EXHIBIT 10.12
 
                                AMENDMENT  NO. 3
                                     TO THE
                              AGREEMENT TO PROVIDE
                  MANAGEMENT SERVICES FOR DIALYSIS FACILITIES
                                 BY AND BETWEEN
                           MONTEFIORE MEDICAL CENTER
                                      AND
                       NEW YORK DIALYSIS MANAGEMENT, INC.
                       ----------------------------------

     THIS AMENDMENT NO. 3 TO THE AGREEMENT TO PROVIDE MANAGEMENT SERVICES FOR
DIALYSIS FACILITIES ("Amendment No. 3") is made this 17th day of July, 1998, by
and between Montefiore Medical Center, a non-profit corporation organized and
existing under the laws of the State of New York ("Hospital"), and New York
Dialysis Management, Inc., a corporation organized and existing under the laws
of the State of New York ("NYDM").

     WHEREAS, the parties hereto have entered into that certain Agreement To
Provide Management Services For Dialysis Facilities (the "Original Management
Agreement"), as amended by Amendment No. 1 thereto and Amendment No. 2 thereto
(as so amended herein referred to as the "Principal Management Agreement"); and

     WHEREAS, the parties have entered into an Agreement to Amend and Not-To-
Compete, dated July 17, 1998 (the "Agreement to Amend") and, as required by and
in consideration of the Agreement to Amend, the parties desire to amend the
Principal Management Agreement, all as set forth herein, effective as of the
Consideration Payment Date, as defined in the Agreement to Amend;

     NOW, THEREFORE, in consideration of the mutual covenants and conditions
herein set forth, the parties hereto agree as follows:

     1.  The second and third sentences of Paragraph 2.B.(iii) of the Original
Management Agreement are hereby deleted.

     2.  The following sentence is hereby added at the end of Paragraph 4.A. of
the Original Management Agreement:

          "At the conclusion of the third three-year term, and on each third
          anniversary thereafter, this Agreement shall automatically be renewed
          for successive three-year terms (subject to the Commissioner's
          approval) unless terminated earlier.  Those provisions which by their
          terms are to be performed following termination, or liabilities for
          obligations required to be performed prior to termination, shall
          survive the termination of this Agreement."

     3.   The language contained in Paragraph 4D. and Paragraph 8 of the
Original 

 
Management Agreement is hereby deleted in its entirety and is no longer of any
force or effect.

     4.   The language contained in Paragraph 5 of the Original Management
Agreement is superceded by the language in Section 3 of the Medical Director and
Administrative Services Agreement by and between Hospital and Everest Dialysis
Services, Inc. ("EDS"), which is attached to the Medical Asset Purchase
Agreement by and between Hospital and EDS, dated as of the date hereof.  Subject
to compliance with applicable rules of the State of New York, Hospital agrees
that it shall provide medical director services to each of the Facilities under
the Principal Management Agreement, as amended, providing those services as set
forth in Section 3 of the Medical Director and Administrative Services Agreement
by and between Hospital and EDS, which is attached to the Medical Asset Purchase
Agreement, unless the provision of such services by Hospital is prohibited by
law or regulation.  In lieu of the medical director fees that would have been
payable under the Principal Management Agreement prior to the effectiveness of
this Amendment, Hospital shall be entitled to the Medical Director fees at the
rates that would otherwise be paid to Hospital pursuant to Section 6 of the
Medical Director and Administrative Services Agreement as if such agreement were
in full force and effect.  Subject to compliance with applicable rules of the
State of New York, NYDM shall provide the services under this Agreement as are
set forth in Section 4 of the Medical Director and Administrative Services
Agreement by and between Hospital and EDS, which is attached to the Medical
Asset Purchase Agreement, unless the provision of such services by NYDM is
prohibited by law or regulation, or such services already are being provided
hereunder, and NYDM shall comply with the quality assurance protocols set forth
in Section 7 of the Medical Director and Administrative Services Agreement by
and between Hospital and EDS, which is attached to the Medical Asset Purchase
Agreement.

     5.   The parties agree that Paragraph 9 of the Principal Management
Agreement shall be of no further force and effect with respect to any future or
subsequent sale of the Business (which shall be defined for purposes hereof as
defined in the Agreement to Amend and shall also include other dialysis
facilities developed pursuant to this Amendment No. 3 and the Operating
Agreement by and between Hospital and EDS, which is attached to the Medical
Asset Purchase Agreement by and between Hospital and EDS, dated as of the date
hereof).

     6.   So long as the Principal Management Agreement or the Administrative
Services Agreement (as hereinafter defined) is in effect, subject to the
following sentence, Hospital shall not enter into any agreement, arrangements,
understanding, or negotiations or discussions with any third parties with regard
to the sale of the Facilities or management of the Facilities by any parties
other than Hospital or NYDM.  If Hospital has given NYDM a bona fide written
notice of termination of the Principal Management Agreement for a material and
egregious breach as provided herein, the preceding sentence shall not apply.

     7.   The following paragraphs are hereby added to the Principal Management
Agreement:

          "19.  The parties agree that notwithstanding anything herein to the

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     contrary, this Agreement shall terminate and be of no further force and
     effect upon the closing of that certain Medical Asset Purchase Agreement by
     and between Hospital and Everest Dialysis Services, Inc. ("EDS") (the
     "Medical Asset Purchase Agreement").  The parties agree that
     notwithstanding anything herein to the contrary, this Agreement may be
     terminated by either party "for cause" only in accordance with the
     following provisions:

               A.  If a party desires to terminate this Agreement for cause, it
          shall first give written notice (the "Breach Notice") to the breaching
          party, of its intention to terminate the agreement for cause
          describing in reasonable detail the material and egregious breach.

               B.  For purposes of this Agreement, "cause" shall mean only a
          material and egregious breach which, with respect to Hospital, means
          (i) a material breach by it of the non-competition provision set forth
          in Section 3 of the Agreement to Amend, (ii) a material breach by it
          of its obligations to provide Medical Director Services pursuant to
          Section 4 of this Amendment No. 3, (iii) a material breach by Hospital
          of its covenants as set forth in Section 5 of the Agreement to Amend,
          or (iv) a material failure of Hospital to remit to NYDM or EDS any
          amounts received with respect to accounts receivable pursuant to any
          contractual obligations to NYDM or EDS which Hospital may have, in
          each case which breach is continuing, and for which Hospital has
          failed to take diligent actions to cure as promptly as possible, and,
          with respect to NYDM, means a material breach by it of its obligations
          (i) to comply with the quality assurance protocols set forth in
          Section 7 of the Medical Director and Administrative Services
          Agreement by and between Hospital and EDS, which is attached to the
          Medical Asset Purchase Agreement; (ii) to develop the dialysis
          facilities on behalf of Hospital upon the terms and conditions as set
          forth in Section 2 of the Operating Agreement attached to the Medical
          Asset Purchase Agreement; or (iii) to pay to Hospital or offset from
          the fees payable from Hospital to NYDM the compensation that would
          otherwise be paid to Hospital pursuant to Section 6 of the Medical
          Director and Administrative Services Agreement as if such agreement
          were in full force and effect, in each case which breach is
          continuing, and for which NYDM has failed to take diligent actions to
          cure as promptly as possible.

               C.  If the material and egregious breach described in the Breach
          Notice has not been cured within sixty (60) days of the breaching
          party's receipt of such notice, or if the breach cannot be cured
          within sixty (60) days and the breaching party is not taking diligent
          actions to cure the breach as promptly as reasonably possible, the 
          non-breaching party may give a notice of termination for cause
          whereupon this Agreement shall be terminated for

                                      -3-

 
          cause upon the breaching party's receipt of such notice.

               D.  Any termination for reasons other than a material and
          egregious breach or as a result of an order, ruling, or regulation
          issued by the New York Public Health Council or the New York
          Department of Health shall be considered for purposes of this
          Agreement as a termination without cause by the terminating party.

               E.  In the event a party breaches this Agreement and the breach
          is not a material and egregious breach as defined herein, the non-
          breaching party shall not have the right to terminate this Agreement
          other than without cause, but nevertheless shall have all other rights
          at law or in equity, which it may exercise in the event the breaching
          party has not cured the breach within sixty (60) days of receipt of
          written notice from the non-breaching party describing in reasonable
          detail the breach, or if the breach cannot be cured within sixty (60)
          days, if the breaching party is not taking diligent actions to cure
          the breach as promptly as reasonably possible.

          "20.  In the event this Agreement must be terminated or not renewed or
     extended as a result of an order, ruling, or regulation issued by the New
     York Public Health Council or the New York Department of Health, and the
     parties also are unable to enter into the Administrative Services and
     Consulting Agreement in the form attached hereto as Exhibit A (the
     "Administrative Services Agreement") as a result of an order, ruling, or
     regulation issued by the New York Public Health Council or the New York
     Department of Health, then:

                    (i) on the date of termination or expiration of this
               Agreement, (A) Hospital shall pay to NYDM an amount equal to the
               sum of (x) twenty three million two hundred ten thousand dollars
               ($23,210,000) reduced in equal monthly amounts pro rata over two
               hundred forty (240) months for each month elapsed from the date
               of this Amendment No. 3 to the date of termination or expiration,
               (y) the depreciated value of all tangible assets of the Business
               then held by NYDM (provided, however, that such obligation by
               Hospital to pay for such tangible assets shall apply to tangible
               assets acquired after the date of this Amendment No. 3 with a
               value at the time of acquisition by NYDM in excess of one hundred
               thousand dollars ($100,000) only if Hospital shall have given its
               prior written consent to such acquisition, which consent shall
               not be unreasonably withheld) as reflected in its financial
               statements in accordance with generally accepted accounting
               principles ("GAAP") (the depreciated value referenced in this
               item (y) shall be referred to herein as the "Depreciated Book
               Value"), (B) NYDM shall transfer to Hospital, free and clear of
               any encumbrances, all tangible assets of the Business then held
               by


                                      -4-

 
               NYDM and all contracts, leases, and agreements relating thereto
               (provided, however, that Hospital shall be obligated to assume,
               and NYDM shall assign, only such contracts, leases, or agreements
               entered into by NYDM after the date of this Amendment No. 3 (i)
               in the normal course of business and if terminable upon no more
               than 90 days notice without any liability or (ii) if Hospital
               shall have given its prior written consent to the entering into
               of such contract, lease, or agreement, which consent shall not be
               unreasonably withheld) and Hospital shall (a) assume all
               obligations thereunder which are to be performed after the
               transfer thereof and (b) reimburse NYDM for any deposits and pre-
               paid expenses under such contracts, leases, or agreements;
               provided, further however, that NYDM shall indemnify and hold
               harmless Hospital for any liability under any of the
               aforementioned contracts, leases, or agreements accruing or
               arising prior to the date of termination or expiration of this
               Agreement, and (C) the Medical Asset Purchase Agreement and the
               Agreement to Amend shall be terminated, and the parties shall
               have no obligations to each other thereunder for obligations
               required to be performed after the time of such termination
               (provided such termination shall not relieve them of liability
               for indemnification or to perform obligations required to be
               performed thereunder prior to such termination);

                    (ii) from and after the date of termination or expiration of
               this Agreement, Hospital and NYDM shall collect all accounts
               receivable for goods and services provided through the Business
               and accrued through the date of termination or expiration and
               remit to NYDM, promptly upon receipt, any and all amounts
               received by Hospital in connection with such accounts receivable;

                    (iii) from and after the date of termination or expiration
               of this Agreement, NYDM shall pay, in the ordinary course, all
               accounts payable for the Business accrued through the date of
               termination or expiration; and

                    (iv) in the event that Hospital, within two (2) years after
               the date of termination or expiration of this Agreement pursuant
               to this Section 20, sells all or substantially all of the
               Business or the assets related thereto, or otherwise transfers
               the economics of the Business, directly or indirectly, or enters
               into a legally binding agreement to do the same, whether in
               connection with a single transaction or a series of related or
               unrelated transactions, for an aggregate purchase price in excess
               of the amount received by

                                      -5-

 
               NYDM in accordance with subparagraph (i)(A) above, then Hospital
               shall pay fifty percent (50%) of such excess to NYDM promptly
               after the receipt thereof. Hospital shall provide NYDM with
               copies of any agreement relating to any such sale of the Business
               or the assets related thereto or transfer of the economics of the
               Business.

          The provisions contained in subparagraphs (ii), (iii) and (iv) shall
     survive the termination or expiration of this Agreement, as applicable, as
     provided for in this Paragraph 20.

          "21.  In the event Hospital terminates this Agreement without cause
     any time prior to the date forty (40) years from the Consideration Payment
     Date or fails to extend the term of this Agreement upon expiration of the
     fourth three-year term or any subsequent term which ends prior to the date
     forty (40) years from the Consideration Payment Date, the following
     provisions shall apply:

               A.  NYDM may elect, at it option, that as a condition to and
          effective upon termination or expiration, Hospital and NYDM shall
          enter into the Administrative Services Agreement.

               B.  (x) In the event the parties are unable to enter into the
          Administrative Services Agreement as a result of an order, ruling, or
          regulation issued by the New York Public Health Council or the New
          York Department of Health, or (y) in the event that NYDM elects that
          the parties shall not enter into the Administrative Services Agreement
          as set forth in 21.A. above, then:

                    (i) as a condition to and on the date of termination or
               expiration of this Agreement (A) Hospital shall pay to NYDM an
               amount equal to the sum of (x) twenty three million two hundred
               ten thousand dollars ($23,210,000), (y) the Depreciated Book
               Value, and (z) the organizational, pre-opening, and start-up
               costs for each dialysis facility developed on behalf of Hospital
               upon the terms and conditions as set forth in Section 2 of the
               Operating Agreement which could be eligible for capitalization
               under GAAP as in effect on July 17, 1998, but prior to and
               without giving effect to the adoption of SOP 98-5, reduced in
               equal monthly amounts pro rata over two hundred forty (240)
               months for each month elapsed from the date of the opening of
               such facility, (B) NYDM shall transfer to Hospital, free and
               clear of any encumbrances, all tangible assets of the Business
               then held by NYDM and all contracts, leases, and agreements
               relating thereto (provided, however, that Hospital shall

                                      -6-

 
               be obligated to assume, and NYDM shall assign, only such
               contracts, leases, or agreements entered into by NYDM after the
               date of this Amendment No. 3 (i) in the normal course of business
               and if terminable upon no more than 90 days notice without any
               liability or (ii) if Hospital shall have given its prior written
               consent to the entering into of such contract, lease, or
               agreement, which consent shall not be unreasonably withheld) and
               Hospital shall (a) assume all obligations thereunder which are to
               be performed after the transfer thereof and (b) reimburse NYDM
               for any deposits and pre-paid expenses under such contracts,
               leases, or agreements; provided, further however, that NYDM shall
               indemnify and hold harmless Hospital for any liability under any
               of the aforementioned contracts, leases, or agreements accruing
               or arising prior to the date of termination or expiration of this
               Agreement, and (C) the Medical Asset Purchase Agreement and the
               Agreement to Amend shall be terminated, and the parties shall
               have no obligations to each other thereunder for obligations
               required to be performed after the time of such termination
               (provided such termination shall not relieve them of liability
               for indemnification or to perform obligations required to be
               performed thereunder prior to such termination);

                    (ii) from and after the date of termination or expiration of
               this Agreement, Hospital and NYDM shall collect all accounts
               receivable for goods and services provided through the Business
               and accrued through the date of termination or expiration and
               remit to NYDM, promptly upon receipt, any and all amounts
               received by Hospital in connection with such accounts receivable;

                    (iii) from and after the date of termination or expiration
               of this Agreement, NYDM shall pay, in the ordinary course, all
               accounts payable for the Business accrued through the date of
               termination or expiration; and

                    (iv) in the event that Hospital, within two (2) years after
               the date of termination of this Agreement by Hospital without
               cause or expiration of this Agreement pursuant to this Section
               21, sells all or substantially all of the Business or the assets
               related thereto, or otherwise transfers the economics of the
               Business, directly or indirectly, or enters into a legally
               binding agreement to do the same, whether in connection with a
               single transaction or a series of related or unrelated
               transactions, for an aggregate purchase price in excess of the
               amount received by NYDM in accordance with subparagraph

                                      -7-

 
               (i)(A) above, then Hospital shall pay fifty percent (50%) of such
               excess to NYDM promptly after the receipt thereof. Hospital shall
               provide NYDM with copies of any agreement relating to any such
               sale of the Business or the assets related thereto or transfer of
               the economics of the Business.

          The provisions contained in subparagraphs (ii), (iii) and (iv) shall
     survive the termination or expiration of this Agreement, as provided for in
     this Paragraph 21.

     "22. In the event Hospital terminates this Agreement without cause any time
after the date forty (40) years from the Consideration Payment Date or fails to
extend the term of this Agreement upon expiration of any term which ends after
the date forty (40) years from the Consideration Payment Date, the following
provisions shall apply:

                    (i) as a condition to and on the date of termination or
               expiration of this Agreement (A) Hospital shall pay to NYDM an
               amount equal to the Depreciated Book Value, (B) NYDM shall
               transfer to Hospital, free and clear of any encumbrances, all
               tangible assets of the Business then held by NYDM and all
               contracts, leases, and agreements relating thereto (provided,
               however, that Hospital shall be obligated to assume, and NYDM
               shall assign, only such contracts, leases, or agreements entered
               into by NYDM after the date of this Amendment No. 3 (i) in the
               normal course of business and if terminable upon no more than 90
               days notice without any liability or (ii) if Hospital shall have
               given its prior written consent to the entering into of such
               contract, lease, or agreement, which consent shall not be
               unreasonably withheld) and Hospital shall (a) assume all
               obligations thereunder which are to be performed after the
               transfer thereof and (b) reimburse NYDM for any deposits and pre-
               paid expenses under such contracts, leases, or agreements;
               provided, further however, that NYDM shall indemnify and hold
               harmless Hospital for any liability under any of the
               aforementioned contracts, leases, or agreements accruing or
               arising prior to the date of termination or expiration of this
               Agreement, and (C) the Medical Asset Purchase Agreement and the
               Agreement to Amend shall be terminated, and the parties shall
               have no obligations to each other thereunder for obligations
               required to be performed after the time of such termination
               (provided such termination shall not relieve them of liability
               for indemnification or to perform obligations required to be
               performed thereunder prior to such termination);

                    (ii) from and after the date of termination or expiration of

                                      -8-

 
               this Agreement, Hospital and NYDM shall collect all accounts
               receivable for goods and services provided through the Business
               and accrued through the date of termination or expiration and
               remit to NYDM, promptly upon receipt, any and all amounts
               received by Hospital in connection with such accounts receivable;
               and

                    (iii) from and after the date of termination or expiration
               of this Agreement, NYDM shall pay, in the ordinary course, all
               accounts payable for the Business accrued through the date of
               termination or expiration.

          The provisions contained in subparagraphs (ii) and (iii) shall survive
     the termination or expiration of this Agreement, as provided for in this
     Paragraph 22.

          "23.  In the event, and only in the event, Hospital terminates this
     Agreement for cause due to a material and egregious breach by NYDM as
     defined above, the following provisions shall apply as Hospital's sole
     remedy for such breach, and Hospital shall have no other remedies for such
     breach:

               A.  As a condition to and on the date of termination, (A)
          Hospital shall pay to NYDM an amount equal to the the Depreciated Book
          Value, (B) NYDM shall transfer to Hospital, free and clear of any
          encumbrances, all tangible assets of the Business then held by NYDM
          and all contracts, leases, and agreements relating thereto (provided,
          however, that Hospital shall be obligated to assume, and NYDM shall
          assign, only such contracts, leases, or agreements entered into by
          NYDM after the date of this Amendment No. 3 (i) in the normal course
          of business and if terminable upon no more than 90 days notice without
          any liability or (ii) if Hospital shall have given its prior written
          consent to the entering into of such contract, lease, or agreement,
          which consent shall not be unreasonably withheld) and Hospital shall
          (a) assume all obligations thereunder which are to be performed after
          the transfer thereof and (b) reimburse NYDM for any deposits and pre-
          paid expenses under such contracts, leases, or agreements; provided,
          further however, that NYDM shall indemnify and hold harmless Hospital
          for any liability under any of the aforementioned contracts, leases,
          or agreements accruing or arising prior to the date of termination or
          expiration of this Agreement, and (C) the Medical Asset Purchase
          Agreement and the Agreement to Amend shall be terminated and the
          parties shall have no further obligations to each other thereunder
          (provided such termination shall not relieve them of liability for
          indemnification or to perform obligations required to be performed
          thereunder prior to such termination);

                                      -9-

 
               B.  From and after the date of termination, Hospital and NYDM
          shall collect all accounts receivable for goods or services provided
          through the Business and remit to NYDM, promptly upon receipt, any and
          all amounts received by Hospital in connection with such accounts
          receivable; and

               C.  From and after the date of termination, NYDM shall pay, in
          the ordinary course, all accounts payable of the Business and accrued
          through the date of termination or expiration.

          The provisions contained in subparagraphs B. and C. shall survive the
     termination of this Agreement as provided for in this Paragraph 23.

          "24.  In the event, and only in the event, NYDM terminates this
     Agreement for cause due to a material and egregious breach by Hospital, as
     defined above, any time prior to the date forty (40) years from the
     Consideration Payment Date, the following provisions shall apply as NYDM's
     sole remedy for such breach, and NYDM shall have no other remedies for such
     breach:

               A.  on the date of termination of this Agreement, (A) Hospital
          shall pay to NYDM an amount equal to (x) twenty three million two
          hundred ten thousand dollars ($23,210,000), (y) the Depreciated Book
          Value, and (z) the organizational, pre-opening, and start-up costs for
          each dialysis facility developed on behalf of Hospital upon the terms
          and conditions as set forth in Section 2 of the Operating Agreement
          which could be eligible for capitalization under GAAP as in effect on
          July 17, 1998, but prior to and without giving effect to the adoption
          of SOP 98-5, reduced in equal monthly amounts pro rata over two
          hundred forty (240) months for each month elapsed from the date of the
          opening of such facility, (B) NYDM shall transfer to Hospital, free
          and clear of any encumbrances, all tangible assets of the Business
          then held by NYDM and all contracts, leases and agreements relating
          thereto (provided, however, that Hospital shall be obligated to
          assume, and NYDM shall assign, only such contracts, leases, or
          agreements entered into by NYDM after the date of this Amendment No. 3
          (i) in the normal course of business and if terminable upon no more
          than 90 days notice without any liability or (ii) if Hospital shall
          have given its prior written consent to the entering into of such
          contract, lease, or agreement, which consent shall not be unreasonably
          withheld) and Hospital shall (a) assume all obligations thereunder
          which are to be performed after the transfer thereof and (b) reimburse
          NYDM for any deposits and pre-paid expenses under such contracts,
          leases, or agreements; provided, further however, that NYDM shall
          indemnify and hold harmless

                                      -10-

 
          Hospital for any liability under any of the aforementioned contracts,
          leases, or agreements accruing or arising prior to the date of
          termination or expiration of this Agreement, and (C) the Medical Asset
          Purchase Agreement and the Agreement to Amend shall be terminated and
          the parties shall have no further obligations to each other thereunder
          (provided such termination shall not relieve them of liability for
          indemnification or to perform obligations required to be performed
          thereunder prior to such termination);

               B.  from and after the date of termination, Hospital and NYDM
          shall collect all accounts receivable for goods and services provided
          through the Business and remit to NYDM, promptly upon receipt, any and
          all amounts received by Hospital in connection with such accounts
          receivable; and

               C.  from and after the date of termination or expiration, NYDM
          shall pay, in the ordinary course, all accounts payable of the
          Business accruing through the date of termination or expiration.

               D.  In the event that Hospital, within two (2) years after the
          date of termination of this Agreement by NYDM for cause due to a
          material and egregious breach by Hospital pursuant to this Section 24,
          sells all or substantially all of the Business or the assets related
          thereto, or otherwise transfers the economics of the Business,
          directly or indirectly, or enters into a legally binding agreement to
          do the same, whether in connection with a single transaction or a
          series of related or unrelated transactions, for an aggregate purchase
          price in excess of the amount received by NYDM in accordance with
          subparagraph (i)(A) above, then Hospital shall pay fifty percent (50%)
          of such excess to NYDM promptly after the receipt thereof. Hospital
          shall provide NYDM with copies of any agreement relating to any such
          sale of the Business or assets related thereto or transfer of the
          economics of the Business.

          The provisions contained in subparagraphs B., C., and D. shall survive
     the termination of this Agreement as provided for in this Paragraph 24.

          "25.  In the event NYDM terminates this Agreement for cause due to a
     material and egregious breach by Hospital, as defined above, any time on or
     after the date forty (40) years from the Consideration Payment Date, the
     following provisions shall apply as NYDM's sole remedy for such breach, and
     NYDM shall have no other remedies for such breach:

                                     -11-

 
               A.  as a condition to and on the date of termination of this
          Agreement, (A) Hospital shall pay to NYDM an amount equal to the
          Depreciated Book Value, (B) NYDM shall transfer to Hospital, free and
          clear of any encumbrances, all tangible assets of the Business then
          held by NYDM and all contracts, leases, and agreements relating
          thereto (provided, however, that Hospital shall be obligated to
          assume, and NYDM shall assign, only such contracts, leases, or
          agreements entered into by NYDM after the date of this Amendment No. 3
          (i) in the normal course of business and if terminable upon no more
          than 90 days notice without any liability or (ii) if Hospital shall
          have given its prior written consent to the entering into of such
          contract, lease, or agreement, which consent shall not be unreasonably
          withheld) and Hospital shall (a) assume all obligations thereunder
          which are to be performed after the transfer thereof and (b) reimburse
          NYDM for any deposits and pre-paid expenses under such contracts,
          leases, or agreements; provided, further however, that NYDM shall
          indemnify and hold harmless Hospital for any liability under any of
          the aforementioned contracts, leases, or agreements accruing or
          arising prior to the date of termination or expiration of this
          Agreement, and (C) the Medical Asset Purchase Agreement and the
          Agreement to Amend shall be terminated and the parties shall have no
          further obligations to each other thereunder (provided such
          termination shall not relieve them of liability for indemnification or
          to perform obligations required to be performed thereunder prior to
          such termination);

               B.  from and after the date of termination, Hospital and NYDM
          shall collect all accounts receivable for goods and services provided
          through the Business and remit to NYDM, promptly upon receipt, any and
          all amounts received by Hospital in connection with such accounts
          receivable; and

               C.  from and after the date of termination or expiration, NYDM
          shall pay, in the ordinary course, all accounts payable of the
          Business accruing through the date of termination or expiration.

          The provisions contained in subparagraphs B. and C. shall survive the
     termination of this Agreement as provided for in this Paragraph 25.

          "26.  Until the termination or expiration of this Agreement, the
     parties shall continue to operate hereunder in the ordinary course of
     business consistent with the past practices and customs of the parties.

          "27.  NYDM agrees that it shall develop the dialysis facilities on
     behalf of Hospital upon the terms and conditions as set forth in Section 2
     of the Operating 

                                      -12-

 
     Agreement attached to the Medical Asset Purchase Agreement, such facilities
     shall be deemed "Facilities" as defined in the Principal Management
     Agreement and all references therein to Facilities shall include such new
     facilities; provided, however, that in the event Hospital unreasonably
     withholds its consent to the entering into by NYDM of any material
     contract, lease, or agreement, or the purchase by NYDM of any material
     asset, necessary for the development of any such Facility, then NYDM shall
     be relieved of its obligation to develop such Facility.

          "28.  NYDM and Hospital agree that they shall comply with the terms
     and conditions as set forth in Section 3 of the Operating Agreement
     attached to the Medical Asset Purchase Agreement until such time as this
     Principal Management Agreement is terminated."

     8.   Except as amended by this Amendment No. 3, the provisions of the
Principal Management Agreement shall remain in full force and effect without
modification.

     IN WITNESS WHEREOF, the parties hereto have executed this Amendment No. 3
as of the date first herein above written.

MONTEFIORE MEDICAL CENTER              NEW YORK DIALYSIS
                                       MANAGEMENT, INC.


/s/ Donald L. Ashkenase                /s/ Craig W. Moore
- ----------------------------------     ----------------------------------
Signature                              Signature


Donald L. Ashkenase                    Craig W. Moore
- ----------------------------------     ----------------------------------
Print Name                             Print Name


Executive Vice President-Corporate     President
- ----------------------------------     ----------------------------------
Title                                  Title

            [Signature Page for Amendment  No. 3 to the Agreement to
       Provide Management Services for Dialysis Facilities by and between
       Montefiore Medical Center and New York Dialysis Management, Inc.]

                                      -13-

 
     Everest HealthCare Services Corporation hereby unconditionally guarantees
the full and complete performance by New York Dialysis Management, Inc., and all
of its successors and assigns, of its covenants and obligations hereunder.

                              EVEREST HEALTHCARE SERVICES
                                    CORPORATION


                              /s/ Craig W. Moore
                              ---------------------------------------
                              Signature

                              Craig W. Moore
                              ---------------------------------------
                              Print Name

                              Chairman and Chief Executive Officer
                              ---------------------------------------
                              Office or Title

                              July 17, 1998
                              ---------------------------------------
                              Date

                                      -14-

 
                                                                       Exhibit A
                                                                       ---------


                CONSULTING AND ADMINISTRATIVE SERVICES AGREEMENT
                                 BY AND BETWEEN
                           MONTEFIORE MEDICAL CENTER
                                      AND
                       NEW YORK DIALYSIS MANAGEMENT, INC.

     THIS CONSULTING AND ADMINISTRATIVE SERVICES AGREEMENT (the "Agreement") is
entered into as of the date set forth in Article IV.A by and between Montefiore
Medical Center, a not-for-profit corporation duly organized and validly existing
under the laws of the State of New York ("MMC"), and New York Dialysis
Management, Inc., a corporation duly organized and validly existing under the
laws of the State of New York ("NYDM").

     WHEREAS, MMC currently owns and operates chronic outpatient dialysis
programs located at 3547 Webster Avenue, Bronx, New York (Dialysis Center I),
3547 Webster Avenue, Bronx, New York (Dialysis Center II), 1325 Morris Park
Avenue, Bronx, New York, and 1695 Eastchester Road, Bronx, New York, and NYDM
has agreed to develop chronic outpatient dialysis sites for MMC, which provide
hemodialysis, peritoneal dialysis, and continuous renal replacement therapies to
end stage renal disease ("ESRD") patients (collectively the "Programs" or the
"Business"); and

     WHEREAS, NYDM, either directly or through its affiliates, provides
consulting services to ESRD programs, conducts research relating to the field of
nephrology, and has developed proprietary systems and techniques to enhance the
operation of ESRD programs; and

     WHEREAS, prior to the effectiveness of this Agreement, MMC and NYDM were
parties to that certain Agreement to Provide Management Services for Dialysis
Facilities, as amended, (the "Management Agreement"), including Amendment No. 3
to the Management Agreement ("Amendment No. 3"); and

     WHEREAS, MMC and NYDM are parties to that certain Agreement to Amend and
Not-to-Compete dated as of July 17, 1998 (the "Agreement to Amend"); and

     WHEREAS, MMC desires to retain NYDM to provide certain consulting services
to the Programs, and NYDM desires to provide such services upon the terms and
conditions set forth herein.

     NOW, THEREFORE, in consideration of the mutual representations, warranties,
covenants and undertakings of the parties hereto, and for other good and
valuable consideration, the receipt and sufficiency of which are hereby
acknowledged, the parties hereto, intending to be legally bound, do hereby agree
as follows:

 
                                  ARTICLE I.
                          RELATIONSHIP OF THE PARTIES
                           AND MISCELLANEOUS MATTERS

     A.  Appointment of NYDM.  MMC engages NYDM, and NYDM accepts such
engagement, pursuant to the terms and conditions hereinafter set forth, to
perform or cause to be performed the consulting services relating to and
required by the Programs, as described in Article II (collectively, the
"Services").

     B.  Retention of Ownership and Control.  MMC shall hold and maintain all 
necessary licenses and approvals required to operate the Programs. The parties
acknowledge and agree that this Agreement is intended to be a consulting
agreement, and is not a delegation of MMC's responsibilities for the day-to-day
operations of the Programs to NYDM. Notwithstanding any other provision in this
Agreement, MMC, shall remain responsible for ensuring that all services provided
pursuant to this Agreement with respect to the Programs comply with all
applicable federal, state, and local laws, rules, regulations and ordinances,
and standards of accreditation, including, but not limited to, those regarding
the establishment and operation of health care facilities in New York. Any
powers and responsibilities not specifically delegated to NYDM through the
provisions of this Agreement are not granted to NYDM and remain the
responsibility of MMC. Specifically, notwithstanding anything in this Agreement
to the contrary, MMC's governing body shall retain for itself and shall not
delegate to NYDM:

          1.   The authority to hire and fire any of MMC's employees and all key
               management employees of the Programs.  Key management employees
               include, but are not limited to, the facility administrator,
               Medical Director(s), the Chief Executive Officer and the Chief
               Financial Officer;

          2.   The authority to maintain and control  the books and records of
               the Programs;

          3.   The authority to dispose of assets of the Programs and to incur
               any liabilities on behalf of the Programs;

          4.   The authority to adopt and enforce polices regarding the
               operation of the Programs;

          5.   The responsibility for insuring that the Programs operate in
               compliance with all laws.

The parties hereto intend that the relationship created by this Agreement shall
not constitute a management agreement as defined in 10 NYCRR (S)405.3(f).  In
the event the New York Department of Health or other applicable agency or
department determines that any of the requirements or obligations contained in
this Agreement result in the creation of a management 

                                      -2-

 
agreement as defined in 10 NYCRR (S)405.3(f), Article VII, B shall apply to this
circumstance.

     C.  Status of Parties.  The parties are independent contractors that engage
in the operation of their own respective businesses.  Neither party is, or is to
be considered, as the agent or employee of the other party for any purpose.
Neither party has authority to enter into contracts or assume any obligations
for the other party or to make any warranties or representations on behalf of
the other party except as specifically provided herein.  Nothing in this
Agreement shall be construed to establish a relationship of co-partners or joint
venturers between the parties.

     D.   Practice of Medicine.  The parties acknowledge and agree that NYDM is
not authorized or qualified to engage in any activity that may constitute the
practice of medicine.  To the extent that any act or service herein required of
NYDM should be construed by a court of competent jurisdiction or any regulatory
or administrative body having oversight responsibilities regarding such
professional activities to constitute the practice of medicine, the requirement
to perform that act or service by NYDM shall be deemed waived and unenforceable.
 
     E.   Appointment of Medical Directors.  MMC shall appoint Medical Directors
for its Programs to direct the medical activities of the various Programs and to
perform the duties as may be assigned from time to time by MMC and required
under the applicable regulations of the Medicare ESRD Program, 42 C.F.R.
(S)405.2161 and by 10 NYCRR (S)751.  MMC agrees that it shall provide medical
director services to each of the Programs under this Agreement, providing those
services as set forth in Section 3 of the Medical Director and Administrative
Services Agreement (the "Medical Director and Administrative Services
Agreement") by and between MMC and Everest Dialysis Services, Inc. ("EDS"),
which is attached to the Medical Asset Purchase Agreement by and between MMC and
EDS (the "MAPA"), as if such agreement were in effect, unless the provision of
such services by MMC is prohibited by law or regulation and all subject to
compliance with applicable rules of the State of New York.

     F.   AECOM Non-Compete.  MMC agrees that it shall enforce, at the request
of NYDM, and will not waive, amend, or terminate prior to their scheduled
expiration any non-competition provisions or restrictive covenants it may have
against the Albert Einstein College of Medicine ("AECOM") pursuant to either
that certain Affiliation Agreement by and between MMC and AECOM or pursuant to
that certain Sale and Purchase Agreement dated July 1, 1991, as it relates to
the Baumritter facility, in each case only in accordance with the terms and
conditions of each such agreement as they are in effect on July 17, 1998.  MMC
shall be responsible for all fees payable for medical director services under
the Affiliation Agreement.  MMC agrees that it shall not support or assist in
any manner, directly or indirectly, the establishment or operation of any
clinical practice of nephrology at AECOM for so long as this Agreement is in
effect, and if MMC has any legal rights to prevent or impede AECOM from
establishing or operating such clinical practice of nephrology, MMC will
exercise those rights.

     G.   Discussions Regarding Sale or Management.  So long as this Agreement
is in effect, subject to the following sentence, MMC shall not enter into any
agreement, arrangements, 

                                      -3-

 
understanding, or negotiations or discussions with any third parties with regard
to the sale of the Business or management of the Business by any parties other
than MMC or NYDM. The preceding sentence shall not apply if MMC has given NYDM a
written notice of termination of this Agreement for a material and egregious
breach as provided herein or during the last year of the term, as set forth
herein.

                                  ARTICLE II.
                              CONSULTING SERVICES

     A.   Scope of Services.  NYDM shall provide to MMC certain administrative
and non-professional services described in this Article II.  NYDM shall
provide the Services described herein, within MMC's treatment capacity, without
discrimination as to race, creed, color, religion, national origin, sex,
disability, sexual orientation or patients' source of payment.

     B.   Personnel; Employment.  NYDM shall employ or arrange for the provision
of all personnel necessary to perform the functions identified in this Article
II; provided however, that the chief executive officer(s) and the chief
financial officer(s) of the Programs, and the Programs' medical directors and
facility administrators, shall be employed by MMC or shall provide services
pursuant to a contractual arrangement with MMC.

     C.   Equipment, Supplies and Facility Services.  NYDM agrees to provide MMC
with all equipment reasonably necessary for the operation of the Programs.  NYDM
shall pay, as a part of the budgeted expenses of the Programs, maintenance and
improvements, supplies, utility expenses (telephone, electric, gas, water)
normal janitorial services, refuse disposal, and all other similar costs
relating to the Programs.  NYDM will assist in the selection of equipment and
supplies and will maintain all of the dialysis equipment of the Programs, in
accordance with NYDM's maintenance policies.  NYDM shall assist in the
negotiation of vendor contracts and assist with the evaluation of alternate
proposals and bids submitted by various companies relating to the Programs.
NYDM shall assist in maintaining records of inventory and arrange for purchases
of necessary and appropriate supplies and equipment on behalf of MMC for the
Programs, including management information systems and related items.  NYDM
shall process all approved invoices, and oversee correct payment and receipt of
goods.  MMC shall be responsible for approving and executing all contracts and
purchases for equipment, supplies, and facility services after consultation with
NYDM.  NYDM shall have no power or authority to incur any debt or liability of
any kind or nature on behalf of the Programs.

     D.   Medical Record Maintenance.  NYDM shall assist MMC with the
organization and maintenance of the medical records reflecting services provided
to patients of the Programs in accordance with all applicable federal, state and
local laws and regulations; provided, however, that the medical records of the
Programs are and shall remain proprietary and confidential information of MMC,
and, in its maintenance of that information, NYDM shall at all times be subject
to the restrictions set forth in Article VI hereof.

                                      -4-

 
     E.   Billing and Collection.  NYDM shall prepare and submit in the name of
MMC all bills for items and services provided by the Programs, and shall
administer controls and systems for the recording and collection of the revenues
of the Programs as follows:

          1.   NYDM shall verify patient eligibility, enrollment and termination
               with respect to Medicare, Medicaid and other third party payor
               programs, and shall respond to all billing inquiries from
               patients, payors and physicians.

          2.   NYDM shall administer the charge structure of the Programs, over
               which MMC retains authority.

          3.   NYDM shall administer collection policies for the Programs that
               are reasonable, appropriate, and consistent with all applicable
               laws, regulations, and third party payor requirements, as
               applicable, it being understood that NYDM has no control over the
               adoption of policies by MMC which relate to the delivery of
               health care services to patients.

          4.   All payments and corresponding documents relating to claims for
               items and services provided by the Programs shall be promptly
               deposited in a designated bank account to which NYDM shall have
               access and signatory authority (the "General Account").  MMC
               shall remit all such payments received and copies of such related
               documents to NYDM when they are deposited to enable NYDM to
               provide assistance to MMC with respect to the payment by MMC of
               the costs and expenses of operation of the Programs and the
               Administrative Fee and other Expenses (as hereinafter defined),
               and to perform NYDM's financial and accounting functions
               hereunder.  With respect to all payments, MMC shall enter into an
               agreement with a depository bank designated by NYDM  (in such
               form as may be required by such bank) to cause the depository
               bank to receive such payments into a lockbox account in the name
               of MMC, negotiate such payments, and sweep the proceeds of such
               account, on a daily basis, into the General Account.  MMC shall
               cooperate with NYDM's collection effort as reasonably requested
               from time to time by NYDM, promptly remit to NYDM amounts
               collected, and execute any documents reasonably necessary to
               perfect NYDM's interests therein.

          5.   Nothing in this section grants NYDM authorization to in any way
               dispose of MMC's assets without prior approval by and
               authorization by MMC.

          6.   NYDM shall prepare, in the name of the Programs and for MMC's
               signature, all cost reports, exception requests and other reports
               and data necessary for obtaining appropriate reimbursement from
               Medicare, Medicaid or other third party payors for the items and
               services provided by 

                                      -5-

 
               the Programs.

          7.   NYDM shall provide regular written reports, not less than
               monthly, to the Chief Executive Officer of MMC, or his/her
               designee, regarding the consulting services provided hereunder.
 
     F.   Accounting and Financial Services.  NYDM shall provide accounting and
financial services to MMC for its Programs, as follows:

          1.   NYDM shall assist MMC in developing an annual budget for the
               Programs (the "Budget") with an estimate of the operating
               revenues and expenses and capital expenditures for the Programs
               for the year.  The Budget shall contain an explanation of plans
               and projections regarding the operations of the Programs,
               utilization, services, staffing and other factors that may affect
               the budget, MMC shall have the sole right to approve and amend
               the Budget.  Upon approval of the Budget by MMC, the parties
               shall use their reasonable efforts to operate the Programs so
               that actual expenses and revenues are consistent with the Budget.

          2.   NYDM shall prepare and submit to MMC monthly and year-to-date
               comparative financial statements for MMC's Program, showing
               actual revenues and expenses of the Program, which shall include
               a report of utilization, an analysis of accounts receivable
               activity and reasonable explanations of any variances from the
               Budget.

          3.   NYDM shall administer financial and accounting systems for the
               Programs, and shall use such accounting policies and procedures
               for the Programs as are adopted by MMC.

          4.   NYDM shall, from the Programs' revenues received pursuant to
               Article II.E, on behalf of MMC, provide assistance to MMC with
               respect to, and shall administer the payment by MMC of, the costs
               and expenses related to the operation of the Programs as set
               forth in Article II.

          5.   The parties agree that the books and business records of the
               Programs remain under the ownership and control of MMC at all
               times, and that NYDM is functioning in an administrative capacity
               in performing the foregoing.  Notwithstanding the foregoing,
               financial, purchasing, payroll and other records of NYDM (i.e.,
               records related to NYDM's operation, such as NYDM's financial
               statements and payroll records relating to NYDM's employees)
               shall be and remain the property of NYDM.

     G.   Policies and Procedures.  NYDM shall administer certain non-clinical
policies and 

                                      -6-

 
procedures of the Programs, as adopted by MMC. MMC reserves the right to change
its Programs' policies, procedures and forms at any time, in its sole
discretion. Without limiting the foregoing, NYDM agrees to do the following:

          1.   To establish, modify, and implement through contract or otherwise
               non-clinical policies and procedures concerning the
               administration of the Programs including purchasing, personnel
               staffing, inventory control, equipment maintenance, accounting,
               legal, data processing, medical record keeping, laboratory,
               billing, collection, public relations, insurance, cash
               management, scheduling, and hours of operation.

          2.   Subject to Article IV.D hereof, to pay, or arrange to pay, all
               wages, salaries, and other compensation, including social
               security, unemployment, withholding, and all other taxes and
               payroll deductions for any and all personnel of the Programs.

          3.   To maintain patient-to-staff ratios at the Programs consistent
               with national averages for academic medical institutions that
               have outsourced their dialysis programs to national vendors.

          4.   To conduct the Programs' reprocessing of dialyzers in accordance
               with all applicable Medicare, AAMI, FDA, and other requirements.

          5.   To consult with the Medical Director(s) regarding the upgrading,
               acquisition, maintenance, and replacement of all major medical
               equipment (defined to mean medical equipment with a cost of
               $5,000 or more) used at the Programs, including any dialysate
               delivery system.

          6.   To make available to the Medical Director and nephrologists on a
               monthly basis, without charge, and in a timely manner, a per-
               patient record of the hemodialysis treatments performed, for the
               expressed purpose that these are to be used by the physicians for
               billing purposes.

     H.   Service Contracts.  With the exception of those ancillary services set
forth in Schedule II.H, which will be provided to the Programs by MMC, NYDM
shall advise and assist MMC in negotiating and maintaining contracts and
arrangements with such individuals or entities appropriate for its Programs for
ancillary medical items and services (e.g., laboratory, blood, EKG, bone
densitometry, pharmacy, etc.), agreements for any other items and services
needed by its Programs, third-party payer contracts, transplant agreements,
affiliation agreements and related agreements for and in the name of the
Programs upon terms reasonably acceptable to NYDM.  NYDM and its affiliates
shall be entitled to provide such services.

     I.   Operating Agreement.  NYDM agrees that it shall develop the dialysis
facilities on 

                                      -7-

 
behalf of MMC upon the terms and conditions as set forth in Section 2 of the
Operating Agreement attached to the Medical Asset Purchase Agreement, as if such
agreement were in effect, such facilities shall be deemed "Programs" as defined
in this Agreement and all references therein to Programs shall include such new
facilities; provided, however, that in the event MMC unreasonably withholds its
consent to the entering into by NYDM of any material contract, lease, or
agreement, or the purchase by NYDM of any material asset, necessary for the
development of any such facility, then NYDM shall be relieved of its obligation
to develop such facility. NYDM and MMC agree that they shall comply with the
terms and conditions as set forth in Section 3 of the Operating Agreement
attached to the MAPA until such time as this Agreement is terminated.

     J.   Quality and Utilization Controls.  NYDM shall advise and assist MMC in
the performance of medical record audits and in conducting utilization review
and quality assurance/control programs and activities as necessary and
appropriate for the operation of the Programs.

     K.   Insurance.  NYDM shall maintain insurance, or shall self-insure,
against liabilities arising out of the services provided by NYDM hereunder,
including, without limitation, general liability insurance covering all services
rendered by NYDM, in amounts of not less than one million dollars ($1,000,000)
per occurrence and three million dollars ($3,000,000) per year in the aggregate.
NYDM shall provide MMC with evidence of the foregoing insurance from time to
time upon request by MMC.  NYDM shall immediately notify MMC of the lapsing,
cancellation of or any other material change in NYDM's insurance.

          MMC shall maintain malpractice and liability insurance, whether self-
insured or purchased through an insurance carrier, of not less than one million
dollars ($1,000,000) per occurrence and three million dollars ($3,000,000) per
year in the aggregate to insure against MMC's acts done within the course and
scope of the performance of its duties under this Agreement.  NYDM shall be an
additional insured on all such policies.  MMC shall notify NYDM in the event
that it becomes aware of an adverse change in (i) the amount of insurance
coverage or (ii) any policy terms, or in the event of cancellation of such
policies.

     L.   Physical Facilities.  NYDM shall provide MMC with physical space for
the Programs pursuant to written leases and shall pay all rents required by such
leases.  Such leases shall be attached to this Agreement upon the effectiveness
of this Agreement.
 
                                  ARTICLE III
                                  COMPENSATION

     A.   Compensation for Administrative and Consulting Services.  In
consideration of the provision of the services listed in Article II, Paragraphs
D, E, F, G, H, I, and J of this Agreement, MMC shall pay to NYDM, and NYDM shall
accept as full and sufficient compensation therefor, a monthly administrative
fee of fifty thousand dollars ($50,000) (the "Administrative Fee"), 


                                      -8-

 
payable to NYDM in arrears on the last day of each month during the term of this
Agreement, subject to Article III.D below. The Administrative Fee shall be
payable to NYDM's address set forth in Section VII.K. NYDM and MMC acknowledge
and agree that, beginning on the first anniversary of this Agreement, they shall
meet annually to consider any adjustment to the Administrative Fee.

     B.   Other Expenses.  In addition to the fees for the services rendered by
NYDM under this Agreement that are payable pursuant to Article III, Paragraph A
hereof, MMC shall reimburse NYDM for any and all direct and indirect expenses
incurred by NYDM for the services rendered pursuant to Article II, Paragraphs B,
C, I, and L, and any related fees or expenses ("Other Expenses").  Payment of
such Other Expenses shall be made by MMC to NYDM promptly, but no later than ten
(10) days after MMC's receipt of a monthly billing statement from NYDM with
respect to Other Expenses incurred during the preceding month, subject to
Article III.D below.

     C.   Equipment Lease.  In addition to the fees and expenses set forth in
Article III, Paragraphs A and B hereof, MMC shall pay NYDM, subject to Article
III.D below, a monthly equipment lease payment in a reasonable amount which the
parties agree to negotiate in good faith in the event this Agreement becomes
effective.

     D.   Expenses of the Program.  NYDM shall, on MMC's behalf, pay the
contractual obligations and operating expenses of the Programs, including the
expenses NYDM incurs under Article II in providing services to the Programs.
Expenses and obligations of the Programs shall be paid pursuant to the following
priority: (i) the fees owed to MMC for the Medical Director services provided at
each of the Programs at the rates set forth in Section 6 of the Medical Director
and Administrative Services Agreement by and between MMC and EDS (ii)
obligations owed to unrelated third parties, and (iii) the Administrative Fee,
Other Expenses, and payments due under the Equipment Lease. The amounts set
forth in sections A, B, and C shall be paid only out of and from the General
Account and no other source, and MMC shall have no obligation to fund or pay any
deficits or shortfalls by paying money into the General Account or otherwise,
and such deficits and shortfalls shall be the obligation of NYDM. To the extent
any amounts deposited in the General Account remain at the end of each month
after payment of all the foregoing obligations and operating expenses of the
Programs, such amounts shall be the sole property of NYDM.

     E.   Audit of Books and Records.  NYDM and MMC each shall have the right,
at their sole cost and expense, and upon reasonable prior notice to the other
party, to audit the books and records maintained by the other party to verify
the costs and expenses of operating MMC's Programs.

     F.   Taxes.  All business-related taxes arising out of the operation of the
Programs and relating to periods subsequent to the date hereof shall be an
expense of the Programs and paid pursuant to Section III.B. hereof.


                                      -9-

 
                                  ARTICLE IV.
                             TERM AND TERMINATION

     A.   Term.  This Agreement shall commence as of the termination of the
Management Agreement and in accordance with Amendment No. 3, and shall continue
for a period of forty (40) years (the "Term") from and after the Consideration
Payment Date under that certain Agreement to Amend, unless earlier terminated as
provided in Section B of this Article.

     B.   Termination.  This Agreement may be terminated upon the occurrence of
the following events:

          1.   The parties agree that notwithstanding anything herein to the
          contrary, this Agreement shall terminate and be of no further force
          and effect upon the closing of the MAPA.  The parties agree that
          notwithstanding anything herein to the contrary, this Agreement may be
          terminated by either party "for cause" only in accordance with the
          following provisions:

               a.  If a party desires to terminate this Agreement for cause, it
               shall first give written notice (the "Breach Notice") to the
               breaching party, of its intention to terminate the agreement for
               cause describing in reasonable detail the material and egregious
               breach.

               b.  For purposes of this Agreement, "cause" shall mean only a
               material and egregious breach which, with respect to MMC, means
               (i) a material breach by it of the non-competition provision set
               forth in Section 3 of the Agreement to Amend, (ii) a material
               breach by it of its obligations to provide Medical Director
               Services pursuant to Article 1.E of this Agreement, (iii) a
               material breach by MMC of its covenants as set forth in Article
               5 of the Agreement to Amend, (iv) a material failure of MMC to
               remit to NYDM any amounts received with respect to accounts
               receivable pursuant to any contractual obligations to NYDM it may
               have to do so, (v) the adoption of a Budget, or amendment
               thereof, by MMC pursuant to Article II, Paragraph F(1) of this
               Agreement which would have the effect of reducing the amounts
               payable to NYDM pursuant to Article III of this Agreement, and to
               which NYDM objects in writing, (vi) the disposition of assets or
               incurrence of any liabilities pursuant to Article I, Paragraph
               B(3) of this Agreement to which NYDM objects in writing, or (vii)
               the adoption of accounting policies and procedures by MMC in
               accordance with Article II, Paragraph F(3) of this Agreement
               different from those reasonably requested by NYDM, in each case
               which breach is continuing, and for which 

                                      -10-

 
               MMC has failed to take diligent actions to cure as promptly as
               possible, and, with respect to NYDM, means a material breach by
               it of its obligations (i) to comply with the quality assurance
               protocols set forth in Section 7 of the Medical Director and
               Administrative Services Agreement by and between MMC and EDS,
               which is attached to the Medical Asset Purchase Agreement; (ii)
               to develop the dialysis facilities on behalf of MMC upon the
               terms and conditions as set forth in Section 2 of the Operating
               Agreement attached to the Medical Asset Purchase Agreement,
               subject to the limitations set forth in II.I; or (iii) to pay to
               MMC or offset from the fees payable from MMC to NYDM the
               compensation that would otherwise be paid to MMC pursuant to
               Section 6 of the Medical Director and Administrative Services
               Agreement as if such agreement were in full force and effect, in
               each case which breach is continuing, and for which NYDM has
               failed to take diligent actions to cure as promptly as possible.

               c.  If the material and egregious breach described in the Breach
               Notice has not been cured within sixty (60) days of the breaching
               party's receipt of such notice, or if the breach cannot be cured
               within sixty (60) days and the breaching party is not taking
               diligent actions to cure the breach as promptly as reasonably
               possible, the non-breaching party may give a notice of
               termination for cause whereupon this Agreement shall be
               terminated for cause upon the breaching party's receipt of such
               notice.

               d.  Any termination for reasons other than a material and
               egregious breach or as a result of an order, ruling, or
               regulation issued by the New York Public Health Council or the
               New York Department of Health shall be considered for purposes of
               this Agreement as a termination without cause by the terminating
               party.

               e.  In the event a party breaches this Agreement and the breach
               is not a material and egregious breach as defined herein, the
               non-breaching party shall not have the right to terminate this
               Agreement, except without cause, but nevertheless shall have all
               other rights at law or in equity, which it may exercise in the
               event the breaching party has not cured the breach within sixty
               (60) days of receipt of written notice from the non-breaching
               party describing in reasonable detail the breach, or if the
               breach cannot be cured within sixty (60) days, if the breaching
               party is not taking diligent actions to cure the breach as
               promptly as reasonably possible.

                                      -11-

 
          2.   In the event this Agreement must be terminated during the Term as
          a result of an order, ruling, or regulation issued by the New York
          Public Health Council or the New York Department of Health, then:

               a.  On the date of termination of this Agreement, (A) MMC shall
               pay to NYDM an amount equal to the sum of (x) twenty three
               million two hundred ten thousand dollars ($23,210,000) reduced in
               equal monthly amounts pro rata over two hundred forty (240)
               months for each month elapsed from the date of this Amendment No.
               3 to the date of termination or expiration, (y) the depreciated
               value of all tangible assets of the Business then held by NYDM
               (provided, however, that such obligation by MMC to pay for such
               tangible assets shall apply to tangible assets acquired after the
               date of this Amendment No. 3 with a value at the time of
               acquisition by NYDM in excess of one hundred thousand dollars
               ($100,000) only if MMC shall have given its prior written consent
               to such acquisition, which consent shall not be unreasonably
               withheld) as reflected in its financial statements in accordance
               with generally accepted accounting principles ("GAAP") (the
               depreciated value referenced in this item (y) shall be referred
               to herein as the "Depreciated Book Value"), (B) NYDM shall
               transfer to MMC, free and clear of any encumbrances, all tangible
               assets of the Business then held by NYDM and all contracts,
               leases, and agreements relating thereto (provided, however, that
               MMC shall be obligated to assume, and NYDM shall assign, only
               such contracts, leases, or agreements entered into by NYDM after
               the date of this Amendment No. 3 (i) in the normal course of
               business and if terminable upon no more than 90 days notice
               without any liability or (ii) if MMC shall have given its prior
               written consent to the entering into of such contract, lease, or
               agreement, which consent shall not be unreasonably withheld) and
               MMC shall (a) assume all obligations thereunder which are to be
               performed after the transfer thereof and (b) reimburse NYDM for
               any deposits and pre-paid expenses under such contracts, leases,
               or agreements; provided further, however, that NYDM shall
               indemnify and hold harmless MMC for any liability under any of
               the aforementioned contracts, leases, or agreements accruing or
               arising prior to the date of termination or expiration of this
               Agreement, and (C) the MAPA and the Agreement to Amend shall be
               terminated, and the parties shall have no obligations to each
               other thereunder for obligations required to be performed after
               the time of such termination (provided such termination shall not
               relieve them of liability for indemnification or to perform
               obligations required to be performed thereunder prior to such
               termination);

               b.  from and after the date of termination or expiration of this


                                      -12-

 
               Agreement, MMC and NYDM shall collect all accounts receivable for
               goods and services provided through the Business and accrued
               through the date of termination or expiration and remit to NYDM,
               promptly upon receipt, any and all amounts received by MMC in
               connection with such accounts receivable;

               c.  from and after the date of termination or expiration of this
               Agreement, NYDM shall pay, in the ordinary course, all accounts
               payable for the Business accrued through the date of termination
               or expiration; and

               d.  in the event that MMC, within two (2) years after the date of
               termination of this Agreement pursuant to this Article IV.B.2,
               sells all or substantially all of the Business or the assets
               related thereto, or otherwise transfers the economics of the
               Business, directly or indirectly, or enters into a legally
               binding agreement to do the same, whether in connection with a
               single transaction or a series of related or unrelated
               transactions, for an aggregate purchase price in excess of the
               amount received by NYDM in accordance with subparagraph (i)(A)
               above, then MMC shall pay fifty percent (50%) of such excess to
               NYDM promptly after the receipt thereof. MMC shall provide NYDM
               with copies of any agreement relating to any such sale of the
               Business or the assets related thereto or transfer of the
               economics of the Business.

               e.  The provisions contained in subparagraphs b, c, and d shall
               survive the termination or expiration of this Agreement, as
               applicable, as provided for in this Article IV.B.2.

          3.   Upon termination of this Agreement at the end of the Term:

               a.  as a condition to and on the date of termination of this
               Agreement (A) MMC shall pay to NYDM an amount equal to the
               Depreciated Book Value, (B) NYDM shall transfer to MMC, free and
               clear of any encumbrances, all tangible assets of the Business
               then held by NYDM and all contracts, leases, and agreements
               relating thereto (provided, however, that MMC shall be obligated
               to assume, and NYDM shall assign, only such contracts, leases, or
               agreements entered into by NYDM after the date of this Amendment
               No. 3 (i) in the normal course of business and if terminable upon
               no more than 90 days notice without any liability or (ii) if MMC
               shall have given its prior written consent to the entering into
               of such 

                                      -13-

 
               contract, lease, or agreement, which consent shall not be
               unreasonably withheld) and MMC shall (a) assume all obligations
               thereunder which are to be performed after the transfer thereof
               and (b) reimburse NYDM for any deposits and pre-paid expenses
               under such contracts, leases, or agreements; provided further,
               however; that NYDM shall indemnify and hold harmless MMC for any
               liability under any of the aforementioned contracts, leases, or
               agreements accruing or arising prior to the date of termination
               or expiration of this Agreement, and (C) the MAPA and the
               Agreement to Amend shall be terminated, and the parties shall
               have no obligations to each other thereunder for obligations
               required to be performed after the time of such termination
               (provided such termination shall not relieve them of liability
               for indemnification or to perform obligations required to be
               performed thereunder prior to such termination);

               b.  from and after the date of termination or expiration of this
               Agreement, MMC and NYDM shall collect all accounts receivable for
               goods and services provided through the Business and accrued
               through the date of termination or expiration and remit to NYDM,
               promptly upon receipt, any and all amounts received by MMC in
               connection with such accounts receivable; and

               c.  from and after the date of termination or expiration of this
               Agreement, NYDM shall pay, in the ordinary course, all accounts
               payable for the Business accrued through the date of termination
               or expiration.

               d.  the provisions contained in subparagraphs b and c shall
               survive the termination or expiration of this Agreement, as
               provided for in this Article IV, B, 3.

          4.   In the event, and only in the event, MMC terminates this
          Agreement for cause due to a material and egregious breach by NYDM as
          defined above, the following provisions shall apply as MMC's sole
          remedy for such breach, and MMC shall have no other remedies for such
          breach:

               a.  As a condition to and on the date of termination, (A) MMC
               shall pay to NYDM an amount equal to the Depreciated Book Value,
               (B) NYDM shall transfer to MMC, free and clear of any
               encumbrances, all tangible assets of the Business then held by
               NYDM and all contracts, leases, and agreements relating thereto
               (provided, however, that MMC shall be obligated to assume, and
               NYDM shall assign, only such contracts, leases, or agreements

                                      -14-

 
               entered into by NYDM after the date of this Amendment No. 3 (i)
               in the normal course of business and if terminable upon no more
               than 90 days notice without any liability or (ii) if MMC shall
               have given its prior written consent to the entering into of such
               contract, lease, or agreement, which consent shall not be
               unreasonably withheld) and MMC shall (a) assume all obligations
               thereunder which are to be performed after the transfer thereof
               and (b) reimburse NYDM for any deposits and pre-paid expenses
               under such contracts, leases, or agreements; provided further,
               however, that NYDM shall indemnify and hold harmless MMC for any
               liability under any of the aforementioned contracts, leases, or
               agreements accruing or arising prior to the date of termination
               or expiration of this Agreement, and (C) the MAPA and the
               Agreement to Amend shall be terminated and the parties shall have
               no further obligations to each other thereunder (provided such
               termination shall not relieve them of liability for
               indemnification or to perform obligations required to be
               performed thereunder prior to such termination);

               b.  From and after the date of termination, MMC and NYDM shall
               collect all accounts receivable for goods or services provided
               through the Business and remit to NYDM, promptly upon receipt,
               any and all amounts received by MMC in connection with such
               accounts receivable; and

               c.  From and after the date of termination, NYDM shall pay, in
               the ordinary course, all accounts payable of the Business and
               accrued through the date of termination or expiration.

               d.  The provisions contained in subparagraphs B. and C. shall
               survive the termination of this Agreement as provided for in this
               Article IV, B, 4.

          5.   In the event, and only in the event, NYDM terminates this
          Agreement for cause due to a material and egregious breach by MMC, as
          defined above, the following provisions shall apply as NYDM's sole
          remedy for such breach, and MMC shall have no other remedies for such
          breach:

               a.  as a condition to and on the date of termination of this
               Agreement, (A) MMC shall pay to NYDM an amount equal to (x)
               twenty three million two hundred ten thousand dollars
               ($23,210,000), (y) the Depreciated Book Value, and (z) the
               organizational, pre-opening, and start-up costs for each dialysis
               facility developed


                                      -15-

 
               on behalf of MMC upon the terms and conditions as set forth in
               Section 2 of the Operating Agreement which could be eligible for
               capitalization under GAAP as in effect on July 17, 1998, but
               prior to and without giving effect to the adoption of SOP 98-5,
               reduced in equal monthly amounts pro rata over two hundred forty
               (240) months for each month elapsed from the date of the opening
               of such facility, (B) NYDM shall transfer to MMC, free and clear
               of any encumbrances, all tangible assets of the Business then
               held by NYDM and all contracts, leases and agreements relating
               thereto (provided, however, that MMC shall be obligated to
               assume, and NYDM shall assign, only such contracts, leases, or
               agreements entered into by NYDM after the date of this Amendment
               No. 3 (i) in the normal course of business and if terminable upon
               no more than 90 days notice without any liability or (ii) if MMC
               shall have given its prior written consent to the entering into
               of such contract, lease, or agreement, which consent shall not be
               unreasonably withheld) and MMC shall (a) assume all obligations
               thereunder which are to be performed after the transfer thereof
               and (b) reimburse NYDM for any deposits and pre-paid expenses
               under such contracts, leases, or agreements; provided further,
               however, that NYDM shall indemnify and hold harmless MMC for any
               liability under any of the aforementioned contracts, leases, or
               agreements accruing or arising prior to the date of termination
               or expiration of this Agreement, and (C) the Medical Asset
               Purchase Agreement and the Agreement to Amend shall be terminated
               and the parties shall have no further obligations to each other
               thereunder (provided such termination shall not relieve them of
               liability for indemnification or to perform obligations required
               to be performed thereunder prior to such termination);

               b.  from and after the date of termination, MMC and NYDM shall
               collect all accounts receivable for goods and services provided
               through the Business and remit to NYDM, promptly upon receipt,
               any and all amounts received by MMC in connection with such
               accounts receivable; and

               c.  from and after the date of termination or expiration, NYDM
               shall pay, in the ordinary course, all accounts payable of the
               Business accruing through the date of termination or expiration.

               d.  The provisions contained in subparagraphs B. and C. shall
               survive the termination of this Agreement as provided for in this
               Article IV.B.5.

                                      -16-

 
                                  ARTICLE V.
                               INDEMNIFICATION

     A.  NYDM Indemnification. NYDM shall indemnify, defend and hold harmless
MMC, its officers, directors, agents, and employees, from and against any and
all liability, suits, claims, losses and damages, and expenses in connection
therewith (including reasonable attorneys' fees), to the extent they arise from
any act or omission of NYDM, its officers, agents or employees during the
performance of and related to any of their activities under this Agreement.

     B.  MMC Indemnification.  MMC shall indemnify, defend and hold harmless
NYDM and its officers, directors, agents and employees, from and against any and
all liability, suits, claims, losses and damages, and expenses in connection
therewith (including reasonable attorneys' fees), to the extent they arise from
any act or omission of MMC, its officers, agents and employees during the
performance of and related to any of their activities under this Agreement.

     C.  Notice of Claims.  In the event that any party hereunder shall receive
any notice of any claim or proceeding against said party (the "Indemnitee") that
gives rise to rights of indemnification hereunder, the Indemnitee shall give the
other party (the "Indemnitor") prompt written notice thereof by prepaid
registered or certified mail, return receipt requested, and the Indemnitor shall
have the right to contest and conduct the defense of any action brought against
the Indemnitee at the Indemnitor's own expense provided, however, that if the
Indemnitor shall fail to notify the Indemnitee of the assumption of the defense
of any such action within twenty (20) days after the giving of such notice by
the Indemnitee, then the Indemnitee shall have the right to take any such action
it deems appropriate to defend, contest, settle, or compromise any such action
or assessment and claim indemnification as provided herein.  If the Indemnitor
does defend any action for which Indemnification is claimed, the Indemnitee
shall be entitled to participate, at its own expense, in the defense of such
action, which defense, however, shall be conducted and managed by the
Indemnitor.  Failure of the Indemnitee to notify the Indemnitor of any claim for
which it is entitled to indemnification hereunder shall not impair, limit, or
affect the indemnification provided herein so long as the ability of the
Indemnitor to contest, defend, or dispute such claim has not been materially and
adversely affected or the Indemnitor has not otherwise been prejudiced by such
failure.

     D.  Obligations Survive.  The obligations of each party in this Article V
shall survive the termination or expiration of this Agreement.

                                  ARTICLE VI.
                                   COVENANTS

     A.  Nondisclosure of MMC's Proprietary Information.  MMC acknowledges and
agrees that during the term hereof it shall have access to Confidential
Information (as defined below) and other proprietary information of NYDM
relating to the operation of ESRD programs 

                                      -17-

 
which shall be deemed to be confidential and MMC shall not, nor shall its
employees and agents, except as may be required by any lawful subpoena, court
order, legal process, or the New York State Department of Health, at any time
without NYDM's prior written consent: (i) disclose any such information to any
third party, or (ii) reproduce or utilize any such information in furtherance of
any other business venture. If MMC is required by lawful subpoena, court order
or legal process to disclose any Confidential Information or other proprietary
information of NYDM, MMC shall provide sufficient notice thereof to NYDM to
enable NYDM to seek a protective order or other appropriate legal or equitable
remedy to prevent such disclosure. For purposes of this Section VI.A., the term
"Confidential Information" shall mean the non-public information of NYDM, or any
entity with which NYDM contracts to provide any of the Services, including, but
not limited to, a formula, pattern, compilation, program, device, method,
system, technique, process, financial information, business strategy, or costing
data, etc. that (1) derives independent economic value, actual or potential,
from not being generally known to, and not being readily ascertainable by proper
means by, other persons who can obtain economic value from its disclosure or
use, or (2) is the subject of efforts that are reasonable under the
circumstances to maintain its secrecy. Confidential Information shall not
include information which: (i) is known to the receiving party prior to
receiving it from the other party, (ii) is generally known to the public, or
(iii) is disclosed to one party at any time by a third party who had the legal
right to disclose it or (iv) is independently developed by the other party in
compliance with law. The provisions of this Section VI.A shall survive
termination of this Agreement. Provided, however, that the foregoing
restrictions shall not limit or restrict MMC's ability or obligations to provide
patient medical records, billing records or similar information to any federal
or state agency or contractor.

     B.  Nondisclosure of NYDM's Proprietary Information.  By virtue of MMC's
retention of NYDM, NYDM will have access to MMC's Confidential Information (as
defined below) and other proprietary information of MMC relating to the
operation of the Programs which shall be deemed to be confidential and NYDM
shall not, nor shall its employees and agents, except as may be required by any
lawful subpoena, court order, legal process, or the New York State Department of
Health, at any time without MMC's prior written consent: (i) disclose any such
information to any third party, or (ii) reproduce or utilize any such
information in furtherance of any other business venture.  If NYDM is required
by lawful subpoena, court order or legal process to disclose any Confidential
Information or other proprietary information of MMC, NYDM shall provide
sufficient notice thereof to MMC to enable MMC to seek a protective order or
other appropriate legal or equitable remedy to prevent such disclosure.   For
the purposes of the Section VI.B, "MMC Confidential Information" shall mean the
non-public information of MMC, including, but not limited to the methods,
systems, techniques, processes, formulas, business strategies, financial
information, patterns, compilations and programs pertaining to MMC's operation
of the Programs that (1) derives independent economic value, actual or
potential, from not being generally known to, and not being readily
ascertainable by proper means by other persons who can obtain economic value
from its disclosure or use, or (2) is the subject of efforts that are reasonable
under the circumstances to maintain its secrecy.  MMC Confidential Information
shall not include information which: (i) is known to the receiving party prior
to receiving it from the other party, (ii) is generally known to the public, or
(iii) is disclosed to one party at any time by a third party who 

                                      -18-

 
had the legal right to disclose it or (iv) is independently developed by the
other party in compliance with law. The provisions of this Section VI.B shall
survive termination of this Agreement.

     C.  Reasonableness of Restrictions.  The parties acknowledge that the 
restrictions in this Article VI are reasonable and necessary to protect the
legitimate interests of NYDM and MMC, respectively and that any violation would
result in irreparable injury to the non-breaching party. The parties further
acknowledge that, in the event of a violation of any such restrictions which is
not remedied within fifteen (15) days after notice thereof, the non-breaching
party shall be entitled to preliminary and permanent injunctive relief without
having to prove actual damages or immediate or irreparable harm or to post a
bond. The non-breaching party shall also be entitled to an equitable accounting
of all earnings, profits and other benefits arising from such violation, which
rights shall be cumulative and in addition to any other rights or remedies to
which the non-breaching party may be entitled to at law or equity.
Notwithstanding the foregoing, if the restrictions specified in this Article VI
are adjudged unreasonable in any court proceeding, the parties hereby agree to
the reformation of such restriction by the court to such limits as it finds
reasonable, and the parties will not assert that such restrictions should be
eliminated in their entirety by such court.

     D.  Salaries.  Each party to this Agreement shall remain liable for the
salary and benefits paid to such party's own employees, and shall be ultimately
responsible for compliance with the state and federal laws pertaining to
employment taxes, workers' compensation, unemployment compensation and other
employment-related statutes pertaining to the party's own employees involved in
the administration and day-to-day operation of the Programs.

                                  ARTICLE VII.
                                 MISCELLANEOUS

     A.  Exhibits and Schedules Incorporated by Reference.  The Exhibits and
Schedules to this Agreement are referred to and made a part of this Agreement by
this reference as if set forth at length verbatim where reference is made to
them in this Agreement.

     B.  Change in Law.  If there is a change in Medicare, Medicaid or other
Federal or State statutes or regulations or in the interpretation thereof, which
renders any of the material terms of this agreement unlawful or unenforceable,
this Agreement shall be amended by the parties hereto as a result of good faith
negotiations to the least extent necessary in order to carry out the original
intention of the parties in compliance with such law or regulation.  In the
event the parties cannot amend this Agreement in order to bring this Agreement
into compliance with such statutes or regulations within fifteen (15) days after
either party provides the other with notice of such change and the need to amend
this Agreement, the parties shall submit the issue to arbitration according to
the following procedure.  If the parties cannot agree upon an arbitrator, each
party shall appoint an arbitrator who in turn shall appoint a third arbitrator.
In the event, within thirty (30) days after the provision of notice set forth
above, the arbitrator cannot determine a permissible manner by which to
restructure this Agreement which maintains the general economic principles
contained herein, 

                                      -19-

 
this Agreement shall terminate, and the provisions of Article IV. B.2. shall
apply. In the event such law or regulation is subsequently amended or
interpreted in such a way to make any provision of this Agreement that was
formerly invalid valid, such provision shall be considered valid from the
effective date of such interpretation or amendment.

     C.  Approvals.  Where the agreement, approval, acceptance or consent by
either party is required under this Agreement, such action shall not be
unreasonably delayed or withheld.

     D.  Assignment.  Neither party shall have the ability to assign this
Agreement with the prior written consent of the other party, except that NYDM
may assign this Agreement to an affiliate without the prior written consent of
MMC.
 
     E.  Amendment.  This Agreement may be amended only by a writing signed by
the party to be bound by such amendment.

     F.  Entire Agreement.  This Agreement supersedes all agreements previously
made between the parties relating to its subject matter.  There are no other
understandings or agreements between them with respect to the subject matter
hereof.

     G.  Confidentiality of Agreement.  With the exception of any disclosure
required for review of this Agreement by the New York Department of Health, the
terms and conditions of this Agreement, as well as any documents or information
(not publicly available) provided in connection with the negotiation and
preparation of this Agreement, shall be maintained confidentially and shall not
be disclosed to any person, firm or entity except to such officers, directors,
trustees, employees and representatives of the parties (and of corporate
affiliates of the parties), as reasonably required for the purposes for which
such information is furnished, or as may be required by law.

     H.  Non-waiver.  No delay or failure by a party to exercise any right under
this Agreement, and no partial or single exercise of that right, shall
constitute a waiver of that or any other right.

     I.  Headings.  Headings in this Agreement are for convenience only and
shall not be used to interpret or construe its provisions.

     J.  Governing Law.  This Agreement shall be construed in accordance with
and governed by the laws of the State of New York.

     K.  Access to NYDM's Books and Records.  For a period of four (4) years
following the last date NYDM furnishes services pursuant to this Agreement, NYDM
shall make available, upon written request by the Secretary of the United States
Department of Health and Human Services ("HHS"),the Comptroller General of the
United States or any of their duly authorized representatives, all contracts,
books, documents and other records of NYDM which are necessary to 

                                      -20-

 
verify the nature and extent of the costs of NYDM's services hereunder.

     L.  Notice.  Whenever notice must be given under the provisions of this
Agreement, such notice must be in writing and will be deemed to have been duly
given by (a)  hand-delivery (with written confirmation of receipt) addressed to
the parties at their respective addresses set forth below; or (b) certified
mail, return receipt requested, postage prepaid, and addressed to the parties at
their respective addresses set forth below; or (c) telecopier (with written
confirmation of receipt), provided that a copy is mailed by registered mail,
return receipt requested, addressed to the parties at their respective addresses
set forth below, and provided further that notice shall be deemed given under
this subsection (c) when actually received by the recipient:

          If to NYDM:
 
          101 North Scoville
          Oak Park, IL 60302
          Attn: Craig Moore
          Fax: (708) 386-1711
 
          with a copy to:

          Katten Muchin & Zavis
          525 West Monroe
          Chicago, Illinois 60661-3693
          Attn.: Alan Berry, Esq. and Matthew S. Brown, Esq.
          Fax: (312) 902-1061

               and

          Hinman, Straub, Pigors & Manning, P.C.
          121 State Street
          Albany, New York 12207-1693
          Attn:  Ray Kolarsey, Esq.
          Fax: (518) 436-4751

          If to MMC:

          111 East 210th Street
          Bronx, New York 10467
          Attn: Stanley L. Jacobson, Esq.
          Fax: (718) 652-2161

                                      -21-

 
          with a copy to:
 
          Green, Stewart, Farber & Anderson, P.C.
          2600 Virginia Avenue, N.W.
          Suite 1111
          Washington, D.C. 30037
          Attn: Philip D. Green, Esquire
          Fax: (202) 342-8734
 
     M.   Compliance with Law.  Notwithstanding any other provision in this
Agreement, MMC remains responsible for ensuring that the ownership and operation
of the Programs, and any Services provided pursuant to this Agreement comply
with all pertinent provisions of federal, state and local statutes, rules and
regulations.

     N.   Representation by Counsel.  The parties agree that each have had the
benefit of representation by legal counsel in negotiating this Agreement.  No
party is to be construed as the drafter of this Agreement for purposes of
determining the meaning of any provision of this Agreement, or for allocating
the benefit of any future ambiguity.

     IN WITNESS WHEREOF, the parties have caused their duly authorized officers
to execute this Agreement.

MONTEFIORE MEDICAL CENTER           NEW YORK DIALYSIS
                                    MANAGEMENT, INC.


- ----------------------------        -------------------------------
Signature                           Signature


- ----------------------------        -------------------------------
Print Name                          Print Name


- ----------------------------        -------------------------------
Title                               Title

                                      -22-

 
     Everest HealthCare Services Corporation hereby unconditionally guarantees
the full and complete performance by New York Dialysis Management, Inc., and all
of its successors and assigns, of its covenants and obligations hereunder.

                    EVEREST HEALTHCARE SERVICES
                         CORPORATION

                    --------------------------------
                    Signature

                    --------------------------------
                    Print Name

                    --------------------------------
                    Office or Title

                    --------------------------------
                    Date

                                      -23-