended methods of disposition set forth in such registration statement; (c) furnish to the Holder such number of copies of such registration statement, each amendment and supplement thereto, the prospectus included in such registration statement (including each preliminary prospectus) and such other documents as the Holder may reasonably request in order to facilitate the disposition of the Acquired Shares; (d) use its reasonable commercial efforts to register or qualify the Acquired Shares under such other securities or blue sky laws of such jurisdictions as the Holder reasonably requests and do any and all other acts and things which may be reasonably necessary or advisable to enable the Holder to consummate the disposition of the Acquired Shares in such jurisdictions (provided that the Company will not be required to (i) qualify generally to do business in any jurisdiction where it would not otherwise be required to qualify but for this subsection, (ii) subject itself to taxation in any such jurisdiction or (iii) consent to general service of process in any such jurisdiction, if in the opinion of counsel reasonably acceptable to the Holder, any of such actions in this clause (iv) would occur or result); (e) notify the Holder, at any time when a prospectus relating thereto is required to be delivered under the Securities Act, of the happening of any event or the 5 6 receipt of any information as a result of which the prospectus included in such registration statement contains an untrue statement of a material fact or omits any fact necessary to make the statements therein not misleading, and prepare a supplement or amendment to such prospectus so that, as thereafter delivered to the purchasers of such shares of Common Stock, such prospectus will not contain an untrue statement of a material fact or omit to state any fact necessary to make the statements therein not misleading; (f) enter into such customary agreements (including underwriting agreements in customary form) and use its reasonable best efforts to take all such other actions in order to expedite or facilitate the disposition of the Acquired Shares; (g) comply with all applicable rules and regulations of the Commission, and make available to its security holders, as soon as reasonably practicable, an earnings statement covering the period of at least twelve months beginning with the first day of the Company's first full calendar quarter after the effective date of the registration statement, which earnings statement shall satisfy the provisions of Section 11(a) of the Securities Act and Rule 158 thereunder; (h) permit the Holder to participate in the preparation of such registration statement and to require the insertion therein of written material concerning the Holder (and any person included therein) and the intended method of distribution, furnished to the Company in writing, which in the reasonable judgment of the Holder and its counsel should be included; (i) in the event of the issuance of any stop order suspending the effectiveness of a registration statement, or of any order suspending or preventing the use of any related prospectus or suspending the qualification of any shares of Common Stock included in such registration statement for sale in any jurisdiction, use its reasonable best efforts to promptly obtain the withdrawal of such order; (j) cause, subject to applicable law and regulations, the Acquired Shares to be listed on each securities exchange on which shares of Common Stock are then listed and, if not so listed, to be listed on the NASD automated quotation system; and (k) use its best efforts to deliver an opinion of counsel to the Company and a cold comfort letter from Company's independent public accountants each in customary form and covering such matters of the type customarily covered by such opinions and letters in an underwritten offering. 3.3 REGISTRATION EXPENSES. All expenses to the Company or the Holder, including reasonable attorneys fees, in connection with any Registration in which any Acquired Shares are included will be paid by the Company ("Registration Expenses"); provided however, that the 6 7 Holder will pay its attorney's fees and other expenses it incurs in connection with the Piggyback Registration and shall be responsible for its pro rata share of underwriters compensation. In addition, the Company will pay its internal expenses (including, without limitation, all salaries and expenses of its officers and employees performing legal or accounting duties), the expense of any annual audit or quarterly review, and the expense of any liability insurance. 3.4 INDEMNIFICATION. (a) The Company agrees to indemnify, to the extent permitted by law, the Holder, its officers and directors, each person who controls the Holder (within the meaning of the Securities Act) and each underwriter for any Registration against all loss, liability, claim, obligation, damage or deficiency (including reasonably attorney's fees and all other expenses incurred in investigating, preparing or defending any litigation or proceeding, commenced or threatened) caused by any untrue or alleged untrue statement of material fact contained in any registration statement, prospectus or preliminary prospectus or any amendment thereof or supplement thereto or any omission or alleged omission of a material fact required to be stated therein or necessary to make the statements therein not misleading, except insofar as the same are caused by or contained in any information furnished in writing to the Company by or on behalf of the Holder expressly for use therein or arises out of such the Holder's failure to deliver a copy of the final prospectus to the person asserting such claim or loss at or prior to the written confirmation of the sale of Acquired Shares by the Holder to such person, provided the untrue statement or omission was corrected in the final prospectus and the Company furnished such person with sufficient copies of the final prospectus for delivery to such person. (b) Each Holder, by availing itself of registration pursuant to the terms hereof, agrees to indemnify the Company, its directors and officers, each person who controls the Company (within the meaning of the Securities Act) and each underwriter for any Registration against any loss, liability, claim, obligation, damage or deficiency (including reasonably attorney's fees and all other expenses incurred in investigating, preparing or defending any litigation or proceeding, commenced or threatened) resulting from any untrue or alleged untrue statement of material fact contained in the registration statement, prospectus or preliminary prospectus or any amendment thereof or supplement thereto or any omission or alleged omission of a material fact required to be stated therein or necessary to make the statements therein not misleading, but only if, and to the extent that, such statement or omission was in reliance upon and in conformity with written information furnished to the Company by or on behalf of such Holder specifically for use in the preparation of such Registration statement. (c) Any person entitled to indemnification hereunder will: (i) give prompt written notice to the indemnifying party of any claim with respect to which it seeks indemnification and 7 8 (ii) unless in such indemnified party's reasonable judgment a conflict of interest between such indemnified and indemnifying parties may exist with respect to such claim, permit such indemnifying party to assume the defense of such claim with counsel reasonably satisfactory to the indemnified party. If such defense is assumed, the indemnifying party will not be subject to any liability for any settlement made by the indemnified party without its consent (but such consent will not be reasonably withheld). (d) The indemnification provided for under this Agreement will remain in full force and effect regardless of any investigation made by or on behalf of the indemnified party or any officer, director or controlling person of such indemnified party and will survive the transfer of the Acquired Shares. (e) In the event the indemnification provided for under this Agreement is unavailable for any reason other than the exceptions to indemnification contained herein, then the indemnifying party shall contribute to the amount paid or payable by the indemnified party as a result of such Damages in such proportion as is appropriate to reflect the relative fault of the indemnifying party on one hand and the indemnified party on the other hand in connection with the statements or omissions that resulted in such Damages, as well as any other relevant equitable considerations. Notwithstanding the foregoing, no person guilty of fraudulent misrepresentations (within the meaning of Section 11(f) of the Securities Act) shall be entitled to contribution from any person who was not guilty of such fraudulent misrepresentation. 3.5 SELECTION OF UNDERWRITERS. The Company will have the right to select the investment banker(s) and manager(s) to administer the offering pursuant to any Registration. 3.6 SEC FILINGS; PUBLIC INFORMATION. So long as NBR or its affiliates holds unregistered Acquired Shares, the Company shall use commercially reasonable efforts to file on a timely basis all reports required to be filed pursuant to the SEA. ARTICLE IV MISCELLANEOUS PROVISIONS 4.1 EXPENSES. Each of the parties hereto shall bear its own costs, fees and expenses in connection with the negotiation, preparation, execution, delivery and performance of this Agreement and the consummation of the transactions contemplated hereby, including without limitation fees, commissions and expenses payable to brokers, finders, investment bankers, consultants, exchange or transfer agents, attorneys, accountants and other professionals, whether 8 9 or not the transactions contemplated herein is consummated, except as may be contemplated by Section 3 hereof. 4.2 AMENDMENT AND MODIFICATION. Subject to applicable law, this Agreement may be amended or modified by the parties hereto; provided, however, that all such amendments and modifications must be in writing duly executed by the parties hereto. 4.3 WAIVER OF COMPLIANCE; CONSENTS. Any failure of a party to comply with any obligation, covenant, agreement or condition herein may be expressly waived in writing by the party entitled hereby to such compliance, but such waiver or failure to insist upon strict compliance with such obligation, covenant, agreement or condition shall not operate as a waiver of, or estoppel with respect to, any subsequent or other failure. No single or partial exercise of a right or remedy shall preclude any other or further exercise thereof or of any other right or remedy hereunder. Whenever this Agreement requires or permits the consent by or on behalf of a party, such consent shall be given in writing in the same manner as for waivers of compliance. 4.4 NO THIRD PARTY BENEFICIARIES. Nothing in this Agreement shall entitle any person or entity (other than a party hereto and his, her or its respective successors and assigns permitted hereby) to any claim, cause of action, remedy or right of any kind. 4.5 NOTICES. All notices, requests, demands and other communications required or permitted hereunder shall be made in writing and shall be deemed to have been duly given and effective: (i) on the date of delivery, if delivered personally; (ii) on the earlier of the fourth (4th) day after mailing or the date of the return receipt acknowledgement, if mailed, postage prepaid, by certified or registered mail, return receipt requested; or (iii) on the date of transmission, if sent by facsimile, telecopy, telegraph, telex or other similar telegraphic communications equipment: If to the Company: Birman Managed Care, Inc. 502 Gould Drive Cookeville, TN 38506 If to NBR: National Benefit Resources, Inc. Suite 300 5402 Parkdale Drive Minneapolis, MN 55416 9 10 With a copy to: Oppenheimer Wolff & Donnelly First Bank Building Suite 1700 St. Paul, MN 55101 Attn: Dennis Whelpley or to such other person or address as a party shall furnish to the other parties hereto in writing in accordance with this subsection. 4.6 ASSIGNMENT. This Agreement and all of the provisions hereof shall be binding upon and inure to the benefit of the parties hereto and their respective heirs, legal representatives, successors and permitted assigns, but neither this Agreement nor any of the rights, interests or obligations hereunder shall be assigned (whether voluntarily, involuntarily, by operation of law or otherwise) by any of the parties hereto without the prior written consent of the other parties. 4.7 GOVERNING LAW. This Agreement and the legal relations among the parties hereto shall be governed by and construed in accordance with the internal substantive laws of the State of Tennessee (without regard to the laws of conflict that might otherwise apply) as to all matters, including without limitation matters of validity, construction, effect, performance and remedies. 4.8 COUNTERPARTS. This Agreement may be executed simultaneously in one or more counterparts, each of which shall be deemed an original, but all of which together shall constitute one and the same instrument. 4.9 HEADINGS. The table of contents and the headings of the sections and subsections of this Agreement are inserted for convenience only and shall not constitute a part hereof. 4.10 ENTIRE AGREEMENT. This Agreement and all Exhibits hereto embody the entire agreement and understanding of the parties hereto in respect of the transactions contemplated by this Agreement and together they are referred to as "this Agreement" or the "Agreement". There are no restrictions, promises, warranties, agreements, covenants or undertakings, other than those expressly set forth or referred to in this Agreement. This Agreement supersedes all prior agreements and understandings between the parties with respect to the transaction or transactions contemplated by this Agreement. 4.11 ARBITRATION. Any controversy or claim arising out of or relating to this Agreement, or the making, performance or interpretation thereof, including without limitation alleged fraudulent inducement thereof, shall be settled by binding arbitration in Minneapolis, Minnesota by one arbitrator appointed in accordance with the Commercial Arbitration Rules of the American Arbitration Association. Judgment upon any arbitration award may be entered in any court having jurisdiction thereof. 10 11 4.12 FURTHER ASSURANCES. Each party hereto shall, before, at and after Closing, execute and deliver such instruments and take such other actions as the other party or parties, as the case may be, may reasonably require in order to carry out the intent of this Agreement. IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be duly executed as of the day and year first above written. BIRMAN MANAGED CARE,INC. - -------------------------------- By: Attest: ----------------------------------- Its: ----------------------------- NATIONAL BENEFIT RESOURCES, INC. - -------------------------------- By: Attest: ---------------------------------- Its: ----------------------------- 11