EXHIBIT 10.19 AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT AMENDMENT NO. 1 AND CONSENT NO. 1 (this "Amendment"), dated as of August 5, 1998, to the Amended and Restated Revolving Credit Agreement (the "Revolving Credit Agreement"), dated as of April 30, 1998, by and among TOTAL RENAL CARE HOLDINGS, INC., a Delaware corporation (the "Borrower"), the lenders party thereto (the "Lenders"), DLJ CAPITAL FUNDING, INC., as Syndication Agent (the "Syndication Agent"), FIRST UNION NATIONAL BANK, as Documentation Agent, and THE BANK OF NEW YORK, as administrative agent (in such capacity, the "Administrative Agent"). RECITALS I. Capitalized terms used herein which are not otherwise defined herein shall have the respective meanings ascribed thereto in the Revolving Credit Agreement. II. The Borrower has requested that the Administrative Agent and the Lenders agree to amend the Revolving Credit Agreement upon the terms and conditions contained herein, and the Administrative Agent and the Required Lenders are willing to so agree. Accordingly, in consideration of the Recitals and the covenants and conditions hereinafter set forth, and for other good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, the parties hereto hereby agree as follows: 1. Section 4.19 of the Revolving Credit Agreement is amended and restated in its entirety to read as follows: The facilities operated by the Borrower and its Subsidiaries (the "Facilities") are qualified for participation in the Medicare and Medicaid programs (together with their respective intermediaries or carriers, the "Government Reimbursement Programs") and are entitled to reimbursement under the Medicare program for services rendered to qualified Medicare beneficiaries, and comply in all material respects with the conditions of participation in all Government Reimbursement Programs. There is no pending or, to Borrower's knowledge, threatened proceeding or investigation by any of the Government Reimbursement Programs with respect to (i) the Borrower's or any of its Subsidiaries' qualification or right to participate in any Government Reimbursement Program, (ii) the compliance or non-compliance by the Borrower or any of its Subsidiaries with the terms or provisions of any Government Reimbursement Program, or (iii) the right of the Borrower or any of its Subsidiaries to receive or retain amounts received or due or to become due from any Government Reimbursement Program, which proceeding or investigation, together with all other such proceedings and investigations, could reasonably be expected to have a Material Adverse Effect. 2. Section 9.1(p) of the Revolving Credit Agreement is amended and restated in its entirety to read as follows: (p) The Borrower or any Subsidiary, in each case to the extent it is engaged in the business of providing services for which Medicare or Medicaid reimbursement is sought, shall for any reason, including, without limitation, as the result of any finding, designation or decertification, lose its right or authorization, or otherwise fail to be eligible, to participate in Medicaid or Medicare programs or to accept assignments or rights to reimbursements under Medicaid regulations or Medicare regulations, or the Borrower or any Subsidiary has, for any reason, had its right to receive reimbursements under Medicaid or Medicare regulations suspended, and such loss, failure or suspension (together with all such other losses, failures and suspensions continuing at such time) shall have resulted in a Material Adverse Effect. 3. The Administrative Agent and the Lenders, to the extent their consent is required, hereby consent to the amendment of the Term Loan Facility in a manner substantially similar to this Amendment (the "First Term Loan Amendment"). 4. Paragraphs 1 through 3 of this Amendment shall become and shall be deemed effective as of April 30, 1998 upon the prior or simultaneous satisfaction of the following condition: (a) The First Term Loan Amendment shall have become effective, and the Administrative Agent shall have received a copy of the executed First Term Loan Amendment. 5. On the date hereof, each Credit Party hereby (a) reaffirms and admits the validity and enforceability of the Loan Documents (as amended by this Amendment) and all of its obligations thereunder, (b) agrees and admits that it has no defenses to or offsets against any such obligation, and (c) represents and warrants that, after giving effect to the effectiveness of this Amendment, no Default or Event of Default has occurred and is continuing, and that each of the representations and warranties made by it in the Loan Documents (as amended by this Amendment) to which it is a party is true and correct with the same effect as though such representation and warranty had been made on the date hereof. 6. In all other respects, the Loan Documents shall remain in full force and effect, and no amendment in respect of any term or condition of any Loan Document contained herein shall be deemed to be an amendment in respect of any other term or condition contained in any Loan Document. 7. This Amendment may be executed in any number of counterparts all of which, taken together, shall constitute one Amendment. In making proof of this Amendment, it shall only be necessary to produce the counterpart executed and delivered by the party to be charged. 8. THIS AMENDMENT IS BEING EXECUTED AND DELIVERED IN, AND IS INTENDED TO BE PERFORMED IN, THE STATE OF NEW YORK AND SHALL BE CONSTRUED AND ENFORCEABLE IN ACCORDANCE WITH, AND BE GOVERNED BY, THE INTERNAL LAWS OF THE STATE OF NEW YORK, WITHOUT REGARD TO PRINCIPLES OF CONFLICT OF LAWS. AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT AS EVIDENCE of the agreement by the parties hereto to the terms and conditions herein contained, each such party has caused this Amendment to be executed on its behalf. TOTAL RENAL CARE HOLDINGS, INC. By: _________________________________ Name: _______________________________ Title: _____________________________ THE BANK OF NEW YORK, Individually, as the Letter of Credit Issuer, as the Swing Line Lender and as Administrative Agent By: _________________________________ Name: _______________________________ Title: ______________________________ DLJ CAPITAL FUNDING, INC., Individually and as Syndication Agent By: _________________________________ Name: _______________________________ Title: ______________________________ FIRST UNION NATIONAL BANK, Individually and as Documentation Agent By: _________________________________ Name: _______________________________ Title: ______________________________ ABN AMRO BANK N.V. By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT ALLIED IRISH BANKS, P.L.C., CAYMAN ISLANDS BRANCH By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ BANCO ESPIRITO SANTO E COMERCIAL DE LISBOA, NASSAU BRANCH By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ BANK LEUMI TRUST COMPANY OF NEW YORK By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ THE BANK OF NOVA SCOTIA By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT BANQUE NATIONALE DE PARIS By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ BHF-BANK AKTIENGESELLSCHAFT By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ CITY NATIONAL BANK By: _________________________________ Name: _______________________________ Title: ______________________________ CREDITANSTALT CORPORATE FINANCE, INC. By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT CREDIT LYONNAIS NEW YORK BRANCH By: _________________________________ Name: _______________________________ Title: ______________________________ DEUTSCHE BANK AG, NEW YORK AND/OR CAYMAN ISLANDS BRANCHES By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ DRESDNER BANK AG, NEW YORK BRANCH AND GRAND CAYMAN BRANCH By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ FLEET NATIONAL BANK By: _________________________________ Name: _______________________________ Title: ______________________________ THE FUJI BANK, LIMITED By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT HIBERNIA NATIONAL BANK By: _________________________________ Name: _______________________________ Title: ______________________________ THE INDUSTRIAL BANK OF JAPAN, LTD., LOS ANGELES AGENCY By: _________________________________ Name: _______________________________ Title: ______________________________ KBC BANK By: _________________________________ Name: _______________________________ Title _______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ LONG TERM CREDIT BANK OF JAPAN, LTD. By: _________________________________ Name: _______________________________ Title: ______________________________ MELLON BANK, N.A. By: _________________________________ Name: _______________________________ Title: ______________________________ MICHIGAN NATIONAL BANK By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT THE MITSUBISHI TRUST AND BANKING CORPORATION By: _________________________________ Name: _______________________________ Title: ______________________________ NATIONAL CITY BANK OF KENTUCKY By: _________________________________ Name: _______________________________ Title: ______________________________ PARIBAS By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title _______________________________ COOPERATIEVE CENTRALE RAIFFEISEN--BOERENLEENBANK B.A, "RABOBANK NEDERLAND", NEW YORK BRANCH By: _________________________________ Name: _______________________________ Title: ______________________________ By: _________________________________ Name: _______________________________ Title: ______________________________ ROYAL BANK OF CANADA By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT THE ROYAL BANK OF SCOTLAND PLC By: _________________________________ Name: _______________________________ Title: ______________________________ THE SANWA BANK, LIMITED By: _________________________________ Name: _______________________________ Title: ______________________________ SOCIETE GENERALE By: _________________________________ Name: _______________________________ Title: ______________________________ THE SUMITOMO TRUST & BANKING CO., LTD., NEW YORK BRANCH By: _________________________________ Name: _______________________________ Title: ______________________________ SUNTRUST BANK, NASHVILLE, N.A. By: _________________________________ Name: _______________________________ Title: ______________________________ THE TOKAI BANK, LIMITED By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT THE TOYO TRUST & BANKING CO., LTD., Los Angeles Agency By: _________________________________ Name: _______________________________ Title: ______________________________ UNION BANK OF CALIFORNIA, N.A. By: _________________________________ Name: _______________________________ Title: ______________________________ U.S. BANK NATIONAL ASSOCIATION By: _________________________________ Name: _______________________________ Title: ______________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT AGREED AND CONSENTED TO: TOTAL RENAL CARE, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ TRC WEST, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ TOTAL RENAL CARE ACQUISITION CORP. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ RENAL TREATMENT CENTERS, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ RENAL TREATMENT CENTERS--MID-ATLANTIC, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ RENAL TREATMENT CENTERS--NORTHEAST, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ AMENDMENT NO. 1 AND CONSENT NO. 1 TO AMENDED AND RESTATED REVOLVING CREDIT AGREEMENT RENAL TREATMENT CENTERS--CALIFORNIA, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ RENAL TREATMENT CENTERS--WEST, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________ RENAL TREATMENT CENTERS--SOUTHEAST, INC. By: ______________________________________ Name: ____________________________________ Title: ___________________________________