INTEGRATED HEALTH SERVICES, INC. 10065 Red Run Boulevard Owings Mills, Maryland 21117 March 24, 1997 To the Administrative Agent and the Lenders parties to the Revolving Credit Agreement referred to below Amendment No.3 to Revolving Credit Agreement Ladies and Gentlemen: Reference is made to the Revolving Credit Agreement, dated as of May 15, 1996, as amended by Amendment No. 1 dated September 6, 1996 and Amendment No. 2 dated November 8, 1996 (such Revolving Credit Agreement as so amended being the "Credit Agreement"), among Integrated Health Services, Inc. ("IHS"), Citibank N.A., as administrative agent thereunder (the "Agent"), and the other financial institutions party thereto, as lenders thereunder. Capitalized terms used and not otherwise defined herein are used herein as defined in the Credit Agreement. IHS has proposed to (i) issue senior subordinated notes in an aggregate principal amount of up to $450,000,000 and (ii) purchase the indebtedness outstanding under the 1994 Subordinated Debt Indenture and the 1995 Subordinated Debt Indenture. In connection with the foregoing, IHS has requested that the Lenders agree to amend certain covenants contained in Article V of the Credit Agreement to permit such transactions. We understand that the Requisite Lenders are, on the terms and conditions stated below, willing to grant our request, and the Requisite Lenders have agreed to amend the Credit Agreement as hereinafter set forth. Effective as of the date hereof and subject to the satisfaction of the condition precedents set forth below, the Credit Agreement is hereby amended as follows: (a) The definition of "1996 Subordinated Debt Indenture" in Section 1.01 is amended in full to read as follows: "'1996 SUBORDINATED DEBT INDENTURE' means the Indenture, dated as of May 15, 1996, between the Borrower, as Issuer, and Signet Trust Company, as Trustee." (b) In Section 1.01, the following definition of "1997 Subordinated Debt Indenture" is added in the appropriate alphabetical order: 2 "'1997 SUBORDINATED DEBT INDENTURE' means the Indenture to be entered into after April 7, 1997 between the Borrower, as Issuer, and the trustee thereunder in connection with a proposed senior subordinated note offering." (c) The definition of "Subordinated Debt Indentures" in Section 1.01 is amended in full to read as follows: "'SUBORDINATED DEBT INDENTURES' means the 1992 Convertible Subordinated Debt Indenture, the 1993 Convertible Subordinated Debt Indenture, the 1994 Subordinated Debt Indenture, the 1995 Subordinated Debt Indenture, the 1996 Subordinated Debt Indenture and, upon the effectiveness thereof, the 1997 Subordinated Debt Indenture" (d) Section 5.03(d) is amended by deleting the period at the end of subsection (v) thereof and substituting therefor "; and" and adding a new subsection (vi) following such subsection (v) to read as follows: "(vi) Subordinated Debt incurred under the 1997 Subordinated Debt Indenture in an aggregate principal amount of up to $450,000,000, with an interest rate not in excess of 10.25%, and any extension, renewal or refinancing of such Debt so long as either (A) the principal amount of such Debt is not increased or (B) any increase in the principal amount of such Debt is permitted pursuant to another clause of this Section 5.03(d); provided that the terms and conditions of such 1997 Subordinated Debt Indenture shall be (1) substantially similar to the terms and conditions contained in the 1996 Subordinated Debt Indenture and (2) satisfactory to the Agent in its sole discretion." (e) Section 5.03(h)(G) is amended in full to read as follows: "(G) so long as no Event of Default exists or would result and unless otherwise prohibited under this Agreement and the 1993 Convertible Subordinated Debt Indenture, the Borrower may pay on January 1, 2001 any principal amount then due and payable under the 1993 Convertible Subordinated Debt Indenture; and" (f) Section 5.03(h) is amended by adding a new subsection (H) following subsection (G) to read as follows: "(H) purchase by tender or otherwise any or all of the indebtedness outstanding under the 1994 Subordinated Debt Indenture and the 1995 Subordinated Debt Indenture for an amount not in excess of 116% of the principal amount purchased, provided that the aggregate amount of such purchases cannot be in excess of the aggregate net proceeds of the Subordinated Debt referred to in Section 5.03(d)(vi)." 3 This Amendment shall become effective on the date when and only when the Agent shall have received (A) counterparts of this Amendment executed by IHS and the Requisite Lenders, or as to any of such Lenders, advice satisfactory to the Agent that such Lender has executed this Amendment and (B) counterparts of the Consent appended hereto (the "Consent"), executed by each Guarantor. IHS represents and warrants as follows: (a) IHS is duly organized and validly existing under the laws of Delaware. Each Guarantor is a corporation or partnership duly organized and validly existing under the laws of the jurisdiction in which it is organized. (b) Each of IHS and each Guarantor has the corporate or partnership power to execute, deliver and perform this Amendment and the Consent, as the case may be, and to take all action necessary to consummate the transactions contemplated hereunder. The execution, delivery and performance by IHS and each Guarantor of this Amendment and the Consent, respectively, have been duly authorized by all necessary action and do not contravene (i) its certificate or articles of incorporation (or, in case of a partnership, governing agreements) or (ii) any law or any indenture, lease or written agreement binding on or affecting it. (c) No authorization or approval or other action by, and no notice to or filing with, any Governmental Authority is required for the due execution, delivery and performance by IHS or any Guarantor of this Amendment or the Consent, respectively. (d) This Amendment and the Consent constitutes legal, valid and binding obligations of IHS and each Guarantor, respectively, enforceable against IHS and each Guarantor, respectively, in accordance with their respective terms subject to laws generally affecting the enforcement of creditors' rights. (e) The Credit Agreement is a "Credit Agreement" within the meaning of the 1997 Subordinated Debt Indenture, upon its effectiveness, and the obligations under the Credit Agreement when incurred will be "Senior Indebtedness" within the meaning of the 1997 Subordinated Debt Indenture. Upon the effectiveness of this Amendment, on and after the date hereof each reference in the Credit Agreement to "this Agreement", "hereunder", "hereof" of words of like import referring to the Credit Agreement, and each reference in the other Loan Documents to "the Credit Agreement", "thereunder", "thereof" or words of like import referring to the Credit Agreement, shall mean and be a reference to the Credit Agreement as amended hereby. Except as specifically amended above, the Credit Agreement, and all other Loan Documents, are and shall continue to be in full force and effect and are hereby in all respects ratified and confirmed. The execution, delivery and effectiveness of this Amendment shall not, except as expressly provided herein, operate as a waiver of any right, power or remedy of any Lender or the Agent 4 under any of the Loan Documents, not constitute a waiver of any provision of any of the Loan Documents. This Amendment shall be governed by, and construed in accordance with, the laws of the State of New York. Please evidence your acknowledgement of and agreement to the foregoing by executing and returning not later than the close of business on April 4, 1997 three counterparts of this Amendment No. 3 to Citicorp Securities, Inc., 399 Park Avenue, 9th Floor, New York, New York 10043, Attention: Rosemary Bell. This Amendment No. 3 is subject to the provisions of Section 8.01 of the Credit Agreement. This Amendment No. 3 may be executed in any number of counterparts and by any combination of the parties hereto in separate counterparts, each of which counterparts shall be an original and all of which taken together shall constitute one and the same Amendment No. 3. Very truly yours, INTEGRATED HEALTH SERVICES, INC. By: ------------------------------------ Name: ----------------------------- Title: ---------------------------- ACKNOWLEDGED, AGREED AND CONSENTED TO as of the date first above written: CITIBANK, N.A., as Administrative Agent and as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- 5 BANK OF AMERICA NATIONAL TRUST AND SAVINGS ASSOCIATION, as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- THE BANK OF NOVA SCOTIA, as LC Bank, a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- CORESTATES BANK, N.A., as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- CREDIT LYONNAIS, NEW YORK BRANCH, as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- 6 DEUTSCHE BANK AG, NEW YORK BRANCH AND/OR CAYMAN ISLANDS BRANCH, as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- FIRST UNION NATIONAL BANK OF NORTH CAROLINA, as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- NATIONSBANK, N.A., as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- PNC BANK, NATIONAL ASSOCIATION, as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- 7 TORONTO DOMINION (TEXAS), INC., as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- VAN KAMPEN AMERICAN CAPITAL PRIME RATE INCOME TRUST, as a Lender and Co-Agent By: -------------------------------- Name: ------------------------- Title: ------------------------- CREDITANSTALT CORPORATE FINANCE, INC., as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- By: -------------------------------- Name: ------------------------- Title: ------------------------- FLEET NATIONAL BANK, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- 8 GENERAL ELECTRIC CAPITAL CORPORATION, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- HIBERNIA NATIONAL BANK, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- AMSOUTH BANK OF ALABAMA, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- THE BANK OF TOKYO-MITSUBISHI TRUST COMPANY, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- 9 THE SANWA BANK, LIMITED, NEW YORK BRANCH as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- SIGNET BANK, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- THE SUMITOMO BANK, LIMITED, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- FIRST AMERICAN NATIONAL BANK, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- ALLIED IRISH BANK, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- PROVIDENT BANK OF MARYLAND, as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- BANK OF AMERICA ILLINOIS as a Lender By: -------------------------------- Name: ------------------------- Title: ------------------------- 2 CONSENT The undersigned, as Guarantors under the Subsidiary Guaranty, dated as of May 15, 1996 or under Agreements to be Bound by such Subsidiary Guaranty (collectively, the "Guaranty"), in favor of the Agent for the Lenders parties to the Credit Agreement referred to in the foregoing Amendment No. 3 hereby consent to such Amendment No. 3 and hereby confirm and agree that notwithstanding the effectiveness of such Amendment No. 3, the Guaranty is, and shall continue to be, in full force and effect and is hereby confirmed and ratified in all respects. 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