Exhibit 10.49 EIGHTH AMENDMENT TO GUARANTEE REIMBURSEMENT AGREEMENT This Eighth Amendment to Guarantee Reimbursement Agreement ("Amendment") dated as of September 2, 1993, is entered into by and between National Medical Enterprises, Inc., a Nevada corporation ("NME") and The Hillhaven Corporation, a Nevada corporation ("New Hillhaven"). RECITALS A. New Hillhaven and NME are parties to that certain Guarantee Reimbursement Agreement, dated as of January 31, 1990 (as the same has been or may be amended, restated, modified, supplemented, renewed or replaced from time to time, the "Reimbursement Agreement"), which provides, among other things, for the reimbursement by New Hillhaven of all Obligations (as defined in the Reimbursement Agreement) paid by NME. Unless otherwise defined herein, all capitalized terms used herein shall have the same meaning ascribed to such terms in the Reimbursement Agreement. B. New Hillhaven, NME, and certain subsidiaries of New Hillhaven and NME, have entered into that certain letter agreement dated June 22, 1993 (the "June 22 Letter"), which among other things, restructures certain relationships of the companies. Among the provisions contained in the June 22 letter that are pertinent to this Reimbursement Agreement, are the following: (1) New Hillhaven will obtain financing consisting of (a) third party bank financing in the approximate amount of $400 million, and (b) public or private debt financing in the approximate amount of $175 million (collectively, the "Financing"), a portion of the proceeds of which Financing will be used to (i) repay certain Obligations currently guaranteed by NME, and (ii) cause NME and/or certain of its subsidiaries to be released from certain other Obligations currently guaranteed by NME and/or certain of its subsidiaries; (2) The annual guarantee fee payable by New Hillhaven under this Reimbursement Agreement in connection with the Obligations shall be limited to a maximum of 2% of the Obligations outstanding and the manner of calculating the fee charged on the Obligations outstanding shall be revised; and (3) NME and/or certain subsidiaries of NME shall assign to New Hillhaven's subsidiary, First Healthcare Corporation ("FHC"), and FHC shall assume the renewal and/or purchase options contained in the Assumed Leases (as that term is defined in the Reimbursement Agreement) that were not assigned to FHC on or before the Distribution Date for those facilities described in Exhibit 1 attached hereto and incorporated herein by this reference (the "Assumed Lease Options"), and those Assumed Lease Options shall be added to the Obligations covered by this Reimbursement Agreement, as more specifically provided herein. C. New Hillhaven and NME desire to amend the Reimbursement Agreement as set forth in this Agreement. NOW THEREFORE, in consideration of the foregoing Recitals and for other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties hereto, intending to be legally bound, hereby agree to amend, modify and supplement the Reimbursement Agreement as follows: AGREEMENT 1. Calculation of the Guarantee Fee After Completion of Financing. The provisions of Section 2(c) of the Reimbursement Agreement are hereby amended to provide that, commencing with the quarterly payment due for the fiscal quarter ending February 28, 1993, the guarantee fee for each quarter shall be the product of (i) the amount of the Obligations outstanding at the close of business on the last day of the preceding fiscal quarter multiplied by (ii) a fraction which is equal to the applicable fraction for the previous fiscal year multiplied by 1.2; provided, however, that at no time shall the fraction to be used in calculating the guarantee fee exceed 2%. Furthermore, notwithstanding the foregoing guaranty fee provisions, the principal amounts of the Obligations described in Exhibit 2 and Exhibit 3 attached hereto shall not be included as part of the Obligations for the purposes of calculating the guarantee fee in the foregoing sentence. Instead, in accordance with prior agreements, (x) New Hillhaven shall pay to NME a guarantee fee of 1% per annum on those Obligations described in Exhibit 2, and (y) no guarantee fee shall be charged on those Obligations described in Exhibit 3. 2. Proration of Guarantee Fee on Obligations Paid With Proceeds of Financing. Notwithstanding any provisions to the contrary, the guarantee fee paid with respect to those Obligations that are paid in full, or as to which NME's guaranty has been released, with proceeds of the Financing during the fiscal year ending May 31, 1994 shall be prorated to the date of payoff, based on the actual number of days elapsed until such Obligation is paid in full or such guaranty has been released. 3. Inclusion of the Assumed Lease Options as Obligations. The Assumed Lease Options are hereby added as, and shall be deemed to be, "Obligations" under (and as defined in) the Reimbursement Agreement, and all terms, covenants and conditions of the Reimbursement Agreement shall apply; provided, however, that the guarantee fee set forth in Paragraph 1 above shall be charged on the aggregate amount of the rents that will become due for the renewal period for any such Assumed Lease, commencing on the earlier of the date that FHC exercises or is required to exercise such Assumed Lease Option, as provided by the terms of the assignment of such Assumed Lease Option. 4. Inclusion of Certain Assumed Obligations. To the extent NME or any subsidiary or affiliate of NME remains primarily or contingently liable therefor, each of the Assumed Existing Debt and the Assumed Lease described in Exhibit 4 attached hereto is hereby added as, and shall be deemed to be, an "Obligation" under (and as defined in) the Reimbursement Agreement, and all terms, covenants and conditions of the Reimbursement Agreement, including payment of a guarantee fee as provided in Paragraph 1 above, shall apply to such Assumed Existing Debt and Assumed Lease. 5. Reaffirmation of Reimbursement Agreement. New Hillhaven reaffirms that the Reimbursement Agreement, as amended hereby, shall remain in full force and effect, and shall continue to be binding upon New Hillhaven. 6. Captions. The captions and headings used herein are for the convenience of reference and shall not be construed in any manner to limit or modify any of the terms hereof. 7. Governing Law. This Amendment shall be governed by and construed in accordance with the laws of the State of California. 8. Counterparts. This Amendment may be executed in counterparts, each of which shall be an original, but all of which together shall constitute but one and the same instrument. IN WITNESS WHEREOF, each of the parties hereto has caused this Amendment to be duly executed on its behalf as of the date first set forth above. NATIONAL MEDICAL ENTERPRISES, INC. By: _________________________ Title: ______________________ THE HILLHAVEN CORPORATION By: _________________________ Title: ______________________ EXHIBIT 1 No. Facility Name 272 Hughes Springs Nursing Home Hughes Springs, Texas 273 Pinecrest Convalescent Home Daingerfield, Texas 274 Coastal Care Center Texas City, Texas 275 Great Southwest Convalescent Center Grand Prairie, Texas 292 Twin City Nursing Home Gas City, Indiana 298 Driftwood Convalescent Hospital Yuba City, California 299 Marysville Convalescent Hospital Marysville, California 305 University Nursing Center Upland, Indiana 880 Four States Nursing Home Texarkana, Texas 881 Southwest Senior Care Center Las Vegas, New Mexico 760 Ridgeview Nursing and Convalescent Center Wichita Falls, Texas 76392 860 Blue Hills Centre Kansas City, Missouri 849 Iliff Care Center Denver, Colorado 295 Whitehouse Country Manor Whitehouse, Ohio 184 Greystone Healthcare Center Blountville, Tennessee 183 Hillhaven Convalescent Center - Ripley Ripley, Tennessee 189 Fairpark Healthcare Center Maryville, Tennessee 179 Hillhaven Convalescent Center of Huntington Huntington, Tennessee 175 Hillhaven of Jefferson City Jefferson City, Tennessee 171 Hillhaven Convalescent Center Bolivar, Tennessee EXHIBIT 2 A ONE PERCENT GUARANTEE FEE IS PAYABLE ON OBLIGATIONS COVERING THE FOLLOWING FACILITIES: Facility 462: Queen Anne Care Center, WA Facility 158: Bellingham Care Center, Bellingham, WA Facility 461: Edmonds Care Center, Edmonds, WA Facility 825: Nansemond Convalescent Center, Suffolk, VA Facility 829: Holmes Convalescent Center, Virginia Beach, VA EXHIBIT 3 NO GUARANTEE FEE IS PAYABLE ON OBLIGATIONS COVERING THE FOLLOWING FACILITIES: Facility 525: Hillhaven Convalescent Hospital, Orange, CA Facility 781: Bashford East Health Care Center, Bashford, KY Facility 804: Hillhaven Convalescent Center and Nursing Home, Birmingham, AL Facility 824: Hillhaven Convalescent Center & Nursing Home, Mobile, AL Facility 160: First Hill Care Center, WA Facility 560: Franklin Woods Healthcare Center, OH Facility 570: Pickerington Health Care Center, OH Facility 822: Hillhaven Convalescent Center, Memphis, TN Facility 416: Park Place Hillhaven Convalescent Center, Great Falls, MT Facility 572: Canal Winchester, OH -- No guarantee fee shall be payable on the Assumed Lease. A guarantee shall be payable on the Assumed Existing Debt as provided in Paragraph 1 of the Amendment. EXHIBIT 4 ASSUMED OBLIGATIONS ASSUMED EXISTING DEBT Facility 572: Canal Winchester Loan Agreement, dated April 1, 1983, between County of Franklin and Aeon, Inc., with an outstanding principal balance as of September 2, 1993 of $1,955,000, secured by an Open-End Mortgage and Security Agreement dated April 1, 1983. Facility 416: Park Place All-Inclusive Promissory Note Secured by Mortgage, dated September 1, 1983, in favor of B.G.M. Enterprises, with an outstanding principal balance as of September 2, 1993 of $257,998.44. All-Inclusive Promissory Note Secured by Mortgage, dated September 1, 1983, in favor of B.G.M. Enterprises, with an outstanding principal balance as of September 2, 1993 of $1,357,016.39. ASSUMED LEASE Facility 572: Canal Winchester Lease and Sublease Agreement, dated October 10, 1985, between Aeon, Inc. and First Healthcare Corporation, and any amendments thereto.