EXECUTION COPY AMENDMENT NO. 1 TO SECOND AMENDED AND RESTATED CREDIT AGREEMENT AMENDMENT NO. 1, dated as of March 7, 1997 by and among: Genesis Health Ventures, Inc. and certain Subsidiaries identified on the signature pages hereto as "Borrowers"; the institutions identified on the signature pages hereto as "Lenders"; Mellon Bank, N.A. as Issuer of Letters of Credit; Mellon Bank, N.A. as Administrative Agent and Co-Syndication Agent; Citibank, N.A. as Co-Syndication Agent; and the other Co-Agents specified on the signature pages hereto. Background A certain Second Amended and Restated Credit Agreement, among Genesis Health Ventures, Inc. and certain Subsidiaries thereof as Borrowers, Mellon Bank, N.A. as Administrative Agent and Co-Syndication Agent, Citibank, N.A. as Co-Syndication Agent, certain other Co-Agents named therein and certain Lenders named therein was entered into on October 7, 1996. On October 11, 1996, in connection with an acquisition by Genesis Health Ventures, Inc., certain additional Subsidiaries became Borrowers thereunder (as so modified, the "Existing Credit Agreement" and, as the same is hereby amended and as the same may be further amended, modified or supplemented from time to time, the "Credit Agreement"). Unless otherwise defined herein, terms are used herein as defined in the Existing Credit Agreement. Also on October 7, 1996, Genesis Eldercare Properties, Inc., one of the Borrowers under the Existing Credit Agreement, entered into a certain Amended and Restated Participation Agreement (the "Participation Agreement") and related documents evidencing a $150,000,000 Synthetic Lease Facility. The Participation Agreement and other Synthetic Lease Facility Documents (as defined in the Credit Agreement) as amended or modified to (but not including) the date hereof are collectively referred to herein as the "Existing Synthetic Lease Facility Documents". Each of the Lenders under the Existing Credit Agreement are participants in the Participation Agreement. Each of the Borrowers under the Credit Agreement are guarantors of the Synthetic Lease Facility (as defined in the Credit Agreement). The Borrowers have requested that the total amount of the commitment under the Existing Credit Agreement be increased from $300,000,000 to $375,000,000. There will not be any increase in amount of the Synthetic Lease Facility. However, in order to continue the proportionate relationship of each Lender under the Credit Agreement and each participant in the Synthetic Lease Facility, both the Existing Credit Agreement and the Existing Synthetic Lease Facility Documents are being amended as of the date hereof to provide for (a) the increase in the total commitment under the Existing Credit Agreement and the inclusion of any new Lenders, (b) the inclusion of any new Lenders under the Credit Agreement as participants in the Synthetic Lease Facility, (c) a downward adjustment in existing interests in the Synthetic Lease Facility to allow for appropriate allocations, and (d) a commensurate increase in commitments under the Credit Agreement. The Lenders are willing to make such changes to the Credit Agreement, subject to the terms and conditions set forth below. NOW THEREFORE, the parties hereto, intending to be legally bound, hereby agree as follows. Agreement 1. Amendments to Existing Credit Agreement. The Existing Credit Agreement shall be, as of the Amendment Effective Date (as defined below), amended in each of the following respects. 1.1 Change in Commitment; New Exhibit G. The total Commitment of all Lenders under the Credit Agreement and the individual Commitment of each Lender under the Credit Agreement shall be amended to be the amounts set forth on a new Exhibit G which shall be delivered by the Agent to each Lender and Borrower within ten days of the Amendment Effective Date. Said new Exhibit G shall also specify the Amendment Effective Date and shall be added as an additional Exhibit to the Credit Agreement. The information on Exhibit G shall conform to the following criteria: (a) As to each Lender that is a party to the Credit Agreement prior to the Amendment Effective Date (an "Existing Lender"), unless otherwise specifically agreed to in a writing between such Existing Lender and the Agent, (i) the sum of its revised Commitment on said Exhibit G and its revised participation in the Synthetic Lease Facility (after giving effect to the related amendments to the Synthetic Lease Facility Documents) shall be equal to (ii) the sum of such Existing Lender's Initial Commitment under the Existing Credit Facility and its initial participation interest in the Synthetic Lease under the Existing Synthetic Lease Facility Documents; (b) Each new Lender and each Existing Lender will have the same percentage interest in the Credit Agreement as such Lender/participant has in the Synthetic Lease Facility; and (c) The aggregate amount of the total Commitments under the Credit Agreement shall not exceed Three Hundred and Seventy-Five Million Dollars ($375,000,000). The increased amount of the Commitments may be allocated among such institutions as the Agent (in its sole discretion) may determine. 1.2 Additional Definition: Amendment Effective Date. The following new definition shall be added to Section 1.1 of the Existing Credit Agreement in its correct alphabetical location: "Amendment Effective Date" shall have the meaning ascribed to such term in Amendment No. 1, dated as of March 7, 1997 to this Agreement. 1.3 Amendment to Section 2.1: Initial Commitment. The second sentence of Section 2.1(a) of the Existing Credit Agreement shall be amended in its entirety to read as follows: -2- On the Amendment Effective Date, each Lender's Commitment shall be equal to the amount set forth as its "Revised Commitment" next to its name on Exhibit G attached hereto, and shall be subject to adjustment pursuant to the terms hereof. 1.4 Amendment to Exhibit F: Commitment Percentage. Exhibit F to the Existing Credit Agreement shall be amended in its entirety to read as set forth on a new Exhibit F to be delivered to the Lenders and the borrowers by the Agent within ten days of the Amendment Effective Date. Said new Exhibit F shall set forth the correct percentage interest of each Lender in the total Commitment under the Credit Agreement after giving effect to the new Commitment allocations set forth on Exhibit G. 1.5 Joinder of Additional Lenders. Each Person that shall agree to be a Lender under the Credit Agreement shall execute a joinder thereto, effective as of the Amendment Effective Date, in form and substance satisfactory to the Agent and thereafter shall be a Lender thereunder and under each Loan Document for all purposes as if it had been an original signatory to the Credit Agreement. 1.6 Amendment to Section 2.7: Prepayments. In order to allow for the prepayment of Loans bearing interest at the Euro-Rate Option prior to the expiration of the applicable Funding Period subject to breakage costs, Section 2.7 is amended by replacing the colon after the parenthetical phrase "(subject, however, to Section 2.12(b) hereof)" with a period and by deleting clauses (a) and (b) thereof. 2. Representations and Warranties. In order to induce the Lenders and the Agent to agree to amend the Credit Agreement, each of the Borrowers, jointly and severally, makes the following representations and warranties, which shall survive the execution and delivery of this Amendment No. 1: (a) No Default has occurred and is continuing or would exist immediately after giving affect to the amendments contained herein; and (b) Each of the representations and warranties set forth in the Credit Agreement is true and correct in all material respects both before and after giving effect to the amendments and transactions contemplated hereby as though each such representation and warranty were made at and as of the date hereof and as of the Amendment Effective Date. 3. Notes. On the Amendment Effective Date, the Borrowers shall issue a replacement Note to each Existing Lender and a new Note to each new Lender. The principal amount of each Lenders' Note shall be equal to the amount of its "Revised Commitment" as specified on Exhibit G. 4. Amendment Effective Date. The amendments set forth in Section 1 above shall be effective on the date (the "Amendment Effective Date") that each of the following conditions is satisfied: 4.1 Execution of Amendment. The Issuer, each of the Borrowers, the Lenders and the Agents shall have executed a counterpart to this Amendment No. 1. -3- 4.2 Joinder of New Lenders. The additional Lenders and the Borrowers shall have executed a joinder to the Credit Agreement as set forth in Section 1.5 above. 4.3 Opinion. The Agent shall have received an opinion of Blank, Rome, Comisky & McCauley as to the enforceability of this Amendment No. 1 and such other matters as the Agent may request. 4.4 Fees. Each of the Existing Lenders shall have received such amendment fees as are specified in the letter dated February 25, 1997 from Carol Paige, Vice President of Mellon Bank, N.A. as Agent to each Existing Lender and all other amounts payable to it under the Loan Documents. 4.5 Amendment to Synthetic Lease Facility Documents. The Existing Synthetic Lease Facility Documents shall have been amended to provide for the inclusion of any new Lenders as participants thereunder and the adjustment in each participant's interest therein to maintain the same proportionate interest under the Credit Agreement and the Synthetic Lease Facility after giving effect to this Amendment No. 1 and those amendments to the Synthetic Lease Facility Documents. In addition, there shall have been appropriate provisions made for payments in connection with the Synthetic Lease Facility Documents to account for the necessary adjustments to the outstanding amounts thereunder to effect the reallocation contemplated hereby. 4.6 Other Documents and Information. The Agent shall have received such other documents and information as it shall reasonably request. 5. Counterparts. This Amendment No. 1 may be executed in counterparts and by different parties hereto in separate counterparts, each of which, when executed and delivered, shall be deemed to be an original and all of which, when taken together, shall constitute one and the same instrument. A facsimile signature shall be deemed to be the functional equivalent of a manually executed original for all purposes. 6. Ratification. The Credit Agreement, as amended by this Amendment No. 1, and the other Loan Documents are, and shall continue to be, in full force and effect and are hereby in all respects confirmed, approved and ratified. Without limiting the generality of the foregoing, the undersigned Borrowers, in their capacity as "Grantors" under the Pledge Agreement, confirm that the security interest granted pursuant to the Pledge Agreement secures all of the Secured Obligations (as defined in the Pledge Agreement) including, without limitation, all repayment obligations in connection with loans made under the new commitment amount and under any other new commitment amount from time to time. 7. Payment of Expenses. Without limiting other payment obligations of the Borrowers set forth in the Loan Documents, the Borrowers hereby, jointly and severally, agree to pay all costs and expenses incurred by the Agent in connection with the preparation, execution and delivery of this Amendment No. 1 and any other documents or instruments which may be delivered in connection herewith, including, without limitation, the reasonable fees and expenses of its counsel, Drinker Biddle & Reath. -4- 8. Authorization to Agents. Each Lender hereby authorizes the Agent and the Collateral Agent to take such action (including, without limitation, signing amendments to Loan Documents) as shall be consistent with the purposes hereof as it shall deem necessary or appropriate to carry out the purposes of this Amendment No. 1. 9. Governing Law. This Amendment No. 1 shall be construed in accordance with, and governed by the laws of, the Commonwealth of Pennsylvania, without regard to choice of law principles. 10. References. From and after the Amendment Effective Date, each reference in the Credit Agreement to "this Agreement", "hereof", "hereunder" or words of like import, and all references to the Credit Agreement in any and all Loan Documents, other agreements, instruments, documents, certificates and writings of every kind and nature, shall be deemed to mean the Credit Agreement as modified and amended by this Amendment No. 1 and as the same may be further amended, modified or supplemented in accordance with the terms thereof. Further, each reference to the "Lenders", the "Notes", "Commitment", "Initial Commitment", or "Commitment Percentage" shall be and mean a reference to the same as modified in accordance with the provisions of this Amendment No. 1 and as the same may be further amended, modified or supplemented from time to time in accordance with the terms of the Credit Agreement. IN WITNESS WHEREOF, the parties have caused this Amendment No. 1 to be duly executed as of the date first above written. GENESIS HEALTH VENTURES, INC., a Pennsylvania corporation By_______________________________________________________ Title: General Counsel-Corporate and Secretary Address for notices: Suite 100 148 West State Street Kennett Square, PA 19348 Attention: Senior Vice President and Chief Financial Officer Telephone: 610-444-6350 Facsimile: 610-444-3365 BREVARD MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Healthcare, Inc., a Pennsylvania corporation, its sole general partners -5- CATONSVILLE MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Health, Inc., a Pennsylvania corporation, one of its general partners EASTON MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Health, Inc., a Pennsylvania corporation, its sole general partner EDELLA STREET ASSOCIATES, a Pennsylvania limited partnership By: Genesis Health Ventures of Clarks Summit, Inc., its sole general partner GENESIS PROPERTIES LIMITED PARTNERSHIP, a Pennsylvania limited partnership By: Genesis Health Ventures of Arlington, Inc., its sole general partner GREENSPRING MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Healthcare, Inc., a Pennsylvania corporation, its sole general partner HAMMONDS LANE MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Healthcare, Inc., a Pennsylvania corporation, one of its general partners MERIDIAN/CONSTELLATION LIMITED PARTNERSHIP By: Meridian Healthcare, Inc., general partner -6- MERIDIAN EDGEWOOD LIMITED PARTNERSHIP By: Meridian Healthcare, Inc., a general partner MERIDIAN PERRING LIMITED PARTNERSHIP By: Meridian Healthcare, Inc., a general partner MERIDIAN VALLEY LIMITED PARTNERSHIP By: Meridian Healthcare, Inc., a general partner MERIDIAN VALLEY VIEW LIMITED PARTNERSHIP By: Meridian Healthcare, Inc., a general partner MILLVILLE MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Healthcare, Inc., a Pennsylvania corporation, its sole general partner PHILADELPHIA AVENUE ASSOCIATES, a Pennsylvania limited partnership By: Philadelphia Avenue Corp., its sole general partner RIVER STREET ASSOCIATES, a Pennsylvania limited partnership By: Genesis Health Ventures of Wilkes-Barre, Inc., its sole general partner SEMINOLE MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Health, Inc., a Pennsylvania corporation, its sole general partner STATE STREET ASSOCIATES, L.P., a Pennsylvania limited partnership By: State Street Associates, Inc. its sole general partner -7- THERAPY CARE SYSTEMS, L.P. a Pennsylvania limited partnership By: Genesis Eldercare Rehabilitation Services, Inc. its sole general partner VOLUSIA MERIDIAN LIMITED PARTNERSHIP, a Maryland limited partnership By: Meridian Health, Inc., a Pennsylvania corporation, its sole general partner GENESIS PROPERTIES OF DELAWARE LTD PARTNERSHIP, L.P., a Delaware limited partnership By: Genesis Properties of Delaware Corporation, a general partner McKERLEY HEALTH FACILITIES, a New Hampshire general partnership By: Meridian Health, Inc., a Pennsylvania corporation, and Meridian Healthcare, Inc., a Pennsylvania corporation, its general partners NORTH CAPE CONVALESCENT CENTER ASSOCIATES, L.P. a Pennsylvania limited partnership By:__________________ On behalf of each of the foregoing as General Counsel-Corporate and Secretary of the general partner GENESIS HEALTH VENTURES OF ARLINGTON, INC., a Pennsylvania corporation GENESIS HEALTH VENTURES OF BLOOMFIELD, INC., a Pennsylvania corporation -8- GENESIS HEALTH VENTURES OF CLARKS SUMMIT, INC., a Pennsylvania corporation GENESIS HEALTH VENTURES OF MASSACHUSETTS, INC., a Pennsylvania corporation GENESIS HEALTH VENTURES OF NAUGATUCK, INC., a Pennsylvania corporation GENESIS HEALTH VENTURES OF SALISBURY, INC., a Pennsylvania corporation GENESIS HEALTH VENTURES OF WAYNE, INC., a Pennsylvania corporation GENESIS HEALTH VENTURES OF WEST VIRGINIA, INC., a Pennsylvania corporation GENESIS HEALTH VENTURES OF WINDSOR, INC., a Pennsylvania corporation GENESIS IMMEDIATE MED CENTER, INC., a Pennsylvania corporation GENESIS ELDERCARE HOME SERVICES, INC. a Pennsylvania corporation GENESIS ELDERCARE PHYSICIAN SERVICES, INC., a Pennsylvania corporation HEALTHCARE RESOURCES CORP., a Pennsylvania corporation KNOLLWOOD MANOR, INC., a Pennsylvania corporation -9- MERIDIAN HEALTH, INC., a Pennsylvania corporation MERIDIAN HEALTHCARE, INC., a Pennsylvania corporation PHILADELPHIA AVENUE CORPORATION, a Pennsylvania corporation GENESIS ELDERCARE STAFFING SERVICES INC. a Pennsylvania corporation STATE STREET ASSOCIATES, INC., a Pennsylvania corporation SUBURBAN MEDICAL SERVICES, INC. a Pennsylvania corporation GENESIS ELDERCARE REHABILITATION SERVICES, INC., a Pennsylvania corporation THERAPY CARE INC., a Pennsylvania corporation THE TIDEWATER HEALTHCARE SHARED SERVICES GROUP, INC., a Pennsylvania corporation WYNCOTE HEALTHCARE CORP. a Pennsylvania corporation ASCO HEALTHCARE, INC., a Maryland corporation BRINTON MANOR, INC., a Delaware corporation CONCORD HEALTHCARE CORPORATION, a Delaware corporation CRYSTAL CITY NURSING CENTER, INC., a Maryland corporation EASTERN MEDICAL SUPPLIES, INC., a Maryland corporation GENESIS HEALTH SERVICES CORPORATION, a Delaware corporation -10- GENESIS HEALTHCARE CENTERS HOLDINGS, INC., a Delaware corporation GENESIS HOLDINGS, INC., a Delaware corporation GENESIS PROPERTIES OF DELAWARE CORPORATION, a Delaware corporation HILLTOP HEALTH CARE CENTER, INC., a Delaware corporation KEYSTONE NURSING HOME, INC., a Delaware corporation LINCOLN NURSING HOME, INC., a Delaware corporation McKERLEY HEALTH CARE CENTERS, INC., a New Hampshire corporation WAYSIDE NURSING HOME, INC., a Delaware corporation PROFESSIONAL PHARMACY SERVICES, INC., a Maryland Corporation MEDICAL SERVICES GROUP, INC., a Maryland Corporation NEIGHBORCARE PHARMACIES, INC., a Maryland Corporation DERBY NURSING CENTER CORPORATION, a Connecticut Corporation GENESIS ELDERCARE NATIONAL CENTERS INC., a Florida Corporation GENESIS ELDERCARE NETWORK SERVICES, INC., a Pennsylvania Corporation GENESIS ELDERCARE PROPERTIES, INC., a Pennsylvania Corporation OAK HILL HEALTH CARE CENTER, INC., a Virginia Corporation VERSALINK, INC., a Delaware Corporation -11- GERIATRIC & MEDICAL COMPANIES, INC. a Delaware corporation GERIATRIC & MEDICAL SERVICES, INC. a New Jersey corporation BURLINGTON WOODS CONVALESCENT CENTER, INC. a New Jersey corporation CRESTVIEW CONVALESCENT HOME, INC. a Pennsylvania corporation CRESTVIEW NORTH, INC. a Pennsylvania corporation DIVERSIFIED DIAGNOSTICS, INC. a Pennsylvania corporation GMC MEDICAL CONSULTING SERVICES, INC. a Pennsylvania corporation GERIATRIC AND MEDICAL INVESTMENTS CORP. a Delaware corporation GERIMED CORP. a Pennsylvania corporation GMS INSURANCE SERVICES, INC. a Pennsylvania corporation HCHS, INC. a Pennsylvania corporation HSS-PARA TRANSIT, INC. a Pennsylvania corporation INNOVATIVE PHARMACY SERVICES, INC. a New Jersey corporation LIFE SUPPORT AMBULANCE, INC. a Pennsylvania corporation LIFE SUPPORT MEDICAL, INC. a Pennsylvania corporation METRO PHARMACEUTICALS, INC. a Pennsylvania corporation -12- UNITED HEALTH CARE SERVICES, INC. a Pennsylvania corporation VALLEY MEDICAL SERVICES, INC. a Pennsylvania corporation VALLEY TRANSPORT AMBULANCE SERVICE, INC. a Pennsylvania corporation VILLAS REALTY & INVESTMENT, INC. a Pennsylvania corporation WEISENFLUH AMBULANCE SERVICE, INC. a Pennsylvania corporation By: ___________________________________________________ On behalf of each of the foregoing as General Counsel-Corporate and Secretary -13- Agents and Lenders: MELLON BANK, N.A., as a Lender, as Issuer, as Agent and as Co-Syndication Agent By ____________________________________________________ Title: Vice President CITIBANK, N.A., as a Lender and as Co-Syndication Agent By ____________________________________________________ Title: FIRST UNION NATIONAL BANK OF NORTH CAROLINA, as a Lender and as a Co-Agent By ____________________________________________________ Title: NATIONSBANK, N.A., as a Lender and as a Co-Agent By ____________________________________________________ Title: -14- FLEET NATIONAL BANK By ____________________________________________________ Title: CORESTATES BANK, N.A. By ____________________________________________________ Title: PNC BANK, NATIONAL ASSOCIATION By ____________________________________________________ Title: BANK OF AMERICA NATIONAL TRUST AND SAVINGS ASSOCIATION By ____________________________________________________ Title: -15- CREDIT LYONNAIS NEW YORK BRANCH By ____________________________________________________ Title: CREDIT SUISSE FIRST BOSTON By ____________________________________________________ Title: By ____________________________________________________ Title: AMSOUTH BANK OF ALABAMA By ____________________________________________________ Title: BANQUE PARIBAS By ____________________________________________________ Title: By ____________________________________________________ Title: -16- CREDITANSTALT CORPORATE FINANCE, INC. By ____________________________________________________ Title: By ____________________________________________________ Title: SIGNET BANK By ____________________________________________________ Title: THE SUMITOMO BANK, LIMITED By ____________________________________________________ Title: By ____________________________________________________ Title: THE FIRST NATIONAL BANK OF MARYLAND By ____________________________________________________ Title: -17-