EXECUTION COPY











                                  $700,000,000


                           REVOLVING CREDIT AGREEMENT

                            Dated as of May 15, 1996


                                      Among


                        INTEGRATED HEALTH SERVICES, INC.,

                                  as Borrower,


                   The Lenders from time to time party hereto,


                                       and


                                 CITIBANK, N.A.

                             as Administrative Agent






                                TABLE OF CONTENTS


                                   ARTICLE I

                        DEFINITIONS AND ACCOUNTING TERMS

SECTION 1.01.  Certain Defined Terms.........................................  1
SECTION 1.02.  Accounting Terms.............................................. 27
SECTION 1.03.  Other Definitional Provisions................................. 27


                                   ARTICLE II

                       AMOUNTS AND TERMS OF THE ADVANCES

SECTION 2.01.  Revolving Facility............................................ 28
         (a)      Advances................................................... 28
         (b)      Borrowings................................................. 28
         (c)      Notice of Borrowing........................................ 28
         (d)      Telephonic Notice of Borrowing............................. 28
         (e)      Funding of Advances........................................ 29
         (f)      Notice of Borrowing Irrevocable............................ 29
         (g)      Assumption of Funding...................................... 29
         (h)      Failure of Lender to Fund.................................. 29
SECTION 2.02.  Letter of Credit Subfacility.................................. 29
         (a)      Issuance of the Letters of Credit.......................... 29
         (b)      LC Application............................................. 30
         (c)      Reimbursement.............................................. 30
         (d)      Reimbursement Obligation Absolute.......................... 30
         (e)      Lender Participation....................................... 31
         (f)      Commercial Practices....................................... 31
         (g)      Replacement of LC Bank..................................... 32
SECTION 2.03.  Promissory Notes.............................................. 32
         (a)      Notes...................................................... 32
         (b)      Recording of Amounts....................................... 32
SECTION 2.04.  Fees.......................................................... 33
         (a)      Closing Fees............................................... 33
         (b)      Commitment Fees............................................ 33
         (c)      Letter of Credit Fees...................................... 33
         (d)      Facing Fees................................................ 33
         (e)      Letter of Credit Administration............................ 33
         (f)      Agent's Fees............................................... 33
         (g)      Contingent Fees............................................ 33




                                       ii

SECTION 2.05.  Voluntary and Scheduled Facility Reductions................... 33
SECTION 2.06.  Principal Payments............................................ 34
         (a)      Final Maturity............................................. 34
         (b)      Excess Revolving Credit Exposure........................... 34
         (c)      Excess LC Exposure......................................... 34
         (d)      Payment on Date of Change of Control....................... 34
         (e)      Facility Reduction for Receivables Sale Program............ 35
         (f)      Application of LC Cash Collateral.......................... 35
SECTION 2.07.  Interest...................................................... 35
         (a)      Base Rate Advances......................................... 35
         (b)      Eurodollar Rate Advances................................... 36
         (c)      Default Interest........................................... 36
SECTION 2.08.  Additional Interest on Eurodollar Rate Advances............... 36
SECTION 2.09.  Interest Rate Determination and Protection.................... 36
         (a)      Determination of Eurodollar Rate........................... 36
         (b)      Notice of Eurodollar Rate.................................. 36
         (c)      Failure to Provide Information............................. 37
         (d)      Suspension of Eurodollar Rate Advances..................... 37
         (e)      Failure to Specify Duration................................ 37
         (f)      Agent's Determination Conclusive........................... 37
SECTION 2.10.  Voluntary Conversion of Advances.............................. 37
         (a)      Notice of Continuance/Conversion........................... 37
         (b)      Telephonic Notice.......................................... 38
         (c)      Requirements............................................... 38
         (d)      Base Rate Advances......................................... 38
SECTION 2.11.  Prepayments................................................... 38
SECTION 2.12.  Funding Losses................................................ 39
SECTION 2.13.  Increased Costs............................................... 39
         (a)      Increase in Cost........................................... 39
         (b)      Increase in Capital Requirements........................... 39
         (c)      Replacement Lenders and Participants....................... 40
SECTION 2.14.  Illegality.................................................... 41
SECTION 2.15.  Payments and Computations..................................... 41
         (a)      Payments................................................... 41
         (b)      Charging of Accounts....................................... 41
         (c)      Computations............................................... 41
         (d)      Payment on Business Day.................................... 42
         (e)      Presumption of Payment..................................... 42
SECTION 2.16.  Taxes......................................................... 42
         (a)      Net Payments............................................... 42
         (b)      Payment of Other Taxes..................................... 42
         (c)      Indemnification............................................ 43




                                       iii

         (d)      Evidence of Payments....................................... 43
         (e)      Withholding Tax Exemption.................................. 43
         (f)      Withholding Taxes.......................................... 44
         (g)      Indemnification of the Agent............................... 44
         (h)      Subsequent Lenders......................................... 44
         (i)      Refund, Deduction or Credit of Taxes....................... 45
         (j)      Exclusion of Certain Taxes................................. 45
         (k)      Additional Cooperation..................................... 45
SECTION 2.17.  Sharing of Payments........................................... 45


                                   ARTICLE III

                              CONDITIONS OF LENDING

SECTION 3.01.  Conditions Precedent on the Closing Date...................... 46
         (a)      Loan Documents............................................. 46
         (b)      Corporate Documents........................................ 47
         (c)      Governmental Consents...................................... 47
         (d)      No Injunction.............................................. 48
         (e)      Other Deliveries........................................... 48
         (f)      Legal Opinions............................................. 48
         (g)      Payout and Release Agreement............................... 49
         (h)      Payment of Existing Facility............................... 49
         (i)      Payment of Fees and Expenses............................... 49
         (j)      Section 3.02 Conditions.................................... 49
SECTION 3.02.  Conditions Precedent to Each Extension of Credit.............. 49
         (a)      Notice..................................................... 49
         (b)      Certification.............................................. 49


                                   ARTICLE IV

                         REPRESENTATIONS AND WARRANTIES

SECTION 4.01.  Representations and Warranties of the Borrower................ 50
         (a)      Organization............................................... 50
         (b)      Power and Authority........................................ 50
         (c)      Due Authorization.......................................... 51
         (d)      Subsidiaries and Ownership of Capital Stock................ 51
         (e)      Health Care Facilities..................................... 51
         (f)      Governmental Approval...................................... 52




                                       iv

         (g)      Binding and Enforceable.................................... 52
         (h)      Financial Information...................................... 52
         (i)      Material Adverse Change.................................... 52
         (j)      Compliance................................................. 52
         (k)      Litigation................................................. 52
         (l)      No Conflict................................................ 53
         (m)      No Default................................................. 53
         (n)      Payment of Taxes........................................... 53
         (o)      Margin Regulations......................................... 53
         (p)      Conduct of Business........................................ 53
         (q)      Health Care Permits........................................ 53
         (r)      Environmental Matters...................................... 54
         (s)      ERISA Compliance........................................... 55
         (t)      Title to Assets............................................ 55
         (u)      Collateral Documents....................................... 56
         (v)      Senior Indebtedness........................................ 56


                                    ARTICLE V

                            COVENANTS OF THE BORROWER

SECTION 5.01.  Financial Covenants........................................... 56
         (a)      Maximum Debt/EBITDAR Ratio................................. 56
         (b)      Minimum Cash Flow Coverage Ratio........................... 57
         (c)      Minimum Interest&Rent Coverage Ratio....................... 58
         (d)      Minimum Net Worth.......................................... 58
SECTION 5.02.  Affirmative Covenants......................................... 58
         (a)      Compliance with Laws....................................... 58
         (b)      Inspection of Property and Books and Records............... 58
         (c)      Reporting Requirements..................................... 59
         (d)      Preservation of Corporate Existence, Etc................... 62
         (e)      New Subsidiaries........................................... 62
         (f)      Maintenance of Property.................................... 62
         (g)      Insurance.................................................. 62
         (h)      Payment of Obligations..................................... 63
         (i)      Environmental Laws......................................... 64
         (j)      Use of Proceeds............................................ 64
         (k)      Health Care Permits and Approvals.......................... 64
         (l)      Further Assurances......................................... 64
SECTION 5.03.  Negative Covenants............................................ 65
         (a)      Liens...................................................... 65




                                       v

         (b)      Disposition of Assets...................................... 67
         (c)      Investments................................................ 68
         (d)      Limitation on Indebtedness................................. 73
         (e)      Transactions with Affiliates............................... 74
         (f)      Accommodation Obligations.................................. 75
         (g)      Leases of Health Care Facilities........................... 75
         (h)      Restricted Junior Payments................................. 76
         (i)      Mergers, Etc............................................... 77
         (j)      Capital Expenditures....................................... 78
         (k)      Conduct of Business........................................ 79
         (l)      Unpledged Assets........................................... 79
         (m)      Compliance with ERISA...................................... 79
         (n)      Health Care Permits and Approvals.......................... 79
         (o)      Retained Interest Criteria................................. 80
         (p)      Payment Restrictions Affecting Subsidiaries................ 80


                                   ARTICLE VI

                                EVENTS OF DEFAULT

SECTION 6.01.  Events of Default............................................. 80
         (a)      Non-Payment of Principal................................... 80
         (b)      Non-Payment of Interest or Fees............................ 80
         (c)      Representations and Warranties............................. 80
         (d)      Financial, Lien and Debt Covenants......................... 81
         (e)      Reporting and Negative Covenants........................... 81
         (f)      Covenants.................................................. 81
         (g)      Debt....................................................... 81
         (h)      Leases..................................................... 81
         (i)      Bankruptcy................................................. 82
         (j)      Judgments.................................................. 82
         (k)      Guaranty................................................... 82
         (l)      Collateral Documents....................................... 82
         (m)      ERISA...................................................... 82
SECTION 6.02.  Rights Not Exclusive.......................................... 83




                                       vi

                                   ARTICLE VII

                                    THE AGENT

SECTION 7.01.  Authorization and Action...................................... 84
SECTION 7.02.  Agent Not Liable.............................................. 84
SECTION 7.03.  Rights as Lender.............................................. 85
SECTION 7.04.  Lender Credit Decision........................................ 85
SECTION 7.05.  Indemnification............................................... 85
SECTION 7.06.  Successor Agent............................................... 86
SECTION 7.07.  Release of Collateral......................................... 86
SECTION 7.08.  Release of Guarantor upon Sale of Stock....................... 86


                                  ARTICLE VIII

                                  MISCELLANEOUS

SECTION 8.01.  Amendments.................................................... 87
SECTION 8.02.  Notices....................................................... 88
SECTION 8.03.  No Waiver; Remedies........................................... 88
SECTION 8.04.  Costs and Expenses............................................ 89
SECTION 8.05.  Right of Set-off.............................................. 89
SECTION 8.06.  Indemnity..................................................... 89
         (a)      General Indemnity.......................................... 89
         (b)      Environmental Indemnity.................................... 90
SECTION 8.07.  Assignments and Participations................................ 90
         (a)      Permitted Assignment....................................... 90
         (b)      Effect of Assignment....................................... 91
         (c)      Maintenance of Agreements.................................. 91
         (d)      Procedure.................................................. 92
         (e)      Participations............................................. 92
         (f)      Additional Information..................................... 92
         (g)      Permitted Assignments...................................... 92
SECTION 8.08.  Binding Effect................................................ 93
SECTION 8.09.  Governing Law; Consent to Jurisdiction; Venue................. 93
SECTION 8.10.  Waiver of Jury Trial.......................................... 93
SECTION 8.11.  Limitation of Liability....................................... 94
SECTION 8.12.  Entire Agreement.............................................. 94
SECTION 8.13.  Survival...................................................... 94
SECTION 8.14.  Execution in Counterparts..................................... 94







                                      vii

                                    EXHIBITS


         Exhibit A         Form of Note

Forms of Loan Administration Documents

  Exhibit B-1    Form of Notice of Borrowing
  Exhibit B-2    Form of Notice of Continuance/Conversion
  Exhibit B-3    Form of LC Application
  Exhibit B-4    Form of Pricing Certificate

Forms of Certain Loan Documents

  Exhibit C-1     Form of Subsidiary Guaranty
  Exhibit C-2     Form of IHS Pledge and Security Agreement
  Exhibit C-3     Form of Subsidiary Pledge and Security Agreement
  Exhibit C-4     Form of Confirmation and Agreement of Guarantors

Forms of Opinion of Counsel

  Exhibit D-1     Form of Opinion of Counsel for the Borrower and the Guarantors
  Exhibit D-2     Form of Opinion of Special Local Counsel for a Guarantor

Other Forms

  Exhibit E-1     Form of Compliance Certificate
  Exhibit E-2     Form of Assignment and Acceptance
  Exhibit E-3     Form of Payment and Release Agreement







                                      viii

                                    SCHEDULES

  Schedule I               List of Lenders, Commitments and Pro Rata Shares
  Schedule 1.01(a)         List of Senior Debt Excluded from Current Portion of
                           Long-Term Debt
  Schedule 1.01(b)         List of "Schedule 1.01(b) Assets" Designated for Sale
  Schedule 1.01(c)         List of "Schedule 1.01(c) Assets" Designated for Sale
  Schedule 2.04(a)         Itemization of Closing Fees
  Schedule 4.01(d)         List of Subsidiaries
  Schedule 4.01(e)         List of Health Care Facilities
  Schedule 4.01(f)         List of Government Approvals
  Schedule 4.01(k)         List of Litigation
  Schedule 4.01(r)         List of Environmental Matters
  Schedule 4.01(s)         List of ERISA Matters
  Schedule 5.03(c)         List of Loans and Investments
  Schedule 5.03(c)(xv)     List of Permitted Acquisitions
  Schedule 5.03(d)         List of Liens and Debt
  Schedule 5.03(f)         List of Accommodation Obligations






                           REVOLVING CREDIT AGREEMENT

     REVOLVING  CREDIT  AGREEMENT,  dated as of May 15, 1996,  among  INTEGRATED
HEALTH  SERVICES,  INC.,  a Delaware  corporation,  the  financial  institutions
signatory hereto as Lenders, and CITIBANK, N.A., a national banking association,
as Administrative Agent for the Lenders.

     In  consideration  of the mutual  agreements set forth herein,  the parties
hereto hereby agree as follows:


                                    ARTICLE I

                        DEFINITIONS AND ACCOUNTING TERMS

     SECTION 1.01. Certain Defined Terms. As used in this Agreement:

     "ACCOMMODATION  OBLIGATION"  means, as applied to any Person, any direct or
indirect guaranty, endorsement or other liability of that Person with respect to
any Debt,  lease,  dividend,  letter of credit or other obligation (the "PRIMARY
OBLIGATION") of another Person (the "PRIMARY OBLIGOR"), including any obligation
of that  Person,  whether or not  contingent,  (i) to  purchase,  repurchase  or
otherwise  acquire any such  primary  obligation  or any  property  constituting
direct or indirect  security  therefor,  or (ii) to advance or provide funds (A)
for the payment or discharge of any such primary obligation,  or (B) to maintain
working  capital  or equity  capital of the  primary  obligor  or  otherwise  to
maintain the net worth or solvency or any balance sheet item, level of income or
financial  condition  of the primary  obligor,  or (iii) to  purchase  property,
securities  or services  primarily  for the purpose of assuring the owner of any
such primary obligation of the ability of the primary obligor to make payment of
such primary obligation, or (iv) otherwise to assure or hold harmless the holder
of any such primary  obligation  against loss in respect thereof.  The amount of
any  Accommodation  Obligation  shall be  deemed  to be an  amount  equal to the
maximum stated or  determinable  amount of the primary  obligation in respect of
which  such   Accommodation   Obligation  is  made  or,  if  not  stated  or  if
indeterminable,  the maximum reasonably estimated potential liability in respect
thereof.

     "ADVANCE" means a loan by a Lender to the Borrower pursuant to Article II.

     "ADJUSTED  STOCKHOLDERS'  EQUITY"  means  the sum of (i) net  stockholders'
equity of the Borrower and its Subsidiaries,  determined as of a particular time
on a consolidated  basis in accordance with GAAP, and (ii) the principal  amount
of Convertible Subordinated Debt then outstanding.

     "AFFILIATE"  of a specified  Person means any other Person that directly or
indirectly through one or more intermediaries  controls,  is controlled by or is
under common  control with the Person  specified.  For this purpose,  "control,"
"controlled by" and "under common control






                                        2

with" with respect to any Person mean the possession, directly or indirectly, of
the power to direct or cause the  direction  of the  management  and policies of
such Person,  whether through the ownership of voting  securities or by contract
or otherwise.

     "AGENT" means  Citibank,  in its capacity as  administrative  agent for the
Lenders hereunder, and any successor appointed pursuant to Section 7.06.

     "AGREEMENT"  means this Revolving Credit Agreement,  as hereafter  amended,
modified or supplemented.

     "APPLICABLE  LENDING  OFFICE"  means,  with  respect to each  Lender,  such
Lender's  Domestic  Lending  Office in the case of a Base Rate  Advance and such
Lender's Eurodollar Lending Office in the case of a Eurodollar Rate Advance.

     "ASSET SALE" means the sale,  transfer or other  disposition  of any asset,
business or property of the Borrower or any of its Subsidiaries, or the issuance
or sale of any capital stock of or other equity, ownership or profit interest in
any Subsidiary of the Borrower  (except a dividend on any such stock or interest
declared and payable solely in additional shares of such stock or interest),  to
any Person other than the Borrower or a wholly-owned Subsidiary of the Borrower,
for a total  consideration  in an amount  greater  than  $5,000,000  in a single
transaction  or  series of  related  transactions.  A  disposition  of  accounts
receivable (i) shall not be an Asset Sale if made pursuant to a Receivables Sale
Program  permitted  under this Agreement and (ii) shall be an Asset Sale only if
disposed  of as  part  of a  disposition  of  all  or  substantially  all of the
operating assets of the business from which such accounts receivable arose.

     "ASSIGNMENT AND ACCEPTANCE" means an assignment and acceptance entered into
by a Lender and an Eligible Assignee,  in substantially the form of Exhibit E-2,
and accepted by the Agent.

     "AUTHORIZED  OFFICER"  means the  principal  financial  officer,  the chief
accounting officer, the controller,  the treasurer or the vice president-finance
of the Borrower.

     "BASE RATE" means, for any day, a fluctuating interest rate per annum equal
to the higher of (i) the then effective rate of interest  announced  publicly by
Citibank in New York, New York,  from time to time, as Citibank's  base rate, or
(ii) the then Federal Funds Rate plus one percent per annum.

     "BASE RATE ADVANCE"  means an Advance which bears  interest by reference to
the Base Rate as provided in Section 2.07(a).


     "BASE RATE MARGIN" means,  for any Pricing  Period,  the rate per annum set
forth below opposite the Pricing Ratio determined for that Pricing Period:





                                        3

                   Pricing Ratio                          Base Rate Margin
                   -------------                          ----------------

        greater than or equal to 6.00                          1.25%

greater than or equal to 5.50 but less than 6.00               0.75%

greater than or equal to 5.00 but less than 5.50               0.50%

greater than or equal to 4.25 but less than 5.00               0.25%

              greater than 4.25                                0.00%


     "BORROWER" means Integrated Health Services, Inc., a Delaware corporation.

     "BORROWING"  means a Base Rate Advance or  Eurodollar  Rate Advance made by
the Lenders on a Borrowing Date.

     "BORROWING  DATE" means the Closing Date or any subsequent  Business Day on
which a Borrowing is requested from the Lenders.

     "BREAKAGE COSTS" is defined in Section 2.12.

     "BUSINESS  DAY"  means any day  except a  Saturday  or Sunday or a day when
commercial banks are authorized or required by law to be closed in New York, New
York, Hartford,  Connecticut, San Francisco,  California or Baltimore,  Maryland
and, where used in reference to any Eurodollar Rate Advance, means such a day on
which dealings are carried on in the London interbank market.

     "CAPITAL  EXPENDITURES" means expenditures for Hard Costs,  whether paid in
cash or accrued as  liabilities,  made by the Borrower or any  Subsidiary of the
Borrower.

     "CAPITAL  LEASE"  means,  with  respect  to any  Person,  any  lease of any
property by that Person as lessee which, in accordance with GAAP, is required to
be accounted for as a capital lease on the balance sheet of that Person.

     "CASH  FLOW  COVERAGE  RATIO"  means the  ratio,  as of the last day of any
Quarter,  of (i) Cash Flow from Operations of the Borrower and its  Subsidiaries
for the 12- month  period then ending to (ii) the sum of (A)  Interest  Expense,
Receivables  Program Charges and Lease Expense counted in determining  such Cash
Flow from  Operations,  (B) the then Current  Portion of Long-Term Debt, and (C)
all cash  dividends  paid on the  Borrower's  common  stock  during the 12-month
period then ending.

     "CASH FLOW FROM  OPERATIONS"  means,  with respect to any Person,  the sum,
determined  as of  the  last  day  of  any  Quarter  for  such  Person  and  its
subsidiaries on a





                                        4

consolidated  basis for the  12-month  period  including  such  Quarter  and the
immediately  preceding  three Quarters  (taken as a single  period),  of (i) net
income after taxes minus any extraordinary  gain and any  non-recurring  gain on
any divestiture and plus any extraordinary  loss and any  non-recurring  loss on
any divestiture,  (ii)  depreciation,  amortization,  and other non-cash charges
deducted in determining net income,  (iii) Interest Expense,  (iv) Lease Expense
and (v) with  respect  to Cash  Flow from  Operations  of the  Borrower  and its
Subsidiaries  only,  Receivables  Program Charges,  all determined in accordance
with GAAP; provided,  however,  that (A) income attributable to any other Person
or  business  that is not at least 50% owned,  directly or  indirectly,  by such
Person  shall be counted,  in  determining  net income,  only to the extent such
income is received in cash by such Person or a subsidiary of such Person in such
period and is not  reinvested in such other Person or business  (other than as a
loan payable on demand) within six months thereafter,  except that, with respect
to the Borrower only, income from minority  Investments  existing on the Closing
Date and described in Schedule  5.03(c) shall be counted in accordance  with the
Borrower's  past  practice,  and (B) no  adjustments  shall  be made to  reflect
minority interests in subsidiaries.

     "CASH PROCEEDS OF SALE" means all cash and cash equivalents received by the
Borrower or any of its Subsidiaries as the cash  consideration in any Asset Sale
or  from  any  payment  or  distribution  on,  or sale or  liquidation  of,  any
promissory  note or other  property  received as non-cash  consideration  in any
Asset Sale.

     "CHANGE OF CONTROL" means (i) a "change in control" as that term is defined
in any of the  Subordinated  Debt  Indentures,  (ii) a transaction  or series of
transactions  whereby any Person or group within the meaning of Section 13(d)(3)
of the 1934 Act and the rules and regulations promulgated thereunder (other than
Robert N. Elkins,  M.D. or a group managed by Robert N. Elkins,  M.D.)  acquires
beneficial  ownership  (within  the  meaning  of Rule  13d-3 of the  1934  Act),
directly or  indirectly,  of  securities  of the Borrower  (or other  securities
convertible into such securities)  representing 40% of the combined voting power
of all securities of the Borrower  entitled to vote in the election of directors
(a  "CONTROLLING  PERSON") or (iii) at any time,  a majority  of the  Borrower's
directors  are  persons  who were not (A) in office  on the  Closing  Date,  (B)
initially  nominated by  directors  who were in office on the Closing Date or by
successor  directors  elected or appointed  upon the initial  nomination of such
directors or successor  directors or (C) initially  nominated by a group managed
by Robert N.  Elkins,  M.D. For this  purpose,  a Person or group shall not be a
Controlling  Person if such Person or group holds voting power in good faith and
not for the purpose of circumventing the effect of the occurrence of a Change of
Control as an agent,  bank,  broker,  nominee,  trustee,  or holder of revocable
proxies given in response to a solicitation pursuant to the 1934 Act, for one or
more beneficial owners who do not  individually,  or, if they are a group acting
in  concert,  as a group,  have  the  voting  power  specified  in the  previous
sentence.

     "CITIBANK" means Citibank, N.A., a national banking association.





                                        5


     "CLOSING DATE" means the date on which all of the conditions  precedent set
forth in Section 3.01 are satisfied or waived in writing by the Lenders.

     "CODE"  means  the  Internal  Revenue  Code  of 1986  and  the  regulations
thereunder.

     "COLLATERAL"  means  all  property  which at any time is  subject  or is to
become  subject  to any Lien  granted  or  created  under any of the  Collateral
Documents.

     "COLLATERAL  DOCUMENTS"  means the Pledge and Security  Agreements  and all
other  security  agreements,   collateral  assignments  and  other  instruments,
documents  and  agreements  at any time  delivered  to the  Agent to  create  or
evidence Liens to secure the Obligations.

     "COMMITMENT  FEE RATE" means,  for commitment  fees accruing in any Pricing
Period, the rate per annum set forth below opposite the Pricing Ratio determined
for such Pricing Period:

                  Pricing Ratio                           Commitment Fee Rate
                  -------------                           -------------------

          greater than or equal to 5.00                         0.50%

greater than or equal to 4.25 but less than 5.00               0.375%

greater than or equal to 3.75 but less than  4.25               0.25%

                 less than 3.75                                 0.20%


     "CONSENT SOLICITATION" means the solicitation of the consent of the holders
of Debt  outstanding  under the 1994  Subordinated  Debt  Indenture and the 1995
Subordinated Debt Indenture to certain amendments to such indentures pursuant to
the  consent,  dated and mailed to such  holders on May 3, 1996,  as  thereafter
amended with the approval of the Agent in its sole discretion.

     "CONVERTIBLE  SUBORDINATED  DEBT" means the Debt outstanding under the 1992
Convertible  Subordinated  Debt Indenture and the 1993 Convertible  Subordinated
Debt Indenture.

     "CURRENT  PORTION OF  LONG-TERM  DEBT"  means  that  portion of Debt of the
Borrower  and its  Subsidiaries  on a  consolidated  basis  (including,  without
limitation,  the Advances,  but excluding the  Subordinated  Debt and the senior
Debt listed on Schedule  1.01(a))  that is, at the end of any  Quarter,  due and
payable within the next 12 months.

     "DEBT,"  as  applied  to  any  Person  and in  each  case  determined  on a
consolidated basis in conformity with GAAP, means (without  duplication) (i) all
indebtedness  for  borrowed  money  (whether  by  loan or the  issuance  of debt
securities or otherwise);  (ii) all obligations issued, undertaken or assumed as
the deferred purchase price of property or services or interest





                                        6


thereon,  except  accounts and accrued  expenses  currently  payable;  (iii) all
reimbursement  obligations  with  respect  to surety  bonds,  letters of credit,
bankers'  acceptances and similar instruments,  whether or not contingent;  (iv)
all  monetary   obligations   under  any  Capital  Lease;  (v)  all  obligations
(contingent or otherwise) to purchase, retire or redeem any capital stock or any
other equity interest of such Person; (vi) all monetary obligations measured by,
or  determined  on the basis of, the value of any capital  stock of such Person;
and (vii) all obligations,  whether or not such  obligations  constitute Debt as
defined in clauses (i) through  (vi) above,  secured by (or for which the holder
of the obligation has an existing right,  contingent or otherwise, to be secured
by) any Lien upon any property of such Person or any  Subsidiary of such Person,
except  any such  obligation  secured  by a Lien that is  imposed by law and not
voluntarily granted.

     "DEBT/EBITDAR  RATIO"  means the ratio,  as of the last day of any Quarter,
of:

          (i) the sum of:

               (A) the  difference,  if any,  between  (x) the sum of (1) Funded
          Debt and (2) eight times the  Specified  Lease Expense of the Borrower
          and its Subsidiaries for the 12-month period then ending, less (y) the
          lesser  of (1)  Quarter-End  Excess  Cash  and (2) the  Advances  then
          outstanding, and

               (B) the Purchasers' Aggregate Net Investment  outstanding on such
          day; to

          (ii) EBITDAR of the Borrower and such  Subsidiaries  for the 12- month
     period then ending,  after pro forma (1) adding to Specified  Lease Expense
     of the Borrower and such  Subsidiaries,  all amounts that would  constitute
     additional  Specified  Lease Expense of the Borrower and such  Subsidiaries
     for such period if any  acquisition  of a company that was made at any time
     during such  period by the  Borrower  or any of its  Subsidiaries  had been
     consummated  at the  commencement  of such period;  (2) adding to Specified
     Lease Expense of the Borrower and such Subsidiaries, all amounts that would
     constitute  additional  Specified  Lease  Expense of the  Borrower and such
     Subsidiaries  for such period if any lease of a Health Care  Facility  that
     was entered  into by the  Borrower or any of its  Subsidiaries  at any time
     during such  period had been so entered  into at the  commencement  of such
     period;  (3) adding to EBITDAR of the Borrower and such  Subsidiaries,  the
     EBITDAR and Non-Recurring  Charges  determined solely for any such acquired
     company  or Health  Care  Facility,  for the  portion of such  period  that
     preceded the  acquisition;  provided,  however,  that for  Quarters  ending
     during the 12-month period  immediately  following the closing of the First
     American Merger,  EBITDAR of First American for the period from the closing
     to the date of determination, annualized for the 12-month period then ended
     shall  be added to  EBITDAR  of the  Borrower  and such  Subsidiaries;  (4)
     subtracting   from  Specified  Lease  Expense  of  the  Borrower  and  such
     Subsidiaries,  the Specified Lease Expense for such period  attributable to
     any business or






                                        7

     facility that was sold or closed by the Borrower or any of its Subsidiaries
     in such period;  and (5) subtracting  from EBITDAR of the Borrower and such
     Subsidiaries,  the EBITDAR for such period of any business or facility that
     was so sold or closed.

     "DOLLARS"  and "$" mean United  States  dollars or such coin or currency of
the United States of America as at the time of payment shall be legal tender for
the payment of public and private debts in the United States of America.

     "DOMESTIC LENDING OFFICE" means, with respect to any Lender,  the office of
such Lender  specified as its  "Domestic  Lending  Office"  opposite its name on
Schedule  I hereto  or in the  Assignment  and  Acceptance  by which it became a
Lender or such other  office of such Lender as such Lender may from time to time
specify to the Borrower and the Agent.

     "EBITDAR" means, with respect to any Person,  the sum of (i) Cash Flow from
Operations  of such Person for any period and (ii) all charges for taxes counted
in determining the consolidated net income of such Person for such period.

     "ELIGIBLE ASSIGNEE" means (i) a commercial bank organized under the laws of
the United States,  or any State  thereof,  and having total assets in excess of
$5,000,000,000;  (ii) a savings and loan  association  or savings bank organized
under the laws of the United  States,  or any State  thereof,  and having  total
assets in excess of $3,000,000,000;  (iii) a commercial bank organized under the
laws of any  other  country  which  is a  member  of the  OECD,  or a  political
subdivision  of  any  such  country,  and  having  total  assets  in  excess  of
$5,000,000,000, if such bank is acting through a branch or agency located in the
United  States;  (iv) the central  bank of any country  which is a member of the
OECD; (v) a finance  company,  insurance or other financial  institution that is
engaged in making,  purchasing or otherwise investing in commercial loans in the
ordinary   course  of  its  business  and  having  total  assets  in  excess  of
$3,000,000,000;  (vi) a fund that is engaged in making,  purchasing or otherwise
investing in commercial  loans in the ordinary course of its business and having
total assets in excess of $200,000,000;  (vii) Affiliates of an existing Lender;
and (viii) any other Person approved by the Agent, the LC Bank and the Borrower,
which approval shall not be unreasonably  withheld;  provided,  however, that no
Person who is a non-resident  alien or a foreign entity for United States income
tax  purposes  (except a commercial  bank of the type  described in clause (iii)
above),  may be an  Eligible  Assignee  unless  each Note to be acquired by such
Person is reissued in registered form prior to transfer.

     "ENVIRONMENTAL  CLAIMS"  means any and all  administrative,  regulatory  or
judicial claims, demands, directives, proceedings, orders, decrees and judgments
relating in any way to any Environmental Law or any Environmental Permit.

     "ENVIRONMENTAL  LAWS" means all  federal,  state and local laws,  statutes,
rules,   regulations,   ordinances  and  codes,  and  any  binding  judicial  or
administrative  interpretation thereof or requirement thereunder,  including any
judicial or administrative order, by any





                                        8

Governmental  Authority,  relating  to the  regulation  or  protection  of human
health, safety, the environment and natural resources.

     "ENVIRONMENTAL   PERMIT"   means  any   license,   permit,   authorization,
registration or approval issued or required under any Environmental Law.

     "ERISA" means the Employee Retirement Income Security Act of 1974.

     "ERISA AFFILIATE" means any entity which is (or at any relevant time was) a
member of a "controlled  group of  corporations,"  under  "common  control" or a
member of an "affiliated  service group" with the Borrower as defined in Section
414(b), (c) or (m) of the Code.

     "ERISA  EVENT" means (i) any of the events set forth in Section  4043(b) of
ERISA or the  regulations  thereunder,  with respect to a Pension  Plan;  (ii) a
withdrawal by the Borrower or any ERISA Affiliate from a Pension Plan subject to
Section 4063 of ERISA during a plan year in which it was a substantial  employer
(as  defined  in Section  4001(a)(2)  of  ERISA);  (iii) a  complete  or partial
withdrawal by the Borrower or any ERISA  Affiliate  from a  Multiemployer  Plan;
(iv) the  filing of a notice of intent to  terminate,  the  treatment  of a plan
amendment  as a  termination  under  Section  4041  or  4041A  of  ERISA  or the
commencement  of  proceedings  by the  PBGC  to  terminate  a  Pension  Plan  or
Multiemployer  Plan subject to Title IV of ERISA; (v) a failure to make required
contributions  to a Pension Plan or  Multiemployer  Plan; (vi) the imposition of
any  liability  under Title VI of ERISA,  other than PBGC  premiums  due but not
delinquent  under  Section  4007  of  ERISA,  upon  the  Borrower  or any  ERISA
Affiliate;  (vii) an  application  for a funding  waiver or an  extension of any
amortization  period  pursuant  to Section  412 of the Code with  respect to any
Pension  Plan;  (viii) the  Borrower or ERISA  Affiliate  engages in a nonexempt
prohibited  transaction or otherwise  becomes liable with respect to a nonexempt
prohibited transaction, the consequences of which, in the aggregate,  constitute
or could reasonably be expected to result in a Material Adverse Change;  or (ix)
a violation of the applicable requirements of Section 404 or 405 of ERISA or the
exclusive  benefit rule under Section  401(a) of the Code by the Borrower or any
ERISA  Affiliate  with respect to any Pension Plan for which the Borrower or any
of its Subsidiaries may be liable,  the consequences of which, in the aggregate,
constitute  or could  reasonably  be  expected  to result in a Material  Adverse
Change.

     "EUROCURRENCY  LIABILITIES"  has  the  meaning  assigned  to  that  term in
Regulation  D of the Board of  Governors of the Federal  Reserve  System,  as in
effect from time to time.

     "EURODOLLAR  LENDING OFFICE" means, with respect to any Lender,  the office
of such Lender specified as its "Eurodollar Lending Office" opposite its name on
Schedule  I hereto  or in the  Assignment  and  Acceptance  by which it became a
Lender (or, if no such office is specified, its Domestic Lending Office) or such
other  office of such Lender as such Lender may from time to time specify to the
Borrower and the Agent as its Eurodollar Lending Office.






                                        9

     "EURODOLLAR  RATE" means,  for any Interest Period for each Eurodollar Rate
Advance comprising part of the same Borrowing,  an interest rate per annum equal
to the average  (rounded  upward to the nearest whole multiple of 1/16 of 1% per
annum,  if such  average is not such a multiple)  of the rate per annum at which
deposits  in U.S.  dollars are  offered by the  principal  office of each of the
Reference Banks in London to prime banks in the interbank market for U.S. Dollar
Deposits at 11:00 a.m.  (London  time) two Business Days before the first day of
such Interest Period in an amount  substantially  equal to such Reference Bank's
Eurodollar Rate Advance comprising part of such Borrowing (or, if such Reference
Bank is not a  Lender,  10% of such  Borrowing)  and for a period  equal to such
Interest Period.

     "EURODOLLAR  RATE  ADVANCE"  means  an  Advance  which  bears  interest  by
reference to the Eurodollar Rate as provided in Section 2.07(b).

     "EURODOLLAR RATE MARGIN" means, for any Pricing Period,  the rate per annum
set forth below opposite the Pricing Ratio determined for that Pricing Period:

             Pricing Ratio                         Eurodollar Rate Margin
             -------------                         ----------------------

      greater than or equal to 6.00                          2.50%

greater than or equal to 5.50 but less than 6.00             2.00%

greater than or equal to 5.00 but less than 5.50             1.75%

greater than or equal to 4.25 but less than 5.00             1.50%

greater than or equal to 3.75 but less than 4.25             1.25%

greater than or equal to 3.25 but less than 3.75             1.00%

greater than or equal to 2.75 but less than 3.25             0.875%

              less than 2.75                                 0.75%

     "EURODOLLAR  RATE  RESERVE  PERCENTAGE"  of any  Lender  for any day in the
Interest  Period for any  Eurodollar  Rate Advance means the reserve  percentage
applicable for such day under regulations  issued from time to time by the Board
of Governors of the Federal  Reserve System (or any  successor) for  determining
the maximum reserve requirement (including any emergency,  supplemental or other
marginal  reserve  requirement)  for such Lender with respect to  liabilities or
assets consisting of or including  Eurocurrency  liabilities having a term equal
to such Interest Period.

     "EVENTS OF DEFAULT" has the meaning provided in Section 6.01.

     "EXISTING  FACILITY"  means the Revolving  Credit and Term Loan  Agreement,
dated as of April 20, 1995,  by and among the Borrower,  Citicorp  USA,  Inc., a
Delaware  corporation,   as






                                       10

administrative agent thereunder,  and the other financial institutions signatory
thereto as lenders, as amended.

     "FACILITY  AMOUNT" means, on any date of  determination,  $700,000,000 less
all Facility Reductions which are then effective.

     "FACILITY  REDUCTION"  means each  temporary or permanent  reduction of the
credit available to the Borrower under this Agreement,  whether voluntarily made
or scheduled to be made pursuant to Section 2.05 or required to be made pursuant
to Section  2.06,  Section  6.01 or any other  provision  of this  Agreement  or
otherwise becoming effective in accordance with this Agreement.

     "FEDERAL FUNDS RATE" means, for any period, a fluctuating interest rate per
annum equal for each day during such period to the weighted average of the rates
on overnight  Federal  funds  transactions  with members of the Federal  Reserve
System arranged by Federal funds brokers, as published for such day (or, if such
day is not a Business Day, for the next  preceding  Business Day) by the Federal
Reserve Bank of New York, or, if such rate is not so published for any day which
is a  Business  Day,  the  average  of the  quotations  for  such  day  on  such
transactions received by Citibank from three Federal funds brokers of recognized
standing selected by it.

     "FEE  LETTER"  means the letter  dated  April 8, 1996 from  Citibank to the
Borrower.

     "FIRST  AMERICAN"  means First  American  Health Care of Georgia,  Inc.,  a
Georgia corporation.

     "FIRST  AMERICAN  MERGER"  means  the  proposed  merger  of a  wholly-owned
Subsidiary of the Borrower with and into First  American  pursuant to which,  on
the terms and conditions set forth in the First American Merger Agreement, First
American will become a wholly-owned Subsidiary of the Borrower.

     "FIRST AMERICAN MERGER AGREEMENT" means the merger  agreement,  dated as of
February 21, 1996,  among the Borrower,  IHS  Acquisition  XIV, Inc., a Delaware
corporation  and  wholly-owned  Subsidiary of the Borrower,  First  American and
certain principal  shareholders thereof, as amended by Amendment No. 1, dated as
of March 12, 1996, and as thereafter  further amended in accordance with Section
5.03(c)(xii).

     "FUNDED DEBT" means all Debt of the type described in clauses (i), (ii) and
(iv) of the  definition of "Debt," plus all  Accommodation  Obligations,  except
those  described  in clauses (i) through  (vi) of Section  5.03(f),  owed by the
Borrower or any of its Subsidiaries and outstanding, on a consolidated basis, on
the last day of any Quarter.






                                       11

     "FUNDED LC EXPOSURE" means the aggregate  principal  amount, as of any date
of determination, of all payments that were made by the LC Bank under any Letter
of Credit but have not been  reimbursed to the LC Bank by the Borrower  pursuant
to Section 2.02(c) or converted into Advances pursuant to Section 2.02(e).

     "GAAP" means  generally  accepted  accounting  principles  set forth in the
opinions and pronouncements of the Accounting  Principles Board and the American
Institute of Certified Public  Accountants and statements and  pronouncements of
the Financial  Accounting Standards Board (or agencies with similar functions of
comparable stature and authority within the accounting  profession),  or in such
other statements by such entity as may be in general use by significant segments
of the U.S.  accounting  profession,  which  are  applicable  to the  facts  and
circumstances on the date of determination.

     "GOVERNMENTAL  AUTHORITY" means any nation, state, sovereign or government,
any  political   subdivision  thereof  and  any  entity  exercising   executive,
legislative,  judicial,  regulatory or administrative functions of or pertaining
to government.

     "GUARANTOR"  means each Subsidiary of the Borrower that executes,  or joins
in, the Guaranty.

     "GUARANTOR  CONFIRMATION"  means a Confirmation and Agreement of Guarantors
in  substantially  the  form of  Exhibit  C-4,  duly  authorized,  executed  and
delivered by the Guarantors, setting forth the Guarantor Liability Limit as to a
particular Guarantor.

     "GUARANTOR LIABILITY LIMIT" means:

               (i) In respect of any  Subsidiary  that is  (either  directly  or
          indirectly  through  one  or  more  wholly-owned  Subsidiaries  of the
          Borrower) a  wholly-owned  Subsidiary  of the  Borrower,  an unlimited
          amount, and

               (ii) In respect of any Subsidiary that is not such a wholly-owned
          Subsidiary of the Borrower, an amount determined as of the last day of
          the then most recently  ended Quarter for which  financial  statements
          are  available  by  multiplying  (A)  EBITDAR  plus any  Non-Recurring
          Charges,  determined  solely for such Subsidiary and its  Subsidiaries
          and any business,  assets or entity  directly or  indirectly  owned by
          such  Subsidiary at such time, on a consolidated  basis,  for the four
          Quarters  most  recently  ended  prior  to  the  date  on  which  such
          Subsidiary  first became a  Subsidiary  not  (directly or  indirectly)
          wholly-owned by the Borrower by (B) six and further by (C) a fraction,
          the  numerator  of which is the number of shares of  capital  stock or
          other  equity,  ownership  or  profit  interests  in  such  Subsidiary
          directly or  indirectly  owned by the  Borrower at such time and after
          giving  effect  to any  transaction  then  being  consummated  and the
          denominator  of which is the  total  number  of all  such  shares  and
          interests outstanding at





                                       12

          such time and after giving effect to any such  transaction;  provided,
          however,  that  if  the  Borrower  elects,  in  respect  of  any  such
          Subsidiary  no later than the date that is 10 Business Days after such
          Subsidiary  first became a  Subsidiary  not  (directly or  indirectly)
          wholly-owned  by the  Borrower,  voluntarily  to reduce  the  Facility
          Amount effective as of such date in accordance with Section 2.05 by an
          amount equal to the amount so determined, then the Guarantor Liability
          Limit as to such Subsidiary (and only as to such Subsidiary)  shall be
          zero.

     "GUARANTY"  means  the  guaranty  by the  Borrower's  Subsidiaries,  except
Inactive  Subsidiaries,  delivered  pursuant to Section 3.01(a) and each joinder
therein by any other Subsidiary of the Borrower and all Guarantor Confirmations,
guaranties,  instruments  and agreements at any time delivered by any Subsidiary
of  the  Borrower  in  respect  of or in  exchange  or  substitution  for  or in
replacement  of such  guaranty or to evidence  its guaranty of payment of any of
the Obligations.

     "HARD COSTS" means the direct costs of building,  improving or  maintaining
any Health Care  Facility or other  property  used by the Borrower or any of its
Subsidiaries (including the cost of land, construction, bricks, mortar, painting
and  related  building  maintenance,  carpeting,  roof  repair and  replacement,
parking  lot  replacement  and  maintenance,  landscaping,  HVAC  equipment  and
sprinkler  systems  and  other  items  generally  considered  hard  costs  under
construction  industry  practice  but not  including  the  purchase  price of an
existing  Health Care  Facility or any  allocated  overhead  and  administrative
expenses  and other items  generally  considered  soft costs under  construction
industry  practice)  and the  purchase  price of any  fixed,  movable  or mobile
equipment located on or used in connection with any such Health Care Facility or
otherwise used in conducting  business if such equipment is or is required to be
reflected as property,  plant and equipment on the consolidated balance sheet of
the Borrower and its Subsidiaries.

     "HAZARDOUS   MATERIALS"   means  (i)  flammable   explosives,   radioactive
materials, friable asbestos, urea formaldehyde foam insulation,  transformers or
other equipment that contain  dielectric  fluid  containing  regulated levels of
polychlorinated biphenyls and petroleum products, and (ii) chemicals, materials,
substances or wastes which are now or hereafter become defined as or included in
the definition,  listing or identification of "hazardous substances," "hazardous
wastes,"  hazardous   materials,"   "extremely  hazardous  wastes,"  "restricted
hazardous  wastes," "toxic  substances,"  "toxic  pollutants,"  "medical waste,"
"infectious  waste,"  "biomedical  waste,"  "biohazardous  waste,"  or  words of
similar import, under any applicable Environmental Law.

     "HEALTH CARE COMPANY" means a Person that is principally engaged,  directly
or indirectly through its Subsidiaries,  in the business of owning, operating or
managing Health Care Facilities or healthcare operations or providing healthcare
services.







                                       13

     "HEALTH CARE  FACILITY"  means a facility  which  provides  any  healthcare
services,  whether  licensed as a skilled nursing  facility,  intermediate  care
facility, personal care facility or a hospital or otherwise.

     "HEALTH CARE PERMIT" means every accreditation,  authorization, certificate
of need,  license or permit that is required  pursuant to applicable  federal or
state law to own, lease, operate or manage a Health Care Facility or conduct the
business of a Health Care Company.

     "INACTIVE SUBSIDIARY" means a Subsidiary of the Borrower that carries on no
business  operations or other activities and has an aggregate  capitalization of
$1,500 or less.

     "INDEMNIFIED LIABILITIES" is defined in Section 8.06(a).

     "INDEMNIFIED PERSON" is defined in Section 8.06(a).

     "INTANGIBLE   ASSETS"   means,   with  respect  to  the  Borrower  and  its
Subsidiaries  on  a  consolidated  basis,  all  assets  properly  classified  as
intangible  assets  under  GAAP,   including  goodwill,   patents,   copyrights,
trademarks,  trade names,  franchises,  licenses,  organization costs,  deferred
charges,  and deferred  pre-opening  costs, but excluding all intangible  assets
classified  as such under the  provisions  of  Statements  87, 88 and 106 of the
Financial  Accounting  Standards  Board  relating to Accounting for Pensions and
Post- Retirement Benefits other than Pensions,  so long as such intangible asset
has a related liability under GAAP of equal or substantially equal amount on the
consolidated  balance sheet of the Borrower and its  Subsidiaries as of the date
of determination.

     "INTEREST&RENT  COVERAGE  RATIO" means the ratio, as of the last day of any
Quarter,  of (A) EBITDAR of the Borrower and its  Subsidiaries  for the 12-month
period  then  ending to (B) the sum of  Interest  Expense,  Receivables  Program
Charges and Lease Expense counted in determining such EBITDAR.

     "INTEREST  EXPENSE" means,  with respect to any Person,  for any period for
such Person and its subsidiaries on a consolidated  basis,  interest expense net
of interest income, determined in conformity with GAAP.

     "INTEREST  PERIOD" means, for each Eurodollar Rate Advance  comprising part
of the same Borrowing,  the period commencing on the date of such Advance or the
date of the  conversion  of any  Advance  into such an Advance and ending on the
last day of the period selected by the Borrower pursuant to the provisions below
and,  thereafter,  each  subsequent  period  commencing  on the  last day of the
immediately  preceding  Interest Period and ending on the last day of the period
selected by the Borrower  pursuant to the provisions below. The duration of each
such Interest Period shall be 1, 2, 3 or 6 months, as the Borrower may select by






                                       14

notice  received  by the Agent not later than  11:00  a.m.  (New York City time)
three  Business Days prior to the first day of such Interest  Period;  provided,
however, that:

          (a) the Borrower  may not select any Interest  Period which ends after
     the Maturity Date;

          (b) the Borrower  may not select any Interest  Period which ends after
     any date on which any payment on any  Advances is due unless,  after giving
     effect to such selection,  the aggregate  unpaid  principal  amount of Base
     Rate Advances and Eurodollar Rate Advances  having  Interest  Periods which
     end on or prior to such date is at least equal to the  principal  amount of
     Advances due and payable on and prior to such date;

          (c)  Interest  Periods  commencing  on  the  same  date  for  Advances
     comprising part of the same Borrowing shall be of the same duration;

          (d) whenever the last day of any Interest Period would otherwise occur
     on a day that is not a Business Day, the last day of such  Interest  Period
     shall be extended to the next succeeding  Business Day, except that if such
     extension  would cause the last day of such Interest Period to occur in the
     next following  calendar month,  the last day of such Interest Period shall
     be the next preceding Business Day; and

          (e) the Borrower may not have more than 15 Interest  Periods in effect
     at any one time.

     "INVESTMENT"  means (i) the  acquisition  of any interest in any  property,
assets or business from any Person,  whether by sale,  lease or otherwise,  (ii)
the  funding  of  any  loan,  extension  of  credit,  accommodation  or  capital
contribution  to or for the benefit of any Person,  and (iii) the acquisition of
any debt or equity  securities  of or claim  against or  interest in any Person,
whether upon original issuance, by purchase or otherwise.

     "LC   APPLICATION"   means  an  application  for  a  Letter  of  Credit  in
substantially  the form of Exhibit B-3, setting forth the information  described
therein and such other  information  as the LC Bank may  reasonably  request and
signed by an Authorized Officer.

     "LC BANK"  means The Bank of Nova  Scotia  and any Lender  which  agrees to
become, and is designated as, a replacement LC Bank pursuant to Section 2.02(g).

     "LC CASH COLLATERAL ACCOUNT" means a general deposit account established at
and  maintained  by  Citibank in the name of and for the benefit of the Agent on
behalf of the Lenders and under the exclusive dominion and control of the Agent.







                                       15

     "LC  EXPOSURE"  means  the  sum,  as of any date of  determination,  of the
Unfunded LC Exposure and the Funded LC Exposure.

     "LC FEE RATE"  means,  for any day,  the then  Eurodollar  Rate Margin less
0.025% per annum.

     "LC  SUBCOMMITMENT"  means the lesser, as of any date of determination,  of
(i) $100,000,000 and (ii) the Facility Amount.

     "LEASE EXPENSE" means, with respect to any Person,  for any period for such
Person and its  subsidiaries on a consolidated  basis,  lease and rental expense
accrued  during such period under all leases and rental  agreements,  other than
Capital  Leases and leases of  personal  property,  of Health  Care  Facilities,
determined in conformity with GAAP.

     "LENDER" means each financial institution  signatory hereto,  including the
LC Bank,  and any other  financial  institution  that  pursuant to Section  8.07
becomes a party to this Agreement.

     "LETTER  OF  CREDIT"  means a letter of credit  that (i) is  available  for
funding in Dollars until an expiry date no later than the Maturity Date, (ii) is
issued by the LC Bank at the request and for the account of the Borrower,  (iii)
is governed by the Uniform Customs and Practices for  Documentary  Credits (1994
Revision),   International  Chamber  of  Commerce  Publication  500,  except  as
otherwise agreed by the LC Bank, and (iv) is in form reasonably  satisfactory to
the LC Bank.

     "LIEN" means any mortgage,  deed of trust, lien, pledge,  charge,  security
interest,  hypothecation,  assignment, deposit arrangement or encumbrance of any
kind in respect  of any asset,  whether  or not  filed,  recorded  or  otherwise
perfected or effective under applicable law, as well as the interest of a vendor
or lessor under any  conditional  sale  agreement,  capital or finance  lease or
other title retention agreement relating to such asset.

     "LOAN AVAILABILITY" means the difference,  as of any date of determination,
between (i) the Facility Amount, and (ii) the Outstanding Revolving Credit.

     "LOAN DOCUMENTS" means this Agreement, the Notes, the Guaranty, the Letters
of Credit, the Collateral Documents, each Rate Contract and all other guaranties
and  other  agreements,  instruments  and  written  indicia  of the  Obligations
delivered  to the Agent or any  Lender by or on  behalf of the  Borrower  or any
other Loan Party pursuant to or in connection with the transactions contemplated
hereby.

     "LOAN PARTIES" means the Borrower and each  Subsidiary of the Borrower that
is a party to any Loan Document.







                                       16

     "MATERIAL  ADVERSE  CHANGE"  means  any  materially  adverse  change in the
financial condition,  assets, nature of the assets,  liabilities,  operations or
prospects of the Borrower and its Subsidiaries, taken as a whole.

     "MATERIAL ENVIRONMENTAL CLAIM" means any Environmental Claim, regardless of
merit, which does or can reasonably be expected to (i) result in the Borrower or
any of its  Subsidiaries  expending  in the  aggregate  an  amount  in excess of
$10,000,000 to defend against,  settle or satisfy, or (ii) prevent or enjoin the
Borrower or any of its Subsidiaries from operating a Health Care Facility on any
property on which it conducts operations.

     "MATERIAL  LEASE" means any lease  agreement  with respect to a Health Care
Facility or Facilities for which during the most recent four Quarters either (i)
total  revenues  from such Health  Care  Facility or  Facilities  represent  ten
percent  or  more  of  the  consolidated   revenues  of  the  Borrower  and  its
Subsidiaries, or (ii) net income from the operation of such Health Care Facility
or Facilities  represents ten percent or more of the  consolidated net income of
the Borrower and its Subsidiaries.

     "MATERIAL  SUBSIDIARY"  means each Subsidiary of the Borrower which has (i)
as of the end of the most recent  Quarter,  total assets (other than  Intangible
Assets) representing ten percent or more of the consolidated total assets (other
than Intangible Assets) of the Borrower and its Subsidiaries,  (ii) for the most
recent four  Quarters,  total revenues  representing  ten percent or more of the
consolidated  revenues of the  Borrower and its  Subsidiaries,  or (iii) for the
most recent four Quarters,  net income  representing  ten percent or more of the
consolidated net income of the Borrower and its Subsidiaries.

     "MATURITY DATE" means June 30, 2002.

     "MINIMUM NET WORTH"  means the sum, as of the last day of any  Quarter,  of
(i) $590,000,000 less up to $10,000,000 of extraordinary  losses  (determined in
accordance  with GAAP) of the Borrower and its  Subsidiaries  on a  consolidated
basis  incurred  at any time  after  December  31,  1995,  plus  (ii) 75% of the
aggregate net income  (determined  in accordance  with GAAP) of the Borrower and
its  Subsidiaries on a consolidated  basis earned in the Quarter ended March 31,
1996 and in each  Quarter  thereafter,  if net income was earned in such Quarter
(and  not  reduced  for a net  loss  in any  Quarter),  plus  (iii)  100% of all
additions to Adjusted  Stockholders' Equity resulting at any time after December
31,  1995 from the sale or  issuance  of any  common or  preferred  stock of the
Borrower, except upon conversion of any Convertible Subordinated Debt.

     "MOODY'S" means Moody's Investor Service, Inc., and its successors.

     "MULTIEMPLOYER  PLAN"  means any Plan which is a  "multiemployer  plan," as
defined in Section 4001(a)(3) of ERISA.






                                       17

     "NET CASH PROCEEDS OF SALE" means, with respect to any Asset Sale, the Cash
Proceeds  of Sale of such  sale  less (i) all  reasonable  brokerage,  legal and
accounting fees and disbursements,  and any governmental fees and taxes incurred
(or reasonably  expected to be incurred) in connection  with such sale which are
not payable to Affiliates of the Borrower (or, if to Affiliates,  are in amounts
no greater than would be payable in an arm's-length transaction);  (ii) any Debt
secured by the assets  subject to such Asset Sale repaid with such  proceeds (to
the extent such  repayment is  permitted  under the Loan  Documents);  and (iii)
reserves  against  any  liabilities  incurred  as a result  of such  Asset  Sale
reflected  on the balance  sheet of the Borrower or any of its  Subsidiaries  in
accordance with GAAP; provided,  however,  that in the event any such reserve is
subsequently decreased,  other than as a result of the accrual or payment of any
liability for which such reserve was established, Net Cash Proceeds of Sale with
respect to such Asset Sale shall be increased by a like amount.

     "1934 ACT" means the  Securities  Exchange Act of 1934 and the  regulations
thereunder.

     "1992 CONVERTIBLE  SUBORDINATED DEBT INDENTURE" means the Indenture,  dated
as of  December 1, 1992,  between  the  Borrower,  as Issuer,  and Signet  Trust
Company, as Trustee.

     "1993  CONVERTIBLE  SUBORDINATED  DEBT  INDENTURE"  means the  Amended  and
Restated  Supplemental  Indenture  dated as of September  15, 1994,  between the
Borrower, as Issuer, and NationsBank of Virginia, N.A., as Trustee.

     "1994  SUBORDINATED DEBT INDENTURE" means the Indenture dated as of July 1,
1994, between the Borrower, as Issuer, and Signet Trust Company, as Trustee.

     "1995 SUBORDINATED DEBT INDENTURE" means the Indenture, dated as of May 15,
1995, between the Borrower, as Issuer and Signet Trust Company, as Trustee.

     "1996  SUBORDINATED  DEBT INDENTURE" means the Indenture to be entered into
after the Closing between the Borrower, as Issuer, and the trustee thereunder in
connection with the proposed senior subordinated note offering.

     "NON-RECURRING  CHARGES" means all charges  against the income of a company
or facility  acquired by the Borrower or one of its  Subsidiaries  that (i) were
taken by the owners of such company or facility  prior to or  concurrently  with
the acquisition,  on the initiative solely of such owners or their management or
accountants  and without any demand or influence from the Borrower or any of its
Affiliates or any Person acting for any of them, and (ii) either (A) reflect the
direct  costs of the  acquisition,  including  fees and  expenses of  attorneys,
accountants,  advisors,  architects,  engineers,  consultants  and  agents,  and
environmental  and travel costs, or (B) are charges taken in the current year to
make  adjustments  for charges for  accruals,  bad debt  provisions or valuation
allowances in a prior year, if (x) the charges in the current year would be






                                       18

entirely eliminated if the prior year's income was restated,  in accordance with
GAAP,  to  reflect  such  adjustments,   and  (y)  the  Borrower  provides  such
information  relating to the adjustments and the restatement of the prior year's
income as the Agent or Requisite Lenders may reasonably request.

     "NOTES" means the promissory  notes of the Borrower  delivered  pursuant to
Section  3.01(a) and all promissory  notes and other evidence of indebtedness at
any time  delivered by the Borrower in exchange or  substitution  therefor or in
replacement thereof or as additional evidence of the Borrower's indebtedness for
the Advances.

     "NOTICE OF BORROWING"  means a notice  substantially in the form of Exhibit
B-1.

     "NOTICE OF CONTINUANCE/CONVERSION" means a notice substantially in the form
of Exhibit B-2.

     "OBLIGATIONS"   means  all  present  and  future  Debts,   obligations  and
liabilities  of every type and  description  of the  Borrower  or any other Loan
Party at any time arising under or in connection with this Agreement,  any other
Loan  Document  or any Rate  Contract,  due or to become due to the  Agent,  any
Lender,  any Person  required to be  indemnified  under any Loan Document or any
other Person and shall  include (i) all  liability for principal of and interest
on any  Advances,  (ii) all  liability  for  principal  of and  interest  on any
reimbursement  owed to the LC Bank for a  payment  made by it under a Letter  of
Credit,  and (iii) all liability  under the Loan  Documents  for any  additional
interest, fees, taxes,  compensation,  costs, losses, expense reimbursements and
indemnification.

     "OECD" means the Organization for Economic Cooperation and Development.

     "OTHER TAXES" is defined in Section 2.16(b).

     "OUTSTANDING   REVOLVING   CREDIT"  means  the  sum,  as  of  any  date  of
determination,  of  (i)  the  aggregate  outstanding  principal  amount  of  the
Advances, and (ii) the LC Exposure.

     "PARTIAL  DISPOSITION  LIMIT"  means,  in respect of any proposed  Retained
Interest Sale in which the Retained  Interest Criteria are not met, that (i) the
sum of (A)  that  portion  of  EBITDAR  of the  Borrower  and  its  Subsidiaries
(determined for the four Quarters most recently ended prior to the  consummation
of such Retained  Interest  Sale) that is  attributable  to the  businesses  and
entities that are to be sold or disposed of in such Retained  Interest Sale, and
(B) the amount of such portion of EBITDAR of the Borrower and such  Subsidiaries
so computed  as of the time of each prior  Retained  Interest  Sale in which the
Retained  Interest Criteria were not met is less than (ii) 15% of EBITDAR of the
Borrower and such  Subsidiaries  for the four Quarters most recently ended prior
to the consummation of such proposed Retained Interest Sale.







                                       19


     "PBGC"  means  the  Pension  Benefit  Guaranty  Corporation  or any  entity
succeeding to any of its functions under ERISA.

     "PENSION  PLAN" means any Plan which is (i) an  "employee  pension  benefit
plan" as defined in Section 3(2) of ERISA and (ii) not a Multiemployer Plan.

     "PERMITTED CASH INVESTMENTS" means:

          (a)  securities  issued or fully  guaranteed  or insured by the United
     States  Government  or any agency  thereof and backed by the full faith and
     credit of the United  States  maturing not more than one year from the date
     of acquisition;

          (b) certificates of deposit, time deposits,  Eurodollar time deposits,
     bankers'  acceptances or deposit  accounts  having in each case a remaining
     term to  maturity  of not more than one year,  which are  either  (i) fully
     insured by the Federal Deposit Insurance  Corporation or (ii) issued by any
     Lender  or by any  commercial  bank  under  the  laws of any  State  or any
     national  banking  association that has combined capital and surplus of not
     less than  $800,000,000 and whose short-term  securities are rated at least
     A-1 by S&P or P-1 by Moody's;

          (c)  commercial  paper  that is rated  at  least  A-1 by S&P or P-1 by
     Moody's,  issued by a company  that is  incorporated  under the laws of the
     United States or of any State and directly issues its own commercial paper,
     and has a remaining term to maturity of not more than one year;

          (d) a  repurchase  agreement  with  (i) any  commercial  bank  that is
     organized or licensed  under the laws of any State or any national  banking
     association and that has total assets of at least  $1,000,000,000,  or (ii)
     any investment  bank that is organized under the laws of any State and that
     has total assets of at least  $1,000,000,000,  if such agreement is secured
     by any one or more of the securities and  obligations  described in clauses
     (a),  (b) or (c) of this  definition  having a market value  (exclusive  of
     accrued  interest  and  valued  at least  monthly)  at  least  equal to the
     principal amount of such investment;

          (e) any money market or other investment fund the investments of which
     are limited to  investments  described in clauses (a),  (b), (c) and (d) of
     this  definition  and which is  managed  by (i) a  commercial  bank that is
     organized under the laws of any State or any national  banking  association
     and that has total assets of at least $1,000,000,000, or (ii) an investment
     bank  that is  organized  under  the laws of any  State  and that has total
     assets of at least $1,000,000,000;






                                       20

          (f)  obligations,  debentures,  notes,  bonds  or other  evidences  of
     indebtedness  rated  at least  A- by S&P or A3 by  Moody's,  so long as the
     aggregate  amount of investments held under this clause (f) does not exceed
     25% of the total amount then invested by the Borrower and its  Subsidiaries
     in Permitted Cash Investments;

          (g)  investments in investment  grade auction rate and adjustable rate
     preferred  equities for issuers  whose actual or implied  senior  long-term
     debt is rated at least A- by S&P or A3 by Moody's;

          (h) investments in investment grade fixed rate preferred  equities for
     issuers whose actual or implied senior  long-term debt is rated at least A-
     by S&P or A3 by Moody's,  so long as the  aggregate  amount of  investments
     held under this clause (h) does not exceed 10% of the total amount invested
     by the Borrower and its Subsidiaries in Permitted Cash Investments;

          (i) adjustable rate  mortgage-backed  securities  rated at least AA by
     S&P or Aa by Moody's; and

          (j) fixed rate mortgage-backed  securities rated at least AA by S&P or
     Aa by Moody's,  so long as the aggregate  amount of investments  held under
     this  clause (j) does not exceed 25% of the total  amount  invested  by the
     Borrower and its Subsidiaries in Permitted Cash Investments.

     "PERMITTED LIENS" means Liens permitted under Section 5.03(a).

     "PERSON" means an individual,  partnership,  corporation, limited liability
company, business trust, joint stock company, trust, unincorporated association,
joint venture or other entity,  or a government or any political  subdivision or
agency thereof.

     "PLAN"  means any  "employee  benefit  plan" as defined in Section  3(3) of
ERISA (i) which the  Borrower  or any ERISA  Affiliate  maintains,  administers,
contributes  to or is required to contribute  to, or, within the six years prior
to the Closing Date, maintained, administered, contributed to or was required to
contribute to, or under which the Borrower or any ERISA  Affiliate may incur any
liability and (ii) which covers any employee or former  employee of the Borrower
or any ERISA Affiliate (with respect to their relationship with such entities).

     "PLEDGE AND SECURITY  AGREEMENTS" means the pledge and security  agreements
executed  by the  Borrower  and  certain  of  the  Borrower's  Subsidiaries  and
delivered  pursuant  to Section  3.01(a) and each  joinder  therein by any other
Subsidiary  of the  Borrower  and  each  other  security  agreement  at any time
delivered  by the  Borrower or any  Subsidiary  of the Borrower to create a Lien
that secures any of the Obligations.







                                       21

     "POTENTIAL  DEFAULT" means any event or condition described in Section 6.01
which,  with any  notice or  passage of time (or both)  expressly  described  in
Section 6.01, would constitute an Event of Default.

     "PRICING  CERTIFICATE"  means a certificate  in  substantially  the form of
Exhibit B-4.

     "PRICING  PERIOD"  means the period that  commences on the Closing Date and
ends on August 20, 1996, and each consecutive  period  thereafter that commences
on the  expiration  of the  prior  period  and  ends on the 20th day of the next
following November, February, May or August.

     "PRICING RATIO" means, for any Pricing Period, the Debt/EBITDAR Ratio as of
the Pricing Test Date for such Pricing Period. If a Pricing  Certificate for the
Pricing Test Date for a particular  Pricing Period is not delivered prior to the
commencement  of such Pricing  Period,  then until (but only until) the Business
Day on which such Pricing  Certificate  is  delivered to the Agent,  the Pricing
Ratio  shall be deemed to be the  Pricing  Ratio for the  immediately  preceding
Pricing Period.

     "PRICING TEST DATE" means, for a particular Pricing Period, the last day of
the Quarter  most  recently  ended  prior to the  commencement  of such  Pricing
Period.

     "PRO RATA SHARE"  means,  in respect of any  Lender,  the ratio of (i) such
Lender's commitment to participate in the extension of credit hereunder, to (ii)
all such commitments,  expressed as a percentage, as set forth in Schedule I or,
if such Lender has entered into one or more Assignments and Acceptances,  in the
Register.

     "PURCHASE LIMIT" is defined in Section 5.03(h).

     "PURCHASERS' AGGREGATE NET INVESTMENT" means the net unrecovered investment
in the accounts  receivable of the Borrower and its  Subsidiaries,  and proceeds
thereof,  held by the  purchasers  in any  Receivables  Sale  Program  or  their
transferees, without counting any Receivables Program Charges.

     "QUALIFIED PLAN" means a pension plan (as defined in Section 3(2) of ERISA)
intended  to be  tax-qualified  under  Section  401(a) of the Code and which the
Borrower or any ERISA Affiliate sponsors,  maintains, or to which it makes or is
obligated to make contributions,  or in the case of a multiple employer plan (as
described in Section 4064(a) of ERISA) has made contributions at any time during
the  immediately  preceding  period  covering  at least  five  plan  years,  but
excluding any Multiemployer Plan.

     "QUARTER"  means,  with  respect to any  Person,  a fiscal  quarter of such
Person.






                                       22

     "QUARTER-END  EXCESS CASH" means the excess,  determined as of the last day
of any Quarter (but only if it is a positive number),  of (i) cash and Permitted
Cash Investments held by the Borrower and its Subsidiaries,  less (ii) 2% of the
sum of the following operating expenses of the Borrower and its Subsidiaries for
the 12-month period then ending,  determined and recorded in accordance with the
Borrower's  current  practice:   "salaries,  wages  and  benefits,"  "corporate,
administrative and general" and "other operating expenses."

     "RATE  CONTRACT"  means any interest  rate swap  agreement,  cap,  floor or
collar  agreement,  interest rate  insurance or other  agreement or  arrangement
designed to provide  protection  against  fluctuations in interest rates entered
into by the Borrower and the Agent or any Lender.

     "RECEIVABLES   PROGRAM   CHARGES"  means  the  discount  or  yield  of  any
Receivables  Sale Program and all program and  administrative  costs,  back-stop
costs and other related costs,  fees and expenses  incurred by or charged to the
Borrower or any of its  Subsidiaries,  and when  determined for any period shall
include all such discount,  yield, costs, fees and expenses accrued or amortized
during such period.

     "RECEIVABLES SALE PROGRAM" means a sale or other disposition of an interest
in  the  accounts  receivable  of any of the  Borrower's  Subsidiaries  and  the
proceeds  thereof  and  records  related  thereto to one or more  purchasers  or
investors,  if the sale or other disposition (i) is made without recourse to the
seller,  (ii) is not  guaranteed  by the  Borrower  or any of its  Subsidiaries,
except a guaranty that the seller will perform its obligations in respect of its
representations and warranties, indemnities and servicing commitments, and (iii)
is structured so that the Purchasers' Aggregate Net Investment in respect of any
and all such accounts  receivable and proceeds  outstanding at any one time will
not exceed $100,000,000.

     "REFERENCE  BANKS"  means  Citibank,   Bank  of  America,   N.T.&S.A.   and
NationsBank, N.A. (Carolinas).

     "REGISTER" is defined in Section 8.07(c).

     "REPORTABLE  EVENT" means any of the events set forth in Section 4043(b) of
ERISA or the  regulations  thereunder,  a  withdrawal  from a plan  described in
Section 4063 of ERISA or a cessation of operations  described in Section 4062(e)
of ERISA.

     "REQUISITE LENDERS" means Lenders at the time in the aggregate holding more
than 66 2/3% in Pro Rata Shares.

     "RETAINED INTEREST" means the stock or equity, ownership or profit interest
which the Borrower or any  Subsidiary of the Borrower  retains,  acquires or has
the right to acquire in any Retained Interest Sale.






                                       23

     "RETAINED INTEREST CRITERIA" means, in respect of any Retained Interest and
the assets, operations, governance, income and profits of any business or entity
to which such Retained Interest directly or indirectly relates,  each and all of
the following requirements:

          (i) The Borrower or a  wholly-owned  Subsidiary  of the Borrower  must
     have the exclusive  right and power,  subject to duties  imposed by law, to
     manage and  control the  ordinary  business  operations  and assets of such
     business or entity and freely to control and distribute  the cash,  income,
     profits,  and asset sale proceeds of such entity or business and, as to any
     such  entity  that is a  Subsidiary  of the  Borrower,  to borrow from such
     entity;

          (ii) The Borrower or a  wholly-owned  Subsidiary  of the Borrower must
     effectively  have the exclusive right and power,  subject to duties imposed
     by law,  to  determine  whether,  when and on what terms such  business  or
     entity shall be financed, sold, dissolved, liquidated or merged and to make
     all other  decisions  requiring  approval of the owners of such business or
     entity,  either  by  reason of lawful  and  enforceable  provisions  in the
     governing documents for such entity or under a voting trust arrangement, an
     irrevocable  proxy, an option to acquire or sell the interests of all other
     Persons  that hold or have the  right to  acquire  an  equity or  ownership
     interest in such business or entity, or other similar arrangements;

          (iii) The  exercise of such  rights and powers by the  Borrower or its
     wholly-owned  Subsidiary  must not be  barred,  limited  or  restricted  by
     contract or  agreement,  except for  provisions  requiring  performance  of
     duties imposed by law;

          (iv) The terms on which the  requirements  in  clauses  (i),  (ii) and
     (iii)  herein  are met must be such  that the  Borrower  or a  wholly-owned
     Subsidiary  of the Borrower has the  exclusive  right and power to maintain
     such  conditions  for as  long as the  Borrower  or any  Subsidiary  of the
     Borrower holds such Retained Interest;

          (v) At the  consummation  of the  transaction  in which such  Retained
     Interest was kept or  acquired,  each  Subsidiary  of the Borrower to which
     such Retained  Interest  directly or  indirectly  relates must reaffirm its
     liability under the Guaranty by executing a Guarantor  Confirmation setting
     forth its Guarantor Liability Limit after giving effect to such transaction
     and each other Guarantor must confirm its consent and agreement  thereto by
     executing such Guarantor Confirmation;

          (vi) No later than the tenth  Business Day following the  consummation
     of the  transaction  in which such Retained  Interest was kept or acquired,
     the Borrower  must deliver to the Agent and Lenders  written  notice of the
     structure and material terms of the agreements and arrangements relating to
     the foregoing and the Retained Interest and related Retained Interest Sale,
     accompanied by:







                                       24

               (A) A  certificate  of an  Authorized  Officer  of  the  Borrower
          stating that at the time of such  consummation  the Retained  Interest
          Criteria were met in respect of such transaction, and

               (B) A Guarantor  Confirmation  signed by the Guarantors,  setting
          forth the Guarantor  Liability  Limit of each  Subsidiary  affected by
          such transaction, after giving effect to such transaction; and

          (vii) The Borrower must not receive from the Requisite Lenders, within
     20 Business Days after such notice,  certificate and Guarantor Confirmation
     were delivered to the Agent and Lenders,  a written statement to the effect
     that,  in the  opinion of the  Lenders  giving  such notice and for reasons
     generally set forth in such statement (which opinion, reasons and statement
     shall be conclusive  and binding on the Borrower and the other Loan Parties
     if held, determined and presented by such Lenders in good faith), either:

               (A) The Retained Interest Criteria are not met in respect of such
          transaction, or

               (B) Such Lenders  notified  the  Borrower at least five  Business
          Days prior to the date of such statement that the Guarantor  Liability
          Limit of any  Subsidiary  affected by such  transaction,  after giving
          effect to such transaction,  was not properly determined, set forth or
          acknowledged  in  the  Guarantor  Confirmation  so  delivered,  and  a
          Guarantor   Confirmation  properly  determining,   setting  forth  and
          acknowledging  such Guarantor  Liability Limit,  duly executed by such
          Subsidiary and all other Guarantors, was not received by the Agent and
          Lenders  within five  Business Days after such notice was given to the
          Borrower.

     "RETAINED INTEREST SALE" means a sale or other disposition of less than all
of the stock of or other equity,  ownership or profit  interest in a Subsidiary,
or less than the entire  ownership of any  business,  asset or entity,  that was
directly or indirectly  owned by the Borrower or any of its  Subsidiaries on the
Closing  Date or any Asset Sale,  merger,  consolidation,  sale and  repurchase,
exchange or other transaction in which,  after giving effect to such transaction
and all related  transactions,  the Borrower or any of its Subsidiaries directly
or  indirectly  retains or  acquires or has the right to acquire any stock of or
any equity, ownership or profit interest in any such Subsidiary, business, asset
or entity.

     "SCHEDULE  1.01(B) ASSETS" means the assets  described in Schedule  1.01(b)
and owned by the Borrower or any wholly-owned  Subsidiary thereof and designated
for sale thereby.

     "SCHEDULE  1.01(C) ASSETS" means the assets  described in Schedule  1.01(c)
and owned by the Borrower or any wholly-owned  Subsidiary thereof and designated
for sale thereby.






                                       25

     "S&P" means  Standard & Poor's  Ratings  Group,  a division of  McGraw-Hill
Corporation, and its successors.

     "SPECIFIED  LEASE  EXPENSE"  means,  with  respect to any  Person,  for any
period,  Lease  Expense of such Person for such period less that portion of such
Lease Expense representing  payments for real estate and personal property taxes
and insurance.

     "STATE" means the District of Columbia or any state of the United States of
America.

     "SUBORDINATED  DEBT" means the Debt outstanding under the Subordinated Debt
Indentures.

     "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 and, upon the
effectiveness thereof, the 1996 Subordinated Debt Indenture.

     "SUBSIDIARY"   means,   with  respect  to  any  Person,   any  corporation,
association,  partnership,  joint venture or other business entity of which more
than 50% of the voting  stock or other equity  interests is owned or  controlled
directly or indirectly by such Person or one or more Subsidiaries of such Person
or a combination thereof.

     "TANGIBLE  ASSETS" means the difference,  as of any date of  determination,
between (i) the total  consolidated  assets of the Borrower and its Subsidiaries
as determined in accordance  with GAAP and required  under GAAP to be shown on a
consolidated  balance sheet of the Borrower and its  Subsidiaries,  and (ii) all
such assets that are Intangible Assets.

     "TAXES" is defined in Section 2.16(a).

     "TERMINATION  DATE" means the  Maturity  Date or such  earlier  date as the
commitments  of the  Lenders  to extend  credit  under this  Agreement  shall be
terminated in whole pursuant to Section 2.05 or the obligation of each Lender to
make  Advances and the LC Bank to issue  Letters of Credit  shall be  terminated
pursuant to Section 6.01.

     "'34 ACT COMPANY" means a Person that is a reporting company under the 1934
Act.

     "UNFUNDED  LC EXPOSURE"  means the maximum  amount which the LC Bank may be
required,   under  all  Letters  of  Credit   outstanding  as  of  any  date  of
determination, to pay on such date or at any future time.






                                       26

     "UNFUNDED  PENSION  LIABILITY" means, with respect to any Pension Plan that
is  subject  to Title IV of ERISA,  the excess of such  Pension  Plan's  accrued
benefits,  as defined in Section 3(23) of ERISA,  over the current value of such
Pension Plan's assets,  as defined in Section 3(26) of ERISA (but excluding from
the definition of "current value" of "assets" of such Pension Plan,  accrued but
unpaid contributions).

     "UNITED STATES" and "U.S." mean the United States of America.

     "WELFARE PLAN" means any Plan which is an "employee  welfare  benefit plan"
as defined in Section 3(1) of ERISA.

     "WITHDRAWAL LIABILITIES" means the aggregate amount of the liabilities,  if
any,  pursuant to Section 4201 of ERISA if the Borrower and each ERISA Affiliate
made a complete  withdrawal  from all  Multiemployer  Plans and any  increase in
contributions pursuant to Section 4243 of ERISA.

     SECTION 1.02.  Accounting Terms. All accounting terms not expressly defined
herein shall be construed,  except where the context otherwise requires, and all
financial computations required under this Agreement shall be made in accordance
with GAAP applied on a consistent basis. If GAAP changes during the term of this
Agreement  so as to affect the  calculation  of any term  defined  herein or any
measure of financial  performance or financial condition employed or referred to
herein,  the Borrower and the Lenders agree to negotiate in good faith toward an
amendment of this Agreement which shall approximate, to the extent possible, the
economic effect of the original provisions hereof after taking into account such
change in GAAP,  but until the parties are able to agree upon such amendment (i)
the Borrower shall be deemed in compliance  with the  provisions  hereof only if
and to the extent it would have been in  compliance  if such  change in GAAP had
not  occurred  and (ii) the  Borrower  shall  deliver  to the  Agent,  with each
financial report delivered by the Borrower hereunder,  information sufficient to
confirm such compliance as if such change in GAAP had not occurred.

     SECTION 1.03. Other Definitional Provisions. (a) Unless otherwise specified
herein or therein,  all terms defined in this  Agreement  shall have the defined
meanings  when used in any other Loan  Document or in any  certificate  or other
document made or delivered pursuant hereto.

     (b) The words  "hereof,"  "herein"  and  "hereunder"  and words of  similar
import when used in this Agreement refer to this Agreement as a whole and not to
any particular  provision of this Agreement,  and section,  schedule and exhibit
references  are to this Agreement  unless  otherwise  specified.  The meaning of
defined  terms shall be equally  applicable  to the singular and plural forms of
the defined terms.  The term  "including"  is not limiting and means  "including
without limitation."







                                       27

     (c) In the  computation of periods of time from a specified date to a later
specified date, the word "from" means "from and  including";  the words "to" and
"until"  each  mean "to but  excluding";  and the word  "through"  means "to and
including."

     (d) References to agreements and other documents shall be deemed to include
all  subsequent  amendments  and other  modifications  thereto,  but only to the
extent such amendments and other  modifications  are not prohibited by the terms
of any Loan Document.

     (e) References to statutes or  regulations  shall be construed as including
all statutory and regulatory provisions consolidating, amending or replacing the
statute or regulation.

     (f) The captions  and headings of this  Agreement  are for  convenience  of
reference only and shall not affect the construction of this Agreement.


                                   ARTICLE II

                        AMOUNTS AND TERMS OF THE ADVANCES

     SECTION 2.01.  Revolving Facility.  (a) Advances.  Subject to the terms and
conditions  herein,  each Lender severally agrees to lend to the Borrower,  from
time to time on any  Borrowing  Date until the  Termination  Date,  an amount in
Dollars  equal to such  Lender's  Pro  Rata  Share  of a  Borrowing  that (i) is
requested by the Borrower for such Borrowing Date and (ii) when  aggregated with
all other Lenders' Pro Rata Shares,  does not exceed the Loan Availability as of
such Borrowing Date.

     (b)  Borrowings.  Each Borrowing  shall be in an aggregate  amount not less
than $1,000,000 or an integral  multiple of $500,000 in excess thereof and shall
consist of either Base Rate Advances or Eurodollar  Rate Advances.  The Borrower
may reborrow under Section 2.01(a) any Advances that it has voluntarily  prepaid
pursuant to Section 2.11 or was required to prepay pursuant to Section 2.06(e).

     (c) Notice of Borrowing. To request a Borrowing, the Borrower shall deliver
a Notice of  Borrowing to the Agent not later than 11:00 a.m. New York City time
(i) three  Business Days prior to the requested  Borrowing  Date, in the case of
Eurodollar  Rate  Advances,  and (ii) one  Business  Day prior to the  requested
Borrowing  Date,  in the case of Base Rate  Advances.  The Agent shall give each
Lender  prompt  notice  thereof  by  telecopier,  telex or cable.  The Notice of
Borrowing shall specify (A) the requested  Borrowing Date, (B) the amount of the
Borrowing and whether it will consist of Base Rate  Advances or Eurodollar  Rate
Advances,  and (C) in the  case of a  Borrowing  comprised  of  Eurodollar  Rate
Advances, the initial Interest Period for such Eurodollar Rate Advances.






                                       28

     (d)  Telephonic  Notice  of  Borrowing.  The  Borrower  may give the  Agent
telephonic  notice of any proposed  Borrowing by the time required under Section
2.01(c)  and in such  event  shall  promptly  (but in no  event  later  than the
Borrowing Date for the requested  Borrowing)  deliver a  confirmatory  Notice of
Borrowing to the Agent.  The Agent shall give each Lender prompt notice  thereof
by telecopier,  telex or cable. If the telephonic request differs in any respect
from the written  Notice of Borrowing  subsequently  delivered,  the  telephonic
request  shall govern as to the terms of all Advances  made in  accordance  with
such  telephonic  request.  The  Agent's  determination  of the  contents of any
telephonic  request shall,  absent  manifest error, be conclusive and binding on
all parties hereto.

     (e) Funding of Advances.  Upon fulfillment of the applicable conditions set
forth in Article III, each Lender shall, before 12:00 noon New York City time on
the Borrowing  Date,  make available for the account of its  Applicable  Lending
Office to the Agent at its  address  referred  to in Section  8.02,  in same day
funds,  such  Lender's Pro Rata Share of a Borrowing.  After the Agent  receives
such funds,  the Agent will,  not later than 5:00 p.m. New York City time on the
Borrowing  Date,  make such  funds  available  to the  Borrower  at the  Agent's
aforesaid address.

     (f)  Notice  of  Borrowing  Irrevocable.   Each  Notice  of  Borrowing  and
telephonic request shall be irrevocable and binding on the Borrower.

     (g) Assumption of Funding.  Unless the Agent receives  notice from a Lender
prior to any  Borrowing  Date that such  Lender will not make  available  to the
Agent such Lender's Pro Rata Share of the Borrowing to be made on such Borrowing
Date,  the  Agent  may  assume  that  such  Lender  has made its Pro Rata  Share
available to the Agent on such Borrowing Date in accordance with Section 2.01(e)
and the Agent may, in  reliance  upon such  assumption,  make  available  to the
Borrower on such Borrowing  Date a  corresponding  amount.  If and to the extent
that such Lender fails to make its Pro Rata Share  available to the Agent,  such
Lender  and the  Borrower  severally  agree to repay to the Agent  forthwith  on
demand such  corresponding  amount together with interest thereon,  for each day
from the date such amount is made  available to the Borrower until the date such
amount is repaid to the Agent, at (i) in the case of the Borrower,  the interest
rate  applicable  at the  time to such  Borrowing  and  (ii) in the case of such
Lender,  the Federal Funds Rate until the third Business Day after demand by the
Agent to such Lender for such repayment and thereafter at the rate applicable at
the  time to such  Borrowing.  If such  Lender  shall  repay to the  Agent  such
corresponding  amount,  such amount so repaid  shall  constitute  such  Lender's
Advance  as  part of such  Borrowing  for  purposes  of this  Agreement  and the
Borrower shall  thereupon be excused from making the repayment  described in the
preceding sentence.

     (h) Failure of Lender to Fund.  All  obligations  of the Lenders  hereunder
shall be several,  but not joint.  The failure of any Lender to make the Advance
to be made by it as part of any Borrowing  shall not relieve any other Lender of
its obligation, if any, hereunder to make






                                       29

its Advance as part of such  Borrowing,  but no Lender shall be responsible  for
the failure of any other Lender to make an Advance on any Borrowing Date.

     SECTION 2.02. Letter of Credit Subfacility.  (a) Issuance of the Letters of
Credit. Subject to the terms and conditions set forth herein, the LC Bank agrees
to issue one or more  Letters of Credit,  at the  request and for the account of
the Borrower,  on any Business Day on or after the Closing Date and prior to the
Termination  Date,  so long as (i) after  giving  effect to the  issuance of any
Letter of Credit so requested,  (A) the  Outstanding  Revolving  Credit does not
exceed the then  Facility  Amount,  and (B) the LC Exposure  does not exceed the
then LC Subcommitment, and (ii) the LC Bank has not received written notice from
the Agent or Requisite  Lenders that an Event of Default or Potential Default is
continuing.

     (b) LC Application. The Borrower may request issuance of a Letter of Credit
by  delivering an LC  Application  to the Agent not later than two Business Days
prior to the date the Letter of Credit is to be issued. The Agent shall promptly
deliver a copy of the LC Application to the LC Bank and each Lender.

     (c)  Reimbursement.  Any payment made by the LC Bank of a draft drawn under
any Letter of Credit shall  constitute  for all purposes of this  Agreement  the
making by the LC Bank of an Advance in the amount of such draft,  which  Advance
shall (i)  constitute a Base Rate Advance  until  converted,  at the  Borrower's
election,  into a Eurodollar  Rate Advance  pursuant to Section  2.10,  and (ii)
satisfy the  Borrower's  obligation  to reimburse the LC Bank under this Section
2.02 . With respect to each Advance made pursuant to this Section  2.02(c),  the
Borrower shall be deemed to have  certified the statements  contained in Section
3.02(b) as of the date the payment  constituting such Advance was made by the LC
Bank;  provided that in the event any such statement was not true and correct as
of such date, such Advance shall be repayable on demand;  provided  further that
upon any such repayment on demand,  the failure of any such statement to be true
and  correct as of such date  shall not  constitute  an Event of  Default  under
Section 6.01, unless the failure of any such statement to be true and correct as
of such date would have  constituted an Event of Default under Section 6.01 even
if such repaid Advance had never been made.

     (d) Reimbursement  Obligation  Absolute.  The obligation of the Borrower to
reimburse  the LC Bank for each  payment made by the LC Bank under any Letter of
Credit,  and to pay  interest  thereon as provided  herein,  shall be  absolute,
unconditional and irrevocable and shall be performed strictly in accordance with
the terms of this  Agreement  under  and  without  regard to any  circumstances,
including  (i)  any  lack  of  validity  or  enforceability  of any of the  Loan
Documents;  (ii) any amendment or waiver of or any consent to departure from all
or any terms of any of the Loan  Documents;  (iii) the  existence  of any claim,
setoff,  defense or other right which the  Borrower may have at any time against
any  beneficiary  or any  transferee of any Letter of Credit (or any Persons for
whom any such beneficiary or transferee may be acting),  the LC Bank, the Agent,
any Lender or any other Person, whether in connection with this Agreement, the






                                       30

transactions  contemplated herein or any unrelated transaction;  (iv) any breach
of contract or dispute  among or between the Borrower,  the Agent,  the LC Bank,
any Lender, or any other Person; (v) any demand, statement,  certificate,  draft
or other  document  presented  under any Letter of Credit  proving to be forged,
fraudulent,  invalid or  insufficient  in any respect or any  statement  therein
being untrue or inaccurate in any respect; (vi) payment by the LC Bank under any
Letter of Credit against  presentation  of any demand,  statement,  certificate,
draft or other  document  which does not  strictly  comply with the terms of any
Letter of Credit; (vii) any non-application or misapplication by any beneficiary
or  transferee  of the proceeds of any amount paid under  anyLetter of Credit or
any other act or omission of such  beneficiary or such  transferee in connection
with any Letter of Credit; (viii) any extension of time for or delay, renewal or
compromise of or other indulgence or modification granted or agreed to by the LC
Bank,  the Agent or any  Lender,  with or without  notice to or  approval by the
Borrower; (ix) any failure to preserve or protect any Collateral, any failure to
perfect or preserve the  perfection of any Lien  thereon,  or the release of any
Collateral;  or (x) any other  circumstance or event whatsoever  relating to the
Borrower or such Letter of Credit or the reimbursement due therefor,  whether or
not similar to any of the foregoing.

     (e) Lender Participation.  Each Lender severally agrees to participate with
the LC Bank in the  extension of credit  arising from the issuance of any Letter
of  Credit in  conformity  with  Section  2.02(a),  in an  amount  equal to such
Lender's Pro Rata Share of the amount available for payment under such Letter of
Credit.  Upon written  demand by the LC Bank,  with a copy of such demand to the
Agent,  each Lender shall  promptly fund its  participation  by paying to the LC
Bank Dollars in an amount  equal to such  Lender's Pro Rata Share of the payment
made by the LC Bank  under any  Letter of  Credit,  together  with all  interest
accrued  and unpaid  thereon for the period from the day on which the payment to
be  reimbursed  was demanded by the LC Bank until the Business Day on which such
funding  from such Lender is received by the LC Bank at the rate per annum equal
to the Federal Funds Rate until the second  Business Day following  such demand,
and  thereafter the rate per annum then  applicable to Base Rate Advances.  Upon
funding its  participation in accordance with this Section 2.02(e),  each Lender
shall be deemed to have made an  Advance as of the date the  relevant  Letter of
Credit was drawn,  and the Advance  deemed  pursuant to Section  2.02(c) to have
been made by the LC Bank upon any such  payment  shall be reduced,  in an amount
equal to such  Lender's  participation.  Each  Lender's  obligation to make such
payment to the LC Bank shall be  absolute,  unconditional  and  irrevocable  and
shall not be affected by any circumstance  whatsoever,  including the occurrence
or continuance of any Potential Default or Event of Default, the failure to meet
any condition that otherwise must be met for the funding of any Advance,  or the
failure of any other Lender to make any payment under this Section 2.02(e),  and
each Lender  further  agrees that such payment shall be made without any offset,
abatement, withholding or reduction whatsoever. If after receipt of such funding
from any Lender the LC Bank  receives  payment  from the  Borrower  or any other
source on account of the  reimbursement  obligation  that was so funded,  or the
interest accrued  thereon,  the LC Bank shall promptly remit such payment to the
Agent  for  prompt   distribution   to  the  Lenders  to  the  extent  of  their
participation therein.







                                       31

     (f)  Commercial  Practices.  The Borrower  assumes all risks of the acts or
omissions of any  beneficiary or transferee of any Letter of Credit with respect
to the use of any Letter of Credit.  The Borrower  agrees that the LC Bank,  the
Agent, the Lenders and their respective  directors,  officers or employees shall
not be liable or responsible  for (i) the use which may be made of any Letter of
Credit  or for  any  acts or  omissions  of any  beneficiary  or  transferee  in
connection therewith;  (ii) any reference which may be made to this Agreement or
to any Letter of Credit in any agreements, instruments or other documents; (iii)
the validity,  sufficiency or genuineness of any document other than a Letter of
Credit,  or of any  endorsement  thereon,  even if such document or  endorsement
should  in  fact  prove  to be in  any or all  respects  invalid,  insufficient,
fraudulent or forged or any  statement  therein prove to be untrue or inaccurate
in any respect whatsoever;  (iv) payment by the LC Bank against  presentation of
documents  which do not strictly  comply with the terms of any Letter of Credit;
or (v) any other  circumstances  whatsoever in making or failing to make payment
under any Letter of Credit,  except only that the LC Bank shall be liable to the
Borrower for acts or events  described in clauses (i) through (v) above,  to the
extent,  but only to the extent, of any direct (as opposed to indirect,  special
or  consequential)  damages  suffered by the Borrower which the Borrower  proves
were  caused by (A) the LC Bank's  willful  misconduct  or gross  negligence  in
determining  whether a draft or  demand  presented  under  any  Letter of Credit
strictly  complies with the terms and conditions  therefor stated in such Letter
of  Credit  or (B) the LC  Bank's  willful  failure  to pay any  draft or demand
presented  under any Letter of Credit that strictly  complies with the terms and
conditions thereof. The LC Bank may accept any document that appears on its face
to  be  in  order,  without  responsibility  for  further   investigation.   The
determination  whether a draft or demand is properly  presented under any Letter
of Credit prior to its expiration or whether a draft or demand  presented  under
any Letter of Credit is in proper and sufficient form may be made by the LC Bank
in its sole discretion,  and such determination  shall be conclusive and binding
upon the Borrower to the extent permitted by law. The Borrower hereby waives any
right to object to any payment  made under any Letter of Credit on  presentation
of any draft or demand that is in the form  provided in the Letter of Credit but
varies with respect to punctuation,  capitalization, spelling or similar matters
of form.

     (g)  Replacement  of LC Bank.  The Borrower may at any time,  upon at least
five Business Days' prior written notice to the Agent and Lenders,  designate as
a  replacement  LC Bank any Lender that has agreed in writing to act as LC Bank.
Thereupon,  (i) the  obligation,  right and  authority  of the  Lender  that was
previously  acting  as LC Bank to issue  Letters  of Credit  hereunder  shall be
terminated,  (ii) such Lender  shall remain  entitled to enforce all  provisions
hereof  applicable to all Letters of Credit  theretofore  issued by or requested
from such Lender,  and (iii) the Lender  designated as the  replacement  LC Bank
shall  thenceforth  issue  Letters  of Credit on the  terms and  subject  to the
conditions herein.

     SECTION 2.03. Promissory Notes. (a) Notes. The Advances made by each Lender
shall be evidenced by the Notes delivered pursuant to Section 3.01(a).






                                       32

     (b) Recording of Amounts.  Each Lender is hereby  authorized (but shall not
be obligated),  at its option, to either (i) endorse the date and amount of each
Advance made by such Lender and each  payment of  principal of Advances  made on
such Lender's Note on a schedule annexed to and constituting a part of such Note
or (ii) record such  Advances and  payments in its books and  records,  and such
schedule or such books and records,  as the case may be, shall  constitute prima
facie evidence of the accuracy of the information contained therein.

     SECTION 2.04.  Fees.  (a) Closing  Fees. On the Closing Date,  the Borrower
will pay to the Agent, for account of the Lenders, the closing fees described in
Schedule 2.04(a).

     (b) Commitment  Fees. On the first day of each Quarter,  commencing July 1,
1996 and continuing  thereafter until the Facility Amount is permanently reduced
to zero, and on the Termination  Date, the Borrower shall pay to the Agent,  for
the  account  of the  Lenders  in  accordance  with  their  Pro Rata  Shares,  a
commitment fee computed by applying the  Commitment Fee Rate to the  difference,
from day to day in the prior  Quarter  or partial  Quarter,  as the case may be,
between (i) the sum of (A) the then Facility Amount and (B) the then Purchasers'
Aggregate Net Investment, less (ii) the then Outstanding Revolving Credit.

     (c) Letter of Credit  Fees.  On the first day of each  Quarter,  commencing
July 1, 1996 and continuing thereafter until the Facility Amount and Unfunded LC
Exposure  have both been  reduced  to zero,  and on the  Termination  Date,  the
Borrower  shall pay to the Agent for the  account of the  Lenders in  accordance
with their Pro Rata Shares a letter of credit fee  computed  by applying  the LC
Fee Rate to the  Unfunded  LC Exposure  from day to day in the prior  Quarter or
partial Quarter, as the case may be.

     (d) Facing Fees. On the first day of each Quarter,  commencing July 1, 1996
and  continuing  thereafter  until the Facility  Amount and Unfunded LC Exposure
have both been reduced to zero, and on the Termination  Date, the Borrower shall
pay to the  Agent  for the  account  of the LC Bank a  facing  fee  computed  by
applying  0.125% per annum to the  Unfunded LC  Exposure  from day to day in the
prior Quarter or partial Quarter, as the case may be.

     (e) Letter of Credit  Administration.  The Borrower shall pay the LC Bank's
usual and  customary  charges for  opening,  amending or honoring  any Letter of
Credit and for any wire transfers.

     (f) Agent's  Fees.  The Borrower  shall pay when due all fees payable under
the Fee Letter.

     (g) Contingent  Fees. The Borrower shall pay to the Agent,  for the account
of the Lenders, when due the contingent fees payable under the Fee Letter.






                                       33

     SECTION 2.05. Voluntary and Scheduled Facility Reductions. (a) The Borrower
at any time may terminate in whole,  and from time to time may reduce ratably in
part,  the unused  portions of the  commitments  of the Lenders to extend credit
hereunder,  by giving the Agent at least  three  Business  Days'  prior  written
notice  that,  effective  as of a  Business  Day set  forth in the  notice,  the
Facility  Amount shall be reduced by an amount that (i) does not exceed the Loan
Availability  as of such  Business  Day and (ii) is equal to either (A) the then
Facility  Amount or (B) an integral  multiple of $1,000,000.  Such notice,  once
given, shall be irrevocable,  and the Facility Amount, once reduced,  may not be
increased under any circumstances.

     (b) The Facility Amount shall be automatically and permanently  reduced (i)
on June 30,  2000 to  $560,000,000,  (ii) on June 30, 2001 to  $315,000,000  and
(iii) on the Termination Date as provided in Section 2.06(a) below.

     SECTION 2.06. Principal Payments. The Borrower agrees to repay the Advances
and reduce the Facility Amount as follows:

          (a) Final Maturity.  On the Termination Date, all outstanding Advances
     shall be due and payable and the Facility Amount and LC Subcommitment shall
     be automatically and permanently reduced to zero.

          (b) Excess Revolving Credit Exposure. If at any time, by reason of any
     voluntary or mandatory  Facility  Reduction  or for any other  reason,  the
     Outstanding Revolving Credit exceeds the then Facility Amount, the Borrower
     shall  immediately,  without  notice or demand,  repay  Advances  or, if no
     Advances  are  outstanding,  deposit  Dollars  to  the LC  Cash  Collateral
     Account, in an amount equal to such excess.

          (c) Excess LC Exposure.  If at any time, by reason of any voluntary or
     mandatory  Facility  Reduction  or for any other  reason,  the LC  Exposure
     exceeds the then LC Subcommitment,  the Borrower shall immediately  deposit
     Dollars  in an  amount  equal  to such  excess  to the LC  Cash  Collateral
     Account.

          (d)  Payment  on Date of Change of  Control.  If,  within  the  period
     commencing  on the date of a Change of Control and ending 30 Business  Days
     after  the  Borrower  gives  the Agent  written  notice  of such  Change of
     Control,  the  Requisite  Lenders shall demand in writing that the Borrower
     repay all  Advances,  then on the 30th day  following  such  demand (i) all
     Advances then  outstanding  shall be due and payable in full,  and (ii) the
     Facility  Amount  and  the LC  Subcommitment  shall  be  automatically  and
     permanently  reduced to zero; and if any LC Exposure remains outstanding on
     such day the  Borrower  on such day shall  deposit  Dollars  to the LC Cash
     Collateral  Account as necessary to cause the amount on deposit  therein to
     be equal to the then LC Exposure.






                                       34

          (e) Facility  Reduction for  Receivables  Sale  Program.  Whenever any
     Receivables Sale Program is in effect, the Facility Amount shall be reduced
     (but in no event  by more  than  $100,000,000)  by an  amount  equal to the
     Purchasers'  Aggregate  Net  Investment,  as  certified  from  time to time
     pursuant to Section  5.02(c)(xv) or 5.02(c)(xvi)  for as long, but only for
     as long,  as the  Receivables  Sale  Program is in effect.  If after giving
     effect to any such reduction the Outstanding  Revolving  Credit exceeds the
     reduced  Facility  Amount,  prepayment  shall be made  pursuant  to Section
     2.06(b) when such reduction becomes effective.

          (f)  Application  of LC  Cash  Collateral.  With  respect  to  Dollars
     deposited to the LC Cash Collateral Account:

               (i) At any time when no Event of Default or Potential Default has
          occurred and is continuing,  the Agent may (and shall,  if so directed
          in  writing  by the  Borrower  or the  Requisite  Lenders)  cause such
          deposit to be applied to repay any or all Funded LC  Exposure,  in any
          order of application;

               (ii)   Whenever   any  Event  of  Default  has  occurred  and  is
          continuing,  the Agent may (and shall if so directed in writing by the
          Requisite Lenders) cause such deposit to be applied to repay or retire
          any or all of the  Obligations,  whether or not then due, in any order
          of application;

               (iii)  If at any  time  when no Event  of  Default  or  Potential
          Default is continuing the Dollars on deposit in the LC Cash Collateral
          Account exceed the then LC Exposure,  the Agent shall,  if so directed
          in writing by the  Borrower,  cause such deposit to be released to the
          Borrower to the extent,  but only to the extent,  such deposit exceeds
          the then LC Exposure; and

               (iv)  Interest  shall accrue and be payable on deposits to the LC
          Cash Collateral Account.

     SECTION 2.07.  Interest.  The Borrower agrees to pay interest on the unpaid
principal  amount of each  Advance  made by each  Lender  (or, in the case of an
Advance made pursuant to Section 2.02(c),  by the LC Bank) from the date of such
Advance  until such  principal  amount shall be repaid in full, at the following
rates per annum:

          (a) Base Rate Advances.  Whenever such Advance is a Base Rate Advance,
     a rate per annum equal on each day to the sum of the Base Rate as in effect
     on such day plus the Base Rate  Margin  determined  for such day,  with all
     such interest  accrued in any one month payable monthly on the first day of
     the next following  month and in any case when the Facility Amount has been
     reduced to zero and all Advances are repaid in full.






                                       35

          (b) Eurodollar  Rate  Advances.  Whenever such Advance is a Eurodollar
     Rate Advance, a rate per annum equal on each day during the Interest Period
     for such Eurodollar Rate Advance to the sum of the Eurodollar Rate for such
     Interest  Period plus the Eurodollar  Rate Margin  determined for such day,
     with all  interest  so  accrued  payable  on the last day of such  Interest
     Period  and,  if such  Interest  Period has a  duration  of more than three
     months,  on the day which  occurs  three months after the first day of such
     Interest Period.

          (c) Default Interest.  For any period of time during which an Event of
     Default under Section 6.01(a), (b), (d), (e), (f), (g), (h), (i), (j), (k),
     (l) (with respect to Material Subsidiaries only) or (m) has occurred and is
     continuing,  the principal  amount of all Advances then  outstanding  shall
     bear  interest  payable upon demand at a rate per annum equal to the sum of
     (i) 2.0%  per  annum  plus  (ii) the rate  otherwise  payable  pursuant  to
     subsection  (a) or (b) above,  but not to exceed the maximum rate permitted
     by applicable law.

     SECTION 2.08. Additional Interest on Eurodollar Rate Advances. The Borrower
shall pay each Lender additional interest on the unpaid principal amount of each
Advance  of such  Lender  for each day that such  Advance  is  outstanding  as a
Eurodollar Rate Advance,  at a rate per annum equal to the remainder obtained by
subtracting (i) the Eurodollar Rate for such Interest Period for such Eurodollar
Rate Advance from (ii) the rate determined by dividing such Eurodollar Rate by a
percentage  equal to 100% minus the Eurodollar  Rate Reserve  Percentage of such
Lender  for such day.  Such  additional  interest  shall be  determined  by such
Lender,  notified to the  Borrower  through  the Agent and  payable  when and as
interest is payable on such Eurodollar Rate Advance or, if later,  five Business
Days after the Borrower  receives notice  thereof.  If the Borrower so requests,
such Lender shall provide the Borrower  through the Agent a certificate  setting
forth the calculation and supporting  information for such additional  interest,
which shall be conclusive and binding for all purposes, absent manifest error.

     SECTION 2.09. Interest Rate Determination and Protection. (a) Determination
of Eurodollar  Rate. The Eurodollar Rate for each Interest Period for Eurodollar
Rate Advances  comprising  part of the same Borrowing shall be determined by the
Agent on the basis of  applicable  rates  furnished to and received by the Agent
from the Reference Banks two Business Days before the first day of such Interest
Period.

     (b) Notice of  Eurodollar  Rate.  The Agent shall give prompt notice to the
Borrower and the Lenders of the  Eurodollar  Rate for any  Interest  Period when
determined by the Agent.

     (c) Failure to Provide Information.  If any one of the Reference Banks does
not furnish to the Agent timely  information  sufficient  to enable the Agent to
determine a Eurodollar Rate, the Agent shall determine such interest rate on the
basis of timely information






                                       36

furnished by the remaining  Reference  Banks.  If fewer than two Reference Banks
furnish timely  information to the Agent for determining the Eurodollar Rate for
any Eurodollar  Rate  Advances,  the Agent shall  determine the Eurodollar  Rate
based on  information  furnished  by  Citibank.  If Citibank is unable to obtain
timely  information  for determining the Eurodollar Rate for any Eurodollar Rate
Advances, the Agent shall forthwith notify the Borrower and the Lenders that the
interest rate cannot be  determined  for such  Eurodollar  Rate Advances and the
obligation  of the Lenders to make or  continue,  or to convert  Advances  into,
Eurodollar  Rate  Advances  shall be suspended  until the Agent shall notify the
Borrower  and the Lenders that the  circumstances  causing  such  suspension  no
longer exist.

     (d)  Suspension  of  Eurodollar  Rate  Advances.  If,  with  respect to any
Eurodollar Rate Advances, the Requisite Lenders notify the Agent that either (i)
the Eurodollar Rate for any Interest Period for such Eurodollar Rate Advances is
at least two basis points less than the cost to such Lenders of obtaining  funds
in Dollars in the London interbank market in the amounts  substantially equal to
such Lenders'  Eurodollar  Rate Advances and for a period equal to such Interest
Period or (ii)  funding  is not  available  to such  Lenders  in such  market in
Dollars,  then the Agent shall  forthwith so notify the Borrower and the Lenders
and thereupon (A) each Eurodollar Rate Advance will  automatically,  on the last
day of the then  existing  Interest  Period  therefor,  convert into a Base Rate
Advance,  and (B) the  obligation  of the  Lenders  to make or  continue,  or to
convert  Advances into,  Eurodollar  Rate Advances shall be suspended  until the
Agent shall notify the Borrower and the Lenders that the  circumstances  causing
such suspension no longer exist.

     (e) Failure to Specify Duration.  If the Borrower fails,  prior to the date
the  Eurodollar  Rate for any Interest  Period is  determined  by the Agent,  to
specify the duration of any Interest  Period for any  Eurodollar  Rate Advances,
the Interest Period shall be one month.

     (f) Agent's Determination Conclusive. Each determination by the Agent of an
interest rate hereunder shall be conclusive and binding for all purposes, absent
manifest error.

     SECTION   2.10.   Voluntary   Conversion   of   Advances.   (a)  Notice  of
Continuance/Conversion. Subject to the provisions of Sections 2.09 and 2.14, the
Borrower   may  on  any   Business   Day,  by  giving  the  Agent  a  Notice  of
Continuance/Conversion  not later than  11:00  a.m.  (New York City time) on the
third preceding Business Day, (i) convert Base Rate Advances comprising the same
Borrowing into Eurodollar Rate Advances,  (ii) convert  Eurodollar Rate Advances
comprising  the same  Borrowing  into  Base  Rate  Advances  or  (iii)  continue
Eurodollar Rate Advances as Eurodollar  Rate Advances,  but (A) the Borrower may
convert a Eurodollar  Rate Advance into a Base Rate Advance only on the last day
of an Interest  Period for such  Eurodollar  Rate Advance,  (B) the Borrower may
continue a Eurodollar  Rate Advance as a Eurodollar  Rate Advance only as of the
last day of an Interest  Period for such  Eurodollar  Rate  Advance,  and (C) no
Advance may be converted into or continued as a






                                       37

Eurodollar  Rate  Advance  at any time  when an Event of  Default  or  Potential
Default has occurred and is continuing.

     (b)   Telephonic    Notice.   In   lieu   of   delivering   a   Notice   of
Continuance/Conversion, the Borrower may give the Agent telephonic notice of any
proposed  conversion or continuance  by the time required under Section  2.10(a)
and in such event  shall  promptly  (but in no event  later than the date of the
requested   conversion  or  continuance)   deliver  a  confirmatory   Notice  of
Continuance/Conversion  to the Agent.  If the telephonic  request differs in any
respect  from  the  written   Notice  of   Continuance/Conversion   subsequently
furnished,  the telephonic  request shall govern as to the terms of such notice.
The Agent's  determination  of the  contents of any  telephonic  request  shall,
absent manifest error, be conclusive and binding on all parties hereto.

     (c)  Requirements.  Each  Notice of  Continuance/Conversion  or  telephonic
request shall specify (i) the date of the  continuance or  conversion,  (ii) the
Advances to be converted or continued and (iii) when Advances are converted into
or continued as Eurodollar  Rate Advances,  the duration of the Interest  Period
for such Advances.

     (d) Base Rate Advances.  Unless a Eurodollar Rate has been determined for a
particular Advance and applies to such Advance on a particular day in accordance
with the provisions hereof,  such Advance shall be a Base Rate Advance and shall
accrue interest at the rate then applicable to Base Rate Advances.

     SECTION  2.11.  Prepayments.  The  Borrower  from time to time may  prepay,
without  premium or  penalty,  the  outstanding  principal  amounts of  Advances
comprising part of the same  Borrowing,  in whole or ratably in part, so long as
(i) the Borrower  gives one  Business  Day's prior  written  notice to the Agent
stating the proposed date and aggregate principal amount of the prepayment, (ii)
each partial  prepayment is made in an aggregate  principal amount of $1,000,000
or an integral  multiple of $500,000 in excess thereof,  (iii) if any Eurodollar
Rate  Advance  is paid  prior to the last day of the  Interest  Period  for such
Advances, all unpaid interest accrued to the date of prepayment on the principal
amount prepaid and all Breakage Costs incurred as a result of the prepayment are
also paid,  and (iv) all unpaid  interest  accrued to the date of  prepayment is
paid concurrently with any prepayment in full. Notice of prepayment, once given,
shall be irrevocable,  and the amount of the prepayment  specified in the notice
shall accordingly be due and payable on the prepayment date specified therein.

     SECTION 2.12.  Funding Losses. If (i) any Eurodollar Rate Advance is repaid
or  converted  to a Base Rate  Advance  on any day other than the last day of an
Interest  Period for such  Eurodollar  Rate Advance  (whether as a result of any
optional prepayment, mandatory prepayment, payment upon acceleration,  mandatory
conversion or otherwise),  (ii) the Borrower fails to borrow any Eurodollar Rate
Advance  in  accordance  with a Notice  of  Borrowing  or a  telephonic  request
delivered to the Agent (whether as a result of the failure to satisfy any






                                       38

applicable  conditions  or  otherwise),  (iii)  any  Base  Rate  Advance  is not
converted into a Eurodollar  Rate Advance or any Eurodollar  Rate Advance is not
continued  as  a  Eurodollar  Rate  Advance  in  accordance  with  a  Notice  of
Continuance/Conversion  or telephonic request delivered to the Agent (whether as
a result of the failure to satisfy any applicable  conditions or otherwise),  or
(iv) the Borrower fails to make any prepayment in accordance  with any notice of
prepayment  delivered  to the Agent,  the  Borrower  shall,  upon  demand by any
Lender,  reimburse such Lender for all costs and losses  incurred by such Lender
as a  result  of such  repayment,  prepayment  or  failure  ("BREAKAGE  COSTS"),
including  costs  and  losses  incurred  by a  Lender  as a  result  of  funding
arrangements  or contracts  entered into by such Lender to fund  Eurodollar Rate
Advances.  Breakage Costs shall be payable only if demanded within 90 days after
the end of the applicable Interest Period and shall be due 30 days after demand.
Demand shall be made by delivery to the Borrower and the Agent of a  certificate
of the  Lender  making  the  demand,  setting  forth in  reasonable  detail  the
calculation  of the Breakage  Costs for which demand is made.  Such  certificate
shall,  in the  absence of  manifest  error,  be  conclusive  and binding on the
Borrower.

     SECTION 2.13.  Increased Costs. (a) Increase in Cost. If, due to either (i)
the introduction of or any change (other than any change by way of imposition or
increase  of reserve  requirements,  in the case of  Eurodollar  Rate  Advances,
included in the Eurodollar Rate Reserve  Percentage) in or in the interpretation
of any law or  regulation or (ii) the  compliance  with any guideline or request
from any central bank or other Governmental Authority (whether or not having the
force of law),  there  shall be any  increase  in the cost to any  Lender or any
participant  under  Section  8.07(e) of agreeing  to make or making,  funding or
maintaining Eurodollar Rate Advances,  then the Borrower shall from time to time
pay to the Agent  for the  account  of such  Lender  or  participant  additional
amounts  sufficient to compensate  such Lender or participant for such increased
cost.  Such costs shall be payable only if demanded within six months after they
were  incurred  and shall be due 30 days after  demand.  Demand shall be made by
delivery  to the  Borrower  and the  Agent of a  certificate  of the  Lender  or
participant   making  the  demand,   setting  forth  in  reasonable  detail  the
calculation of the costs for which demand is made.  Such  certificate  shall, in
the absence of manifest error, be conclusive and binding on the Borrower.

     (b)  Increase  in  Capital  Requirements.  If any  Lender  determines  that
compliance  with any law or  regulation  or any  guideline  or request  from any
central bank or other Governmental Authority (whether or not having the force of
law)  affects or would  affect the amount of capital  required or expected to be
maintained by such Lender or any  corporation  controlling  such Lender and that
the amount of such capital is  increased by or based upon the  existence of such
Lender's  commitment  to lend or  funding  hereunder  and other  commitments  or
funding of this type,  then,  upon demand by such Lender,  the  Borrower  shall,
within 30 days after demand from time to time by such  Lender,  pay to the Agent
for the account of such Lender additional  amounts sufficient to compensate such
Lender or such  corporation  in the light of such  circumstances,  to the extent
that such Lender  determines  such  increase in capital to be  allocable  to the
existence of such Lender's  commitment to lend or funding hereunder.  Demand for
such payment may be made at any time but must be made in writing, with a copy to
the Agent. No






                                       39

such compensation may be demanded as to increased capital maintained by a Lender
more than 12 months before  compensation was first demanded by such Lender under
this Section 2.13(b).  Demand for such compensation shall be made by delivery to
the Borrower  and the Agent of a  certificate  of the Lender  making the demand,
setting forth the amount  demanded.  Such  certificate  shall, in the absence of
manifest error, be conclusive and binding on the Borrower.

     (c) Replacement  Lenders and  Participants.  If, and on each occasion that,
(i) a  Lender  or a  participant  under  Section  8.07(e)  makes  a  demand  for
compensation  pursuant to Section 2.08,  Section 2.13(a) or Section 2.13(b) with
respect to  Eurodollar  Rate  Advances or (ii) a Lender is excused  from funding
Eurodollar  Rate Advances  pursuant to Section 2.14 or (iii) Taxes are required,
pursuant to Section  2.16(a),  to be deducted from or with respect to any amount
payable  to any  Lender or the  Agent,  the  Borrower  may in whole  permanently
replace  such  Lender  or  participant,  as the  case may be,  with an  Eligible
Assignee willing to become a Lender hereunder, on the following terms:

          (A) The replacement  Lender must be satisfactory to the LC Bank in its
     reasonable discretion;

          (B) The  Borrower  shall give the Agent and the Lender or  participant
     being  replaced at least five Business  Days' prior  written  notice of the
     replacement. The notice must be given within 180 days after the date of the
     event  specified in clause (i),  (ii) or (iii)  above,  as the case may be,
     pursuant to which such  replacement  is made, and must state the day (which
     must be a Business  Day not more than 10 days after the notice is given) on
     which the replacement will be effective.

          (C) On the  effective  date of the  replacement,  (1) the  replacement
     Lender  shall  purchase  the  Advances  owed to  such  replaced  Lender  or
     participant for a purchase price equal to the principal  amount thereof and
     all interest accrued thereon as of such effective date,  payable in cash on
     such  effective  date,  (2) an  Assignment  and  Acceptance  covering  such
     Advances shall be delivered to the  replacement  Lender by the Lender being
     replaced or by the participant  being replaced and the Lender from which it
     holds its  participation,  and (3) the Borrower  shall pay to the Agent for
     the  account of the  replaced  Lender or  participant  all  Breakage  Costs
     resulting  from  the  replacement  and  all  additional   interest,   fees,
     compensation, costs, losses, taxes, expense reimbursements, indemnities and
     other Obligations due to the Lender or participant being replaced.

          (D) The  Borrower  will  remain  liable  to each  replaced  Lender  or
     participant for all Obligations that survive the repayment of the Advances.

     SECTION  2.14.  Illegality.  Notwithstanding  any other  provision  of this
Agreement,  if any Lender shall notify the Agent that the introduction of or any
change in or in the  interpretation  of any law or regulation makes it unlawful,
or any central bank or other






                                       40

Governmental  Authority  asserts  that it is  unlawful,  for any  Lender  or its
Eurodollar  Lending  Office  to  perform  its  obligations   hereunder  to  make
Eurodollar  Rate  Advances  or to  fund or  maintain  Eurodollar  Rate  Advances
hereunder,  then (i) the  obligation  of such Lender to make or continue,  or to
convert  Advances into,  Eurodollar  Rate Advances shall be suspended  until the
Agent shall notify the Borrower and the Lenders that the  circumstances  causing
such suspension no longer exist,  and (ii) the Borrower shall  forthwith  either
(A) prepay in full all Eurodollar Rate Advances of such Lender then outstanding,
together with interest accrued thereon and Breakage Costs related thereto or (B)
convert all Eurodollar Rate Advances of such Lender then  outstanding  into Base
Rate Advances and pay all interest accrued thereon to the date of conversion and
all Breakage Costs related thereto.

     SECTION 2.15. Payments and Computations.  (a) Payments.  The Borrower shall
make each payment  hereunder  and under the Notes not later than 11:00 a.m. (New
York City time) on the day payment is due,  in Dollars  received by the Agent at
its address  referred to in Section 8.02 in same day funds. Any payment due to a
Lender  shall be paid to the Agent for  account of such  Lender.  When the Agent
receives a payment for account of a Lender,  the Agent will promptly  cause like
funds to be  distributed  to such Lender for account of its  Applicable  Lending
Office.

     (b)  Charging of  Accounts.  If and to the extent any  payment  owed to the
Agent or any Lender is not made within three Business Days after the date it was
due  hereunder  or under  the Note  held by such  Lender,  the  Borrower  hereby
authorizes  the Agent and such  Lender to setoff  and  charge  any amount so due
against any deposit  account  maintained  by the Borrower with the Agent or such
Lender, whether or not the deposit therein is then due.

     (c)  Computations.  All computations of interest,  additional  interest and
fees  accruing  at a per annum  rate  shall be made on the  basis of the  actual
number of days (including the first day but excluding the last day) occurring in
the period for which such interest,  additional  interest or commitment fees are
payable and a year of 360 days.

     (d) Payment on Business  Day.  Whenever any payment  hereunder or under the
Notes is due on a day other than a Business  Day,  such payment shall be made on
the next  succeeding  Business Day, and such extension of time shall be included
in the computation of interest or fees. If, however,  such extension would cause
payment of interest on or principal of  Eurodollar  Rate  Advances to be made in
the  next  following  calendar  month,  such  payment  shall be made on the next
preceding Business Day.

     (e)  Presumption  of  Payment.  Unless the Agent  receives  notice from the
Borrower  prior to the date on which  any  payment  is due to the  Agent for the
benefit of the Lenders hereunder that the Borrower will not make such payment in
full,  the Agent may assume that the  Borrower  has made such payment in full to
the Agent on such date and the Agent  may,  in  reliance  upon such  assumption,
cause to be distributed to each Lender on such due date an






                                       41

amount  equal to the  amount  then due such  Lender.  If and to the  extent  the
Borrower  does not make such payment to the Agent in full when due,  each Lender
shall repay to the Agent  forthwith  on demand such amount  distributed  to such
Lender,  together with  interest  thereon for each day from the date such amount
was  distributed  to such Lender until the Business Day such Lender  repays such
amount to the Agent,  at the  Federal  Funds Rate until the third  Business  Day
after such demand and thereafter at the rate applicable to Base Rate Advances.

     SECTION 2.16. Taxes. (a) Net Payments. Any and all payments by the Borrower
hereunder  or under  the  Notes  shall be made  free  and  clear of and  without
deduction for any and all present or future taxes, levies, imposts,  deductions,
charges or withholdings, and all liabilities with respect thereto, excluding, in
the case of each  Lender and the Agent,  taxes  imposed on its net  income,  and
franchise taxes imposed on it, by the jurisdiction  under the laws of which such
Lender  or the  Agent  (as  the  case  may  be) is  organized  or any  political
subdivision  thereof and, in the case of each Lender,  taxes  imposed on its net
income,  and franchise taxes imposed on it, by the jurisdiction of such Lender's
Applicable  Lending  Office  or any  political  subdivision  thereof  (all  such
non-excluded  taxes,  levies,  imposts,  deductions,  charges,  withholdings and
liabilities,  collectively,  are "TAXES"). If the Borrower is required by law to
deduct any Taxes from or in respect of any sum  payable  hereunder  or under any
Note to any Lender or the Agent,  (i) the sum payable  shall be increased as may
be necessary so that after making all required deductions  (including deductions
applicable  to  additional  sums payable under this Section 2.16) such Lender or
the Agent (as the case may be) receives an amount equal to the sum it would have
received if no such  deductions had been made, (ii) the Borrower shall make such
deductions,  and (iii) the  Borrower  shall pay the full amount  deducted to the
relevant  taxation  authority or other  authority in accordance  with applicable
law.

     (b) Payment of Other  Taxes.  In addition,  the Borrower  agrees to pay any
present or future  stamp or  documentary  taxes or any other  excise or property
taxes,  charges or similar levies which arise from any payment made hereunder or
under the Notes or from the execution, delivery or registration of, or otherwise
similarly with respect to, this Agreement,  the Notes or any other Loan Document
("OTHER TAXES").

     (c) Indemnification.  The Borrower will indemnify each Lender and the Agent
for the full amount of Taxes or Other Taxes  (including any Taxes or Other Taxes
imposed by any  jurisdiction on amounts payable under this Section 2.16) paid by
such  Lender  or the  Agent  (as the case may be) and any  liability  (including
penalties,  interest and expenses,  but excluding any liability arising from the
gross negligence or willful misconduct of such Person) arising therefrom or with
respect  thereto,  whether or not such Taxes or Other  Taxes were  correctly  or
legally  asserted.  Payment  under  this  indemnity  shall be due 30 days  after
written demand therefor.  Any Person entitled to indemnification by the Borrower
pursuant to this Section  2.16(c) shall give the Borrower  written notice of any
matter  which  such  Person  has  determined  has  given  rise  to  a  right  of
indemnification  hereunder  within 120 days after the earlier of (i) the date on
which such Person makes  payment of the Taxes or Other Taxes giving rise to such
right or






                                       42

(ii) the date on which such Person  receives  written demand for payment of such
Taxes or Other  Taxes  from the  applicable  Governmental  Authority;  provided,
however,  that the failure by any Person timely to provide such notice (A) shall
not release the Borrower from any of its obligations  under this Section 2.16(c)
except to the extent the Borrower is materially  prejudiced by such failure,  or
such  notice was  provided  more than 240 days after the latest date such notice
could have been timely  given,  and (B) shall not relieve the Borrower  from any
other  obligation or liability  that it may have to such Person  otherwise  than
under this Section 2.16(c).

     (d) Evidence of  Payments.  Within 30 days after the date of any payment of
Taxes hereunder by the Borrower,  the Borrower will furnish to the Agent, at its
address  referred to in Section  8.02,  the original or a certified  copy of any
receipt issued to the Borrower evidencing payment thereof.

     (e) Withholding Tax Exemption.  If any Lender is a "foreign  person" within
the meaning of the Code,  such Lender shall deliver to the Agent (i) (A) if such
Lender  qualifies  for an  exemption  from,  or a reduction  of,  United  States
withholding tax under a tax treaty, a properly  completed and executed  Internal
Revenue  Service Form 1001 (or applicable  successor form) before the payment of
any interest in the first  calendar year and in each third  succeeding  calendar
year during which interest may be paid under this Agreement,  (B) if such Lender
qualifies for an exemption from United States  withholding tax for interest paid
under this Agreement  because it is  effectively  connected with a United States
trade or business of such Lender,  two properly completed and executed copies of
Internal  Revenue  Service Form 4224 (or applicable  successor  form) before the
payment of any interest is due in the first taxable year of such Lender,  and in
each succeeding  taxable year of such Lender,  during which interest may be paid
under  this  Agreement,  or (C) if such  Lender  is not a "bank" as  defined  in
Section  881(c)(3)(A)  of the Code, a properly  completed and executed  Internal
Revenue  Service Form W- 8 (or applicable  successor form) before the payment of
any  interest  is due in the  first  taxable  year of such  Lender,  and in each
succeeding taxable year of such Lender,  during which interest may be paid under
this  Agreement,   certifying  that  such  Lender  is  a  foreign   corporation,
partnership,  estate or trust,  together with a certificate of a duly authorized
officer  representing  that such Lender is not a "bank" for  purposes of Section
881(c) of the Code,  is not a 10%  shareholder  (within  the  meaning of Section
871(h)(3)(B)  of the  Code)  of the  Borrower  and is not a  controlled  foreign
corporation  related to the Borrower (within the meaning of Section 864(d)(4) of
the Code),  and (ii) such other form or forms as may be required  or  reasonably
requested by the Agent to establish or substantiate exemption from, or reduction
of,  United  States  withholding  tax under the Code or other laws of the United
States.  Each Lender  agrees to notify the Agent of any change in  circumstances
which would modify or render invalid any claimed exemption or reduction.  If any
form or document  referred to in this  subsection (e) requires the disclosure of
information,  other than  information  necessary  to compute the tax payable and
information  required on the date hereof by Internal  Revenue Service Form 1001,
4224  or W-8  (or  applicable  successor  forms)  (or  the  related  certificate
described above), that the Lender reasonably considers






                                       43

to be  confidential,  the Lender  shall give notice  thereof to the Borrower and
shall not be  obligated  to include in such form or document  such  confidential
information.

     (f)  Withholding  Taxes.  Where any Lender  which is a "foreign  person" is
entitled  to a  reduction  in the  applicable  withholding  tax,  the  Agent may
withhold  from any interest  payment to such Lender an amount  equivalent to the
applicable  withholding  tax after taking into account  such  reduction.  If the
forms or other  documentation  required by Section  2.16(e) are not delivered to
the Agent,  then the Agent may withhold from any interest  payment to any Lender
not providing  such forms or other  documentation,  an amount  equivalent to the
applicable withholding tax.

     (g)  Indemnification  of the Agent. If the Internal  Revenue Service or any
authority of the United  States or other  jurisdiction  asserts a claim that the
Agent did not  properly  withhold tax from amounts paid to or for the account of
any Lender which is a "foreign  person"  (because the  appropriate  form was not
delivered,  was not properly  executed,  or because such Lender failed to notify
the Agent of a change in  circumstances  which  rendered the exemption  from, or
reduction of, withholding tax ineffective,  or for any other reason) such Lender
shall indemnify the Agent fully for all amounts paid, directly or indirectly, by
the Agent as tax or otherwise,  including penalties and interest,  together with
all  reasonable  expenses  incurred,  including  reasonable  legal  expenses and
allocated staff costs and any other reasonable out-of-pocket expenses.

     (h)  Subsequent  Lenders.  For  purposes  of this  Section  2.16,  the term
"Lender" shall include any assignee  pursuant to, and after  compliance with the
requirements   of,  Section  8.07;   provided  that  no  Person   acquiring  any
participation  pursuant  to  Section  8.07(e)  shall be  deemed a  "Lender"  for
purposes of this Section 2.16 unless and until the Borrower has been notified of
such  participation.  If  any  Lender  grants  participations  in  or  otherwise
transfers its rights under this Agreement,  the participant or transferee  shall
be bound by the terms of  Sections  2.16(e),  (f) and (g) as though it were such
Lender.

     (i) Refund, Deduction or Credit of Taxes. If any Lender determines,  in its
sole good faith discretion, that it has actually and finally realized, by reason
of a refund, deduction or credit of any Taxes paid or reimbursed by the Borrower
pursuant to  subsection  (a), (b) or (c) above in respect of payments  under the
Loan  Documents,  a current  monetary  benefit that it would  otherwise not have
obtained,  and that would result in the total  payments  under this Section 2.16
exceeding the amount needed to make such Lender whole,  such Lender shall pay to
the Borrower, with reasonable promptness following the date on which it actually
realizes  such  benefit,  an amount  equal to the  lesser of the  amount of such
benefit  or the  amount  of such  excess,  in each  case  net of all  reasonable
out-of-pocket expenses in securing such refund, deduction or credit.







                                       44

     (j) Exclusion of Certain Taxes. Notwithstanding any other provision of this
Agreement, the Borrower shall not be required to pay any amount hereunder to any
Lender or the Agent in  respect  of any Taxes to the  extent  that,  on the date
hereof or any other  date such  Lender  became a party to (or  participant  with
respect to) this Agreement or (with respect to payments to an Applicable Lending
Office) the date such Lender  designated  such  Applicable  Lending  Office with
respect to this  Agreement or any Notes,  the obligation to withhold or pay such
Taxes existed or would exist upon the payment of an amount by the Borrower under
this Agreement or any Note;  provided,  however,  that this paragraph  shall not
apply (i) to any Lender or  Applicable  Lending  Office  that became a Lender or
Applicable Lending Office as a result of an assignment, transfer, or designation
made at the  request  of the  Borrower,  or (ii) to the  extent  that the amount
otherwise  payable by the  Borrower  pursuant to this Section 2.16 to any Lender
that is an assignee  pursuant to (and in compliance  with the  requirements  of)
Section 8.07 does not exceed the amount that would have been payable  under this
Section 2.16 to the assigning Lender in the absence of such assignment.

     (k) Additional  Cooperation.  Any Lender  claiming any amount pursuant this
Section 2.16 shall use reasonable efforts  (consistent with legal and regulatory
restrictions)  to file any certificate or document  reasonably  requested by the
Borrower  or to change the  jurisdiction  of such  Lender's  Applicable  Lending
Office if such a filing or change  would avoid the need for or reduce the amount
payable by the Borrower under this Section 2.16 and would not, in the good-faith
determination of such Lender, otherwise be disadvantageous to such Lender.

     SECTION 2.17.  Sharing of Payments.  If after the occurrence and during the
continuance of any Event of Default any Lender shall obtain any payment (whether
voluntary,  involuntary,  through  the  exercise  of any  right of  set-off,  or
otherwise) on account of any Advances owed to it in excess of its Pro Rata Share
of all such  payments,  such  Lender  shall  forthwith  purchase  from the other
Lenders such  participations  in the Advances made by them as shall be necessary
to cause such purchasing Lender to share the excess payment ratably with each of
them. If all or any portion of such excess payment is thereafter  recovered from
such purchasing Lender,  such purchase from the other Lenders shall be rescinded
and each such other  Lender  shall repay to the  purchasing  Lender the purchase
price to the extent of its allocable  share of such  recovery  together with its
allocable share of any interest  required to be paid by the purchasing Lender on
the amount so  recovered.  The  Borrower  agrees  that any Lender  purchasing  a
participation  from  another  Lender  pursuant to this  Section 2.17 may, to the
fullest extent permitted by law, exercise collection rights (including the right
of set-off) with respect to such  participation  as fully as if such Lender were
the direct creditor of the Borrower in the amount of such participation.








                                       45

                                   ARTICLE III

                              CONDITIONS OF LENDING

     SECTION  3.01.  Conditions  Precedent on the Closing Date.  This  Agreement
shall become  effective and binding upon the parties  hereto only if each of the
following conditions precedent is satisfied no later than May 15, 1996:

          (a) Loan  Documents.  The Agent must have  received,  with  sufficient
     copies for each Lender:

               (i) this Agreement  duly executed by the Borrower,  the Agent and
          each of the Lenders;

               (ii) a promissory note, in  substantially  the form of Exhibit A,
          payable to the order of each  Lender in an original  principal  amount
          equal to such  Lender's Pro Rata Share of the  Facility  Amount on the
          Closing Date, duly executed by the Borrower;

               (iii) a guaranty,  in substantially the form of Exhibit C-1, duly
          executed  by each  Subsidiary  of the  Borrower  that  is not,  on the
          Closing Date, an Inactive Subsidiary;

               (iv) a pledge and security  agreement duly executed and delivered
          in  substantially  the  form of  Exhibit  C-2 by the  Borrower  and in
          substantially  the  form  of  Exhibit  C-3 by each  Subsidiary  of the
          Borrower that owns, as of the Closing Date, any shares of the stock of
          or other equity, ownership or profit interest in any Subsidiary of the
          Borrower,  together  with (A)  certificates  representing  the Pledged
          Shares  referred  to in  Schedule A to each such  Pledge and  Security
          Agreement,  other than  shares in respect  of  Inactive  Subsidiaries,
          accompanied  by  undated  stock  powers  executed  in  blank,  and (B)
          evidence  satisfactory to the Lenders that all other actions necessary
          or, in the opinion of the  Lenders,  desirable  to perfect and protect
          the security  interests created by the Pledge and Security  Agreements
          have been taken,  including  delivery to the Agent of all  instruments
          constituting   Collateral,   duly  endorsed,  and  delivery  of  UCC-1
          financing  statements duly executed by each Grantor under a Pledge and
          Security Agreement and in form sufficient for filing in all offices in
          which the Agent or any Lender may consider  filing to be  appropriate;
          and

               (v) the schedules to this Agreement and the Loan Documents.







                                       46

          (b) Corporate Documents. The Agent must have received, with sufficient
     copies for each Lender:

               (i) copies of the articles or  certificate of  incorporation  and
          by-laws or other  governing  documents of each Loan Party as in effect
          on the Closing  Date,  certified as of the Closing Date by a Secretary
          or an Assistant Secretary of such Loan Party;

               (ii) copies of resolutions of the Board of Directors of each Loan
          Party approving the transactions  contemplated  hereby and authorizing
          the execution, delivery and performance of each Loan Document to which
          it is a party,  certified  as of the Closing Date by a Secretary or an
          Assistant Secretary of such Loan Party;

               (iii) a certificate of the Secretary or an Assistant Secretary of
          each  Loan  Party  certifying  the names  and true  signatures  of the
          officers of such Loan Party  authorized  to sign each Loan Document to
          which it is a party and,  in the case of the  Borrower,  to request an
          extension of credit hereunder; and

               (iv) a good standing  certificate for each Loan Party,  issued as
          of a recent date by the  Secretary of State of the state in which such
          Loan  Party is  incorporated  or formed  and each state in which it is
          qualified to do business.

          (c)  Governmental  Consents.  Each Loan Party must have  obtained  all
     consents,  approvals  and  authorizations  required  from any  Governmental
     Authority in connection with the execution, delivery and performance of its
     obligations under the Loan Documents.

          (d) No Injunction.  No law or regulation shall prohibit, and no order,
     judgment or decree of any Governmental Authority shall enjoin,  prohibit or
     restrain,  and no litigation  shall be pending or  threatened  which in the
     reasonable  judgment  of the  Agent  or  Requisite  Lenders  would  enjoin,
     prohibit or restrain (i) the making of the  Advances,  (ii) the issuance of
     any  Letter  of  Credit  or  (iii)  the  consummation  of the  transactions
     contemplated by the Loan Documents.

          (e) Other  Deliveries.  The Agent must have received,  with sufficient
     copies for each Lender:

               (i) a copy of the  Borrower's  financial  statements on Form 10-K
          for the year ended December 31, 1995, certified in a manner acceptable
          to the Requisite Lenders by KPMG Peat Marwick;







                                       47

               (ii) a certificate dated as of the Closing Date and signed by the
          Chairman,  Chief  Executive  Officer  or  Authorized  Officer  of  the
          Borrower,   certifying   that,  as  of  the  Closing  Date,   (A)  the
          representations  and  warranties  contained  in  Article  IV  of  this
          Agreement  are true and  correct  on and as of the  Closing  Date,  as
          though  made  on and as of such  date,  (B) no  Event  of  Default  or
          Potential  Default has occurred and is continuing,  (C) since December
          31, 1995, there has been no Material  Adverse Change,  and (D) each of
          the other conditions  precedent set forth in this Article III has been
          satisfied;

               (iii) all documents  evidencing other necessary  corporate action
          and governmental  approvals, if any, with respect to this Agreement or
          any other Loan Document; and

               (iv)  such   other   certificates,   agreements,   documents   or
          instruments  as the  Agent or the  Requisite  Lenders  may  reasonably
          request in writing.

          (f) Legal  Opinions.  The Agent must have  received,  with  sufficient
     copies for each Lender:

               (i) an opinion of Hunton & Williams, counsel for the Borrower and
          the Guarantors, substantially in the form of Exhibit D-1 hereto and as
          to such other matters as any Lender  through the Agent may  reasonably
          request; and

               (ii)  an  opinion  of  special  local  counsel  for  each  of the
          Guarantors  substantially  in the form of Exhibit D-2 hereto and as to
          such  other  matters as any Lender  through  the Agent may  reasonably
          request.

          (g) Payout and Release  Agreement.  The Agent must have received (with
     sufficient  copies for each  Lender) a payout  and  release  agreement,  in
     substantially  the form of Exhibit E-3,  duly  executed by the Borrower and
     its Subsidiaries and the other parties identified therein.

          (h) Payment of Existing  Facility.  The first Borrowing must have been
     requested  by the  Borrower,  in an  amount  sufficient  to pay in full the
     "Amount  Outstanding"  set  forth  in  the  payout  and  release  agreement
     delivered  pursuant  to  Section  3.01(g),  the Agent  must  have  received
     irrevocable  instructions  from the  Borrower to apply  proceeds  from such
     Borrowing to pay such Amount  Outstanding  in full, and the Agent must have
     received an LC Application for all Letters of Credit  outstanding under the
     Existing  Facility  duly  executed by the  Borrower  and accepted by the LC
     Bank,  confirming  that all such Letters of Credit shall be deemed  applied
     for, issued and






                                       48

     outstanding  under this  Agreement and that all  participation  obligations
     arising in respect thereof under the Existing Facility are discharged.

          (i) Payment of Fees and Expenses.  All fees and expense reimbursements
     due to the Agent and the Lenders  under this  Agreement  and the Fee Letter
     must have been paid.

          (j)  Section  3.02  Conditions.  Each of the  conditions  set forth in
     Section 3.02 must be satisfied.

     SECTION  3.02.  Conditions  Precedent  to Each  Extension  of  Credit.  The
obligation  of each Lender to make an Advance on the  occasion of any  Borrowing
and the  obligation  of the LC Bank to issue any  Letter of Credit is subject to
the conditions  precedent that on the date the Borrowing is to be made or Letter
of Credit is to be issued:

          (a) Notice. The Borrower shall have delivered a fully completed Notice
     of Borrowing or LC Application, as the case may be, dated such date.

          (b) Certification. Each of the following statements shall be true, and
     the Agent shall have  received for the account of each Lender a certificate
     dated such date and signed by an Authorized Officer, certifying that:

               (i) the representations and warranties contained in Article IV of
          this  Agreement  and  in  Article  III  of  the  Pledge  and  Security
          Agreements are correct on and as of such date, before and after giving
          effect to the  extension  of credit to be made  hereunder on such date
          and the application of the proceeds  therefrom,  as though made on and
          as of such date;

               (ii) no event has  occurred  and is  continuing,  or would result
          from such extension of credit or from the  application of the proceeds
          therefrom,  which  constitutes  an Event  of  Default  or a  Potential
          Default; and

               (iii) the  incurrence  of  indebtedness  by the  Borrower  in the
          amount of such  Borrowing  or for the LC Exposure  resulting  from the
          issuance  of such  Letter  of Credit is  permitted  under  each of the
          Subordinated  Debt  Indentures (and if after such Borrowing is made or
          Letter of Credit is issued the aggregate  principal amount of Advances
          and LC  Exposure  outstanding  under this  Agreement  is greater  than
          $154,000,000  (or such  other  amount as  determined  pursuant  to the
          Consent  Solicitation),  such  certificate  shall include  information
          sufficient to confirm  specifically  that such incurrence is permitted
          under  Section  4.9 of the 1994  Subordinated  Debt  Indenture,  under
          Section 3.9 of the 1995






                                       49

          Subordinated Debt Indenture and, upon the effectiveness thereof, under
          of the terms of the 1996 Subordinated Debt Indenture).

The delivery of a Notice of Borrowing or LC  Application  and the  acceptance by
the  Borrower  of the  proceeds of a  Borrowing  or of a Letter of Credit  shall
constitute a representation  and warranty by the Borrower that, on the date such
Advance  is made or Letter of Credit is issued,  the  foregoing  statements  are
true.


                                   ARTICLE IV

                         REPRESENTATIONS AND WARRANTIES

     SECTION 4.01.  Representations and Warranties of the Borrower. The Borrower
represents and warrants as follows:

          (a) Organization. Each Loan Party is a corporation or partnership duly
     organized,  validly existing and in good standing (except where the failure
     of one or more Loan  Parties,  other  than the  Borrower  and its  Material
     Subsidiaries,  to be in good  standing  after the  Closing  Date  could not
     reasonably  be expected to result in a Material  Adverse  Change) under the
     laws of the  jurisdiction in which it is organized and is duly qualified to
     do business in each  jurisdiction  where the character of its properties or
     the nature of its activities makes such qualification necessary.

          (b)  Power  and  Authority.  Each  Loan  Party  has the  corporate  or
     partnership  power (i) to carry on its business as now being  conducted and
     as proposed  to be  conducted  by it, (ii) to execute,  deliver and perform
     each Loan  Document  to which it is a party,  and (iii) to take all  action
     necessary  to  consummate  the  transactions  contemplated  under each Loan
     Document to which it is a party.

          (c) Due Authorization. The execution, delivery and performance by each
     Loan  Party of each Loan  Document  to which it is or will be a party  have
     been duly authorized by all necessary action of its board of directors (or,
     in case of a partnership, of its governing authority) 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 and do not result in or
     require the  creation of any Lien  (other than  pursuant to the  Collateral
     Documents) upon any of its property or assets.

          (d) Subsidiaries and Ownership of Capital Stock. Set forth in Schedule
     4.01(d), as such schedule may be amended pursuant to Section 5.02(c)(xiii),
     is a  complete  list,  as of the  latest of (i) the date  hereof,  (ii) the
     Closing Date, (iii) the date of






                                       50

     delivery to the Agent of the then most recently  required  amended Schedule
     4.01(d) pursuant to Section 5.02(c)(xiii), and (iv) in the event an amended
     Schedule  4.01(d) is not timely  delivered to the Agent pursuant to Section
     5.02(c)(xiii),  the date of the last day on  which  such  amended  schedule
     could have been timely delivered,  of all direct and indirect  Subsidiaries
     of the  Borrower.  Such  schedules  also set forth the number of issued and
     authorized  shares of each  class of  capital  stock of and  other  equity,
     ownership or profit  interests in such  Subsidiary  and the identity of the
     holders  of all such  shares.  Except  as set forth in such  schedules,  no
     capital stock of or other equity,  ownership or profit interest in any such
     Subsidiary  is subject to  issuance  or sale under any  warrant,  option or
     purchase right,  conversion or exchange right, call, commitment or claim of
     any right,  title or interest therein or thereto.  The outstanding  capital
     stock of each such Subsidiary is duly  authorized,  validly  issued,  fully
     paid and  nonassessable  and is not "margin stock," as that term is defined
     in  Regulations  G, T, U and X of the  Board of  Governors  of the  Federal
     Reserve System.

          (e) Health Care  Facilities.  Set forth in Schedule  4.01(e),  as such
     schedule  may be amended  pursuant to Section  5.02(c)(xiv),  is a complete
     list, as of the latest of (i) the date hereof, (ii) the Closing Date, (iii)
     the  date of  delivery  to the  Agent of the then  most  recently  required
     amended Schedule  4.01(e) pursuant to Section  5.02(c)(xiv) and (iv) in the
     event an amended  Schedule  4.01(e) is not  timely  delivered  to the Agent
     pursuant  to Section  5.02(c)(xiv),  the date of the last day on which such
     amended  schedule  could have been  timely  delivered,  of each Health Care
     Facility  owned,  leased,  managed  or  operated  by  the  Borrower  or any
     Subsidiary of the Borrower which is a skilled nursing  facility,  hospital,
     assisted living facility or retirement  facility,  and Schedule 4.01(e), as
     it may be so amended,  specifically  sets forth,  with respect to each such
     Health  Care  Facility,  whether  such  Health  Care  Facility  is a leased
     facility or an owned facility.

          (f)  Governmental  Approval.  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 each of the
     Loan Parties of any Loan Document to which it is or will be a party, except
     for those listed on Schedule 4.01(f),  each of which has been duly obtained
     or made and is in full force and effect.

          (g) Binding and  Enforceable.  This  Agreement is, and each other Loan
     Document to which any Loan Party will be a party is or when  delivered will
     be, legal,  valid and binding  obligations of the Loan Parties  enforceable
     against the Loan Parties in accordance with their respective terms, subject
     to laws generally affecting the enforcement of creditors' rights.

          (h) Financial  Information.  The  consolidated  balance  sheets of the
     Borrower and its Subsidiaries as at December 31, 1994 and December 31, 1995
     and their






                                       51

     related income and cash flow  statements  for the periods then ended,  each
     other financial statement of the Borrower and its Subsidiaries delivered to
     the Agent or Lenders on or prior to the Closing  Date,  and each  financial
     statement delivered to the Lenders pursuant to Section 5.02(c), as and when
     delivered  to  the  Agent  or  Lenders  fairly  presents  the  consolidated
     financial  condition of the Borrower  and its  Subsidiaries  as at the date
     thereof and the  consolidated  results of their  operations  for the period
     then ended, all in accordance with GAAP consistently applied.

          (i) Material  Adverse Change.  Since December 31, 1995, there has been
     no Material Adverse Change.

          (j)  Compliance.  Except as permitted  pursuant to Section 5.02(k) and
     Section 5.03(n),  each Loan Party is in compliance in all material respects
     with all material applicable laws, rules, regulations and orders.

          (k)  Litigation.  Set forth on Schedule  4.01(k) is a list,  as of the
     Closing Date, of all pending or overtly  threatened  actions or proceedings
     affecting  any  Loan  Party  before  any  court,   governmental  agency  or
     arbitrator,  and all loss  contingencies  within the meaning of GAAP, other
     than any action or  proceeding  that would not subject the Loan  Parties to
     liability  in excess  of  $5,000,000  individually  or  $30,000,000  in the
     aggregate in the case of two or more related actions or proceedings. Except
     as  identified  on  Schedule  4.01(k),  there  is  no  pending  or  overtly
     threatened action or proceeding  affecting any Loan Party before any court,
     governmental  agency or arbitrator,  which would, if adversely  determined,
     result in a Material Adverse Change or which relates to or could reasonably
     be expected to affect the legality,  validity or enforceability of any Loan
     Document.

          (l) No Conflict. The execution,  delivery and performance by each Loan
     Party of each of the Loan  Documents to which it is a party do not and will
     not (i)  conflict  with,  result  in a breach  of, or  constitute  (with or
     without  notice  or the  lapse  of  time  or  both) a  default  under,  any
     instrument,  lease,  indenture,  agreement or other contractual  obligation
     issued by any Loan Party or  enforceable  against it or any of its property
     or assets,  except  under  immaterial  agreements  for supplies or services
     which are readily replaceable without any adverse effect on such Loan Party
     or its business or (ii) require any approval of its stockholders.

          (m)  No  Default.  No  event  has  occurred  and is  continuing  which
     constitutes an Event of Default or a Potential Default.

          (n) Payment of Taxes. Each Loan Party has filed all federal income tax
     returns and all other tax  returns  required to be filed by it and has paid
     all taxes and






                                       52

     assessments  payable by it which have become due except to the extent being
     contested in accordance with the provisions of Section 5.02(h).

          (o) Margin Regulations. No proceeds of any Advance or Letter of Credit
     will be used for any purpose that  requires any Lender to deliver or obtain
     any certification  under, or to comply with any margin requirement or other
     provision  of,  Regulations  G, T, U or X of the Board of  Governors of the
     Federal Reserve System.

          (p) Conduct of  Business.  The Borrower is a holding  company  engaged
     primarily  in the business of (i) holding  stock of and claims  against its
     Subsidiaries;  (ii) managing and developing corporate opportunities related
     to the business of its Subsidiaries;  (iii)  administering and coordinating
     the overall  operating  business of its Subsidiaries and other  investments
     permitted  hereunder;  (iv)  obtaining of financing for the business of its
     Subsidiaries; and (v) holding interests in and title to assets and property
     necessary or appropriate  to conduct such business in the ordinary  course.
     The Subsidiaries of the Borrower (other than any such Subsidiaries  engaged
     in the insurance  business as permitted  under Section  5.03(c)(xiii))  are
     principally  engaged in the  business of a  Healthcare  Company,  including
     making   Investments  in   Subsidiaries  or  Persons  that  are  Healthcare
     Companies.

          (q) Health Care Permits.  (i) Except as permitted  pursuant to Section
     5.02(k) and Section 5.03(n), (A) each Loan Party now has, and has no reason
     to  believe it will not be able to  maintain  in  effect,  all Health  Care
     Permits  necessary  for the lawful  conduct of its  business or  operations
     wherever  now  conducted  and as planned  to be  conducted,  including  the
     ownership  and  operation  of its Health Care  Facilities,  pursuant to all
     applicable laws and all  requirements of  Governmental  Authorities  having
     jurisdiction  over such Loan Party or over any part of its operations;  (B)
     all such Health Care Permits are in full force and effect and have not been
     amended  or  otherwise  modified  (except  for  modifications  which do not
     constitute  and  cannot  reasonably  be  expected  to result in a  Material
     Adverse Change),  rescinded,  revoked or assigned;  (C) no Loan Party is in
     default in any  material  respect  under,  or in  violation in any material
     respect of, any such Health Care Permit (and to the best  knowledge  of the
     Borrower,  no event has occurred,  and no condition exists, which, with the
     giving of notice or passage  of time or both,  would  constitute  a default
     thereunder  or violation  thereof)  that has caused or could  reasonably be
     expected to cause the loss of any such Health Care Permit;  (D) neither the
     Borrower nor any other Loan Party has received any notice of any  violation
     of  applicable  laws which has caused or could  reasonably  be  expected to
     cause any such Health Care Permit to be modified (except for  modifications
     not amounting to a Material Adverse Change),  rescinded or revoked;  (E) to
     the best  knowledge  of the  Borrower,  no  condition  exists  or event has
     occurred  which could  reasonably be expected to result in the  suspension,
     revocation,  impairment,  forfeiture  or  non-renewal  of such  Health Care
     Permit;  and (F) the  continuation,  validity and effectiveness of all such
     Health






                                       53

     Care Permits will not in any way be adversely  affected by the transactions
     contemplated  by this  Agreement,  except that the exercise by the Agent of
     its rights and  remedies  in  respect of the  Collateral  is subject to the
     licensing power of health care regulatory authorities.

        (ii)  Except as  permitted  pursuant  to  Section  5.02(k)  and  Section
     5.03(n), all Health Care Facilities owned,  leased,  managed or operated by
     any Loan Party are entitled to participate  in, and receive  payment under,
     the appropriate Medicare,  Medicaid and related reimbursement  programs and
     in any similar state or local  government-sponsored  program, to the extent
     that such Loan Party has decided to  participate in any such state or local
     program,  and to receive  reimbursement  from private and commercial payors
     and health maintenance organizations to the extent applicable thereto.

          (r) Environmental Matters. Except as set forth in Schedule 4.01(r), as
     it may  from  time to time be  amended  by the  Borrower,  (i) no  Material
     Environmental  Claim is  pending  or,  to the  knowledge  of the  Borrower,
     overtly threatened against the Borrower or any of its Subsidiaries,  or any
     property  or  assets  currently  owned or leased  thereby,  and (ii) to the
     knowledge of the Borrower,  no Material  Environmental  Claim is pending or
     overtly  threatened  against  any  property or assets  previously  owned or
     leased by the Borrower or any of its  Subsidiaries.  Except as set forth in
     Schedule 4.01(r),  and except in respect of matters that, in the aggregate,
     are  not  and  cannot  reasonably  be  expected  to  result  in a  Material
     Environmental  Claim or a Material  Adverse  Change,  the operations of the
     Borrower  and its  Subsidiaries  comply and have  complied in all  material
     respects with all applicable Environmental Laws.

          (s) ERISA  Compliance.  (i) Each Plan is in compliance in all material
     respects  with the  applicable  provisions  of  ERISA,  the Code and  other
     applicable Federal or state law.

        (ii) Each  Pension  Plan which is  intended  to be  tax-qualified  under
     Section 401(a) of the Code has been  determined by the IRS to qualify under
     Section  401 of the  Code,  and the  trusts  created  thereunder  have been
     determined to be exempt from tax under the provisions of Section 501 of the
     Code, and to the best knowledge of the Borrower  nothing has occurred which
     would cause the loss of such qualification or tax-exempt status.

        (iii) Except as set forth in Schedule  4.01(s),  (A) none of the Pension
     Plans  which is  subject  to Title IV of ERISA  has any  material  Unfunded
     Pension Liability as to which the Borrower or any ERISA Affiliate is or may
     be  liable;  (B)  neither  the  Borrower  nor any ERISA  Affiliate  has nor
     reasonably  expects  to incur  any  material  liability  (and no event  has
     occurred  which,  with the giving of notice  under  Section  4219 of ERISA,
     would  result in such  material  liability)  under  Section 4201 or 4243 of
     ERISA with respect to any






                                       54

     Multiemployer  Plan;  (C) no  ERISA  Event  has  occurred  or,  to the best
     knowledge of the Borrower, is reasonably expected to occur; and (D) neither
     the Borrower nor any ERISA  Affiliate has maintained any Welfare Plan which
     provides,  or  requires  the  Borrower or any ERISA  Affiliate  to provide,
     medical or other welfare benefits to any participant  after the termination
     of such participant's  employment with the Borrower or such ERISA Affiliate
     (except  to the extent  required  by the  provisions  of Part 6 of Title I,
     Subtitle B of ERISA or Sections 162(k) and 4980B of the Code).

        (iv) Each  Welfare  Plan which is a "group  health  plan," as defined in
     Section 607(1) of ERISA, has been operated in compliance with provisions of
     Part 6 of Title I of ERISA and Sections 162(k) and 4980B of the Code at all
     times.

        (v) Neither the Borrower nor any ERISA  Affiliate has engaged,  directly
     or indirectly,  in a prohibited  transaction (as defined in Section 4975 of
     the Code or Section 406 of ERISA) for which no statutory or  administrative
     exemption is  applicable in connection  with any Plan the  consequences  of
     which, in the aggregate, constitute or can reasonably be expected to result
     in a Material Adverse Change.

          (t) Title to Assets. Each Loan Party has title, as of the date of each
     of its financial  statements  delivered  hereunder,  to all of its material
     assets reflected therein, except assets leased to it under a Capital Lease,
     free and clear of all Liens except Permitted Liens.

          (u)  Collateral  Documents.  On and after the Closing  Date and,  with
     respect to perfection upon the filing of the financing statements delivered
     pursuant to Section 3.01(a), the provisions of each Collateral Document are
     effective to create in favor of the Agent,  for the benefit of the Lenders,
     legal,  valid and  perfected  security  interests  in all right,  title and
     interest in the Collateral described therein, enforceable against each Loan
     Party that owns an interest in such  Collateral,  subject to laws generally
     affecting the enforcement of creditors' rights.

          (v) Senior  Indebtedness.  This Agreement is a "Bank Credit Agreement"
     within the meaning of the 1992 Convertible  Subordinated Debt Indenture and
     the 1993 Convertible  Subordinated Debt Indenture and a "Credit  Agreement"
     within  the  meaning  of the 1994  Subordinated  Debt  Indenture,  the 1995
     Subordinated Debt Indenture and, upon the effectiveness  thereof,  the 1996
     Subordinated Debt Indenture.  The Obligations when incurred will be "Senior
     Indebtedness" within the meaning of the Subordinated Debt Indentures.








                                       55

                                    ARTICLE V

                            COVENANTS OF THE BORROWER

     SECTION  5.01.  Financial  Covenants.  So  long as any  Obligation  remains
unpaid,  any Letter of Credit remains  outstanding or any Lender is obligated to
extend credit  hereunder,  unless the  Requisite  Lenders  otherwise  consent in
writing the Borrower will:

          (a)  Maximum  Debt/EBITDAR  Ratio.   Maintain  a  Debt/EBITDAR  Ratio,
     determined  as of the last day of each  Quarter,  at an amount not  greater
     than that set forth for such Quarter below:


            Quarter(s) Ended                        Debt/EBITDAR Ratio
            ----------------                        ------------------
             March 31, 1996                                6.00
             June 30, 1996                                 6.50
           September 30, 1996                              6.50
           December 31, 1996                               6.00
             March 31, 1997                                5.75
             June 30, 1997                                 5.75
           September 30, 1997                              5.50
           December 31, 1997                               5.35
             March 31, 1998                                5.25
             June 30, 1998                                 5.25
           September 30, 1998                              5.00
           December 31, 1998                               4.75
         In 1999 and thereafter                            4.50


          (b) Minimum Cash Flow  Coverage  Ratio.  Maintain a Cash Flow Coverage
     Ratio, determined as of the last day of each Quarter, at an amount not less
     than that set forth for such Quarter below:







                                       56


                                                        Cash Flow
            Quarter(s) Ended                          Coverage Ratio
            ----------------                          --------------
                In 1996                                    1.10
             March 31, 1997                                1.25
             June 30, 1997                                 1.25
           September 30, 1997                              1.50
           December 31, 1997                               1.50
             March 31, 1998                                1.60
             June 30, 1998                                 1.60
           September 30, 1998                              1.70
           December 31, 1998                               1.70
         In 1999 and thereafter                            2.00


          (c) Minimum  Interest&Rent  Coverage Ratio.  Maintain an Interest&Rent
     Coverage Ratio, determined as of the last day of each Quarter, at an amount
     not less than that set forth for such Quarter below:

                                                      Interest & Rent
            Quarter(s) Ended                          Coverage Ratio
            ----------------                          --------------
                In 1996                                    1.50
                In 1997                                    1.75
                In 1998                                    2.10
                In 1999                                    2.50
         In 2000 and thereafter                            3.00

          (d)  Minimum  Net  Worth.  Maintain  Adjusted   Stockholders'  Equity,
     determined as of the last day of each  Quarter,  at an amount not less than
     the then Minimum Net Worth.

     SECTION 5.02.  Affirmative  Covenants.  So long as any  Obligation  remains
unpaid,  any Letter of Credit remains  outstanding or any Lender is obligated to
extend credit  hereunder,  unless the  Requisite  Lenders  otherwise  consent in
writing the Borrower will, and will cause its Subsidiaries to:







                                       57

          (a)  Compliance  with Laws.  Comply in all material  respects with all
     applicable laws, rules, regulations and orders.

          (b)  Inspection of Property and Books and Records.  Except in the case
     of Inactive Subsidiaries,  (i) maintain proper books of record and account,
     in  which  full,   true  and  correct   entries  in  conformity  with  GAAP
     consistently  applied  shall  be made  of all  financial  transactions  and
     matters involving its assets and business,  and (ii) permit representatives
     of the Agent or any Lender to visit and inspect any of its  properties,  to
     examine its  corporate,  financial  and  operating  records and make copies
     thereof or abstracts  therefrom,  and to discuss its affairs,  finances and
     accounts with its officers,  employees and independent public  accountants,
     all at the expense of the Borrower, in the case of visits or inspections by
     the Agent and,  if an Event of Default is then  continuing,  by any Lender,
     and at such  reasonable  times during normal business hours and as often as
     may  be  reasonably  requested,  upon  reasonable  advance  notice  to  the
     Borrower,  except  that when an Event of  Default  exists  the Agent or any
     Lender may take any such  action at any time during  business  hours and on
     same-day notice.

          (c) Reporting Requirements. Furnish to the Lenders:

               (i) as soon as  available  and in any event  within 50 days after
          the end of each of the first three  Quarters in each fiscal year,  the
          consolidated  balance sheet of the Borrower and its Subsidiaries as at
          the end of such  Quarter and their  consolidated  income and cash flow
          statements for such Quarter and for the fiscal year to date, certified
          by an Authorized Officer;

               (ii) as soon as  available  and in any event within 95 days after
          the end of each  fiscal  year of the  Borrower,  a copy of the  annual
          report  on  Form  10-K  for  such  year  for  the   Borrower  and  its
          Subsidiaries,  containing financial statements for such year certified
          in a manner  acceptable to the Requisite  Lenders by KPMG Peat Marwick
          or other independent  public  accountants  acceptable to the Requisite
          Lenders;

               (iii) as soon as  possible  and in any event  within 10  Business
          Days after becoming aware of any (A) Change of Control or (B) Event of
          Default or Potential Default continuing on the date of such statement,
          a  statement  of an  Authorized  Officer or the office of the  General
          Counsel  of the  Borrower  setting  forth  details  of such  Change of
          Control or Event of Default or Potential Default,  as the case may be,
          and the action  which the Borrower has taken and proposes to take with
          respect thereto;







                                       58

               (iv) promptly after the filing thereof, copies of all reports and
          all  registration  statements for the sale of newly issued stock filed
          with the Securities and Exchange Commission or any national securities
          exchange;

               (v) notice  when,  but in no event later than ten days after,  it
          becomes aware of any Material  Environmental  Claim or the presence of
          any  Hazardous  Material in, on or under any of its  property  that is
          likely   to   prohibit   or   restrict   materially   the   occupancy,
          transferability or use of such property under any Environmental Laws;

               (vi) notice upon, but in no event later than ten days after,  the
          occurrence  of any ERISA  Event  affecting  the  Borrower or any ERISA
          Affiliate, together with (A) a copy of any notice with respect to such
          ERISA Event that may be required to be filed with the PBGC and (B) any
          notice  delivered by the PBGC to the  Borrower or any ERISA  Affiliate
          with respect to such ERISA Event;

               (vii) concurrently with the delivery of the financial  statements
          referred to in clause (i) and (ii) above, a compliance  certificate of
          an  Authorized  Officer in  substantially  the form of Exhibit E-1 (A)
          stating that, to the best of such officer's  knowledge,  the Borrower,
          during such  period,  has  observed or  performed  all  covenants  and
          agreements and satisfied all conditions  required under this Agreement
          to be  observed,  performed  or satisfied by it, and that such officer
          has obtained no knowledge of any Event of Default or Potential Default
          except as  specified  in such  certificate,  (B) showing in detail the
          calculations supporting such statement in respect of Section 5.01, and
          (C) setting forth, and showing in detail the calculations  supporting,
          the Pricing Ratio  determined as of the most recent  Pricing Test Date
          in the period covered by such certificate;

               (viii)  within 50 days after the end of each  Quarter,  a Pricing
          Certificate  setting  forth the Pricing  Ratio as calculated as of the
          last day of such Quarter;

               (ix) prior to the  consummation  of any  acquisition  of a Health
          Care Company or Health Care  Facility for aggregate  consideration  of
          $50,000,000  or  more,  a  term  sheet  describing  such  acquisition;
          provided  that the  Borrower  shall not be  required to deliver a term
          sheet  hereunder  with  respect  to the  First  American  Merger;  and
          promptly, and in any case within 10 Business Days of any such request,
          any additional  information  relating to such  acquisition  reasonably
          requested by the Agent or the Requisite Lenders;

               (x) prior to the consummation of any acquisition of a Health Care
          Company or Health Care Facility for which a pro forma  calculation  of
          the




                                       59

          Interest&Rent Coverage Ratio is required under Section 5.03(c)(xi),  a
          term sheet describing such acquisition, and such pro forma calculation
          of the  Interest&Rent  Coverage Ratio;  and promptly,  and in any case
          within  10  Business  Days  of  any  such  request,   any   additional
          information  relating to such acquisition  reasonably requested by the
          Agent or the Requisite Lenders;

               (xi)  within  10  Business  Days  after the  consummation  of any
          acquisition  of a Health  Care  Company or Health  Care  Facility  for
          aggregate  consideration  of less than $50,000,000 and for which a pro
          forma calculation of the Interest&Rent  Coverage Ratio is not required
          under Section  5.03(c)(xi),  a term sheet describing such acquisition;
          and  promptly,  and in any case  within 10  Business  Days of any such
          request,  any  additional  information  relating  to such  acquisition
          reasonably requested by the Agent or the Requisite Lenders;

               (xii) as soon as possible,  and in any event within five Business
          Days (A) after becoming aware thereof, notice of the occurrence of any
          event that is or would (with the passage of time, notice or both) be a
          default  under or a violation of any Health Care Permit  necessary for
          the lawful  conduct of the business or  operations  of any Loan Party,
          including the  ownership and operation of its Health Care  Facilities,
          and that is or can  reasonably  be  expected  to result in a  Material
          Adverse Change; (B) after receipt thereof, any notice of any violation
          of  applicable  laws that  causes or could  reasonably  be expected to
          cause  any  such  Health  Care  Permit  to  be  modified  (except  for
          modifications  which  do  not  constitute  and  cannot  reasonably  be
          expected  to  result  in a  Material  Adverse  Change),  rescinded  or
          revoked;  and  (C)  after  becoming  aware  thereof,   notice  of  the
          occurrence of any event that constitutes or can reasonably be expected
          to result in a Material Adverse Change;

               (xiii) concurrently with the delivery of the financial statements
          referred to in clause (i) and (ii) above, Schedule 4.01(d), as amended
          to reflect the formation, acquisition or disposition of any Subsidiary
          of the Borrower during the Quarter then ended;

               (xiv) concurrently with the delivery of the financial  statements
          referred to in clause (i) and (ii) above, Schedule 4.01(e), as amended
          to reflect the  acquisition or disposition of any Health Care Facility
          which  is  a  skilled  nursing  facility,  hospital,  assisted  living
          facility or retirement facility during the Quarter then ended;

               (xv) at  least  10  Business  Days  prior  to  entering  into any
          Receivables Sale Program, a written  description of the material terms
          and  provider  of  such  program,   the  method  of  determining   the
          Purchasers'  Aggregate




                                       60

          Net Investment and the  Receivables  Program  Charges of such program,
          the maximum amount of the Purchasers'  Aggregate Net Investment  under
          such program, and the amount and due date of any Facility Reduction or
          repayment required under Section 2.06(e) in respect of such program;

               (xvi)  no later  than the  effective  date of any  change  in the
          Purchasers'  Aggregate  Net  Investment  under  any  Receivables  Sale
          Program,  written  notice of the  amount  and  effective  date of such
          change  and  the  amount  of any  Facility  Reduction  and  prepayment
          required under Section 2.06(e) after giving effect to such change; and

               (xvii)  such  other  information   respecting  the  condition  or
          operations,  financial  or  otherwise,  of the  Borrower or any of its
          Subsidiaries as the Agent or any Lender through the Agent from time to
          time may reasonably request.

          (d)  Preservation  of  Corporate  Existence,  Etc.  Subject to Section
     5.03(i) and except in the case of Inactive  Subsidiaries,  (i) preserve and
     maintain in full force and effect its  corporate or  partnership  existence
     and  good  standing  under  the  laws  of  its  State  or  jurisdiction  of
     incorporation or organization and all rights,  privileges,  qualifications,
     permits,  licenses  and  franchises  necessary  or  desirable in the normal
     conduct  of its  business  (provided  that the  failure  at any one time to
     maintain  Health  Care  Permits  with  respect  to any  three  Health  Care
     Facilities owned or leased by any one or more  Subsidiaries of the Borrower
     shall not  constitute  a failure to comply with this  Section  5.02(d)(i)),
     (ii) use its reasonable efforts, in the ordinary course and consistent with
     past  practice,  to preserve  its  business  organization  and preserve the
     goodwill and business of the customers, suppliers and others doing business
     with it,  and (iii)  preserve  or renew all of its  registered  trademarks,
     trade names and services marks, the  non-preservation  of which constitutes
     or could reasonably be expected to result in a Material Adverse Change.

          (e) New  Subsidiaries.  Promptly,  and in any event within 10 Business
     Days,  of (i) the  formation  or  acquisition  of a new  Subsidiary  of the
     Borrower  (other than an Inactive  Subsidiary),  (ii) the date a Subsidiary
     ceases  to be an  Inactive  Subsidiary,  or (iii)  the  date on  which  any
     Subsidiary of the Borrower that has not executed and delivered a Pledge and
     Security  Agreement  acquires  any stock of or other  equity,  ownership or
     profit  interest in, or debt or liability  of or other claim  against,  any
     other Subsidiary,  (A) notify the Agent of such event; (B) amend Schedule A
     of the relevant  Pledge and Security  Agreement as  appropriate in light of
     such event;  (C) cause such  Subsidiary to execute and deliver a Pledge and
     Security  Agreement  in  substantially  the  form  of  Exhibit  C-3 and all
     financing statements and other documents required thereunder or appropriate
     to perfect the security interest created thereby;  (D) deliver to the Agent
     all  stock  certificates  and  other  instruments  added to the  Collateral
     thereby,  accompanied  by




                                       61

     an undated  stock power or  transfer  document  executed in blank;  and (E)
     cause such  Subsidiary to deliver an executed  counterpart  of the Guaranty
     and  deliver  to the  Agent a  Guarantor  Confirmation  setting  forth  the
     Guarantor Liability Limit as to such Subsidiary.

          (f)  Maintenance  of Property.  Maintain and preserve all its property
     which is  necessary  for use in its  business  in good  working  order  and
     condition,  except  ordinary  wear and tear and except as  permitted  under
     Section  5.03(b),  and use the  standard of care typical in the industry in
     the operation of the Health Care Facilities.

          (g) Insurance. Maintain insurance with financially sound and reputable
     insurers with respect to its properties and business against loss or damage
     of the kinds customarily  insured against by Persons engaged in the same or
     similar  business,  of such types and in such  amounts  as are  customarily
     carried  under  similar  circumstances  by such  other  Persons,  including
     workers' compensation insurance, public liability and property and casualty
     insurance, except that (i) the Borrower shall be permitted to maintain self
     insurance  with respect to health care  benefits  provided to employees and
     with  respect to workers'  compensation  insurance  so long as the Borrower
     also maintains,  with financially sound and reputable  insurers,  stop loss
     insurance  of the type and in  amounts  customarily  maintained  by Persons
     engaged in the same or similar  business as are  customarily  carried under
     similar  circumstances by such other Persons and (ii) insurance need not be
     maintained by or for the benefit of Inactive Subsidiaries.  Upon request of
     the Agent,  the  Borrower  shall  furnish  the Agent,  with copies for each
     Lender, at reasonable intervals (but not more than once per calendar year),
     a certificate of an Authorized Officer (and, if requested by the Agent, any
     insurance  broker of the  Borrower)  setting forth the nature and extent of
     all insurance maintained by the Borrower and its Subsidiaries in accordance
     with this Section  5.02(g) (and which,  in the case of a  certificate  of a
     broker, was placed through such broker).

          (h) Payment of  Obligations.  Pay and discharge all of its obligations
     and liabilities, including:

               (i)  as  they  become  due  and  payable,   all  claims  for  tax
          liabilities, assessments and governmental charges or levies against it
          or upon its properties or assets;

               (ii) as they become due and payable,  all lawful claims which, if
          unpaid,  would,  with the  passage  of time or notice or both,  by law
          become a Lien upon its property;

               (iii)  before   expiration  of  any  period  of  grace  expressly
          provided, all claims for payments due under any lease of a Health Care
          Facility or any equipment therein; and




                                       62

               (iv) before expiration of any period of grace expressly provided,
          all  claims  for  Debts as and when due and  payable  (subject  to any
          subordination  provisions contained in any instrument  evidencing,  or
          indenture or agreement governing, such Debt);

     except  that it may  contest  in good  faith any  claims and may permit the
     claims so contested to remain unpaid during any period,  including appeals,
     when it is in good  faith  contesting  the  same,  so long as (A)  adequate
     reserves  have been  established  to the extent  required  by GAAP or other
     adequate  provision for the payment  thereof has been made, (B) enforcement
     of the contested  claim is  effectively  stayed for the entire  duration of
     such contest,  and (C) any claim  determined  to be due,  together with any
     interest or penalties  thereon,  is paid promptly,  and in any event within
     three Business Days, after resolution of such contest.

          (i) Environmental  Laws.  Conduct its operations and keep and maintain
     its property in  compliance in all material  respects  with all  applicable
     Environmental Laws and Environmental Permits; and prepare at the Borrower's
     sole cost and expense and deliver to the Agent and the Lenders such updates
     as the Agent or the Requisite  Lenders may reasonably  request  relating to
     any Material Environmental Claim.

          (j) Use of Proceeds. Use the proceeds of the Advances first to pay all
     obligations under the Existing Facility and from time to time to retire all
     Funded LC Exposure and other  Obligations then due hereunder and thereafter
     for working  capital,  acquisitions  (provided that any such acquisition is
     approved by the board of  directors  or  equivalent  governing  body of the
     target of such acquisition at the time of the initial offer by the Borrower
     or one or more of its Subsidiaries) and other general corporate purposes of
     the Borrower and its  Subsidiaries  not in contravention of any law or this
     Agreement.

          (k) Health Care Permits and Approvals.  Take all action  necessary (i)
     to maintain in full force and effect all Health Care Permits  necessary for
     the lawful conduct of its business or operations wherever now conducted and
     as planned to be  conducted,  including  the ownership and operation of its
     Health  Care   Facilities,   pursuant  to  all  applicable   laws  and  all
     requirements of Governmental Authorities having jurisdiction over it or any
     part of its  operations;  and (ii) ensure  that all Health Care  Facilities
     owned or leased by it are entitled to participate  in, and receive  payment
     under,  the  appropriate  Medicare,   Medicaid  and  related  reimbursement
     programs,  and any similar state or local  government-sponsored  program to
     the extent  that it has decided to  participate  in any such state or local
     program,  and to receive  reimbursement  from private and commercial payors
     and health  maintenance  organizations  to the extent  applicable  thereto;
     provided  that the failure at any one time to maintain  Health Care Permits
     with respect to any three Health Care Facilities owned or leased by any one
     or more




                                       63

     Subsidiaries  of the Borrower shall not constitute a failure to comply with
     this Section 5.02(k).

          (l) Further  Assurances.  (i) Promptly and in no event later than five
     Business  Days after  becoming  aware  thereof,  notify the  Lenders if any
     written information,  exhibits and reports furnished to the Lenders contain
     any untrue  statement of a material fact or omit to state any material fact
     or any  fact  necessary  to  make  the  statements  contained  therein  not
     misleading  in light of the  circumstances  in which made,  and correct any
     defect  or  error  that  may be  discovered  therein  or in the  execution,
     acknowledgement or recordation of any Loan Document.

        (ii)  Promptly  upon  request  by the  Agent or the  Requisite  Lenders,
     execute, deliver, acknowledge,  file, re-file, register and re-register any
     and all such  further  acts,  security  agreements,  assignments,  estoppel
     certificates,  financing statements and continuations thereof,  termination
     statements, notices of assignment, transfers, certificates,  assurances and
     other  instruments  as the Agent or the  Requisite  Lenders may  reasonably
     require  from time to time in order (A) to carry out more  effectively  the
     purposes of this  Agreement or any other Loan  Document,  (B) to subject to
     the Liens created by any of the Collateral Documents any of the properties,
     rights  or  interests  described  in or  intended  to  be  covered  by  any
     Collateral  Document,  (C) to comply with Section 5.03(1), (D) to establish
     and maintain the validity,  effectiveness,  perfection  and priority of any
     Collateral  Document or any Liens intended to be created thereby, or (E) to
     better assure,  convey,  grant,  assign,  transfer,  preserve,  protect and
     confirm to the Agent and the Lenders the rights granted or now or hereafter
     intended to be granted to the Lenders  under any Loan Document or under any
     other instrument executed in connection therewith.

     SECTION 5.03. Negative Covenants. So long as any Obligation remains unpaid,
any Letter of Credit  remains  outstanding  or any Lender is obligated to extend
credit  hereunder,  without the  written  consent of the  Requisite  Lenders the
Borrower  will not, and will not cause or permit any  Subsidiary of the Borrower
to:

          (a) Liens.  Directly or  indirectly  make,  create,  incur,  assume or
     suffer to exist any Lien upon or with  respect to any part of its  property
     or assets,  whether now owned or  hereafter  acquired,  or become or remain
     bound by any agreement to do so, except:

               (i) any Lien (other than a Lien on the  Collateral)  (A) existing
          on the Closing Date and described in Schedule  5.03(d),  securing Debt
          permitted  under  Section  5.03(d)(ii),  or (B)  granted to secure any
          extension, renewal, refinancing or replacement of any such Debt if (1)
          the  principal  amount  secured  thereby is not  increased and (2) the
          property  subject to the Lien so  granted  is




                                       64

          limited to the property  that was subject to the original Lien and any
          accessions,  fixtures,  improvements or equipment added thereto in the
          ordinary course of business;

               (ii) any Lien created under any Loan Document;

               (iii) any Lien for taxes, fees, assessments or other governmental
          charges which are not delinquent and remain payable without penalty or
          which are being contested as permitted under Section 5.02(h);

               (iv)  any  carriers',  warehousemen's,   mechanics',  landlords',
          materialmen's,  repairmen's  or  other  similar  Lien  arising  in the
          ordinary course of business which is not delinquent or remains payable
          without penalty or which is being contested as permitted under Section
          5.02(h);

               (v) any Lien (other than a Lien imposed by Environmental  Laws or
          by ERISA) on the property of the  Borrower or any of its  Subsidiaries
          imposed by law,  or pledges or deposits  required  by law  pursuant to
          worker's   compensation,   unemployment  insurance  and  other  social
          security legislation;

               (vi) any easement,  right-of-way,  restriction  and other similar
          encumbrance  with  respect to real  property  incurred in the ordinary
          course  of  business  if,  in  the  aggregate,   such  items  are  not
          substantial in amount and do not  constitute and cannot  reasonably be
          expected to result in a Material Adverse Change;

               (vii) any Lien arising out of any  judgment or award  against it,
          if (A)  such  Lien is  being  contested  as  permitted  under  Section
          5.02(h),  (B) there is no material likelihood of the sale,  forfeiture
          or loss of any  part of its  properties,  and (C) such  Lien  does not
          materially  interfere  with  the  use  of  any  material  part  of its
          properties;

               (viii)  any  Lien  on  property  of  a  Person  which  becomes  a
          Subsidiary  after the date of this  Agreement  if such Lien existed at
          the time such Person  became a Subsidiary  of the Borrower and was not
          created in anticipation thereof;

               (ix) any Lien  upon  property  of a  Subsidiary  of the  Borrower
          securing Debt of such Subsidiary  permitted under Section 5.03(d)(iv),
          if with  respect  to such  Lien  each of the  conditions  set forth in
          Section 5.03(d)(iv) is satisfied;




                                       65

               (x) the interest of the purchasers, and their transferees,  under
          any  Receivables  Sale  Program  in  the  accounts  receivable  of the
          Borrower's  Subsidiaries  and  proceeds  thereof and  records  related
          thereto;  provided that the Facility  Reduction required under Section
          2.06(e) is in effect;

               (xi) any Lien upon  property of the  Borrower  or any  Subsidiary
          thereof securing Debt permitted under Section 5.03(d)(iii)(A); and

               (xii) any Lien held by a third party insurance company with which
          the Borrower or any  Subsidiary  thereof has  established  a dedicated
          cash collateral  account and deposited therein an amount not in excess
          of $15,000,000  less the aggregate  amount of any Investments  made by
          the   Borrower  or  any   Subsidiary   thereof   pursuant  to  Section
          5.03(c)(xiii);  provided that such account shall not collateralize any
          obligations  of any Person other than the  Borrower  and  wholly-owned
          Subsidiaries thereof;

     or become or remain  bound by any  agreement  restricting  its  ability  to
     grant,  create,  incur,  assume  or  suffer  to exist any Lien upon or with
     respect  to any  part of its  property  or  assets,  whether  now  owned or
     hereafter  acquired,   except  (A)  restrictions  set  forth  in  the  Loan
     Documents,  (B) restrictions set forth in the Subordinated Debt Indentures,
     (C)  restrictions on the enforcement of junior Liens on property secured by
     a Lien permitted under clauses (i) or (ix) of this Section 5.03(a), if such
     restrictions are enforceable solely by the holder of the Lien so permitted,
     (D) restrictions on the creation of a Lien on the lessee's interest under a
     lease, if such  restrictions  are enforceable  solely by the lessor (or any
     lender to such lessor  providing  financing  secured by  assignment of such
     lease) under such lease,  and (E) restrictions on the creation of a Lien on
     the accounts  receivable  subject to a Receivables  Sale  Program,  and the
     proceeds  thereof and records related  thereto,  if such  restrictions  are
     enforceable  solely by the purchasers  under such  Receivables Sale Program
     and their transferees.

          (b)  Disposition  of  Assets.  Engage in any Asset  Sale or  otherwise
     directly or indirectly sell, assign,  lease, convey,  transfer or otherwise
     dispose of all or any portion of its assets, business or property, or agree
     to do any of the foregoing, except:

               (i) the  disposition  of inventory  or used,  worn-out or surplus
          property or equipment or Permitted  Cash  Investments  in the ordinary
          course of business;

               (ii) the sale of equipment for credit  against the purchase price
          of similar  replacement  equipment  or if the proceeds of the sale are
          reasonably   promptly   applied  to  the  purchase  price  of  similar
          replacement equipment;




                                       66

               (iii) the  disposition  of accounts  receivable of the Borrower's
          Subsidiaries pursuant to a Receivables Sale Program; provided that the
          Facility Reduction required under Section 2.06(e) is in effect;

               (iv)  the sale of  Schedule  1.01(b)  Assets,  so long as (A) the
          entire  consideration for such Asset Sale consists of cash received at
          the closing thereof, (B) the consideration received for such assets is
          not less than the sales price specified  therefor in Schedule  1.01(b)
          and (C) at the time of or after giving  effect to such Asset Sale,  no
          Event of Default or Potential Default exists;

               (v) the sale of Schedule  1.01(c)  Assets  which is made for fair
          market value,  so long as (A) at least 70% of the total  consideration
          for such Asset Sale consists of cash received at the closing  thereof,
          (B) the  Agent  concurrently  acquires,  on the terms set forth in the
          Pledge and Security Agreements,  a legal, valid and perfected security
          interest in any and all non-cash  consideration received in such Asset
          Sale, (C) at the time of or after giving effect to such Asset Sale, no
          Event of Default or Potential  Default  exists,  and (D) if such Asset
          Sale is a Retained  Interest Sale,  then,  after giving effect to such
          transaction  and all  related  transactions,  either (1) the  Retained
          Interest  Criteria shall be met with respect to such  transactions  at
          the time of consummation thereof, or (2) the Partial Disposition Limit
          shall not be exceeded;

               (vi) any other Asset Sale which is made for fair market value, so
          long as (A) the sum of the aggregate  consideration  received pursuant
          to such Asset Sale plus the aggregate  consideration received pursuant
          to all such  other  Asset  Sales  in any  calendar  year is less  than
          $30,000,000,  (B) the Agent  concurrently  acquires,  on the terms set
          forth in the  Pledge  and  Security  Agreements,  a legal,  valid  and
          perfected  security  interest  in any and all  non-cash  consideration
          received in such Asset Sale, (C) at the time of or after giving effect
          to such Asset Sale, no Event of Default or Potential  Default  exists,
          and (D) if such Asset Sale is a Retained  Interest Sale,  then,  after
          giving effect to such transaction and all related transactions, either
          (1) the Retained  Interest  Criteria shall be met with respect to such
          transactions at the time of consummation  thereof,  or (2) the Partial
          Disposition Limit shall not be exceeded; and

               (vii) the sale for fair market value or liquidation of any assets
          acquired or  Investments  made pursuant to Section  5.03(c)(xiii),  so
          long as the entire consideration therefor consists of cash received at
          the closing thereof.

          (c)  Investments.  Directly  or  indirectly  make,  acquire,  carry or
     maintain  any  Investment,  or become or remain  bound by any  agreement to
     make, acquire, carry or maintain any Investment, except:




                                       67

               (i) Investments in Permitted Cash Investments;

               (ii)  Investments in accounts or notes receivable or other claims
          arising  from the sale or lease of goods or services  in the  ordinary
          course of business;

               (iii) Investments by the Borrower in a wholly-owned Subsidiary of
          the  Borrower,  for purposes  related to the  business and  operations
          conducted by such Subsidiary in the ordinary course and not to acquire
          any new business, Health Care Facility or Health Care Company;

               (iv) loans and advances,  in an aggregate amount not greater than
          $10,000,000  in any calendar  year, to employees of the Borrower or of
          any Subsidiary of the Borrower;

               (v)  Investments  held  on the  Closing  Date  and  described  in
          Schedule 5.03(c);

               (vi) loans made to the Borrower,  any wholly-owned  Subsidiary of
          the Borrower or any  Subsidiary  of the Borrower then  satisfying  the
          Retained Interest Criteria by a Subsidiary of the Borrower;

               (vii)  Investments in the construction or improvement of a Health
          Care Facility and other Investments in assets added to property, plant
          or  equipment,  but (A) only if the Hard  Costs  associated  with such
          Investments  are counted as Capital  Expenditures  and (B) excluding a
          purchase or other acquisition of a Health Care Facility;

               (viii)  Investments (A) in the common stock of companies that are
          '34 Act Companies if the aggregate  amount so invested at any one time
          does not exceed $50,000,  or (B) in the stock of Health Care Companies
          that are '34 Act Companies if the aggregate  amount so invested at any
          one  time  does not  exceed  $20,000,000;  provided  that,  except  as
          otherwise  permitted under Sections  5.03(c)(x) and 5.03(c)(xiv),  the
          Borrower  and its  Subsidiaries  shall  not hold more than 4.9% of the
          outstanding stock of any '34 Act Company at any one time;

               (ix)   Investments   in  promissory   notes  and  other  non-cash
          consideration  received in  connection  with any Asset Sale  permitted
          under Section 5.03(b)(v) or Section 5.03(b)(vi);

               (x) Investments in Persons that are not wholly-owned Subsidiaries
          of the Borrower (including, without limitation, joint ventures) and




                                       68

          that are not '34 Act  Companies  at the  time of any such  Investment;
          provided  that (A) the  aggregate  amount of such  Investments  in any
          calendar year shall not exceed (1) $40,000,000  plus the lesser of (x)
          $40,000,000 minus the amount so invested in the prior calendar year or
          (y) $15,000,000,  or (2) in the event that the  Debt/EBITDAR  Ratio is
          less  than 5.50 for two  consecutive  Quarters,  $60,000,000  plus the
          lesser of (x)  $60,000,000  minus the amount so  invested in the prior
          calendar year or (y) $20,000,000; provided, however, that in the event
          that the  Debt/EBITDAR  Ratio is thereafter  greater than 5.50 for any
          two  consecutive  Quarters,  the limitation set forth in subclause (1)
          above shall apply until the Debt/EBITDAR Ratio is again less than 5.50
          for two  consecutive  Quarters;  provided  further  that  neither  the
          Borrower nor any  Subsidiary  thereof shall be obligated to dispose of
          any Investment  permitted  under this clause (A) in the event that the
          aggregate amount of Investments hereunder in any calendar year exceeds
          the  limitation  set  forth in  subclause  (1)  above,  so long as any
          Investments  made in excess of such limitation  were, at the time such
          Investments were made,  permitted under and made within the limitation
          set forth in subclause  (2) above;  (B) any such  Investment  shall be
          made by the Borrower through a wholly-owned Subsidiary of the Borrower
          that (1) is engaged only in activities  related to the Person in which
          such  Investment  is made  and (2)  complies  with the  provisions  of
          Section 5.02(e)  (except that any such Investment  which is a loan may
          be made directly by the Borrower so long as the Borrower complies with
          Section 5.03(1) and Section 5.02(l)), and neither the Borrower nor any
          of its  Subsidiaries  nor any of their  properties  shall be or become
          bound by or subject to any contractual  obligation that is or would be
          violated or put in default by reason of such  compliance  or by reason
          of the  enforcement  of the claims and Liens of the Agent and  Lenders
          arising from such  compliance;  and (C) at the time of or after giving
          effect  to any  such  Investment,  no Event of  Default  or  Potential
          Default exists or would result;  provided further that the Borrower or
          any  Subsidiary  thereof may continue to carry such  Investment in the
          event such Person becomes a '34 Act Company;

               (xi)   Investments   by   existing,   newly-formed   or  acquired
          wholly-owned  Subsidiaries  of the Borrower in one or more Health Care
          Companies or Health Care  Facilities;  provided that (A) the aggregate
          cash portion of the aggregate  consideration  for all such Investments
          shall not exceed an amount  equal to 50% of the Net Cash  Proceeds  of
          Sale of (1) Schedule  1.01(b) Assets,  (2) Schedule 1.01(c) Assets and
          (3) assets sold  pursuant  to Section  5.03(b)(vi);  provided  further
          that,  notwithstanding the foregoing limitations,  the Borrower or any
          wholly-owned  Subsidiary  thereof  may  make  Investments  under  this
          Section  5.03(c)(xi) for consideration  (exclusive of the value of any
          equity interests of the Borrower or such Subsidiary  thereof issued as
          part  of  such  Investments)  of up  to  an  aggregate  for  all  such
          Investments of $150,000,000 if, on a pro forma basis,




                                       69

          after giving effect to any such Investment (including Interest Expense
          arising from Debt  incurred in connection  with any such  Investment),
          the Interest&Rent Coverage Ratio for the 12-month period ending at the
          end of the most recently ended Quarter exceeds:

                  Year                           Minimum Pro Forma Ratio
                  ----                           -----------------------
                  1996                                     1.75
                  1997                                     2.00
                  1998                                     2.25
                  1999                                     2.65
          2000 and thereafter                              3.15

          (B) at the time of or after giving effect to any such  Investment,  no
          Event of Default or Potential Default exists or results;  and (C) each
          entity that becomes a Subsidiary of the Borrower in connection with or
          as a result of any such Investment shall comply with the provisions of
          Section 5.02(e),  and neither the Borrower nor any of its Subsidiaries
          nor any of their  properties shall be or become bound by or subject to
          any  contractual  obligation  that is or would be  violated  or put in
          default by reason of such  compliance or by reason of the  enforcement
          of the claims  and Liens of the Agent and  Lenders  arising  from such
          compliance;

               (xii)  The  First  American  Merger;  provided  that  (A) (x) the
          Settlement   Releases  (as  defined  in  the  First  American   Merger
          Agreement)  shall have been received and (y) the order  confirming the
          plan of reorganization in the bankruptcy  proceeding of First American
          shall be final and  nonappealable and the terms and conditions of such
          order,  plan of  reorganization  and any  amendment,  modification  or
          waiver of any provision of the First American  Merger  Agreement after
          the  date  hereof  shall  be  satisfactory  to the  Agent  in its sole
          discretion; provided further that, to the extent any term or condition
          of any such  order,  plan of  reorganization  or any  such  amendment,
          modification or waiver (x) increases (1) the aggregate  purchase price
          payable by the Borrower or any of its  Subsidiaries in connection with
          such merger,  (2) the cash portion of such  purchase  price payable by
          the Borrower or any of its  Subsidiaries at the closing of such merger
          or  (3)  by  more  than   $10,000,000  the  aggregate  amount  of  any
          obligations  assumed by the  Borrower  or any of its  Subsidiaries  in
          connection  with such  merger,  or (y)  accelerates  the timing of any
          payment of consideration (deferred, contingent or otherwise) in excess
          of  $10,000,000  in the  aggregate  under  the First  American  Merger
          Agreement,  such terms or  conditions or  amendment,  modification  or
          waiver shall be  satisfactory  to the Requisite  Lenders in their sole
          discretion;  (B) at the time of or after  giving  effect  to the First
          American Merger,  no Event of




                                       70

          Default  or  Potential  Default  shall  exist or  result;  and (C) the
          Borrower  shall comply with the  provisions  of Section  5.02(e),  and
          neither  the  Borrower  nor any of its  subsidiaries  nor any of their
          properties  shall be or become bound by or subject to any  contractual
          obligation that is or would be violated or put in default by reason of
          such  compliance  or by reason of the  enforcement  of the  claims and
          Liens of the Agent and Lenders arising from such compliance;

               (xiii) Investments in one or more insurance company  Subsidiaries
          in an aggregate amount not greater than $15,000,000 less the aggregate
          amount of all deposits by the Borrower or any subsidiary  thereof with
          one or more third party insurance companies, and with respect to which
          deposits  Liens  are  permitted  pursuant  to  Section   5.03(a)(xii);
          provided  that  (A)  in  the  case  of  any  such  insurance   company
          Subsidiary,  it shall be formed as an insurance  company  solely to do
          business as such under and in accordance  with all laws,  regulations,
          directives and administrative orders applicable to insurance companies
          in its  jurisdiction of  organization;  (B) no such  Subsidiary  shall
          insure   obligations  of  any  Person  other  than  the  Borrower  and
          wholly-owned  Subsidiaries  thereof;  and (C) the aggregate  potential
          liability of the Borrower and its subsidiaries in connection with such
          Investment  shall not  exceed  the  aggregate  amount  of  Investments
          permitted under this Section 5.03(c)(xiii);

               (xiv) Investments carried or maintained in Affiliates arising out
          of Retained Interest Sales,  including any such Investment  carried or
          maintained in a Person that becomes a '34 Act Company; and

               (xv) The acquisitions described in Schedule 5.03(c)(xv); provided
          that (A) the aggregate cash portion of the  consideration for any such
          acquisition  shall  not  exceed  the  cash  purchase  price  specified
          therefor in Schedule  5.03(c)(xv);  (B) at the time of or after giving
          effect  to any such  acquisition,  no Event of  Default  or  Potential
          Default shall exist or result;  and (C) the Borrower shall comply with
          the provisions of Section 5.02(e), and neither the Borrower nor any of
          its  Subsidiaries nor any of their properties shall be or become bound
          by or  subject  to any  contractual  obligation  that is or  would  be
          violated or put in default by reason of such  compliance  or by reason
          of the  enforcement  of the claims and Liens of the Agent and  Lenders
          arising from such compliance.

          (d) Limitation on Indebtedness.  Directly or indirectly create, incur,
     assume,  guarantee  or  suffer  to  exist,  or  otherwise  become or remain
     directly or indirectly liable with respect to, any Debt, except:

               (i) the Obligations;




                                       71

               (ii) Debt  existing on the Closing Date and described in Schedule
          5.03(d) 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);

               (iii)  any  intercompany  loan  made (A) by the  Borrower  or any
          wholly-owned  Subsidiary thereof to any Person that is a Subsidiary of
          the  Borrower  at the time such loan is made;  provided  that any such
          loan made by the Borrower or any  wholly-owned  Subsidiary  thereof to
          any Person that is a  wholly-owned  Subsidiary  of the Borrower at the
          time such loan is made shall be repayable on demand;  provided further
          that, in the case of any loan to a non-wholly-owned  Subsidiary of the
          Borrower,  (1) the Investment in such loan is permitted  under Section
          5.03(c)  and (2) such loan  shall be  subject  to the  limitations  on
          Investments  provided  for  therein;  or (B) to  the  Borrower  or any
          wholly-owned Subsidiary thereof by any Subsidiary of the Borrower;

               (iv)  Debt (A)  owed by a  Health  Care  Company  acquired  in an
          acquisition permitted under Section 5.03(c)(xi),  Section 5.03(c)(xii)
          or  Section  5.03(c)(xv),  if such Debt was  outstanding  prior to the
          acquisition,  (B)  owed  by a  Subsidiary  of  the  Borrower,  if  the
          Subsidiary makes an acquisition  permitted under Section  5.03(c)(xi),
          Section  5.03(c)(xii) or Section  5.03(c)(xv) and incurs and uses such
          Debt  for  the  purpose  of  paying  the   purchase   price  or  other
          consideration  for the  acquisition,  or (C)  incurred  or used by any
          Subsidiary  of the  Borrower  to  purchase  or  otherwise  acquire any
          equipment for its business,  but such Debt shall be permitted  only if
          and so long as the following conditions are met:

                    (1)  such  Debt (I) may be  secured  only by  assets  of the
               Subsidiary  that  incurred it, (II) may be incurred and owed only
               by a  single  Subsidiary  that,  if it  owes  Debt  of  the  type
               described at (A) and (B) in this clause (iv),  has no significant
               assets except those acquired in such acquisition,  and equipment,
               fixtures  and   improvements   thereon,   replacements   thereof,
               inventory  therefor,  and assets generated by operation  thereof,
               (III) must not be subject to terms that are violated, or pursuant
               to which such Debt is put into default,  by reason of any breach,
               default  or event of default  under any  indenture  or  agreement
               governing  any other Debt or lease binding on the Borrower or any
               of its other Subsidiaries, (IV) must permit the Borrower and such
               Subsidiary  to comply with Section  5.02(e),  and (V) must not be
               violated  or put  into  default  or  require  any  prepayment  or
               repurchase  of such Debt by reason of any change in control  over
               the Borrower or such Subsidiary except, if required by the holder
               of




                                       72

               such Debt despite best efforts by the Borrower to the contrary, a
               right to consent to a change of ownership of such  Subsidiary  if
               such consent may not unreasonably be withheld; and

                    (2) the aggregate principal amount of all such Debt incurred
               at any time after the  Closing  Date and  outstanding  at any one
               time in a particular year must not exceed:

                  Year                                Maximum Amount
                  ----                                --------------
                  1996                                 $45,000,000
                  1997                                 $55,000,000
                  1998                                 $65,000,000
          1999 and thereafter                          $75,000,000

          ; and

               (v) Subordinated  Debt incurred under the 1996  Subordinated Debt
          Indenture,  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 1996 Subordinated Debt Indenture shall be
          (1) substantially similar to the terms and conditions contained in the
          1994  Subordinated  Debt  Indenture  and the  1995  Subordinated  Debt
          Indenture and (2) satisfactory to the Agent in its sole discretion.

          (e)  Transactions  with  Affiliates.  Enter or agree to enter into any
     transaction  with any Affiliate of the Borrower or of any Subsidiary of the
     Borrower except (i) under the Loan Documents or (ii) in the ordinary course
     of business and pursuant to the reasonable  requirements of the business of
     the Borrower or such Subsidiary and upon fair and reasonable  terms no less
     favorable  to the  Borrower or such  Subsidiary  than the  Borrower or such
     Subsidiary  would obtain in a comparable  arm's-length  transaction  with a
     Person  not  an  Affiliate  of  the  Borrower  or  such   Subsidiary.

          (f)  Accommodation  Obligations.  Create,  incur,  assume or suffer to
     exist any Accommodation Obligations except:

               (i)  endorsements  of checks  for  collection  or  deposit in the
          ordinary course of business;




                                       73

               (ii)   Accommodation   Obligations   of  the   Borrower  and  its
          Subsidiaries existing as of the Closing Date and described in Schedule
          5.03(f);

               (iii) the Obligations;

               (iv) a guaranty by the Borrower of Debt of a Subsidiary permitted
          under Section 5.03(d)(iv);

               (v) a guaranty by the Borrower of the obligations of a Subsidiary
          under a lease agreement permitted under Section 5.03(g);

               (vi) a guaranty of the  performance  of the  representations  and
          warranties,  indemnities and servicing commitments of a Subsidiary (A)
          to  the  purchasers   under  a  Receivables  Sale  Program  and  their
          transferees,  (B) contained in any purchase or sale agreement  entered
          into in connection  with any Investment or Asset Sale permitted  under
          this Agreement,  and (C) contained in any management agreement entered
          into in the ordinary course of such Subsidiary's business; and

               (vii) any other  Accommodation  Obligation to the extent the same
          does not cause an Event of Default under Section 5.01(a).

          (g) Leases of Health Care  Facilities.  Enter into or become obligated
     as lessee under any lease of a Health Care Facility, whether or not it is a
     Capital  Lease,  unless (i) the lease is free from  provisions  pursuant to
     which the lease is  violated  or put into  default by reason of any breach,
     default or event of default under any indenture or agreement  governing any
     Debt of,  or other  lease  binding  on,  the  Borrower  or any of its other
     Subsidiaries,  except  another  lease entered into by the same lessor or by
     one of its  Affiliates,  (ii)  the  lease  permits  the  Borrower  and such
     Subsidiary  to  comply  with  Section  5.02(e)  and  does not  include  any
     provision  that is or would be violated or put in default by reason of such
     compliance or by reason of the  enforcement  of the claims and Liens of the
     Agent and Lenders arising from such compliance, and (iii) the lease is free
     from provisions  pursuant to which the lease is or would be violated or put
     into default, or any prepayment would be required,  by reason of any change
     in control of the Borrower or such  Subsidiary  except,  if required by the
     lessor  despite best efforts by the  Borrower to the  contrary,  a right to
     consent to a change of ownership of such Subsidiary if such consent may not
     unreasonably be withheld; provided that at any one time the Borrower or any
     of its  Subsidiaries  may be obligated as a lessee under one or more leases
     of Health  Care  Facilities  not  otherwise  permitted  under this  Section
     5.03(g) so long as the aggregate annual rent payment  obligations under all
     such leases is less than $10,000,000.




                                       74

          (h) Restricted Junior Payments.  Directly or indirectly (i) declare or
     make any  dividend  payment or other  distribution  of assets,  properties,
     cash,  rights,  obligations  or  securities on account of any shares of any
     class of its  capital  stock  or any  other  equity,  ownership  or  profit
     interests;  (ii) purchase, redeem or otherwise acquire for value any shares
     of any class of  capital  stock of, or other  equity,  ownership  or profit
     interests  in, the  Borrower or any of its  Subsidiaries  or any  warrants,
     rights or options to acquire any such shares or interests, now or hereafter
     outstanding;  (iii) enter into any agreement restricting the ability of any
     Subsidiary of the Borrower to declare or make any dividend payment or other
     distribution of assets, properties, cash, rights, obligations or securities
     to its stockholders;  (iv) agree to or permit any amendment or modification
     of, or change in,  any of the terms of the  Subordinated  Debt  Indentures,
     except as contemplated by and pursuant to the Consent Solicitation;  or (v)
     pay,  prepay,  redeem,  or purchase or otherwise  acquire any  Subordinated
     Debt,  or make any deposit to provide  for the payment of any  Subordinated
     Debt when due, or exchange  any  Subordinated  Debt,  or give any notice in
     respect thereof; except that:

               (A) the Borrower may declare and pay cash dividends on its common
          stock,  so long as (1) no Event of  Default  or  Potential  Default is
          continuing  at the time any such dividend is declared or paid or would
          result from the payment and (2) the aggregate  amount of all such cash
          dividends  paid in any one calendar year does not exceed the lesser of
          (x) $0.05 per share and (y) $10,000,000 in the aggregate;

               (B) the  Borrower  from  time to time  may  purchase  outstanding
          shares of the  Borrower's  common stock,  so long as (1) the aggregate
          amount  expended for all such  purchases at any time after the Closing
          Date does not exceed  $20,000,000  (the "PURCHASE  LIMIT") and (2) the
          purchase  is  made in  compliance  with  all  applicable  laws  and no
          Potential  Default or Event of Default exists at the time of, or would
          result from,  any such purchase  (and,  for this purpose,  the amounts
          counted  toward  the  Purchase  Limit  shall not be  reduced  by or on
          account of any subsequent resale of the Borrower's common stock);

               (C) the Borrower  may declare and make any  dividend  payments or
          other distributions  payable solely by the Borrower in common stock of
          the Borrower;

               (D) so long as no Event of Default  exists or would  result,  any
          Subsidiary  may (1) make any  lawful  distribution  to the  holders of
          shares of its stock or other equity, ownership or profit interests and
          (2) purchase,  acquire or retire any such shares or interests that are
          not held by the Borrower or a wholly-owned Subsidiary of the Borrower,
          if the Investment in such shares or




                                       75

          interests  is  permitted  at  the  time  under   Section   5.03(c)(x),
          5.03(c)(xi) or Section 5.03(c)(xii);

               (E)  the   Borrower   may  pay  when  due  the  interest  on  the
          Subordinated Debt if such interest is permitted to be paid at the time
          under the subordination  provisions of the governing Subordinated Debt
          Indenture;

               (F) the Borrower may give notice of a redemption  with respect to
          any issue of  Convertible  Subordinated  Debt,  if and only if (1) the
          purpose of such  notice is to force the  holders  of such  Convertible
          Subordinated Debt to convert their Convertible  Subordinated Debt into
          common stock of the Borrower and (2) at the time of the giving of such
          notice no Event of Default or  Potential  Default has  occurred and is
          continuing;   provided,  however,  that  the  Borrower  may  make  any
          redemption payment by reason of tenders actually made pursuant to such
          notice  only  if  either  (x)  the  conversion  of  such   Convertible
          Subordinated  Debt to common  stock is  underwritten  by a third party
          acceptable  to  the  Agent  and  the  Requisite  Lenders  or  (y)  any
          redemption  payment  required to be made pursuant to such notice would
          not cause  Adjusted  Stockholders'  Equity to be less than Minimum Net
          Worth and no Event of Default or Potential  Default is  continuing  at
          the  time  of,  or  would  exist  after  giving  effect  to,  any such
          redemption payment; and

               (G) so long as no Event of  Default  exists or would  result  and
          unless otherwise prohibited under this Agreement, the 1993 Convertible
          Subordinated  Debt Indenture or the 1995  Subordinated Debt Indenture,
          the   Borrower   may  pay  on  January  1,  2001  and  May  15,  2002,
          respectively, any principal amount then due and payable under the 1993
          Convertible Subordinated Debt Indenture and the 1995 Subordinated Debt
          Indenture.

          (i) Mergers,  Etc. Merge or consolidate with or into or enter into any
     agreement to merge or consolidate with or into any Person except that:

               (i) a  wholly-owned  Subsidiary  of the  Borrower may engage in a
          merger  or  consolidation  with  any  one or more  other  wholly-owned
          Subsidiaries  of  the  Borrower  if  the  surviving  corporation  is a
          wholly-owned  Subsidiary  of the  Borrower  (A) that has  executed the
          Guaranty and (B) all the stock of which is held by the Agent in pledge
          pursuant to the Collateral Documents;

               (ii) a non-wholly-owned  Subsidiary of the Borrower may engage in
          a merger or consolidation with any one or more other non-wholly- owned
          Subsidiaries of the Borrower;  provided that the surviving corporation
          is a Subsidiary  of the  Borrower,  (A) that has executed the Guaranty
          and (B) the stock




                                       76

          of  which,  to the  extent  owned by the  Borrower  or any  Subsidiary
          thereof,  is held by the Agent in pledge  pursuant  to the  Collateral
          Documents;  and provided further that, after giving effect to any such
          merger  or  consolidation,   (1)  the  Borrower  shall,   directly  or
          indirectly,  own  an  equity  interest  in the  surviving  corporation
          substantially  equivalent  in  aggregate  value  to its  prior  equity
          interests in the non-wholly-owned Subsidiaries party to such merger or
          consolidation,  and (2) the  surviving  corporation  shall satisfy the
          Retained Interest Criteria as if such merger or consolidation had been
          a Retained Interest Sale;

               (iii) a  wholly-owned  Subsidiary of the Borrower may engage in a
          merger or  consolidation  in connection with an acquisition  permitted
          under Section  5.03(c)(xi)  or Section  5.03(c)(xii),  but only if the
          surviving corporation is a wholly-owned Subsidiary of the Borrower (A)
          that has  executed the Guaranty and (B) all the stock of which is held
          by the Agent in pledge pursuant to the Collateral Documents; and

               (iv) a  Subsidiary  of the  Borrower  may  engage  in a merger or
          consolidation   if  the  purpose  and  effect  thereof  is  solely  to
          consummate a transaction permitted under Section 5.03(b)(iv),  Section
          5.03(b)(v) or Section 5.03(b)(vi).

          (j)  Capital  Expenditures.   Make  Capital  Expenditures  during  any
     calendar year in an amount in excess of the amount set forth below opposite
     such year:


                    Year                                    Amount
                    ----                                    ------
                    1996                                 $100,000,000
                    1997                                 $ 90,000,000
              1998 and thereafter                        $ 80,000,000

     plus in each  calendar  year the  lesser  of (i)  $10,000,000  and (ii) the
     excess,  if any,  of (A) the amount set forth above for the prior year over
     (B) the Capital Expenditures made in the prior year.

          (k)  Conduct  of  Business.  Engage  in any  business  other  than the
     businesses  of the  Borrower  and its  Subsidiaries  described  in  Section
     4.01(p) and any business or activity substantially similar thereto.

          (l) Unpledged  Assets.  In the case of the  Borrower,  own or hold any
     assets, Investments or property upon which the Agent does not hold a valid,
     perfected  and  sole  Lien as  security  for the  Obligations,  except  (i)
     Investments  permitted under clauses (i) and (iv) of Section 5.03(c),  (ii)
     Investments permitted under Section  5.03(c)(xiii),  but




                                       77

     only  to the  extent  that  the  perfection  of the  Agent's  Lien  on such
     Investments  is  prohibited  by  applicable  law,  (iii)  other  assets and
     property having an aggregate value not greater than  $30,000,000,  and (iv)
     shares of Inactive Subsidiaries.

          (m) Compliance with ERISA. Directly or indirectly (or permit any ERISA
     Affiliate  directly or  indirectly  to) (i)  terminate  any Plan subject to
     Title IV of ERISA so as to result in liability to the Borrower or any ERISA
     Affiliate  in excess of  $2,000,000;  (ii) permit any ERISA Event to exist;
     (iii) make a complete  or partial  withdrawal  (within the meaning of ERISA
     Section 4201) from any  Multiemployer  Plan so as to result in liability to
     the Borrower or any ERISA Affiliate in excess of $2,000,000; or (iv) permit
     the total Unfunded  Pension  Liabilities  (using the actuarial  assumptions
     utilized by the PBGC) for all Pension Plans (other than Pension Plans which
     have no Unfunded Pension Liabilities) to exceed $2,000,000.

          (n) Health Care Permits and Approvals. Engage in any activity that (i)
     is or could reasonably be expected to result in a material default under or
     violation of any Health Care Permit necessary for the lawful conduct of its
     business or  operations  or (ii) causes or could  reasonably be expected to
     cause the loss by any Health Care  Company or Health Care  Facility  owned,
     leased,  managed  or  operated  by it of the right to  participate  in, and
     receive  payment  under,  the  appropriate  Medicare,  Medicaid and related
     reimbursement programs, and any similar state or local government-sponsored
     program to the extent that it has decided to  participate in any such state
     or local program,  or to receive  reimbursement from private and commercial
     payors  and  health  maintenance  organizations  to the  extent  applicable
     thereto;  provided that the failure at any one time to maintain Health Care
     Permits with respect to any three Health Care Facilities owned or leased by
     one or more  Subsidiaries of the Borrower shall not constitute a failure to
     comply with this Section 5.03(n).

          (o) Retained  Interest  Criteria.  Cause,  permit or suffer any of the
     Retained Interest Criteria not to be met and maintained  continuously after
     the consummation of any transaction  permitted under Section  5.03(b)(v)(D)
     or Section  5.03(b)(vi)(D),  for as long as the Retained Interest surviving
     such transaction, or any portion thereof or non-cash proceeds therefrom, is
     held by the Borrower or any of its subsidiaries.

          (p) Payment  Restrictions  Affecting  Subsidiaries.  Cause,  permit or
     suffer  any  Subsidiary  to  become or remain  subject  to any  contractual
     obligation  that  in any  manner  limits  or  restricts  its  right  to pay
     dividends or make  distributions,  whether in cash or in  property,  to its
     stockholders  or to make loans or sell assets to the Borrower or any of its
     Subsidiaries  or to  enter  into  any  other  lawful  transaction  with the
     Borrower or any of its  Subsidiaries,  except  limitations and restrictions
     set forth in the Subordinated Debt Indentures or the Loan Documents.






                                       78


                                   ARTICLE VI

                                EVENTS OF DEFAULT

     SECTION 6.01. Events of Default. If any of the following events ("EVENTS OF
DEFAULT") shall occur and be continuing:

          (a)  Non-Payment of Principal.  The Borrower fails to pay when due any
     principal of any Advance; or

          (b)  Non-Payment  of Interest or Fees.  The Borrower fails to pay when
     due any interest  payable  under  Section  2.07,  any  additional  interest
     payable under Section 2.08, any fee payable under Section 2.04 or any other
     amount payable  hereunder and such failure  continues for five days or such
     other period of grace provided for herein; or

          (c)  Representations  and Warranties.  Any  representation or warranty
     made by any Loan Party under or in connection with any Loan Document proves
     to have been  incorrect  in any  material  respect when made and either (i)
     such   representation   or  warranty   cannot  be  remedied  or  (ii)  such
     representation  or  warranty  continues  to be  incorrect  in any  material
     respect for ten days after either (A) such incorrectness is acknowledged in
     writing  by the  Borrower  or (B)  written  notice  thereof is given to the
     Borrower by the Agent or any Lender; or

          (d) Financial,  Lien and Debt Covenants. The Borrower fails to perform
     or observe  any term,  covenant  or  agreement  set forth in Section  5.01,
     Section 5.03(a) or Section 5.03(d); or

          (e) Reporting and Negative Covenants. The Borrower fails to perform or
     observe any term,  covenant or  agreement  set forth in Section  5.02(c) or
     Section  5.03 (other than  Sections  5.03(a) or 5.03(d))  and such  failure
     continues  for ten days after either (i) it is  acknowledged  in writing by
     the Borrower or (ii) written notice thereof is given to the Borrower by the
     Agent or any Lender; or

          (f)  Covenants.  The  Borrower  or any Loan Party  fails to perform or
     observe any term,  covenant or agreement contained in this Agreement or any
     other  Loan  Document  (other  than  those  specifically   referred  to  in
     subsections  (a),  (b),  (c),  (d) and (e) of this  Section  6.01) and such
     failure  continues  for 30 days  after  either  (i) it is  acknowledged  in
     writing by the  Borrower  or (ii)  written  notice  thereof is given to the
     Borrower by the Agent or any Lender; or




                                       79

          (g) Debt.  The Borrower or any of its  Subsidiaries  (i) fails to pay,
     when  due and  payable  (whether  at the  scheduled  maturity  or upon  any
     required prepayment,  acceleration,  demand or otherwise), any principal of
     or premium or interest  on any Debt  (except  the Notes)  outstanding  in a
     principal amount of at least  $10,000,000,  and such failure  continues for
     longer than the period of grace, if any,  specified for such failure in the
     indenture or agreement  governing  such Debt,  or (ii) commits or permits a
     breach or default under any  financial  test or covenant  which,  under the
     terms of the  indenture or agreement  governing any Debt (except the Notes)
     outstanding  in a principal  amount of at least  $20,000,000,  requires the
     maintenance  of a  specified  net  worth or  working  capital  or any other
     quantifiable measure of financial condition or financial  performance,  and
     such breach or default  continues  for longer than the period of grace,  if
     any, specified for such failure in such indenture or agreement; or any such
     Debt of at  least  $20,000,000  is  declared  to be due and  payable  or is
     required to be prepaid prior to the stated maturity thereof; or

          (h)  Leases.  (i) Except as  otherwise  permitted  pursuant to Section
     5.02(h),  the  Borrower  or any of its  Subsidiaries  (A) fails to make any
     payment  within the period  required  under any  Material  Lease,  and such
     failure  continues for longer than the period of grace,  if any,  specified
     for such failure in such Material Lease, or (B) fails to perform or observe
     any other term, covenant or agreement that (1) is contained in any Material
     Lease and (2) requires the payment of money or can be performed or observed
     by the payment of money,  and such  failure  continues  for longer than the
     period of grace, if any, specified for such failure in such Material Lease;
     or (ii) any Material  Lease is terminated as a result of any failure by the
     Borrower  or any of its  Subsidiaries  to  perform  or  observe  any  term,
     covenant or agreement contained therein; or

          (i) Bankruptcy.  The Borrower or any Material  Subsidiary is generally
     not paying its debts as they become due or admits in writing its  inability
     to pay its debts generally or makes a general assignment for the benefit of
     creditors;  or any proceeding is instituted by or against any Loan Party or
     any Subsidiary of a Loan Party seeking an order for relief under the United
     States Bankruptcy Code or seeking liquidation,  winding up, reorganization,
     arrangement,  adjustment,  protection,  relief, or composition of it or its
     debts or the appointment of a receiver, trustee, custodian or other similar
     official for it or for any  substantial  part of its property under any law
     relating to bankruptcy, insolvency, liquidation or reorganization or relief
     of debtors and either (i) any such relief in any such  proceeding is sought
     or  consented  to by it or an order for any such relief is entered  against
     it, or (ii) any such proceeding  instituted against it remains  undismissed
     and  unstayed  for a period of 60 days;  or any Loan Party or any  Material
     Subsidiary  takes any corporate  action to authorize any of the actions set
     forth above in this Section 6.01(i); or

          (j)  Judgments.  Any  judgment  or order for the  payment  of money is
     rendered against any of the Loan Parties or any of their Subsidiaries in an
     amount in




                                       80

     excess of  $10,000,000  for any  single  judgment  or order or in excess of
     $50,000,000  for all such  judgments  or orders and either (i)  enforcement
     proceedings  are  commenced by any creditor upon such judgment or order and
     not stayed, or (ii) there is any period of 60 consecutive days during which
     a stay of  enforcement  of such  judgment or order,  by reason of a pending
     appeal or otherwise, is not in effect; or

          (k) Guaranty. Any provision of the Guaranty after delivery thereof for
     any reason  ceases to be valid and binding on each Loan Party that is party
     thereto,  or any Loan  Party  shall  repudiate  or  purport  to revoke  the
     Guaranty; or

          (l) Collateral  Documents.  The Collateral  Documents,  after delivery
     thereof  pursuant to Section  3.01,  for any reason (other than pursuant to
     the terms  thereof)  cease to create a valid and perfected  first  priority
     security interest in any material portion of the Collateral purported to be
     covered thereby; or

          (m) ERISA.  (i) The Borrower or any ERISA  Affiliate  fails to satisfy
     its contribution requirements under Section 412(c)(11) of the Code, whether
     or not it has sought a waiver under Section  412(d) of the Code; or (ii) in
     the case of an ERISA Event  involving the withdrawal from a Pension Plan of
     a  "substantial  employer"  (as  defined in Section  4001(a)(2)  or Section
     4062(e) of ERISA), the withdrawing  employer's  proportionate share of that
     Pension Plan's Unfunded  Pension  Liabilities is more than  $2,000,000;  or
     (iii) in the case of an ERISA  Event  involving  the  complete  or  partial
     withdrawal  from a Multiemployer  Plan, the  withdrawing  employer incurs a
     withdrawal liability in an aggregate amount exceeding $2,000,000; or (iv) a
     Plan that is  intended to be  qualified  under  Section  401(a) of the Code
     loses its  qualification,  and with respect to such loss of  qualification,
     the  Borrower  or any ERISA  Affiliate  can  reasonably  be  expected to be
     required  to pay (for  additional  taxes,  payments to or on behalf of Plan
     participants,  or otherwise) an aggregate amount exceeding  $2,000,000;  or
     (v) any  combination  of events  listed in clauses (ii) through (iv) occurs
     that involves a net increase in aggregate Unfunded Pension  Liabilities and
     unfunded liabilities in excess of $5,000,000;

then, and in any such event, the Agent (A) shall at the request, or may with the
consent,  of the  Requisite  Lenders,  by notice to the  Borrower,  declare  the
obligation of each Lender to make Advances and the  obligation of the LC Bank to
issue Letters of Credit to be  terminated,  whereupon  the same shall  forthwith
terminate and the Facility Amount and LC  Subcommitment  shall be  automatically
and permanently  reduced to zero, and (B) shall at the request,  or may with the
consent,  of the  Requisite  Lenders,  by notice to the  Borrower,  declare  the
Advances and all fixed and  contingent  obligations of the Borrower to reimburse
the LC Bank for any  payment  that has been or may be made  under any  Letter of
Credit,  together with all interest  thereon and all other amounts payable under
this Agreement,  to be immediately  due and payable,  and thereupon the Advances
and all such fixed and contingent reimbursement obligations,  interest and other




                                       81

amounts shall become and be immediately  due and payable,  without  presentment,
demand, protest or further notice of any kind, all of which are hereby expressly
waived by the Borrower; provided, however, that if an order for relief under the
United States  Bankruptcy  Code is entered at the request or upon the consent of
the Borrower or  involuntarily  against the Borrower (x) the  obligation of each
Lender to make  Advances and the  obligation  of the LC Bank to issue Letters of
Credit  shall  automatically  be  terminated  and  the  Facility  Amount  and LC
Subcommitment  shall be automatically  and permanently  reduced to zero, and (y)
the Advances and all such fixed and contingent  obligations,  interest and other
amounts shall automatically  become and be immediately due and payable,  without
presentment,  demand, protest or any notice of any kind, all of which are hereby
expressly waived by the Borrower.

     SECTION  6.02.  Rights  Not  Exclusive.  The  rights  provided  for in this
Agreement and the other Loan  Documents are  cumulative and are not exclusive of
any other rights, powers or privileges or remedies provided by law or in equity,
or under any other instrument, document or agreement.


                                   ARTICLE VII

                                    THE AGENT

     SECTION 7.01.  Authorization  and Action.  Each Lender hereby  appoints and
authorizes  the Agent to take such action as agent on its behalf and to exercise
such powers  under this  Agreement  as are  delegated  to the Agent by the terms
hereof,  together with such powers as are reasonably  incidental  thereto. As to
any matters not expressly provided for by this Agreement (including  enforcement
or  collection  of the Notes),  the Agent shall not be required to exercise  any
discretion  or take any action,  but shall be required to act or to refrain from
acting (and shall be fully  protected  in so acting or  refraining  from acting)
upon the instructions of the Requisite  Lenders,  and such instructions shall be
binding upon all Lenders and all holders of Notes;  provided,  however, that the
Agent  shall not be  required  to take any  action  which  exposes  the Agent to
personal liability or which is contrary to this Agreement or applicable law. The
Agent shall not be liable to any Lender if, in accordance with the terms of this
Agreement,  it takes or omits to take any action pursuant to the instructions of
the Requisite Lenders.  The Agent agrees to give to each Lender prompt notice of
each notice given to it by the Borrower pursuant to the terms of this Agreement.
The Agent agrees to perform and discharge the duties and powers  delegated to it
under this Agreement and the other Loan  Documents in accordance  with the terms
hereof and thereof.

     SECTION 7.02. Agent Not Liable. Neither the Agent nor any of its directors,
officers, agents or employees shall be liable for any action taken or omitted to
be taken by it or any of them under or in connection with this Agreement, except
for its or their own gross  negligence or willful  misconduct.  Without limiting
the generality of the  foregoing,  the Agent




                                       82

(i) may  treat  the  payee of any Note as the  holder  thereof  until  the Agent
receives  written  notice of the  assignment or transfer  thereof signed by such
payee and  including  the  agreement of the assignee or  transferee  to be bound
hereby as it would have been if it had been an original Lender party hereto,  in
form satisfactory to the Agent;  (ii) may consult with legal counsel  (including
counsel for the  Borrower),  independent  public  accountants  and other experts
selected  by it and shall not be liable  for any  action  taken or omitted to be
taken  in good  faith  by it in  accordance  with the  advice  of such  counsel,
accountants or experts;  (iii) makes no warranty or representation to any Lender
and shall not be  responsible  to any Lender for any  statements,  warranties or
representations  (whether  written or oral) made in or in  connection  with this
Agreement;  (iv)  shall not have any duty to  ascertain  or to inquire as to the
performance  or observance of any of the terms,  covenants or conditions of this
Agreement on the part of the Borrower or to inspect the property  (including the
books and records) of the Borrower;  (v) shall not be  responsible to any Lender
for  the  due  execution,  legality,  validity,   enforceability,   genuineness,
sufficiency  or value of this  Agreement or any other Loan Document or any other
instrument  or  document  furnished  pursuant  to any Loan  Document  or for the
creation, validity,  enforceability,  sufficiency, value, perfection or priority
of any Lien purported to be granted to the Agent, whether pursuant to any of the
Collateral Documents or otherwise; and (vi) shall incur no liability under or in
respect of this  Agreement by acting upon any notice,  consent,  certificate  or
other  instrument or writing  (which may be by  telecopier,  telegram,  cable or
telex)  believed  by it in good  faith to be  genuine  and signed or sent by the
proper party or parties.

     SECTION 7.03. Rights as Lender. With respect to its commitment and Pro Rata
Share hereunder,  the Advances and Notes held by it and all other rights, claims
and  interests  accorded it as Lender,  Citibank  shall have the same rights and
powers  under this  Agreement  as any other  Lender and may exercise the same as
though it were not the Agent;  and the term "Lender" or "Lenders"  shall include
Citibank in its  individual  capacity.  Citibank and its  Affiliates  may accept
deposits from, lend money to, act as trustee under  indentures of, and generally
engage in any kind of business with, the Borrower,  any of its  Subsidiaries and
any Person who may do business  with or own  securities  of the  Borrower or any
such  Subsidiary,  all as if Citibank were not the Agent and without any duty to
account  therefor to the Lenders.  Any Lender and its respective  Affiliates may
accept  deposits  from,  lend money to, act as trustee under  indentures of, and
generally  engage  in any  kind  of  business  with,  the  Borrower,  any of its
Subsidiaries  and any Person who may do business  with or own  securities of the
Borrower  or any  such  Subsidiary,  all as if such  Lender  were  not a  Lender
hereunder and without any duty to account therefor to the other Lenders.

     SECTION 7.04. Lender Credit Decision. Each Lender acknowledges that it has,
independently  and without reliance upon the Agent or any other Lender and based
on the  financial  statements  referred  to in  Section  4.01(h)  and such other
documents  and  information  as it has deemed  appropriate,  made its own credit
analysis  and  decision  to  enter  into  this   Agreement.   Each  Lender  also
acknowledges that it will,  independently and without reliance upon the Agent or
any  other  Lender  and  based on such  documents  and  information  as it deems




                                       83

appropriate at the time,  continue to make its own credit decisions in taking or
not taking action under this Agreement.

     SECTION 7.05. Indemnification. The Lenders agree to indemnify the Agent (to
the extent not reimbursed by the Borrower)  ratably  according to their Pro Rata
Shares from and against any and all liabilities,  obligations,  losses, damages,
penalties,  actions,  judgments,  suits, costs, expenses or disbursements of any
kind or nature  whatsoever  which may be imposed  on,  incurred  by, or asserted
against the Agent in any way relating to or arising out of this Agreement or the
other  Loan  Documents  or any action  taken or omitted by the Agent  under this
Agreement or the other Loan  Documents;  provided that no Lender shall be liable
for any portion of such liabilities,  obligations,  losses, damages,  penalties,
actions,  judgments,  suits, costs, expenses or disbursements resulting from the
Agent's gross negligence or willful misconduct.  Without limiting the foregoing,
each Lender agrees to reimburse  the Agent  promptly upon demand for its ratable
share of any reasonable  out-of-pocket  expenses (including  reasonable fees and
expenses of counsel)  incurred by the Agent in connection with the  preparation,
execution, delivery, modification, amendment, protection or enforcement (whether
through negotiations,  by legal proceedings,  in bankruptcy or otherwise) of, or
legal advice in respect of rights or  responsibilities  under, this Agreement or
the other Loan  Documents,  to the extent that the Agent is not  reimbursed  for
such expenses by the Borrower.

     SECTION 7.06.  Successor  Agent. The Agent may resign at any time by giving
written notice thereof to the Lenders and the Borrower and may be removed at any
time with or without cause by the Requisite  Lenders.  Upon any such resignation
or removal,  the Requisite Lenders shall,  subject to the written consent of the
Borrower,  which consent shall not be unreasonably withheld or delayed, have the
right to appoint a successor  Agent.  If no  successor  Agent shall have been so
appointed by the Requisite  Lenders,  and shall have accepted such  appointment,
within 30 days after the retiring Agent's giving of notice of resignation or the
Requisite  Lenders' removal of the retiring Agent,  then the retiring Agent may,
on behalf of the Lenders, appoint a successor Agent, which shall be a commercial
bank  organized  under the laws of the United  States of America or of any State
and having total assets of at least $20,000,000,000.  Upon the acceptance of any
appointment as Agent hereunder by a successor Agent,  such successor Agent shall
thereupon succeed to and become vested with all the rights,  powers,  privileges
and duties of the retiring  Agent,  and the retiring  Agent shall be  discharged
from its duties and obligations under this Agreement. After any retiring Agent's
resignation  or removal  hereunder as Agent,  the provisions of this Article VII
shall inure to its benefit as to any actions  taken or omitted to be taken by it
while it was Agent under this Agreement.

     SECTION  7.07.  Release  of  Collateral.  The Agent is  hereby  irrevocably
authorized  to release any Lien granted to or held by the Agent upon (i) any and
all Collateral  when the Facility Amount has been  permanently  reduced to zero,
all Letters of Credit  issued  hereunder  have expired or been  discharged,  all
outstanding Advances and LC Exposure have been repaid, and all other Obligations
that are then due and  payable  and of which the Agent then




                                       84

has written notice  demanding  payment prior to release of Collateral  have been
paid, (ii) any Collateral  constituting  property sold or to be sold or disposed
of as part of or in  connection  with any  disposition  permitted  under Section
5.03(b), or (iii) any Collateral  consisting of an instrument evidencing Debt or
other debt instrument,  if the indebtedness  evidenced  thereby has been paid in
full.  Upon request by the Agent or the Borrower at any time,  each Lender shall
confirm in writing the Agent's  authority to release  Collateral,  or particular
types or items of  Collateral,  as set forth in this  Section  7.07.  Subject to
Section  8.01(g),  the Agent shall not be  obligated  to release any  Collateral
unless it receives such written confirmation from the Requisite Lenders.

     SECTION 7.08.  Release of Guarantor  upon Sale of Stock.  If (i) either (A)
all of the outstanding  shares of capital stock and other equity,  ownership and
profit  interests in any  Guarantor are sold to a Person not an Affiliate of the
Borrower in a transaction which is permitted under Section 5.03(b)(iv),  Section
5.03(b)(v) or Section  5.03(b)(vi) and which is not a Retained  Interest Sale or
(B) the Guarantor Liability Limit of any Guarantor is reduced to zero as part of
a Retained Interest Sale and by reason of a voluntary  reduction of the Facility
Amount  that is elected by the  Borrower at the time and in the manner set forth
in the definition of "Guarantor Liability Limit," and if (ii) the conditions set
forth in Section 5.03(b)(iv),  Section 5.03(b)(v) or Section 5.03(b)(vi), as the
case may be, are met in respect of such  transaction,  then upon  request by the
Agent or the Borrower each Lender shall confirm in writing that the liability of
such Guarantor under the Guaranty is released and discharged effective when such
transaction  is  consummated  and such  requirements  are met,  as set  forth in
Section 2.13 of the Guaranty.  Such  confirmation from the Requisite Lenders (1)
shall  establish  conclusively  that the liability of such  Guarantor  under the
Guaranty is released and discharged as set forth in Section 2.13 of the Guaranty
and (2) may be relied on,  without  further  inquiry,  by the  purchaser in such
transaction and each of its transferees.


                                  ARTICLE VIII

                                  MISCELLANEOUS

     SECTION 8.01.  Amendments.  No amendment or waiver of any provision of this
Agreement or the Notes, nor consent to any departure by the Borrower  therefrom,
shall be effective  unless it is in writing and signed by the Requisite  Lenders
(and any such  waiver  or  consent  shall in any case be  effective  only in the
specific  instance  and  for the  specific  purpose  for  which  given),  but no
amendment,  waiver or consent shall,  unless in writing and signed by the Lender
to be bound or affected thereby, do any of the following:

          (a) change the obligation of such Lender to extend credit hereunder or
     subject such Lender to any additional obligations;




                                       85

          (b) reduce the  principal  of or  interest on the Notes or any fees or
     other  amounts  payable to such  Lender  hereunder  or under any other Loan
     Document;

          (c) postpone any date fixed for any payment  (including  any mandatory
     prepayment) of principal of or interest on any Advances or LC Exposure held
     by such Lender or any fees or other  amounts  payable to such Lender  under
     any Loan Document;

          (d)  waive,   reduce  or  postpone  any  Facility  Reduction  required
     hereunder;

          (e) amend the  definition  of "Facility  Amount,"  "Pro Rata Share" or
     "Requisite Lenders";

          (f)  waive any  Event of  Default  that is  continuing  under  Section
     6.01(a) or 6.01(b) in respect of a payment due to such Lender;

          (g) release any  substantial  portion of the Collateral  other than in
     accordance with the terms of this Agreement;

          (h) release or limit the liability of any Guarantor under the Guaranty
     other than in accordance with the terms of the Guaranty;

          (i) amend Section 2.13, Section 2.17 or Section 6.01(a); or

          (j) amend this Section 8.01;

and (x) no amendment,  waiver or consent shall,  unless in writing and signed by
the Agent in addition to the Lenders required above to take such action,  affect
the rights or duties of the Agent under this  Agreement or any Loan Document and
(y) no amendment,  waiver or consent shall,  unless in writing and signed by the
LC Bank in addition to the Lenders  required  above to take such action,  affect
the rights or duties of the LC Bank under this Agreement.

     SECTION 8.02. Notices.  All notices and other  communications  provided for
hereunder shall be in writing (including telecopier, telegraphic, telex or cable
communication)  and  mailed,   telecopied,   telegraphed,   telexed,  cabled  or
delivered,  if to the Borrower,  at Integrated Health Services,  Inc., 10065 Red
Run Boulevard,  Owings Mills,  Maryland  21117,  Attention:  General Counsel and
Attention:  Eleanor  Harding,  Senior Vice  President,  with a copy to: Hunton &
Williams,  43rd Floor,  MetLife  Building,  200 Park Avenue,  New York, New York
10166, Attention: John R. Fallon, Jr.; if to any Lender, at its Domestic Lending
Office specified opposite its name on Schedule I hereto; and if to the Agent, at
Citibank,  N.A., 399 Park Avenue, New York, New York 10043, Attention:  Margaret
A. Brown,  Vice President,  with a copy to: Shearman & Sterling,  555 California
Street,  20th Floor,  San  Francisco,  California  94104,




                                       86

Attention:  Steven E.  Sherman;  or, as to each party,  at such other address as
shall be designated by such party in a written notice to the other parties.  All
such notices and  communications  shall, when mailed,  telecopied,  telegraphed,
telexed  or cabled,  be  effective  when  deposited  in the  mails,  telecopied,
delivered to the telegraph  company,  confirmed by telex answerback or delivered
to the cable company,  respectively,  except that notices and  communications to
the Agent pursuant to Article II or VII shall not be effective until received by
the Agent.

     SECTION  8.03. No Waiver;  Remedies.  No failure on the part of any Lender,
the LC Bank or the  Agent to  exercise,  and no delay in  exercising,  any right
under any Loan Document shall operate as a waiver thereof;  nor shall any single
or partial  exercise of any such right  preclude  any other or further  exercise
thereof or the exercise of any other right.  The  remedies  herein  provided are
cumulative and not exclusive of any remedies provided by law.

     SECTION 8.04. Costs and Expenses.  The Borrower agrees to pay on demand all
reasonable  costs and  expenses  incurred  by the Agent in  connection  with the
preparation, negotiation, execution, delivery, modification and amendment of the
Loan Documents and the other documents to be delivered under the Loan Documents,
including  the  reasonable  fees and  out-of-pocket  expenses of counsel for the
Agent with  respect  thereto and with  respect to  advising  the Agent as to its
rights and  responsibilities  under the Loan  Documents.  The  Borrower  further
agrees to pay on demand all reasonable costs and expenses,  including reasonable
fees and expenses of attorneys  (including allocable costs of in-house counsel),
accountants, advisors and other experts, incurred by the Agent or the Lenders in
respect of any Event of Default or while any Event of Default is  continuing  or
in connection with the protection,  resolution or enforcement  (whether  through
negotiations,   by  legal  proceedings,  in  bankruptcy  or  otherwise)  of  the
Obligations or the Collateral or any right, remedy,  power, interest or claim of
the Agent or any Lender under any Loan Document.

     SECTION  8.05.  Right  of  Set-off.   Whenever  any  Event  of  Default  is
continuing,  each Lender may at any time or from time to time,  with the consent
of the  Requisite  Lenders but without any prior  notice to the  Borrower or any
other Person,  set off and apply any and all deposits (general or special,  time
or  demand,  provisional  or final) at any time held and other  debt at any time
owing by such  Lender  to or for the  credit  or the  account  of the  Borrower,
whether or not then due, and whether or not then fully secured,  against any and
all  Advances,  LC Exposure  and other  Obligations  then owing to such  Lender,
whether or not then due.  After any such set-off and  application  is made,  the
Lender that made it shall promptly notify the Borrower thereof,  but the failure
to do so shall not affect the validity of the set-off and  application and shall
not expose such Lender to any liability. The Lenders' right of setoff under this
Section 8.05 is cumulative  with and additional to all other rights and remedies
(including other rights of set-off) of the Lenders.

     SECTION 8.06.  Indemnity.  (a) General  Indemnity.  The Borrower shall pay,
defend,  indemnify, and hold each Lender, the Agent, their respective Affiliates
and each of their




                                       87

respective officers, directors, employees, counsel, agents and attorneys-in-fact
(each,  an  "INDEMNIFIED   PERSON")  harmless  from  and  against  any  and  all
liabilities, obligations, losses, damages, penalties, actions, judgments, suits,
costs,  charges,  expenses  or  disbursements  (including  reasonable  fees  and
expenses  of  counsel  and  allocated  costs of  internal  counsel  incurred  in
defending any such action or incurred in enforcing this Section  8.06(a)) of any
kind or nature whatsoever with respect to the execution,  delivery,  enforcement
and   performance  of  this  Agreement  and  any  other  Loan  Document  or  the
transactions  contemplated  herein,  and  with  respect  to  any  investigation,
litigation  or  proceeding  related to this  Agreement  or the  Advances  or the
Letters  of  Credit  or the  use of the  proceeds  thereof,  whether  or not any
Indemnified  Person is a party  thereto (all the  foregoing,  collectively,  the
"INDEMNIFIED  LIABILITIES"),  except that the Borrower  shall have no obligation
hereunder  to any  Indemnified  Person with respect to  Indemnified  Liabilities
arising from the gross  negligence  or willful  misconduct  of such  Indemnified
Person.

     (b) Environmental Indemnity. The Borrower shall pay, defend, indemnify, and
hold harmless each Indemnified  Person from and against any and all liabilities,
obligations,  losses,  damages,  penalties,  actions,  judgments,  suits, costs,
charges,  expenses or disbursements  (including  reasonable fees and expenses of
counsel and the allocated cost of internal counsel), which may be incurred by or
asserted against any Indemnified Person in connection with or arising out of any
pending or threatened  investigation  or  Environmental  Claim arising out of or
related to any acts or  omissions  or any property of the Borrower or any of its
Subsidiaries.  In no event shall any site visit, observation,  or testing by the
Agent or any Lender be a representation  that Hazardous Materials are or are not
present in, on, or under the site, or that there has been or shall be compliance
with any Environmental Law. Neither the Borrower nor any other party is entitled
to rely on any site visit,  observation,  or testing by the Agent or any Lender.
Neither the Agent nor any Lender  owes any duty of care to protect the  Borrower
or any other Person  against,  or to inform the Borrower or any other Person of,
any adverse condition affecting any site or property.

     SECTION 8.07.  Assignments and  Participations.  (a) Permitted  Assignment.
Each Lender may assign to one or more banks or other  entities  all or a portion
of its rights and obligations under this Agreement, but (i) each such assignment
shall be of a constant,  and not a varying,  percentage  of all of the assigning
Lender's rights and obligations under this Agreement, unless otherwise consented
to by the Agent;  (ii) the amount of the commitment and outstanding  Advances of
the assigning Lender being assigned pursuant to each such assignment (determined
as of the date of the Assignment and Acceptance with respect to such assignment)
shall  not  be  less  than  $5,000,000  or the  total  amount  of the  remaining
commitment and outstanding Advances of such Lender, except that an assignment to
an  existing  Lender may be in an amount less than  $5,000,000,  (iii) each such
assignment shall be to an Eligible  Assignee,  and (iv) the parties to each such
assignment  shall  execute  and  deliver to the Agent,  for its  acceptance  and
recording in the Register, an Assignment and Acceptance,  together with any Note
or Notes subject to such assignment and a processing and recordation fee payable
to the Agent of $2,500. Upon such




                                       88

execution, delivery, acceptance and recording, from and after the effective date
specified in each Assignment and Acceptance,  (A) the assignee  thereunder shall
be a party hereto and, to the extent that rights and obligations  hereunder have
been assigned to it pursuant to such Assignment and Acceptance,  have the rights
and  obligations of a Lender  hereunder and (B) the Lender  assignor  thereunder
shall, to the extent that rights and obligations hereunder have been assigned by
it pursuant to such  Assignment  and  Acceptance,  relinquish  its rights and be
released  from its  obligations  under this  Agreement  (and,  in the case of an
Assignment and Acceptance  covering all or the remaining portion of an assigning
Lender's rights and obligations under this Agreement, such Lender shall cease to
be a party hereto).

     (b) Effect of  Assignment.  By executing and  delivering an Assignment  and
Acceptance,  the Lender assignor  thereunder and the assignee thereunder confirm
to and agree with each other and the other parties hereto that (i) other than as
provided in such  Assignment  and  Acceptance,  such  assigning  Lender makes no
representation  or warranty  and assumes no  responsibility  with respect to any
statements,  warranties or  representations  made in or in connection  with this
Agreement or the execution,  legality,  validity,  enforceability,  genuineness,
sufficiency  or value of this  Agreement  or any other  instrument  or  document
furnished   pursuant   hereto  or  as  to  the   Collateral   or  the  validity,
enforceability,  perfection  or priority of any Lien upon the  Collateral;  (ii)
such  assigning  Lender  makes no  representation  or  warranty  and  assumes no
responsibility  with respect to the  financial  condition of the Borrower or the
performance or observance by the Borrower of any of its  obligations  under this
Agreement or any other instrument or document furnished  pursuant hereto;  (iii)
such assignee  confirms that it has received a copy of this Agreement,  together
with copies of the financial  statements referred to in Section 4.01(h) and such
other  documents and  information  as it has deemed  appropriate to make its own
credit analysis and decision to enter into such Assignment and Acceptance;  (iv)
such assignee  will,  independently  and without  reliance upon the Agent,  such
assigning Lender or any other Lender and based on such documents and information
as it shall  deem  appropriate  at the  time,  continue  to make its own  credit
decisions in taking or not taking action under this Agreement; (v) such assignee
confirms  that it is an  Eligible  Assignee;  (vi) such  assignee  appoints  and
authorizes  the Agent to take such action as agent on its behalf and to exercise
such powers  under this  Agreement  as are  delegated  to the Agent by the terms
hereof,  together with such powers as are reasonably  incidental thereto;  (vii)
such assignee  agrees that it will perform in accordance with their terms all of
the  obligations  which  by the  terms  of this  Agreement  are  required  to be
performed by it as a Lender;  and (viii) such assignee  confirms and agrees that
it shall have no greater indemnification rights pursuant to Section 2.16(c) than
its Lender assignor.

     (c) Maintenance of Agreements. The Agent, acting for this purpose (but only
for this purpose) as the agent of the Borrower (and in such capacity neither the
Agent nor any of its directors,  officers,  agents or employees  shall be liable
for any  action  taken or  omitted  to be taken by it or any of them under or in
connection  with  this  Section  8.07(c),  except  for its or  their  own  gross
negligence or willful misconduct),  shall maintain at its address referred to in
Section 8.02 a copy of each Assignment and Acceptance  delivered to and accepted
by it and a  register  for




                                        89

the  recordation  of the names and addresses of the Lenders and the  commitments
and Pro Rata  Shares of, and  principal  amount of the  Advances  owing to, each
Lender from time to time (the "REGISTER").  The entries in the Register shall be
conclusive  and  binding  for  all  purposes,  absent  manifest  error,  and the
Borrower,  the Agent and the  Lenders  shall  treat  each  Person  whose name is
recorded  in the  Register  as a  Lender  hereunder  for  all  purposes  of this
Agreement. The Register shall be available for inspection by the Borrower or any
Lender  at any  reasonable  time and from  time to time  upon  reasonable  prior
notice.

     (d) Procedure. Upon its receipt of an Assignment and Acceptance executed by
an assigning Lender and an assignee Lender  representing  that it is an Eligible
Assignee,  together with any Note or Notes subject to such assignment, the Agent
shall,  if  such  Assignment  and  Acceptance  has  been  completed  and  is  in
substantially  the form of Exhibit E-2 hereto,  (i) accept such  Assignment  and
Acceptance,  (ii) record the information  contained  therein in the Register and
(iii) give prompt  notice  thereof to the  Borrower.  Within five  Business Days
after its  receipt of such  notice,  the  Borrower,  at its own  expense,  shall
execute and deliver to the Agent in exchange for the surrendered Note or Notes a
new Note or Notes to the order of such Eligible  Assignee in an aggregate amount
equal to the interest in the  surrendered  Note or Notes assigned to it pursuant
to such Assignment and Acceptance  and, if the assigning  Lender has retained an
interest in the  surrendered  Note or Notes, a new Note or Notes to the order of
the assigning  Lender in an aggregate  amount equal to the interest so retained.
Such new Note or Notes shall be in an  aggregate  principal  amount equal to the
aggregate principal amount of such surrendered Note or Notes, shall be dated the
effective  date of such  Assignment  and  Acceptance  and shall  otherwise be in
substantially the form of Exhibit A.

     (e)  Participations.  Each  Lender may sell  participations  to one or more
banks or other entities in all or a portion of its rights and obligations  under
this  Agreement,   but  (i)  such  Lender's  obligations  under  this  Agreement
(including its  commitment to the Borrower  hereunder)  shall remain  unchanged,
(ii) such Lender shall remain solely responsible to the other parties hereto for
the performance of such  obligations,  (iii) such Lender shall remain the holder
of any such  Note or Notes  for all  purposes  of this  Agreement,  and (iv) the
Borrower,  the Agent and the other  Lenders  shall  continue  to deal solely and
directly  with  such  Lender  in  connection   with  such  Lender's  rights  and
obligations under this Agreement.

     (f)  Additional  Information.  Any  Lender  may,  in  connection  with  any
assignment or participation or proposed assignment or participation  pursuant to
this Section 8.07,  disclose to the assignee or participant or proposed assignee
or  participant,  any  information  relating to the  Borrower  furnished to such
Lender by or on behalf of the Borrower,  but only if the assignee or participant
or proposed assignee or participant is obligated to preserve the confidentiality
of any  confidential  information  relating to the Borrower  received by it from
such Lender.




                                       90

     (g)  Permitted  Assignments.  Any  Lender  may assign any of its rights and
obligations  under this Agreement to any of its Affiliates  without notice to or
consent of the Borrower or the Agent,  and such Lender or any of its  Affiliates
may assign any of its rights (including,  without limitation,  rights to payment
of  principal  and/or  interest  under the Notes)  under this  Agreement  to any
Federal Reserve Bank without notice to or consent of the Borrower or the Agent.

     SECTION 8.08. Binding Effect. This Agreement shall become effective when it
has been executed by the parties  hereto and the conditions set forth in Section
3.01 have been satisfied and  thereafter  shall be binding upon and inure to the
benefit  of the  Borrower,  the  Agent  and each  Lender  and  their  respective
successors  and assigns,  except that the  Borrower  shall not have the right to
assign its rights  hereunder or any interest  herein  without the prior  written
consent  of each of the  Lenders  and the  Agent.  When  (and  only  when)  this
Agreement becomes effective,  the commitments of the financial institutions that
are party to the Existing  Facility to extend credit under the Existing Facility
shall  be  terminated,  but  all  claims  against  the  Borrower  or  any of its
Subsidiaries  under  or in  respect  of the  Existing  Facility,  and all  Liens
securing  any such claim,  shall  remain in full force and effect until paid and
released as set forth in the payout and release agreement  delivered pursuant to
Section 3.01(g).

     SECTION 8.09. Governing Law; Consent to Jurisdiction; Venue. This Agreement
and the other Loan  Documents  shall be governed by, and construed in accordance
with,  the laws of the State of New York.  Any legal action or  proceeding  with
respect  to any Loan  Document  may be brought in the courts of the State of New
York or of the  United  States for the  Southern  District  of New York,  and by
execution and delivery of this  Agreement,  each of the Borrower,  the Agent and
the  Lenders  consents,  for  itself  and in  respect  of its  property,  to the
jurisdiction  of those courts.  Each of the Borrower,  the Agent and the Lenders
irrevocably waives any objection, including any objection to the laying of venue
or based on the grounds of forum non  conveniens,  which it may now or hereafter
have to the bringing of any action or proceeding in such jurisdiction in respect
of any Loan  Document.  The  Borrower,  the Agent  and the  Lenders  each  waive
personal service of any summons,  complaint or other process,  which may be made
by any other means permitted by New York law.

     SECTION 8.10. Waiver of Jury Trial. THE BORROWER, THE LENDERS AND THE AGENT
WAIVE THEIR RESPECTIVE RIGHTS TO A TRIAL BY JURY OF ANY CLAIM OR CAUSE OF ACTION
BASED UPON OR ARISING  OUT OF OR  RELATED  TO THIS  AGREEMENT  OR ANY OTHER LOAN
DOCUMENT  OR THE  TRANSACTIONS  CONTEMPLATED  HEREBY OR THEREBY  IN ANY  ACTION,
PROCEEDING OR OTHER LITIGATION OF ANY TYPE BROUGHT BY ANY OF THE PARTIES AGAINST
ANY OTHER PARTY OR PARTIES, WHETHER BASED ON CONTRACT, TORT, STATUTORY LIABILITY
OR OTHERWISE.  THE BORROWER, THE LENDERS AND THE AGENT AGREE THAT ANY SUCH CLAIM
OR CAUSE OF ACTION SHALL BE TRIED BY THE COURT WITHOUT A JURY. THIS WAIVER




                                       91

SHALL APPLY TO EACH FUTURE AMENDMENT, RENEWAL, SUPPLEMENT OR MODIFICATION OF ANY
LOAN DOCUMENT AND TO EACH FUTURE LOAN DOCUMENT.

     SECTION  8.11.  Limitation  of  Liability.  No  claim  may be  made  by the
Borrower,  any  Subsidiary of the Borrower,  any Lender,  the Agent or any other
Person  against  the Agent or any other  Lender  or the  Affiliates,  directors,
officers,  employees,  attorneys  or  agents  of any of them  for  any  special,
indirect or  consequential  damages or, to the fullest extent  permitted by law,
for any  punitive  damages in  respect of any claim or cause of action  (whether
based on contract,  tort,  statutory  liability,  or any other ground) based on,
arising out of or related to any Loan Document or the transactions  contemplated
hereby or any act, omission or event occurring in connection therewith,  and the
Borrower (for itself and on behalf of each of its  Subsidiaries),  the Agent and
each Lender hereby waive,  release and agree never to sue upon any claim for any
such damages,  whether such claim now exists or hereafter  arises and whether or
not it is now known or suspected to exist in its favor.

     SECTION 8.12.  Entire  Agreement.  This Agreement,  together with the other
Loan  Documents,  embodies  the entire  Agreement  and  understanding  among the
Borrower,  the Lenders and the Agent and supersedes all prior or contemporaneous
agreements and  understandings of such persons,  verbal or written,  relating to
the subject  matter  hereof and thereof  except for the Fee Letter and any prior
arrangements  made  with  respect  to the  payment  by the  Borrower  of (or any
indemnification  for) any fees,  costs or expenses payable to or incurred (or to
be incurred) by or on behalf of the Agent or any Lender.

     SECTION 8.13. Survival. The Borrower's liability for any and all additional
interest,  fees, taxes,  compensation,  costs, losses,  expense  reimbursements,
indemnification  and other similar  Obligations  arising under any Loan Document
shall survive the expiration or termination of the commitments of the Lenders to
extend credit  hereunder and the repayment and retirement of all Advances and LC
Exposure at any time outstanding hereunder.

     SECTION 8.14. Execution in Counterparts.  This Agreement may be executed in
any  number  of  counterparts  and  by  different  parties  hereto  in  separate
counterparts,  each of which when so executed  shall be deemed to be an original
and all of which taken together shall constitute one and the same agreement.


              [THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK]






                                      S-1

     IN WITNESS  WHEREOF,  the parties  hereto have caused this  Agreement to be
executed by their respective officers thereunto duly authorized,  as of the date
first above written.

                                      INTEGRATED HEALTH SERVICES, INC.


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      CITIBANK, N.A.,
                                           as Administrative Agent and Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      BANK OF AMERICA N.T.&S.A.
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      THE BANK OF NOVA SCOTIA,
                                           as LC Bank, a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:




                                      S-2

                                      CORESTATES BANK, N.A.,
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      CREDIT LYONNAIS
                                          NEW YORK BRANCH,
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      DEUTSCHE BANK AG,
                                           NEW YORK BRANCH AND/OR
                                           CAYMAN ISLANDS BRANCH
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      FIRST UNION NATIONAL BANK OF
                                           NORTH CAROLINA,
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:




                                      S-3

                                      NATIONSBANK, N.A.,
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      PNC BANK, NATIONAL ASSOCIATION,
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      TORONTO DOMINION (TEXAS), INC.,
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      VAN KAMPEN AMERICAN CAPITAL
                                           PRIME RATE INCOME TRUST,
                                           as a Lender and Co-Agent


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:




                                      S-4

                                      CREDITANSTALT CORPORATE
                                           FINANCE, INC.,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      FLEET NATIONAL BANK,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      GENERAL ELECTRIC CAPITAL
                                           CORPORATION,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      HIBERNIA NATIONAL BANK,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:




                                      S-5

                                      AMSOUTH BANK,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      THE BANK OF TOKYO-MITSUBISHI
                                           TRUST COMPANY,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                       THE SANWA BANK, LIMITED,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      SIGNET BANK,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:




                                      S-6

                                      THE SUMITOMO BANK, LIMITED,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:


                                      FIRST AMERICAN NATIONAL BANK,
                                           as a Lender


                                      By: /s/ 
                                         ------------------------------------
                                           Name:
                                           Title:



                        INTEGRATED HEALTH SERVICES, INC.
                             10065 Red Run Boulevard
                          Owings Mills, Maryland 21117


                                September 6, 1996


To the Administrative Agent and
  the Lenders parties to the Revolving
  Credit Agreement referred to below


                  Amendment No. 1 to Revolving Credit Agreement
              Consent of Administrative Agent and Requisite Lenders
              -----------------------------------------------------


Ladies and Gentlemen:

     Reference is made to the revolving  credit  agreement,  dated as of May 15,
1996 (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.

     First  American and IHS have amended the First  American  Merger  Agreement
pursuant to an amendment,  dated as of September 9, 1996 (the "Amendment"),  and
the plan of  reorganization  (the "Plan of  Reorganization")  in the  bankruptcy
proceeding of First  American in order to  incorporate  settlements  among First
American,  the  Health  Care  Financing  Administration  and the  Department  of
Justice.  The  Amendment,  among other  things,  increases  the  purchase  price
potentially  payable by IHS in connection  with the First American Merger by $35
million,  so that the aggregate purchase price could be as high as $312 million.
Copies  of the  Amendment  and the  amended  Plan of  Reorganization  have  been
provided to you under separate cover.

     Pursuant to Section  5.03(c)(xii)(A) of the Credit Agreement,  in order for
IHS to  consummate  the First  American  Merger  pursuant to the First  American
Merger  Agreement,  as  amended  by the  Amendment,  and  the  amended  Plan  of
Reorganization,  (i) the terms and  conditions  of the Amendment and the amended
Plan of Reorganization must be satisfactory to the Agent in its sole discretion,
and (ii) the  terms of the  Amendment  and the  amended  Plan of  Reorganization
relating to the increase in the aggregate purchase price potentially  payable by
IHS in connection  therewith must be  satisfactory  to the Requisite  Lenders in
their sole  discretion.  IHS hereby  requests  that you consent to the terms and
conditions of the Amendment  and the amended Plan of  Reorganization  and to the
consummation of the First American Merger






                                       2

pursuant to the First American  Merger  Agreement,  as amended by the Amendment,
and the amended Plan of Reorganization.

     IHS also  hereby  requests  that you agree (i) to amend the  definition  of
"Debt" in the  Credit  Agreement  by adding  to the end of such  definition  the
proviso ";  provided,  however,  that the  contingent  payments which may become
payable in accordance  with the First American Merger  Agreement,  including any
payments made to the Health Care Financing  Administration  or the Department of
Justice as required under the First American Merger Agreement, in a total amount
not in excess of $162  million,  shall not  consitute  Debt for purposes of this
Agreement";  and (ii) to amend Section  5.03(c)(xii) of the Credit  Agreement by
deleting  in  the  fourth  line  of  such   section  the  words  "be  final  and
nonappealable"  and inserting in their place the words "have been  entered,  and
its effectiveness shall not have been stayed or enjoined in any manner,".

     Please  evidence your  acknowledgement  of and agreement and consent to the
foregoing  by  executing  and  returning  not later  than close of  business  on
September 11, 1996 the three  counterparts  of this  Amendment No. 1 and consent
enclosed herewith to Citicorp Securities,  Inc., 399 Park Avenue, 9th Floor, New
York, New York 10043, Attention: Rosemary Bell. This Amendment No. 1 and consent
shall  become  effective  as of  the  date  first  above  written  when  and  if
counterparts of this Amendment No. 1 and consent shall have been executed by the
Requisite  Lenders and the consent  attached  hereto shall have been executed by
the Guarantors. This Amendment No. 1 and consent is subject to the provisions of
Section 8.01 of the Credit Agreement.

     This  Amendment  No.  1 and  consent  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. 1 and consent.

                                            Very truly yours,

                                            INTEGRATED HEALTH
                                               SERVICES, INC.


                                            By: /s/ 
                                               --------------------------------
                                               Name:
                                               Title:







                                       3

ACKNOWLEDGED, AGREED AND CONSENTED TO as of the date first above written:

CITIBANK, N.A.,
   as Administrative Agent and as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    

BANK OF AMERICA NATIONAL TRUST
   AND SAVINGS ASSOCIATION,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


THE BANK OF NOVA SCOTIA,
   as LC Bank, a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


CORESTATES BANK, N.A.,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    






                                       4

CREDIT LYONNAIS,
   NEW YORK BRANCH,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


DEUTSCHE BANK AG,
   NEW YORK BRANCH AND/OR
   CAYMAN ISLANDS BRANCH,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


FIRST UNION NATIONAL BANK
   OF NORTH CAROLINA,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


NATIONSBANK, N.A.,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    






                                        5

PNC BANK, NATIONAL ASSOCIATION,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


TORONTO DOMINION (TEXAS), INC.,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


VAN KAMPEN AMERICAN CAPITAL
   PRIME RATE INCOME TRUST,
   as a Lender and Co-Agent


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


CREDITANSTALT CORPORATE
   FINANCE, INC.,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    






                                        6

FLEET NATIONAL BANK,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


GENERAL ELECTRIC
   CAPITAL CORPORATION,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


HIBERNIA NATIONAL BANK,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


AMSOUTH BANK OF ALABAMA,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    






                                        7

THE BANK OF TOKYO-MITSUBISHI
   TRUST COMPANY,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


THE SANWA BANK, LIMITED,
  NEW YORK BRANCH
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


SIGNET BANK,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    


THE SUMITOMO BANK, LIMITED,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    






                                        8

FIRST AMERICAN NATIONAL BANK,
   as a Lender


By: /s/                           
   -------------------------------------
   Name:                     
   Title:                    







                                     CONSENT

     The undersigned,  as Guarantors under the Subsidiary Guaranty,  dated as of
May 15, 1996 (the "Guaranty"),  in favor of the Agent for the Lenders parties to
the Credit  Agreement  referred to in the  foregoing  letter waiver and consent,
hereby  consent to such letter  waiver and consent and hereby  confirm and agree
that  notwithstanding  the effectiveness of such letter waiver and consent,  the
Guaranty  is, and shall  continue  to be, in full force and effect and is hereby
confirmed and ratified in all respects.

     ALABAMA SENIOR LIFE CARE, INC.
     ALPINE MANOR, INC.
     AMCARE HEALTH SERVICES, INC.
     AMCARE, INC.
     ARBOR LIVING CENTERS OF FLORIDA, INC.
     ARBOR LIVING CENTERS OF TEXAS, INC.
     ASIA CARE, INC.
     BETHAMY LIVING CENTER MANAGEMENT COMPANY
     BETHAMY LIVING CENTERS LIMITED PARTNERSHIP
     BRIAR HILL, INC.
     BRIARCLIFF NURSING HOME, INC.
     CAMBRIDGE CARE CENTERS, INC.
     CAMBRIDGE GROUP OF INDIANA, INC.
     CAMBRIDGE GROUP OF PENNSYLVANIA, INC.
     CAMBRIDGE GROUP OF TEXAS, INC.
     CARE CENTERS HOLDING, INC.
     CARRIAGE-By: -THE-LAKE OF IHS, INC.
     CEDARCROFT HEALTH SERVICES, INC.
     CENTRAL PARK LODGES, INC.
     CENTRAL PARK LODGES OF WEST PALM BEACH, INC.
     CENTRAL PARK LODGES (TARPON SPRINGS), INC.
     CLARA BURKE NURSING HOME, INC.
     CLAREMONT INTEGRATED HEALTH, INC.
     COMPREHENSIVE POSTACUTE SERVICES, INC.
     DERRY INTEGRATED HEALTH, INC.
     ELIZABELL CO., INC.
     ELM CREEK OF IHS, INC.
     F.L.C. BENEVA NURSING PAVILION, INC.
     F.L.C. SARASOTA NURSING PAVILION, INC.
     FERRIGAN MOBILE X-RAY, INC.
     FIRELANDS OF IHS, INC.
     FLORIDA LIFE CARE, INC.
     FLORIDA LIFE CARE, INC.
     GAINESVILLE HEALTH CARE CENTER, INC.
     GRAVOIS HEALTH CARE, INC.






                                        2

     HEALTH CARE SYSTEMS, INC.
     HEALTHCARE PHARMACY SERVICES OF FLORIDA, INC.
     HEALTHCARE PHARMACY SERVICES OF PENNSYLVANIA, INC.
     HEALTHCARE PHARMACY SERVICES OF TEXAS, INC.
     HOME HEALTH INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT I, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT VII-B, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
     HOSPICE OF INTEGRATED HEALTH SERVICES, INC.
     IHS ACQUISITION XIII, INC.
     IHS AT LANSING, INC.
     IHS OF DANA, INC.
     INTEGRACARE, INC.
     INTEGRATED-BALLARD, INC.
     INTEGRATED HEALTH GROUP LIMITED PARTNERSHIP
     INTEGRATED HEALTH OF LOCUST VALLEY ROAD, INC.
     INTEGRATED HEALTH OF WATERFORD COMMONS, INC.
     INTEGRATED HEALTH SERVICES AT ALEXANDRIA, INC.
     INTEGRATED HEALTH SERVICES AT BIG SAIL, INC.
     INTEGRATED HEALTH SERVICES AT BLUE RIDGE MANOR, INC.
     INTEGRATED HEALTH SERVICES AT BRIARCLIFF HAVEN, INC.
     INTEGRATED HEALTH SERVICES AT CADIZ, INC.
     INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA, INC.
     INTEGRATED HEALTH SERVICES AT CHEYENNE, INC.
     INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS, INC.
     INTEGRATED HEALTH SERVICES AT COLUMBUS, INC.
     INTEGRATED HEALTH SERVICES AT DAYTON, INC.
     INTEGRATED HEALTH SERVICES AT DRIFTWOOD, INC.
     INTEGRATED HEALTH SERVICES AT EASTERN MASSACHUSETTS, INC.
     INTEGRATED HEALTH SERVICES AT GRANDVIEW CARE CENTER, INC.
     INTEGRATED HEALTH SERVICES AT GREAT BEND, INC.
     INTEGRATED HEALTH SERVICES AT HOPEDALE, INC.
     INTEGRATED HEALTH SERVICES AT HOUSTON, INC.
     INTEGRATED HEALTH SERVICES AT INDIAN CREEK, INC.
     INTEGRATED HEALTH SERVICES AT KEN, INC.
     INTEGRATED HEALTH SERVICES AT NEWARK, INC.
     INTEGRATED HEALTH SERVICES AT ORMOND BEACH, INC.
     INTEGRATED HEALTH SERVICES AT PARK REGENCY, INC.
     INTEGRATED HEALTH SERVICES AT PENN, INC.
     INTEGRATED HEALTH SERVICES AT SILVERCREST, INC.
     INTEGRATED HEALTH SERVICES AT SOMERSET VALLEY, INC.
     INTEGRATED HEALTH SERVICES AT SOUTHERN HILLS, INC.
     
     
     

     
     
                                        3
     
     INTEGRATED HEALTH SERVICES AT STEUBENVILLE
     INTEGRATED HEALTH SERVICES AT SYCARMORE CREEK, INC.
     INTEGRATED HEALTH SERVICES AT THREE RIVERS, INC.
     INTEGRATED HEALTH SERVICES AT TREYBURN, INC.
     INTEGRATED HEALTH SERVICES FINANCIAL HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES NPR, INC.
     INTEGRATED HEALTH SERVICES OF ARCADIA, INC.
     INTEGRATED HEALTH SERVICES OF ATHENS, INC.
     INTEGRATED HEALTH SERVICES OF BRENTWOOD, INC.
     INTEGRATED HEALTH SERVICES OF CALIFORNIA, INC.
     INTEGRATED HEALTH SERVICES OF CLIFF MANOR, INC.
     INTEGRATED HEALTH SERVICES OF COLORADO AT CHERRY CREEK,
     INC.
     INTEGRATED HEALTH SERVICES OF EAGLE CREEK, INC.
     INTEGRATED HEALTH SERVICES OF GREEN BRIAR, INC.
     INTEGRATED HEALTH SERVICES OF HERITAGE MANOR, INC.
     INTEGRATED HEALTH SERVICES OF HICKORY CREEK, INC.
     INTEGRATED HEALTH SERVICES OF INDIAN HILLS, INC.
     INTEGRATED HEALTH SERVICES OF JACKSONVILLE, INC.
     INTEGRATED HEALTH SERVICES OF KURT, INC.
     INTEGRATED HEALTH SERVICES OF LESTER, INC.
     INTEGRATED HEALTH SERVICES OF MELISSA, INC.
     INTEGRATED HEALTH SERVICES OF MISSOURI, INC.
     INTEGRATED HEALTH SERVICES OF ORANGE PARK, INC.
     INTEGRATED HEALTH SERVICES OF RIVERBEND, INC.
     INTEGRATED HEALTH SERVICES OF SCENIC HILLS, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW II, INC.
     INTEGRATED LIVING COMMUNITIES AT DENTON (MARYLAND), INC.
     INTEGRATED LIVING COMMUNITIES OF SARASOTA, INC.
     INTEGRATED LIVING COMMUNITIES RETIREMENT MANAGEMENT, INC.
     INTEGRATED MANAGEMENT-CARRINGTON PONTE, INC.
     INTEGRATED MANAGEMENT-GOVERNOR'S PARK, INC.
     INTEGRATED OF AMARILLO, INC.
     INTEGRATED PHYSICIAN GROUP SERVICES, INC.
     ISABETH CO., INC.
     LPC BETHAMY HEALTH CORPORATION
     MANCHESTER INTEGRATED HEALTH, INC.
     MOBILE RAY OF NEW ORLEANS, INC.
     MOUNTAIN VIEW NURSING CENTER, INC.
     NEW SOUTHWOOD ASSOCIATES, INC.
     PALESTINE NURSING CENTER, INC.
     
     
     

     
     
                                        4
     
     PALESTINE NURSING CENTER, INC.
     PATIENT CARE PHARMACY, INC.
     PATIENT CARE PHARMACY - COLORADO SPRINGS, INC.
     PHARMACEUTICAL DOSE SERVICE, INC.
     PINELLAS PARK NURSING HOME, INC.
     PROFESSIONAL REVIEW NETWORK, INC.
     REHAB MANAGEMENT SYSTEMS, INC.
     REST HAVEN NURSING CENTERS, INC.
     REST HAVEN NURSING CENTERS (CHESTNUT HILL), INC.
     REST HAVEN NURSING CENTERS (WHITEMARSH), INC.
     RIKAD PROPERTIES, INC.
     SAMARITAN CARE, INC.
     SAMARITAN CARE, INC.
     SAMARITAN MANAGEMENT, INC.
     SENIOR LIFE CARE, INC.
     SENIOR LIFE CARE OF CALIFORNIA, INC.
     SENIOR LIFE CARE OF LOUISIANA, INC.
     SENIOR LIFE CARE OF OKLAHOMA, INC.
     SENIOR LIFE CARE OF TENNESSEE, INC.
     SENIOR LIFE CARE OF TEXAS, INC.
     SLC COMMUNITY CARE, INC.
     SOUTHWOOD HOLDINGS, INC.
     SPRING CREEK OF IHS, INC.
     SYMPHONY ANCILLARY SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 1, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 2, INC.
     SYMPHONY HEALTH CARE CONSULTING, INC.
     SYMPHONY HEALTH SERVICES, INC.
     SYMPHONY HOME CARE SERVICES, INC.
     SYMPHONY HOME CARE SERVICES NO. 1, INC.
     SYMPHONY HOME CARE SERVICES NO. 2, INC.
     SYMPHONY HOME CARE SERVICES NO. 3, INC.
     SYMPHONY HOME CARE SERVICES NO. 4, INC.
     SYMPHONY HOME CARE SERVICES NO. 5, INC.
     SYMPHONY HOME CARE SERVICES NO. 6, INC.
     SYMPHONY HOME CARE SERVICES NO. 7, INC.
     SYMPHONY HOME CARE SERVICES NO. 8, INC.
     SYMPHONY HOME CARE SERVICES NO. 9, INC.
     SYMPHONY HOME CARE SERVICES NO. 10, INC.
     SYMPHONY HOME CARE SERVICES NO. 11, INC.
     SYMPHONY HOME CARE SERVICES NO. 12, INC.
     SYMPHONY HOME CARE SERVICES NO. 13, INC.






                                        5


     SYMPHONY HOME CARE SERVICES NO. 14, INC.
     SYMPHONY HOME CARE SERVICES NO. 15, INC.
     SYMPHONY HOME CARE SERVICES NO. 16, INC.
     SYMPHONY HOME CARE SERVICES NO. 17, INC.
     SYMPHONY HOME CARE SERVICES NO. 100, INC.
     SYMPHONY HOME CARE SERVICES NO. 101, INC.
     SYMPHONY HOME CARE SERVICES NO. 102, INC.
     SYMPHONY HOME CARE SERVICES NO. 103, INC.
     SYMPHONY HOME CARE SERVICES NO. 104, INC.
     SYMPHONY HOME CARE SERVICES NO. 105, INC.
     SYMPHONY HOME CARE SERVICES NO. 106, INC.
     SYMPHONY HOME CARE SERVICES NO. 107, INC.
     SYMPHONY HOME CARE SERVICES NO. 108, INC.
     SYMPHONY HOME CARE SERVICES NO. 109, INC.
     SYMPHONY HOME CARE SERVICES NO. 110, INC.
     SYMPHONY HOME CARE SERVICES NO. 113, INC.
     SYMPHONY HOME CARE SERVICES NO. 114, INC.
     SYMPHONY HOME CARE SERVICES NO. 115, INC.
     SYMPHONY HOME CARE SERVICES NO. 116, INC.
     SYMPHONY HOME CARE SERVICES NO. 117, INC.
     SYMPHONY HOME CARE SERVICES NO. 118, INC.
     SYMPHONY HOME CARE SERVICES NO. 119, INC.
     SYMPHONY HOME CARE SERVICES NO. 120, INC.
     SYMPHONY HOME CARE SERVICES NO. 121, INC.
     SYMPHONY HOME CARE SERVICES NO. 122, INC.
     SYMPHONY PHARMACY SERVICES, INC.
     SYMPHONY REHABILITATION SERVICES, INC.
     SYMPHONY REHABILITATION SERVICES NO. 1, INC.
     SYMPHONY REHABILITATION SERVICES NO. 2, INC.
     SYMPHONY REHABILITATION SERVICES NO. 3, INC.
     SYMPHONY REHABILITATION SERVICES NO. 4, INC.
     SYMPHONY RESPIRATORY SERVICES, INC.
     TEXAS LPC, INC.
     WEST COAST CAMBRIDGE, INC.
     WOODRIDGE CONVALESCENT CENTER, INC.


     By: /s/ 
        ---------------------------------
        Name:
        Title:
             of Each Guarantor or of the
             General Partner of such Guarantor




                        INTEGRATED HEALTH SERVICES, INC.
                             10065 Red Run Boulevard
                          Owings Mills, Maryland 21117


                                November 8, 1996


To the Administrative Agent and
  the Lenders parties to the Revolving
  Credit Agreement referred to below


                  Amendment No.2 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 (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 acquire Coram Healthcare  Corporation ("Coram") pursunt
to an  Agreement  and Plan of Merger  entered  into as of October  19, 1996 (the
"Merger Agreement") and in connection therewith has requested that the Requisite
Lenders  agree to amend certain  covenants  contained in Article V of the Credit
Agreement to permit such  acquisition.  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) Section  5.03(c) is amended by  deleting  the period at the end of
     subsection (xv) thereof and substituting  therefor "; and" and adding a new
     subsection (xvi) following such subsection (xv) to read as follows:

               "(xvi) The merger  pursuant to the  Agreement  and Plan of Merger
               ('Merger  Agreement')  entered  into as of October 19, 1996 among
               Coram  Healthcare  Corporation  ('Coram'),  the  Borrower and IHS
               Acquisition XIX, Inc. (the 'Coram Merger'), provided that (A) any
               amendment or modification of such Merger Agreement after November
               8,1996 which increases the Debt assumed






                                        2

               thereunder by the Borrower or any of its Subsidiaries or the cash
               consideration  payable by the Borrower or any of its Subsidiaries
               in  connection  therewith  in  excess  of  $10,000,000  shall  be
               satisfactory to the Requisite  Lenders in their sole  discretion,
               (B) at the time of or after giving effect to the Coram Merger, no
               Event of Default or Potential  Default  shall exist or result and
               (C) the  Borrower  shall  comply with the  provisions  of Section
               5.02(e), and neither the Borrower nor any of its Subsidiaries nor
               any of their properties shall be or become bound by or subject to
               any contractual obligation that is or would be violated or put in
               default  by  reason  of  such  compliance  or by  reason  of  the
               enforcement  of the claims and Liens of the Agent and the Lenders
               arising from such compliance."

          (b) 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) In connection  with the Coram Merger,  (A) Debt owed by the
               Borrower to Coram Funding, Inc. ('Coram Funding') in an aggregate
               principal  amount not in excess of the amount equal to the sum of
               $172,300,000  plus  interest  at the rate of 11% per  annum  from
               January 1, 1997 to the date of the  cloisng  of the Coram  Merger
               divided by 0.98625 and which shall mature in full no earlier than
               the tenth  anniversary of its issuance,  bear interest at rate no
               greater  than  11%  per  annum,  have  subordination  provisions,
               covenants  and other terms and  conditions  identical to those in
               the 1996 Subordinated  Debt Indenture (except certain  exceptions
               thereto as set forth in the  Agreement  dated as of  October  19,
               1996  between  the  Borrower  and  Coram  Funding)  and  have  no
               scheduled principal payments until maturity, and (B) Debt owed by
               Coram to MedPartners,  Inc. in an aggregate  principal amount not
               in excess of  $52,687,000  (plus an amount  equal to the  accrued
               interest  from  September 30, 1996 through the date of closing of
               the Coram  Merger  on the 7%  Convertible  Subordinated  Notes of
               Coram  to  Caremark   Inc.  due  October  1,  2005  and  the  12%
               Non-Convertible Subordinated Notes of Coram to Caremark, Inc. due
               October  1,  2005) and which  shall  mature no  earlier  than the
               second anniversary of its issuance and bear interest at a rate no
               greater  that the  lesser  of (1) 8% per  annum  or (2)  one-half
               percent below the interest rate in effect from time to time under
               this Agreement."

     This  Amendment  shall become  effective 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, (B) an amendment fee for the
ratable  account of each  Lender in an  aggregate  amount  equal to .0005 of the
Facility Amount and the supplemental fee as set forth in a letter dated November
8, 1996 from the






                                        3

Agent to IHS (the "Agent's Letter") and (C) counterparts of the Consent appended
hereto (the "Consent"),  executed by each Guarantor. In addition, this Amendment
shall be of no force or effect if (i) the Agent  does not  receive  on or before
the date of the  closing  of the  acquisition  of Coram  pursuant  to the Merger
Agreement  an  additional  fee for the  ratable  account  of each  Lender  in an
aggregate amount equal to .001375 of the Facility Amount and (ii) the Agent does
not receive  the  additional  fee as set forth in the Agent's  Letter by the due
date therefor.

          IHS represents and warrants as follows:

          (a) IHS is duly organized, validly existing and in good standing 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.

     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 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.







                                        4


     Please evidence your  acknowledgement  of and agreement to the foregoing by
executing  and  returning  not later than close of business on November 13, 1996
the three  counterparts of this Amendment No. 2 and consent enclosed herewith to
Citicorp Securities, Inc., 399 Park Avenue, 9th Floor, New York, New York 10043,
Attention:  Rosemary  Bell.  This  Amendment No. 2 and consent is subject to the
provisions of Section 8.01 of the Credit Agreement.

     This  Amendment  No.  2 and  consent  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. 2 and consent.

                                               Very truly yours,

                                               INTEGRATED HEALTH
                                                  SERVICES, INC.


                                               By: /s/ 
                                                  ------------------------------
                                                  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: /s/ 
   -------------------------------------
   Name:
   Title:


BANK OF AMERICA NATIONAL TRUST
   AND SAVINGS ASSOCIATION,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:





                                        5


THE BANK OF NOVA SCOTIA,
   as LC Bank, a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


CORESTATES BANK, N.A.,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


CREDIT LYONNAIS,
   NEW YORK BRANCH,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


DEUTSCHE BANK AG,
   NEW YORK BRANCH AND/OR
   CAYMAN ISLANDS BRANCH,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        6


FIRST UNION NATIONAL BANK
   OF NORTH CAROLINA,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


NATIONSBANK, N.A.,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


PNC BANK, NATIONAL ASSOCIATION,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


TORONTO DOMINION (TEXAS), INC.,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        7


VAN KAMPEN AMERICAN CAPITAL
   PRIME RATE INCOME TRUST,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


CREDITANSTALT CORPORATE
   FINANCE, INC.,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


By: /s/ 
   -------------------------------------
   Name:
   Title:


FLEET NATIONAL BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


GENERAL ELECTRIC
   CAPITAL CORPORATION,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:





                                        8


HIBERNIA NATIONAL BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


AMSOUTH BANK OF ALABAMA,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


THE BANK OF TOKYO-MITSUBISHI
   TRUST COMPANY,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


THE SANWA BANK, LIMITED,
  NEW YORK BRANCH
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        9


SIGNET BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


THE SUMITOMO BANK, LIMITED,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


FIRST AMERICAN NATIONAL BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:









                                       10

ALLIED IRISH BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


PROVIDENT BANK OF MARYLAND,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


BANK OF AMERICA ILLINOIS
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:








                                     CONSENT

     The undersigned,  as Guarantors under the Subsidiary Guaranty,  dated as of
May 15, 1996 (the "Guaranty"),  in favor of the Agent for the Lenders parties to
the Credit Agreement referred to in the foregoing Amendment No. 2 hereby consent
to such  Amendment No. 2 and hereby confirm and agree that  notwithstanding  the
effectiveness  of such  Amendment No. 2, the Guaranty is, and shall  continue to
be, in full  force  and  effect  and is hereby  confirmed  and  ratified  in all
respects.

     ABC GP, INC.
     ABC HOME HEALTH AND HOSPICE OF ALBANY, INC.
     ABC HOME HEALTH AND HOSPICE OF ATHENS, INC.
     ABC HOME HEALTH AND HOSPICE OF BRUNSWICK, INC.
     ABC HOME HEALTH AND HOSPICE OF DUBLIN, INC.
     ABC HOME HEALTH AND HOSPICE OF MACON, INC.
     ABC HOME HEALTH AND HOSPICE OF SAVANNAH, INC.
     ABC HOME HEALTH AND HOSPICE OF TIFTON, INC.
     ABC HOME HEALTH AND HOSPICE OF VIDALIA, INC.
     ABC HOME HEALTH AND HOSPICE OF WAYCROSS, INC.
     ABC HOME NURSING, INC.
     ABC NEWCO, INC.
     ABC PHARMACEUTICALS, INC.
     ALABAMA SENIOR LIFE CARE, INC.
     ALPINE MANOR, INC.
     AMCARE HEALTH SERVICES, INC.
     AMCARE, INC.
     ARBOR LIVING CENTERS OF FLORIDA, INC.
     ARBOR LIVING CENTERS OF TEXAS, INC.
     ASIA CARE, INC.
     BETHAMY LIVING CENTER MANAGEMENT COMPANY
     BETHAMY LIVING CENTERS LIMITED PARTNERSHIP
     BRIAR HILL, INC.
     BRIARCLIFF NURSING HOME, INC.
     CAMBRIDGE CARE CENTERS, INC.
     CAMBRIDGE GROUP OF INDIANA, INC.
     CAMBRIDGE GROUP OF PENNSYLVANIA, INC.
     CAMBRIDGE GROUP OF TEXAS, INC.
     CARE CENTERS HOLDING, INC.
     CARRIAGE-By-THE-LAKE OF IHS, INC.
     CEDARCROFT HEALTH SERVICES, INC.
     CENTRAL PARK LODGES, INC.
     CENTRAL PARK LODGES OF WEST PALM BEACH, INC.
     CENTRAL PARK LODGES (TARPON SPRINGS), INC.
     CLARA BURKE NURSING HOME, INC.







     CLAREMONT INTEGRATED HEALTH, INC.
     COMPREHENSIVE POSTACUTE SERVICES, INC.
     DERRY INTEGRATED HEALTH, INC.
     ELIZABELL CO., INC.
     ELM CREEK OF IHS, INC.
     F.L.C. BENEVA NURSING PAVILION, INC.
     F.L.C. SARASOTA NURSING PAVILION, INC.
     FERRIGAN MOBILE X-RAY, INC.
     FIRELANDS OF IHS, INC.
     FIRST AMERICAN HOME CARE OF ALABAMA, INC.
     FIRST AMERICAN HOME CARE OF ARKANSAS, INC.
     FIRST AMERICAN HOME CARE OF CALIFORNIA, INC.
     FIRST AMERICAN HOME CARE OF COLORADO, INC.
     FIRST AMERICAN HOME CARE OF FLORIDA, INC.
     FIRST AMERICAN HOME CARE OF FT. LAUDERDALE, INC.
     FIRST AMERICAN HOME CARE OF GEORGIA, INC.
     FIRST AMERICAN HOME CARE OF ILLINOIS, INC.
     FIRST AMERICAN HOME CARE OF INDIANA, INC.
     FIRST AMERICAN HOME CARE OF LOUISIANA, INC.
     FIRST AMERICAN HOME CARE OF MICHIGAN, INC.
     FIRST AMERICAN HOME CARE OF MISSISSIPPI, INC.
     FIRST AMERICAN HOME CARE OF MISSOURI, INC.
     FIRST AMERICAN HOME CARE OF NAPLES, INC.
     FIRST AMERICAN HOME CARE OF NEBRASKA, INC.
     FIRST AMERICAN HOME CARE OF NEW MEXICO, INC.
     FIRST AMERICAN HOME CARE OF NORTH CAROLINA, INC.
     FIRST AMERICAN HOME CARE OF PENNSYLVANIA, INC.
     FIRST AMERICAN HOME CARE OF OHIO, INC.
     FIRST AMERICAN HOME CARE OF OKLAHOMA, INC.
     FIRST AMERICAN HOME CARE OF SOUTH CAROLINA, INC.
     FIRST AMERICAN HOME CARE OF TENNESSEE, INC.
     FIRST AMERICAN HOME CARE OF TEXAS, INC.
     FIRST AMERICAN HOME CARE OF VALDOSTA, INC.
     FIRST AMERICAN HOME CARE OF VIRGINIA, INC.
     FIRST AMERICAN HOME CARE OF WEST VIRGINIA, INC.
     FIRST AMERICAN INTERNATIONAL, INC.
     FLORIDA LIFE CARE, INC.
     GAINESVILLE HEALTH CARE CENTER, INC.
     GRAVOIS HEALTH CARE, INC.
     HEALTH CARE SYSTEMS, INC.
     HEALTHCARE PHARMACY SERVICES OF FLORIDA, INC.
     HEALTHCARE PHARMACY SERVICES OF PENNSYLVANIA, INC.
     HEALTHCARE PHARMACY SERVICES OF TEXAS, INC.
     HOME HEALTH INTEGRATED HEALTH SERVICES OF FLORIDA, INC.







     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT I, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT VII-B, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
     HOSPICE OF INTEGRATED HEALTH SERVICES, INC.
     IHS ACQUISITION XIII, INC.
     IHS ACQUISITION XVIII, INC.
     IHS AT LANSING, INC.
     IHS CHICAGO POST-ACUTE NETWORK, INC.
     IHS OF DANA, INC.
     INTEGRACARE, INC.
     INTEGRATED-BALLARD, INC.
     INTEGRATED HEALTH GROUP LIMITED PARTNERSHIP
     INTEGRATED HEALTH OF LOCUST VALLEY ROAD, INC.
     INTEGRATED HEALTH OF WATERFORD COMMONS, INC.
     INTEGRATED HEALTH SERVICES AT ALEXANDRIA, INC.
     INTEGRATED HEALTH SERVICES AT BIG SAIL, INC.
     INTEGRATED HEALTH SERVICES AT BLUE RIDGE MANOR, INC.
     INTEGRATED HEALTH SERVICES AT BRIARCLIFF HAVEN, INC.
     INTEGRATED HEALTH SERVICES AT CADIZ, INC.
     INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA, INC.
     INTEGRATED HEALTH SERVICES AT CHEYENNE, INC.
     INTEGRATED HEALTH SERVICES AT CINCINNATI, INC.
     INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS, INC.
     INTEGRATED HEALTH SERVICES AT COLUMBUS, INC.
     INTEGRATED HEALTH SERVICES AT DAYTON, INC.
     INTEGRATED HEALTH SERVICES AT DRIFTWOOD, INC.
     INTEGRATED HEALTH SERVICES AT EASTERN MASSACHUSETTS, INC.
     INTEGRATED HEALTH SERVICES AT GRANDVIEW CARE CENTER, INC.
     INTEGRATED HEALTH SERVICES AT GREAT BEND, INC.
     INTEGRATED HEALTH SERVICES AT HOPEDALE, INC.
     INTEGRATED HEALTH SERVICES AT HOUSTON, INC.
     INTEGRATED HEALTH SERVICES AT INDIAN CREEK, INC.
     INTEGRATED HEALTH SERVICES AT KENT, INC.
     INTEGRATED HEALTH SERVICES AT KING DAVID CENTER, INC.
     INTEGRATED HEALTH SERVICES AT NEWARK, INC.
     INTEGRATED HEALTH SERVICES AT ORMOND BEACH, INC.
     INTEGRATED HEALTH SERVICES AT PARK REGENCY, INC.
     INTEGRATED HEALTH SERVICES AT PENN, INC.
     INTEGRATED HEALTH SERVICES AT SILVERCREST, INC.
     INTEGRATED HEALTH SERVICES AT SOMERSET VALLEY, INC.
     INTEGRATED HEALTH SERVICES AT SOUTHERN HILLS, INC.
     INTEGRATED HEALTH SERVICES AT STEUBENVILLE
     INTEGRATED HEALTH SERVICES AT SYCARMORE CREEK, INC.
     INTEGRATED HEALTH SERVICES AT THREE RIVERS, INC.







     INTEGRATED HEALTH SERVICES AT TREYBURN, INC.
     INTEGRATED HEALTH SERVICES FINANCIAL HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES NPR, INC.
     INTEGRATED HEALTH SERVICES OF ARCADIA, INC.
     INTEGRATED HEALTH SERVICES OF ATHENS, INC.
     INTEGRATED HEALTH SERVICES OF BRENTWOOD, INC.
     INTEGRATED HEALTH SERVICES OF BRUNSWICK, INC.
     INTEGRATED HEALTH SERVICES OF CALIFORNIA, INC.
     INTEGRATED HEALTH SERVICES OF CLIFF MANOR, INC.
     INTEGRATED HEALTH SERVICES OF COLORADO AT CHERRY CREEK, INC.
     INTEGRATED HEALTH SERVICES OF EAGLE CREEK, INC.
     INTEGRATED HEALTH SERVICES OF GREEN BRIAR, INC.
     INTEGRATED HEALTH SERVICES OF HERITAGE MANOR, INC.
     INTEGRATED HEALTH SERVICES OF HICKORY CREEK, INC.
     INTEGRATED HEALTH SERVICES OF INDIAN HILLS, INC.
     INTEGRATED HEALTH SERVICES OF JACKSONVILLE, INC.
     INTEGRATED HEALTH SERVICES OF KURT, INC.
     INTEGRATED HEALTH SERVICES OF LESTER, INC.
     INTEGRATED HEALTH SERVICES OF MELISSA, INC.
     INTEGRATED HEALTH SERVICES OF MISSOURI, INC.
     INTEGRATED HEALTH SERVICES OF ORANGE PARK, INC.
     INTEGRATED HEALTH SERVICES OF RIVERBEND, INC.
     INTEGRATED HEALTH SERVICES OF SCENIC HILLS, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW II, INC.
     INTEGRATED HEALTH SERVICES OF SUNSET, INC.
     INTEGRATED MANAGEMENT-GOVERNOR'S PARK, INC.
     INTEGRATED OF AMARILLO, INC.
     INTEGRATED PHYSICIAN GROUP SERVICES, INC.
     ISABETH CO., INC.
     J.R. REHAB ASSOCIATES, INC.
     LPC BETHAMY HEALTH CORPORATION
     MANCHESTER INTEGRATED HEALTH, INC.
     MOBILE RAY OF NEW ORLEANS, INC.
     MOUNTAIN VIEW NURSING CENTER, INC.
     NEW SOUTHWOOD ASSOCIATES, INC.
     PALESTINE NURSING CENTER, INC.
     PATIENT CARE PHARMACY, INC.
     PATIENT CARE PHARMACY - COLORADO SPRINGS, INC.
     PHARMACEUTICAL DOSE SERVICE, INC.
     PINELLAS PARK NURSING HOME, INC.
     PROFESSIONAL REVIEW NETWORK, INC.
     REHAB MANAGEMENT SYSTEMS, INC.
     
     
     

     
     
     
     REST HAVEN NURSING CENTERS, INC.
     REST HAVEN NURSING CENTERS (CHESTNUT HILL), INC.
     REST HAVEN NURSING CENTERS (WHITEMARSH), INC.
     RIKAD PROPERTIES, INC.
     SAMARITAN CARE, INC. (Illinois Domestic)
     SAMARITAN CARE, INC. (Michigan Domestic)
     SAMARITAN MANAGEMENT, INC.
     SLC COMMUNITY CARE, INC.
     SOUTHWOOD HOLDINGS, INC.
     SPRING CREEK OF IHS, INC.
     SYMPHONY ANCILLARY SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 1, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 2, INC.
     SYMPHONY HEALTH CARE CONSULTING, INC.
     SYMPHONY HEALTH SERVICES, INC.
     SYMPHONY HOME CARE SERVICES, INC.
     SYMPHONY HOME CARE SERVICES NO. 1, INC.
     SYMPHONY HOME CARE SERVICES NO. 2, INC.
     SYMPHONY HOME CARE SERVICES NO. 3, INC.
     SYMPHONY HOME CARE SERVICES NO. 4, INC.
     SYMPHONY HOME CARE SERVICES NO. 5, INC.
     SYMPHONY HOME CARE SERVICES NO. 6, INC.
     SYMPHONY HOME CARE SERVICES NO. 7, INC.
     SYMPHONY HOME CARE SERVICES NO. 8, INC.
     SYMPHONY HOME CARE SERVICES NO. 9, INC.
     SYMPHONY HOME CARE SERVICES NO. 10, INC.
     SYMPHONY HOME CARE SERVICES NO. 11, INC.
     SYMPHONY HOME CARE SERVICES NO. 12, INC.
     SYMPHONY HOME CARE SERVICES NO. 13, INC.
     SYMPHONY HOME CARE SERVICES NO. 14, INC.
     SYMPHONY HOME CARE SERVICES NO. 15, INC.
     SYMPHONY HOME CARE SERVICES NO. 16, INC.
     SYMPHONY HOME CARE SERVICES NO. 17, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- CALIFORNIA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- LOUISIANA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- OKLAHOMA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- TENNESSEE, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- TEXAS. INC.
     SYMPHONY HOME CARE SERVICES NO. 19, INC.
     SYMPHONY HOME CARE SERVICES NO. 100, INC.
     SYMPHONY HOME CARE SERVICES NO. 101, INC.
     SYMPHONY HOME CARE SERVICES NO. 102, INC.
     SYMPHONY HOME CARE SERVICES NO. 103, INC.
     
     
     

     
     
     SYMPHONY HOME CARE SERVICES NO. 104, INC.
     SYMPHONY HOME CARE SERVICES NO. 105, INC.
     SYMPHONY HOME CARE SERVICES NO. 106, INC.
     SYMPHONY HOME CARE SERVICES NO. 107, INC.
     SYMPHONY HOME CARE SERVICES NO. 108, INC.
     SYMPHONY HOME CARE SERVICES NO. 109, INC.
     SYMPHONY HOME CARE SERVICES NO. 110, INC.
     SYMPHONY HOME CARE SERVICES NO. 113, INC.
     SYMPHONY HOME CARE SERVICES NO. 114, INC.
     SYMPHONY HOME CARE SERVICES NO. 115, INC.
     SYMPHONY HOME CARE SERVICES NO. 116, INC.
     SYMPHONY HOME CARE SERVICES NO. 117, INC.
     SYMPHONY HOME CARE SERVICES NO. 118, INC.
     SYMPHONY HOME CARE SERVICES NO. 119, INC.
     SYMPHONY HOME CARE SERVICES NO. 120, INC.
     SYMPHONY HOME CARE SERVICES NO. 121, INC.
     SYMPHONY HOME CARE SERVICES NO. 122, INC.
     SYMPHONY PHARMACY SERVICES, INC.
     SYMPHONY REHABILITATION SERVICES, INC.
     SYMPHONY REHABILITATION SERVICES NO. 1, INC.
     SYMPHONY REHABILITATION SERVICES NO. 2, INC.
     SYMPHONY REHABILITATION SERVICES NO. 3, INC.
     SYMPHONY REHABILITATION SERVICES NO. 4, INC.
     SYMPHONY RESPIRATORY SERVICES, INC.
     TEXAS LPC, INC.
     WEST COAST CAMBRIDGE, INC.
     WOODRIDGE CONVALESCENT CENTER, INC.
     
     
     By: /s/ 
        ---------------------------------
        Name:
        Title:
             of Each Guarantor or of the
             General Partner of such Guarantor



                        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 under any of the Loan Documents,






                                        4

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: /s/ 
                                                   -----------------------------
                                                   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: /s/ 
   -------------------------------------
   Name:
   Title:


BANK OF AMERICA NATIONAL TRUST
   AND SAVINGS ASSOCIATION,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        5


THE BANK OF NOVA SCOTIA,
   as LC Bank, a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


CORESTATES BANK, N.A.,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


CREDIT LYONNAIS,
   NEW YORK BRANCH,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


DEUTSCHE BANK AG,
   NEW YORK BRANCH AND/OR
   CAYMAN ISLANDS BRANCH,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        6


FIRST UNION NATIONAL BANK
   OF NORTH CAROLINA,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


NATIONSBANK, N.A.,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


PNC BANK, NATIONAL ASSOCIATION,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


TORONTO DOMINION (TEXAS), INC.,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:


VAN KAMPEN AMERICAN CAPITAL
   PRIME RATE INCOME TRUST,
   as a Lender and Co-Agent


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        7


CREDITANSTALT CORPORATE
   FINANCE, INC.,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


By: /s/ 
   -------------------------------------
   Name:
   Title:


FLEET NATIONAL BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


GENERAL ELECTRIC
   CAPITAL CORPORATION,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


HIBERNIA NATIONAL BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        8



AMSOUTH BANK OF ALABAMA,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


THE BANK OF TOKYO-MITSUBISHI
   TRUST COMPANY,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


THE SANWA BANK, LIMITED,
  NEW YORK BRANCH
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


SIGNET BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


THE SUMITOMO BANK, LIMITED,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:






                                        9


FIRST AMERICAN NATIONAL BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


ALLIED IRISH BANK,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


PROVIDENT BANK OF MARYLAND,
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:


BANK OF AMERICA ILLINOIS
   as a Lender


By: /s/ 
   -------------------------------------
   Name:
   Title:








                                     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.

     ABC GP, INC.
     ABC HOME HEALTH AND HOSPICE OF ALBANY, INC.
     ABC HOME HEALTH AND HOSPICE OF ATHENS, INC.
     ABC HOME HEALTH AND HOSPICE OF BRUNSWICK, INC.
     ABC HOME HEALTH AND HOSPICE OF DUBLIN, INC.
     ABC HOME HEALTH AND HOSPICE OF MACON, INC.
     ABC HOME HEALTH AND HOSPICE OF SAVANNAH, INC.
     ABC HOME HEALTH AND HOSPICE OF TIFTON, INC.
     ABC HOME HEALTH AND HOSPICE OF VIDALIA, INC.
     ABC HOME HEALTH AND HOSPICE OF WAYCROSS, INC.
     ABC HOME NURSING, INC.
     ABC NEWCO, INC.
     ABC PHARMACEUTICALS, INC.
     ALABAMA SENIOR LIFE CARE, INC.
     ALPINE MANOR, INC.
     ARBOR LIVING CENTERS OF FLORIDA, INC.
     ARBOR LIVING CENTERS OF TEXAS, INC.
     ASIA CARE, INC.
     BETHAMY LIVING CENTER MANAGEMENT COMPANY
     BETHAMY LIVING CENTERS LIMITED PARTNERSHIP
     BRIAR HILL, INC.
     BRIARCLIFF NURSING HOME, INC.
     CAMBRIDGE CARE CENTERS, INC.
     CAMBRIDGE GROUP OF INDIANA, INC.
     CAMBRIDGE GROUP OF PENNSYLVANIA, INC.
     CAMBRIDGE GROUP OF TEXAS, INC.
     CARE CENTERS HOLDING, INC.
     CARRIAGE-By-THE-LAKE OF IHS, INC.
     CEDARCROFT HEALTH SERVICES, INC.
     CENTRAL PARK LODGES, INC.
     CENTRAL PARK LODGES OF WEST PALM BEACH, INC.
     CENTRAL PARK LODGES (TARPON SPRINGS), INC.
     CLARA BURKE NURSING HOME, INC.
     CLAREMONT INTEGRATED HEALTH, INC.
     COMPREHENSIVE POSTACUTE SERVICES, INC.
     DERRY INTEGRATED HEALTH, INC.
     ELIZABELL CO., INC.






                                        3

     ELM CREEK OF IHS, INC.
     F.L.C. BENEVA NURSING PAVILION, INC.
     F.L.C. SARASOTA NURSING PAVILION, INC.
     FERRIGAN MOBILE X-RAY, INC.
     FIRELANDS OF IHS, INC.
     FIRST AMERICAN HOME CARE OF ALABAMA, INC.
     FIRST AMERICAN HOME CARE OF ARKANSAS, INC.
     FIRST AMERICAN HOME CARE OF CALIFORNIA, INC.
     FIRST AMERICAN HOME CARE OF COLORADO, INC.
     FIRST AMERICAN HOME CARE OF FLORIDA, INC.
     FIRST AMERICAN HOME CARE OF FT. LAUDERDALE, INC.
     FIRST AMERICAN HOME CARE OF GEORGIA, INC.
     FIRST AMERICAN HOME CARE OF ILLINOIS, INC.
     FIRST AMERICAN HOME CARE OF INDIANA, INC.
     FIRST AMERICAN HOME CARE OF LOUISIANA, INC.
     FIRST AMERICAN HOME CARE OF MICHIGAN, INC.
     FIRST AMERICAN HOME CARE OF MISSISSIPPI, INC.
     FIRST AMERICAN HOME CARE OF MISSOURI, INC.
     FIRST AMERICAN HOME CARE OF NAPLES, INC.
     FIRST AMERICAN HOME CARE OF NEBRASKA, INC.
     FIRST AMERICAN HOME CARE OF NEW MEXICO, INC.
     FIRST AMERICAN HOME CARE OF NORTH CAROLINA, INC.
     FIRST AMERICAN HOME CARE OF OHIO, INC.
     FIRST AMERICAN HOME CARE OF OKLAHOMA, INC.
     FIRST AMERICAN HOME CARE OF PENNSYLVANIA, INC.
     FIRST AMERICAN HOME CARE OF SOUTH CAROLINA, INC.
     FIRST AMERICAN HOME CARE OF TENNESSEE, INC.
     FIRST AMERICAN HOME CARE OF TEXAS, INC.
     FIRST AMERICAN HOME CARE OF VALDOSTA, INC.
     FIRST AMERICAN HOME CARE OF VIRGINIA, INC.
     FIRST AMERICAN HOME CARE OF WEST VIRGINIA, INC.
     FIRST AMERICAN INTERNATIONAL, INC.
     FLORIDA LIFE CARE, INC.
     GAINESVILLE HEALTH CARE CENTER, INC.
     GRAVOIS HEALTH CARE, INC.
     HEALTH CARE SYSTEMS, INC.
     HOME HEALTH INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT I, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT VII-B, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
     HOSPICE OF INTEGRATED HEALTH SERVICES, INC.
     IHS ACQUISITION XIII, INC.
     IHS ACQUISITION XV, INC.
     IHS ACQUISITION XVIII, INC.
     IHS ACQUISITION XIX, INCL






                                        4


     IHS ACQUISITION XXII, INC.
     IHS AT LANSING, INC.
     IHS CHICAGO POST-ACUTE NETWORK, INC.
     IHS DEVELOPMENT-HIGHLANDS PARK, INC.
     IHS HOME CARE, INC.
     IHS LAND ACQUISITION-HIGHLANDS PARK, INC.
     IHS MANAGEMENT GROUP, INC.
     IHS NETWORK SERVICES, INC.
     IHS OF DANA, INC.
     IN-HOME HEALTH CARE, INC.
     INTEGRACARE, INC.
     INTEGRATED-BALLARD, INC.
     INTEGRATED HEALTH GROUP LIMITED PARTNERSHIP
     INTEGRATED HEALTH OF LOCUST VALLEY ROAD, INC.
     INTEGRATED HEALTH OF WATERFORD COMMONS, INC.
     INTEGRATED HEALTH SERVICES AT ALEXANDRIA, INC.
     INTEGRATED HEALTH SERVICES AT BIG SAIL, INC.
     INTEGRATED HEALTH SERVICES AT BLUE RIDGE MANOR, INC.
     INTEGRATED HEALTH SERVICES AT BRIARCLIFF HAVEN, INC.
     INTEGRATED HEALTH SERVICES AT CADIZ, INC.
     INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA, INC.
     INTEGRATED HEALTH SERVICES AT CHEYENNE, INC.
     INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS, INC.
     INTEGRATED HEALTH SERVICES AT COLUMBUS, INC.
     INTEGRATED HEALTH SERVICES AT DAYTON, INC.
     INTEGRATED HEALTH SERVICES AT DRIFTWOOD, INC.
     INTEGRATED HEALTH SERVICES AT EASTERN MASSACHUSETTS, INC.
     INTEGRATED HEALTH SERVICES AT GRANDVIEW CARE CENTER, INC.
     INTEGRATED HEALTH SERVICES AT GREAT BEND, INC.
     INTEGRATED HEALTH SERVICES AT HIGHLANDS PARK, INC.
     INTEGRATED HEALTH SERVICES AT HOPEDALE, INC.
     INTEGRATED HEALTH SERVICES AT HOUSTON, INC.
     INTEGRATED HEALTH SERVICES AT INDIAN CREEK, INC.
     INTEGRATED HEALTH SERVICES AT KENT, INC.
     INTEGRATED HEALTH SERVICES AT KING DAVID CENTER, INC.
     INTEGRATED HEALTH SERVICES AT NEWARK, INC.
     INTEGRATED HEALTH SERVICES AT ORMOND BEACH, INC.
     INTEGRATED HEALTH SERVICES AT PARK REGENCY, INC.
     INTEGRATED HEALTH SERVICES AT PENN, INC.
     INTEGRATED HEALTH SERVICES AT SILVERCREST, INC.
     INTEGRATED HEALTH SERVICES AT SOMERSET VALLEY, INC.
     INTEGRATED HEALTH SERVICES AT SOUTHERN HILLS, INC.
     INTEGRATED HEALTH SERVICES AT STEUBENVILLE
     INTEGRATED HEALTH SERVICES AT SYCARMORE CREEK, INC.
     INTEGRATED HEALTH SERVICES AT THREE RIVERS, INC.






                                        5

     INTEGRATED HEALTH SERVICES AT TREYBURN, INC.
     INTEGRATED HEALTH SERVICES FINANCIAL HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES NPR, INC.
     INTEGRATED HEALTH SERVICES OF ARCADIA, INC.
     INTEGRATED HEALTH SERVICES OF ATHENS, INC.
     INTEGRATED HEALTH SERVICES OF BRENTWOOD, INC.
     INTEGRATED HEALTH SERVICES OF BRUNSWICK, INC.
     INTEGRATED HEALTH SERVICES OF CALIFORNIA, INC.
     INTEGRATED HEALTH SERVICES OF CLIFF MANOR, INC.
     INTEGRATED HEALTH SERVICES OF COLORADO AT CHERRY CREEK, INC.
     INTEGRATED HEALTH SERVICES OF EAGLE CREEK, INC.
     INTEGRATED HEALTH SERVICES OF GREEN BRIAR, INC.
     INTEGRATED HEALTH SERVICES OF HERITAGE MANOR, INC.
     INTEGRATED HEALTH SERVICES OF HICKORY CREEK, INC.
     INTEGRATED HEALTH SERVICES OF INDIAN HILLS, INC.
     INTEGRATED HEALTH SERVICES OF JACKSONVILLE, INC.
     INTEGRATED HEALTH SERVICES OF KURT, INC.
     INTEGRATED HEALTH SERVICES OF LESTER, INC.
     INTEGRATED HEALTH SERVICES OF MELISSA, INC.
     INTEGRATED HEALTH SERVICES OF MISSOURI, INC.
     INTEGRATED HEALTH SERVICES OF ORANGE PARK, INC.
     INTEGRATED HEALTH SERVICES OF RIVERBEND, INC.
     INTEGRATED HEALTH SERVICES OF SCENIC HILLS, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW II, INC.
     INTEGRATED HEALTH SERVICES OF SUNSET, INC.
     INTEGRATED MANAGED CARE, INC. (formerly Isabeth Co., Inc.)
     INTEGRATED MANAGEMENT-GOVERNOR'S PARK, INC.
     INTEGRATED OF AMARILLO, INC.
     INTEGRATED PHYSICIAN GROUP SERVICES, INC.
     J.R. REHAB ASSOCIATES, INC.
     LIFEWAY, INC.
     LPC BETHAMY HEALTH CORPORATION, L.P.
     MANCHESTER INTEGRATED HEALTH, INC.
     MOBILE RAY OF NEW ORLEANS, INC.
     MOUNTAIN VIEW NURSING CENTER, INC.
     NEW SOUTHWOOD ASSOCIATES, INC.
     PALESTINE NURSING CENTER, INC.
     PINELLAS PARK NURSING HOME, INC.
     PREFERRED HOME HEALTH SERVICES, INC.
     PROFESSIONAL REVIEW NETWORK, INC.
     REHAB MANAGEMENT SYSTEMS, INC.
     REST HAVEN NURSING CENTERS, INC.
     REST HAVEN NURSING CENTERS (CHESTNUT HILL), INC.






                                        6


     REST HAVEN NURSING CENTERS (WHITEMARSH), INC.
     RIKAD PROPERTIES, INC.
     SAMARITAN CARE, INC. (Illinois Domestic)
     SAMARITAN CARE, INC. (Michigan Domestic)
     SAMARITAN MANAGEMENT, INC.
     SHC OF ARIZONA, L.P.
     SHC SERVICES OF ARIZONA, L.P.
     SIGNATURE HOME CARE GROUP, INC.
     SIGNATURE HOME CARE, INC.
     SIGNATURE HOME CARE OF ARLINGTON, INC.
     SIGNATURE HOME CARE OF FLORIDA, INC.
     SIGNATURE HOME CARE OF GEORGIA, INC.
     SIGNATURE HOME CARE OF KANSAS, INC.
     SIGNATURE HOME CARE OF NEW JERSEY, INC.
     SIGNATURE HOME CARE OF NEW JERSEY GENERAL PARTNERSHIP
     SIGNATURE HOME CARE OF SAN ANTONIO, INC.
     SIGNATURE HOME CARE SERVICES OF FLORIDA, INC.
     SIGNATURE HOME CARE SERVICES OF SAN ANTONIO, INC.
     SIGNATURE MANAGEMENT SERVICES, INC.
     SIGNATURE RECEIVABLES CORP.
     SLC COMMUNITY CARE, INC.
     SOUTHWOOD HOLDINGS, INC.
     SPRING CREEK OF IHS, INC.
     SYMPHONY ANCILLARY SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 1, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 2, INC.
     SYMPHONY HEALTH CARE CONSULTING, INC.
     SYMPHONY HEALTH SERVICES, INC.
     SYMPHONY HOME CARE SERVICES, INC.
     SYMPHONY HOME CARE SERVICES NO. 1, INC.
     SYMPHONY HOME CARE SERVICES NO. 2, INC.
     SYMPHONY HOME CARE SERVICES NO. 3, INC.
     SYMPHONY HOME CARE SERVICES NO. 4, INC.
     SYMPHONY HOME CARE SERVICES NO. 5, INC.
     SYMPHONY HOME CARE SERVICES NO. 6, INC.
     SYMPHONY HOME CARE SERVICES NO. 7, INC.
     SYMPHONY HOME CARE SERVICES NO. 8, INC.
     SYMPHONY HOME CARE SERVICES NO. 9, INC.
     SYMPHONY HOME CARE SERVICES NO. 10, INC.
     SYMPHONY HOME CARE SERVICES NO. 11, INC.
     SYMPHONY HOME CARE SERVICES NO. 12, INC.
     SYMPHONY HOME CARE SERVICES NO. 13, INC.
     SYMPHONY HOME CARE SERVICES NO. 14, INC.
     SYMPHONY HOME CARE SERVICES NO. 15, INC.
     





                                        7

     SYMPHONY HOME CARE SERVICES NO. 16, INC.
     SYMPHONY HOME CARE SERVICES NO. 17, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- CALIFORNIA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- LOUISIANA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- OKLAHOMA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- TEXAS. INC.
     SYMPHONY HOME CARE SERVICES NO. 19, INC.
     SYMPHONY HOME CARE SERVICES NO. 100, INC.
     SYMPHONY HOME CARE SERVICES NO. 101, INC.
     SYMPHONY HOME CARE SERVICES NO. 102, INC.
     SYMPHONY HOME CARE SERVICES NO. 103, INC.
     SYMPHONY HOME CARE SERVICES NO. 104, INC.
     SYMPHONY HOME CARE SERVICES NO. 105, INC.
     SYMPHONY HOME CARE SERVICES NO. 106, INC.
     SYMPHONY HOME CARE SERVICES NO. 107, INC.
     SYMPHONY HOME CARE SERVICES NO. 108, INC.
     SYMPHONY HOME CARE SERVICES NO. 109, INC.
     SYMPHONY HOME CARE SERVICES NO. 110, INC.
     SYMPHONY HOME CARE SERVICES NO. 113, INC.
     SYMPHONY HOME CARE SERVICES NO. 114, INC.
     SYMPHONY HOME CARE SERVICES NO. 115, INC.
     SYMPHONY HOME CARE SERVICES NO. 116, INC.
     SYMPHONY HOME CARE SERVICES NO. 117, INC.
     SYMPHONY HOME CARE SERVICES NO. 118, INC.
     SYMPHONY HOME CARE SERVICES NO. 119, INC.
     SYMPHONY HOME CARE SERVICES NO. 120, INC.
     SYMPHONY HOME CARE SERVICES NO. 121, INC.
     SYMPHONY HOME CARE SERVICES NO. 122, INC.
     SYMPHONY REHABILITATION SERVICES, INC.
     SYMPHONY REHABILITATION SERVICES NO. 1, INC.
     SYMPHONY REHABILITATION SERVICES NO. 2, INC.
     SYMPHONY REHABILITATION SERVICES NO. 3, INC.
     SYMPHONY REHABILITATION SERVICES NO. 4, INC.
     SYMPHONY RESPIRATORY SERVICES, INC.
     TEXAS LPC, INC.





                                       8

     THE BESTON CORPORATION
     WEST COAST CAMBRIDGE, INC.
     WOODRIDGE CONVALESCENT CENTER, INC.
     
     
     By: /s/ 
        ---------------------------------
        Name:
        Title:
             of Each Guarantor or of the
             General Partner of such Guarantor







                        INTEGRATED HEALTH SERVICES, INC.
                             10065 Red Run Boulevard
                          Owings Mills, Maryland 21117


                                  July 3, 1997


To the Administrative Agent and
  the Lenders parties to the Revolving
  Credit Agreement referred to below


                  Amendment No. 4 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,  Amendment No. 2
dated November 8, 1996 and Amendment No. 3 dated March 24, 1997 (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 enter into a lease  financing  facility (the "Synthetic
Lease Facility")  pursuant to which one or more of its  Subsidiaries  will enter
into one or more leases for its headquarters  facility and other properties.  As
part of such lease  financings,  IHS and its  Subsidiaries  (other than Inactive
Subsidiaries) propose to guaranty certain obligations of such Subsidiaries under
such leases and grant a security  interest  in the  Collateral  to secure  those
guaranties,  with such  security  interest  to be pari passu  with the  security
interest of the Lenders.  In addition,  IHS has proposed to sell certain  assets
which  sales  require  the  consent  of the  Requisite  Lenders,  to  amend  the
definition  of "Cash  Flow  from  Operations",  to amend  the  Credit  Agreement
covenant relating to stock repurchases and to acquire Community Care of America,
Inc. In connection  with the  foregoing,  IHS has  requested  that the Requisite
Lenders  agree to amend certain  covenants  contained in Article V of the Credit
Agreement  and to amend the  definition of  "Debt/EBITDAR  Ratio" to permit such
transactions,  to amend Schedule 1.01 (c) to the Credit Agreement and to replace
the  Pledge  and  Security   Agreements   heretofore  executed  by  IHS  or  its
Subsidiaries  with the  Pledge and  Security  Agreements  in the forms  attached
hereto.  We  understand  that  the  Requisite  Lenders  are,  on the  terms  and
conditions  stated  below,  willing  to grant our  requests,  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:







                                        2

          (a) Section 1.01 is amended by adding the following definitions in the
     appropriate alphabetical order:

          "'CCA' means Community Care of America, Inc."

          "'SYNTHETIC LEASE FACILITY' means the lease to be entered into between
          State Street Bank and Trust Company,  as Corporate Owner Trustee,  and
          Integrated Health Services at Highlands Park, Inc., as Lessee, and the
          other  leases  to be  entered  into by  Subsidiaries  of the  Borrower
          pursuant to the  Participation  Agreement to be entered into among the
          Borrower,  Integrated  Health  Services at Highlands  Park,  Inc., IHS
          Development  -  Highlands  Park,  Inc.,  State  Street  Bank and Trust
          Company, as Corporate Owner Trustee, an Individual Owner Trustee,  the
          Certificate  Holder  party  thereto,  the  Note  Holders  thereto  and
          Citibank, N. A., as Agent."

          (b) The  definition of "CASH FLOW FROM  OPERATIONS" in Section 1.01 is
     amended in full to read as follows:

          "'CASH FLOW FROM OPERATIONS'  means,  with respect to any Person,  the
          sum,  determined as of the last day of any Quarter for such Person and
          its  subsidiaries  on a  consolidated  basis for the  12-month  period
          including such Quarter and the  immediately  preceding  three Quarters
          (taken as a single  period),  of (i) net income  after taxes minus any
          extraordinary  gain and any non-recurring  gain on any divestiture and
          plus  any  extraordinary  loss  and  any  non-recurring  loss  on  any
          divestiture,  (ii)  depreciation,  amortization,  and  other  non-cash
          charges  deducted in determining net income,  (iii) Interest  Expense,
          (iv) Lease  Expense and (v) with respect to Cash Flow from  Operations
          of  the  Borrower  and  its  Subsidiaries  only,  Receivables  Program
          Charges,  all determined in accordance with GAAP;  provided,  however,
          that (A) income  attributable  to any other Person or business that is
          not at least 50% owned,  directly or indirectly,  by such Person shall
          be counted,  in determining net income, only to the extent such income
          is received in cash by such Person or a  subsidiary  of such Person in
          such  period and is not  reinvested  in such other  Person or business
          (other than as a loan payable on demand) within six months thereafter,
          except that,  with respect to the Borrower only,  income from minority
          Investments  existing on the Closing  Date and  described  in Schedule
          5.03(c)  shall be  counted  in  accordance  with the  Borrower's  past
          practice,  (B) no  adjustments  shall  be  made  to  reflect  minority
          interests in  subsidiaries  and (C)  non-recurring  cash charges in an
          aggregate  amount not in excess of $30,000,000 in connection  with the
          terminated acquisition






                                        3

          of Coram shall be included as an addback to net income for purposes of
          this definition."

          (c) The  definition  of "DEBT" in  Section  1.01 is amended in full to
     read as follows:

          "'DEBT' as applied  to any  Person  and in each case  determined  on a
          consolidated   basis  in   conformity   with  GAAP,   means   (without
          duplication)  (i) all indebtedness for borrowed money (whether by loan
          or the issuance of debt securities or otherwise); (ii) all obligations
          issued,  undertaken  or  assumed  as the  deferred  purchase  price of
          property or services or interest thereon,  except accounts and accrued
          expenses currently payable;  (iii) all monetary  obligations under the
          Synthetic  Lease Facility,  (iv) all  reimbursement  obligations  with
          respect to surety bonds,  letters of credit,  bankers' acceptances and
          similar  instruments,  whether  or not  contingent;  (v) all  monetary
          obligations under any Capital Lease; (vi) all obligations  (contingent
          or otherwise)  to purchase,  retire or redeem any capital stock or any
          other equity interest of such Person;  (vii) all monetary  obligations
          measured by, or  determined  on the basis of, the value of any capital
          stock of such Person; and (viii) all obligations,  whether or not such
          obligations  constitute  Debt as defined in clauses (i) through  (vii)
          above,  secured by (or for which the holder of the  obligation  has an
          existing  right,  contingent or otherwise,  to be secured by) any Lien
          upon any  property of such Person or any  Subsidiary  of such  Person,
          except  any such  obligation  secured by a Lien that is imposed by law
          and not voluntarily granted;  provided,  however,  that the contingent
          payments  which  may  become  payable  in  connection  with the  First
          American  Merger,  including  any  payments  made to the  Health  Care
          Financing  Administration  or the  Department  of Justice as  required
          under the First  American  Merger  Agreement  in a total amount not in
          excess of $162 million, shall not constitute Debt for purposes of this
          Agreement."

          (d)  Subparagraph  (3) in the  definition of  "DEBT/EBITDAR  RATIO" in
     Section 1.01 is amended in full to read as follows:

          "(3)  adding to EBITDAR of the  Borrower  and such  Subsidiaries,  the
          EBITDAR  and  Non-Recurring  Charges  determined  solely  for any such
          acquired  company or Health  Care  Facility,  for the  portion of such
          period that  preceded the  acquisition;  provided,  however,  that for
          Quarters ending during the 12-month period  immediately  following the
          closing of the First  American  Merger,  EBITDAR of First American for
          the period from the closing to the date of determination,






                                        4

          annualized  for the  12-month  period  then  ended  shall  be added to
          EBITDAR of the Borrower and such Subsidiaries; provided, further, that
          for Quarters ending during the 12-month period  immediately  following
          the closing of the  acquisition of CCA,  EBITDAR of CCA for the period
          from the  closing  to the date of  determination,  annualized  for the
          12-month  period then ended shall be added to EBITDAR of the  Borrower
          and such Subsidiaries."

          (e) Section  5.03(a) is amended by  deleting  the period at the end of
     subsection (xii) thereof and substituting therefor "; and" and adding a new
     subsection (xiii) following such subsection (xii) to read as follows:

          "(xiii) any Liens upon (a) stock of  Subsidiaries  and certain related
          assets  granted by the  Borrower  or one or more  Subsidiaries  of the
          Borrower and (b) real property  interests and certain  related  assets
          granted by one or more  Subsidiaries of the Borrower,  in each case in
          connection with the Synthetic Lease Facility."

          (f) Section  5.03(c)(viii) is amended by adding to the end thereof the
     following provision:

          "provided,  further, that the acquisition of CCA will not be deemed an
          Investment for purposes of this Subsection 5.03(c)(viii);"

          (g) Section  5.03(c) is amended by  deleting  the period at the end of
     subsection  (xv)  thereof  and  substituting  ";  and"  and  adding  a  new
     subsection (xvi) following such subsection (xv) to read as follows:

          "(xvi)  The  acquisition  of  CCA  by  the  Borrower  or  any  of  its
          Subsidiaries  substantially on the terms set forth in the letter dated
          June 24, 1997 from the Borrower to the Lenders, provided, that (A) the
          purchase  price for the shares of CCA does not exceed $4.50 per share,
          (B) at the time of or after  giving  effect  to such  acquisition,  no
          Event of Default or Potential  Default shall exist or result,  and (C)
          the Borrower shall comply with the provisions of Section 5.02(e),  and
          neither  the  Borrower  nor any of its  Subsidiaries  nor any of their
          properties  shall be or become bound by or subject to any  contractual
          obligation that is or would be violated or put in default by reason of
          such  compliance  or by reason of the  enforcement  of the  claims and
          Liens of the Agent and Lenders arising from such compliance; provided,
          further, that the acquisition of CCA shall not be deemed an Investment
          for purposes of Section 5.03(c)(xi)."






                                        5


          (h) Section  5.03(d) is amended by  deleting  the period at the end of
     subsection (vi) thereof and substituting  therefor "; and" and adding a new
     subsection (vii) following such subsection (vi) to read as follows:

          "(vii)  Debt  in an  aggregate  principal  amount  not  in  excess  of
          $100,000,000  incurred by the Borrower or any of its  Subsidiaries  in
          connection with the Synthetic Lease Facility."

          (i) Section  5.03 (f) is amended by deleting  the period at the end of
     subsection (vi) thereof and substituting  therefor "; and" and adding a new
     subsection (vii) following such subsection (vi) to read as follows:

          "(vii)  Accommodation  Obligations  incurred by the Borrower or any of
          its Subsidiaries in connection with the Synthetic Lease Facility."

          (j) Section 5.03(h)(B) is amended in full to read as follows:

          "(B) The Borrower from time to time may purchase outstanding shares of
          the Borrower's common stock or purchase  options,  or enter into other
          transactions,  to purchase  such stock,  so long as (1) the  aggregate
          amount expended for all such purchases, options and other transactions
          at any time after the Closing  Date does not exceed  $50,000,000  (the
          "Purchase  Limit")  and  (2)  any  such  purchase,   option  or  other
          transaction  is made in  compliance  with all  applicable  laws and no
          Potential  Default or Event of Default exists at the time of, or would
          result from, any such purchase,  option or other transaction (and, for
          this purpose,  the amounts counted toward the Purchase Limit shall not
          be reduced by or on account of any subsequent resale of the Borrower's
          Common Stock);"






                                        6

          (k)  Schedule  1.01(c)  is amended  by adding to the end  thereof  the
     following assets:

                Health Care Facilities Assets Designated for Sale
                -------------------------------------------------

Facility Name                          Location                         # Units
- -------------                          --------                         -------
Avenel (Owned)                         Plantation, FL                   120
Auburndale (Owned)                     Auburndale, FL                   120
Sarasota Pavillion (Owned)             Sarasota, FL                     180
Central Florida at Orlando
   (Owned)                             Orlando, FL                      120
Central Florida at Vero Beach (
  (Owned)                              Vero Beach, FL                   110
Chestnut Hill (Owned)                  Philadelphia, PA                 200
Claremont (Owned)                      Claremont, NH                     62
Clearwater (Owned)                     Clearwater, FL                   150
Derry (Owned)                          Derry, NH                        112
Jacksonville (Owned)                   Jacksonville, FL                 120
Pinellas Park (Owned)                  Pinellas Park, FL                120
William & Mary (Owned)                 St. Petersburg, FL                96
Tarpon Springs (Owned)                 Tarpon Springs, FL               120
Venice North (Owned)                   Venice, FL                       178

     In  connection  with the  Synthetic  Lease  Facility,  the  Lenders  hereby
instruct  the Agent,  coincidentally  with the  closing of the  Synthetic  Lease
Facility, to enter into the Intercreditor  Agreement and the Pledge and Security
Agreements  to be  delivered  as provided in this  Amendment.  Upon the delivery
thereof,  the Pledge and  Security  Agreements,  in the forms  attached  hereto,
thereafter  shall be deemed Pledge and Security  Agreements  for all purposes of
the  Loan  Documents  and  each  Lender  shall  be  bound  by the  terms of such
Intercreditor Agreement.

     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,  (B)  counterparts  of the
Consent  appended  hereto (the  "Consent"),  executed by each  Guarantor and (C)
evidence  that all  amounts  due and payable  under  Section  8.04 of the Credit
Agreement  have been paid in full,  provided,  that the closing of the Synthetic
Lease  Facility  shall not occur until and unless the Agent shall have  received
(1)  counterparts  of  the   Intercreditor   and  Collateral  Agency  Agreement,
substantially in the form of Exhibit A hereto,  executed by the parties thereto,
(2) a pledge and security agreement, duly executed and delivered,  substantially
in the form of Exhibit B-1 in the case of IHS and  substantially  in the form of
Exhibit B-2 in the case of each  Subsidiary  that has prior hereto  executed and
delivered a Pledge and Security Agreement, together with (a) the certificates or
other  instruments  pledged under each  respective  existing Pledge and Security
Agreement, accompanied by undated stock powers or transfer documents executed in
blank,  and (b)  evidence  satisfactory  to the Lenders  that all other  actions
necessary or, in the opinion of the






                                        7

Lenders, desirable to perfect and protect the security interests created by such
pledge and security agreements have been taken,  including delivery to the Agent
of all instruments constituting Collateral, duly endorsed, and delivery of UCC-1
financing statements or amendments thereto duly executed by each Grantor under a
pledge and security  agreement and in form  sufficient for filing in all offices
in which the Agent or any Lender may consider  filing to be appropriate  and (3)
an opinion of LeBoeuf,  Lamb Greene & MacRae,  LLP, counsel to the Borrower,  in
form and substance satisfactory to the Agent.

          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 Guarantors  executing the Consent are all of the  Subsidiaries
     (other than Inactive Subsidiaries) of IHS.

     Upon the effectiveness of this Amendment, on and after the date hereof each
reference in the Credit Agreement to "this Agreement",  "hereunder", "hereof" or
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 under any of the Loan Documents,  not
constitute a waiver of any provision of any of the Loan Documents. This






                                        8

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 July 8, 1997
three  counterparts  of this Amendment No. 4 to Citicorp  Securities,  Inc., 399
Park Avenue, 9th Floor, New York, New York 10043, Attention: Rosemary Bell. This
Amendment  No. 4 is subject  to the  provisions  of  Section  8.01 of the Credit
Agreement.

     This Amendment No. 4 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. 4.

                                                Very truly yours,

                                                INTEGRATED HEALTH
                                                   SERVICES, INC.


                                                By: /s/ 
                                                   -----------------------------
                                                   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: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


BANK OF AMERICA NATIONAL TRUST
   AND SAVINGS ASSOCIATION,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  




                                        9



THE BANK OF NOVA SCOTIA,
   as LC Bank, a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


CORESTATES BANK, N.A.,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


CREDIT LYONNAIS,
   NEW YORK BRANCH,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


DEUTSCHE BANK AG,
   NEW YORK BRANCH AND/OR
   CAYMAN ISLANDS BRANCH,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  






                                       10



FIRST UNION NATIONAL BANK
   OF NORTH CAROLINA,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


NATIONSBANK, N.A.,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


PNC BANK, NATIONAL ASSOCIATION,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


TORONTO DOMINION (TEXAS), INC.,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


VAN KAMPEN AMERICAN CAPITAL
   PRIME RATE INCOME TRUST,
   as a Lender and Co-Agent


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  






                                       11



CREDITANSTALT CORPORATE
   FINANCE, INC.,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


FLEET NATIONAL BANK,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


GENERAL ELECTRIC
   CAPITAL CORPORATION,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


HIBERNIA NATIONAL BANK,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  






                                       12


AMSOUTH BANK OF ALABAMA,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


THE BANK OF TOKYO-MITSUBISHI
   TRUST COMPANY,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


THE SANWA BANK, LIMITED,
  NEW YORK BRANCH
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


SIGNET BANK,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


THE SUMITOMO BANK, LIMITED,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  






                                       13


FIRST AMERICAN NATIONAL BANK,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


ALLIED IRISH BANK,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


PROVIDENT BANK OF MARYLAND,
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


BANK OF AMERICA ILLINOIS
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  


CRESTAR BANK
   as a Lender


By: /s/                         
   -------------------------------------
   Name:                   
   Title:                  








                                     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. 4 hereby consent
to such  Amendment No. 4 and hereby confirm and agree that  notwithstanding  the
effectiveness  of such  Amendment No. 4, the Guaranty is, and shall  continue to
be, in full  force  and  effect  and is hereby  confirmed  and  ratified  in all
respects.

     ABC GP, INC.
     ABC HOME HEALTH AND HOSPICE OF ALBANY, INC.
     ABC HOME HEALTH AND HOSPICE OF ATHENS, INC.
     ABC HOME HEALTH AND HOSPICE OF BRUNSWICK, INC.
     ABC HOME HEALTH AND HOSPICE OF DUBLIN, INC.
     ABC HOME HEALTH AND HOSPICE OF MACON, INC.
     ABC HOME HEALTH AND HOSPICE OF SAVANNAH, INC.
     ABC HOME HEALTH AND HOSPICE OF TIFTON, INC.
     ABC HOME HEALTH AND HOSPICE OF VIDALIA, INC.
     ABC HOME HEALTH AND HOSPICE OF WAYCROSS, INC.
     ABC HOME NURSING, INC.
     ABC NEWCO, INC.
     ABC PHARMACEUTICALS, INC.
     ALABAMA SENIOR LIFE CARE, INC.
     ALPINE MANOR, INC.
     ARBOR LIVING CENTERS OF FLORIDA, INC.
     ARBOR LIVING CENTERS OF TEXAS, INC.
     ASIA CARE, INC.
     BETHAMY LIVING CENTER MANAGEMENT COMPANY
     BETHAMY LIVING CENTERS LIMITED PARTNERSHIP
     BRIAR HILL, INC.
     BRIARCLIFF NURSING HOME, INC.
     CAMBRIDGE CARE CENTERS, INC.
     CAMBRIDGE GROUP OF INDIANA, INC.
     CAMBRIDGE GROUP OF PENNSYLVANIA, INC.
     CAMBRIDGE GROUP OF TEXAS, INC.
     CARE CENTERS HOLDING, INC.
     CARRIAGE-BY-THE-LAKE OF IHS, INC.
     CEDARCROFT HEALTH SERVICES, INC.
     CENTRAL PARK LODGES, INC.
     CENTRAL PARK LODGES OF WEST PALM BEACH, INC.
     CENTRAL PARK LODGES (TARPON SPRINGS), INC.
     CLARA BURKE NURSING HOME, INC.
     CLAREMONT INTEGRATED HEALTH, INC.
     COMPREHENSIVE POSTACUTE SERVICES, INC.
     DERRY INTEGRATED HEALTH, INC.
     ELIZABELL CO., INC.







                                        2

     ELM CREEK OF IHS, INC.
     F.L.C. BENEVA NURSING PAVILION, INC.
     F.L.C. SARASOTA NURSING PAVILION, INC.
     FERRIGAN MOBILE X-RAY, INC.
     FIRELANDS OF IHS, INC.
     FIRST AMERICAN HOME CARE OF ALABAMA, INC.
     FIRST AMERICAN HOME CARE OF ARKANSAS, INC.
     FIRST AMERICAN HOME CARE OF CALIFORNIA, INC.
     FIRST AMERICAN HOME CARE OF COLORADO, INC.
     FIRST AMERICAN HOME CARE OF FLORIDA, INC.
     FIRST AMERICAN HOME CARE OF FT. LAUDERDALE, INC.
     FIRST AMERICAN HOME CARE OF GEORGIA, INC.
     FIRST AMERICAN HOME CARE OF ILLINOIS, INC.
     FIRST AMERICAN HOME CARE OF INDIANA, INC.
     FIRST AMERICAN HOME CARE OF LOUISIANA, INC.
     FIRST AMERICAN HOME CARE OF MICHIGAN, INC.
     FIRST AMERICAN HOME CARE OF MISSISSIPPI, INC.
     FIRST AMERICAN HOME CARE OF MISSOURI, INC.
     FIRST AMERICAN HOME CARE OF NAPLES, INC.
     FIRST AMERICAN HOME CARE OF NEBRASKA, INC.
     FIRST AMERICAN HOME CARE OF NEW MEXICO, INC.
     FIRST AMERICAN HOME CARE OF NORTH CAROLINA, INC.
     FIRST AMERICAN HOME CARE OF OHIO, INC.
     FIRST AMERICAN HOME CARE OF OKLAHOMA, INC.
     FIRST AMERICAN HOME CARE OF PENNSYLVANIA, INC.
     FIRST AMERICAN HOME CARE OF SOUTH CAROLINA, INC.
     FIRST AMERICAN HOME CARE OF TENNESSEE, INC.
     FIRST AMERICAN HOME CARE OF TEXAS, INC.
     FIRST AMERICAN HOME CARE OF VALDOSTA, INC.
     FIRST AMERICAN HOME CARE OF VIRGINIA, INC.
     FIRST AMERICAN HOME CARE OF WEST VIRGINIA, INC.
     FIRST AMERICAN INTERNATIONAL, INC.
     FLORIDA LIFE CARE, INC.
     GAINESVILLE HEALTH CARE CENTER, INC.
     GRAVOIS HEALTH CARE, INC.
     HEALTH CARE SYSTEMS, INC.
     HOME HEALTH INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT I, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF DISTRICT VII-B, INC.
     HOSPICE INTEGRATED HEALTH SERVICES OF FLORIDA, INC.
     HOSPICE OF INTEGRATED HEALTH SERVICES, INC.
     IHS ACQUISITION XIII, INC.
     IHS ACQUISITION XV, INC.
     IHS ACQUISITION XVIII, INC.








                                        3

     IHS ACQUISITION XIX, INC.
     IHS ACQUISITION XXII, INC.
     IHS AT LANSING, INC.
     IHS CHICAGO POST-ACUTE NETWORK, INC.
     IHS DEVELOPMENT-HIGHLANDS PARK, INC.
     IHS HOME CARE, INC.
     IHS LAND ACQUISITION-HIGHLANDS PARK, INC.
     IHS MANAGEMENT GROUP, INC.
     IHS NETWORK SERVICES, INC.
     IHS OF DANA, INC.
     IN-HOME HEALTH CARE, INC.
     INTEGRACARE, INC.
     INTEGRATED-BALLARD, INC.
     INTEGRATED HEALTH GROUP LIMITED PARTNERSHIP
     INTEGRATED HEALTH OF LOCUST VALLEY ROAD, INC.
     INTEGRATED HEALTH OF WATERFORD COMMONS, INC.
     INTEGRATED HEALTH SERVICES AT ALEXANDRIA, INC.
     INTEGRATED HEALTH SERVICES AT BIG SAIL, INC.
     INTEGRATED HEALTH SERVICES AT BLUE RIDGE MANOR, INC.
     INTEGRATED HEALTH SERVICES AT BRIARCLIFF HAVEN, INC.
     INTEGRATED HEALTH SERVICES AT CADIZ, INC.
     INTEGRATED HEALTH SERVICES AT CENTRAL FLORIDA, INC.
     INTEGRATED HEALTH SERVICES AT CHEYENNE, INC.
     INTEGRATED HEALTH SERVICES AT COLORADO SPRINGS, INC.
     INTEGRATED HEALTH SERVICES AT COLUMBUS, INC.
     INTEGRATED HEALTH SERVICES AT DAYTON, INC.
     INTEGRATED HEALTH SERVICES AT DRIFTWOOD, INC.
     INTEGRATED HEALTH SERVICES AT EASTERN MASSACHUSETTS, INC.
     INTEGRATED HEALTH SERVICES AT GRANDVIEW CARE CENTER, INC.
     INTEGRATED HEALTH SERVICES AT GREAT BEND, INC.
     INTEGRATED HEALTH SERVICES AT HIGHLANDS PARK, INC.
     INTEGRATED HEALTH SERVICES AT HOPEDALE, INC.
     INTEGRATED HEALTH SERVICES AT HOUSTON, INC.
     INTEGRATED HEALTH SERVICES AT INDIAN CREEK, INC.
     INTEGRATED HEALTH SERVICES AT KENT, INC.
     INTEGRATED HEALTH SERVICES AT KING DAVID CENTER, INC.
     INTEGRATED HEALTH SERVICES AT NEWARK, INC.
     INTEGRATED HEALTH SERVICES AT ORMOND BEACH, INC.
     INTEGRATED HEALTH SERVICES AT PARK REGENCY, INC.
     INTEGRATED HEALTH SERVICES AT PENN, INC.
     INTEGRATED HEALTH SERVICES AT SILVERCREST, INC.
     INTEGRATED HEALTH SERVICES AT SOMERSET VALLEY, INC.
     INTEGRATED HEALTH SERVICES AT SOUTHERN HILLS, INC.
     INTEGRATED HEALTH SERVICES AT STEUBENVILLE
     INTEGRATED HEALTH SERVICES AT SYCAMORE CREEK, INC.






                                        4

     INTEGRATED HEALTH SERVICES AT THREE RIVERS, INC.
     INTEGRATED HEALTH SERVICES AT TREYBURN, INC.
     INTEGRATED HEALTH SERVICES FINANCIAL HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES HOLDINGS, INC.
     INTEGRATED HEALTH SERVICES NPR, INC.
     INTEGRATED HEALTH SERVICES OF ARCADIA, INC.
     INTEGRATED HEALTH SERVICES OF ATHENS, INC.
     INTEGRATED HEALTH SERVICES OF BRENTWOOD, INC.
     INTEGRATED HEALTH SERVICES OF BRUNSWICK, INC.
     INTEGRATED HEALTH SERVICES OF CALIFORNIA, INC.
     INTEGRATED HEALTH SERVICES OF CLIFF MANOR, INC.
     INTEGRATED HEALTH SERVICES OF COLORADO AT CHERRY CREEK, INC.
     INTEGRATED HEALTH SERVICES OF EAGLE CREEK, INC.
     INTEGRATED HEALTH SERVICES OF GREEN BRIAR, INC.
     INTEGRATED HEALTH SERVICES OF HERITAGE MANOR, INC.
     INTEGRATED HEALTH SERVICES OF HICKORY CREEK, INC.
     INTEGRATED HEALTH SERVICES OF INDIAN HILLS, INC.
     INTEGRATED HEALTH SERVICES OF JACKSONVILLE, INC.
     INTEGRATED HEALTH SERVICES OF KURT, INC.
     INTEGRATED HEALTH SERVICES OF LESTER, INC.
     INTEGRATED HEALTH SERVICES OF MELISSA, INC.
     INTEGRATED HEALTH SERVICES OF MISSOURI, INC.
     INTEGRATED HEALTH SERVICES OF ORANGE PARK, INC.
     INTEGRATED HEALTH SERVICES OF RIVERBEND, INC.
     INTEGRATED HEALTH SERVICES OF SCENIC HILLS, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW, INC.
     INTEGRATED HEALTH SERVICES OF SKYVIEW II, INC.
     INTEGRATED HEALTH SERVICES OF SUNSET, INC.
     INTEGRATED MANAGED CARE, INC. (formerly Isabeth Co., Inc.)
     INTEGRATED MANAGEMENT-GOVERNOR'S PARK, INC.
     INTEGRATED OF AMARILLO, INC.
     INTEGRATED PHYSICIAN GROUP SERVICES, INC.
     J.R. REHAB ASSOCIATES, INC.
     LIFEWAY, INC.
     LPC BETHAMY HEALTH CORPORATION, L.P.
     MANCHESTER INTEGRATED HEALTH, INC.
     MOBILE RAY OF NEW ORLEANS, INC.
     MOUNTAIN VIEW NURSING CENTER, INC.
     NEW SOUTHWOOD ASSOCIATES, INC.
     PALESTINE NURSING CENTER, INC.
     PINELLAS PARK NURSING HOME, INC.
     PREFERRED HOME HEALTH SERVICES, INC.
     PROFESSIONAL REVIEW NETWORK, INC.
     REHAB MANAGEMENT SYSTEMS, INC.
     REST HAVEN NURSING CENTER, INC.






                                        5

     REST HAVEN NURSING CENTER (CHESTNUT HILL), INC.
     REST HAVEN NURSING CENTER (WHITEMARSH), INC.
     RIKAD PROPERTIES, INC.
     SAMARITAN CARE, INC. (Illinois Domestic)
     SAMARITAN CARE, INC. (Michigan Domestic)
     SAMARITAN MANAGEMENT, INC.
     SHC OF ARIZONA, L.C.
     SHC SERVICES OF ARIZONA, L.C.
     SIGNATURE HOME CARE GROUP, INC.
     SIGNATURE HOME CARE, INC.
     SIGNATURE HOME CARE OF ARLINGTON, INC.
     SIGNATURE HOME CARE OF FLORIDA, INC.
     SIGNATURE HOME CARE OF GEORGIA, INC.
     SIGNATURE HOME CARE OF KANSAS, INC.
     SIGNATURE HOME CARE OF NEW JERSEY, INC.
     SIGNATURE HOME CARE OF NEW JERSEY GENERAL PARTNERSHIP
     SIGNATURE HOME CARE OF SAN ANTONIO, INC.
     SIGNATURE HOME CARE SERVICES OF FLORIDA, INC.
     SIGNATURE HOME CARE SERVICES OF SAN ANTONIO, INC.
     SIGNATURE MANAGEMENT SERVICES, INC.
     SIGNATURE RECEIVABLES CORP.
     SLC COMMUNITY CARE, INC.
     SOUTHWOOD HOLDINGS, INC.
     SPRING CREEK OF IHS, INC.
     SYMPHONY ANCILLARY SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 1, INC.
     SYMPHONY DIAGNOSTIC SERVICES NO. 2, INC.
     SYMPHONY HEALTH CARE CONSULTING, INC.
     SYMPHONY HEALTH SERVICES, INC.
     SYMPHONY HOME CARE SERVICES, INC.
     SYMPHONY HOME CARE SERVICES NO. 1, INC.
     SYMPHONY HOME CARE SERVICES NO. 2, INC.
     SYMPHONY HOME CARE SERVICES NO. 3, INC.
     SYMPHONY HOME CARE SERVICES NO. 4, INC.
     SYMPHONY HOME CARE SERVICES NO. 5, INC.
     SYMPHONY HOME CARE SERVICES NO. 6, INC.
     SYMPHONY HOME CARE SERVICES NO. 7, INC.
     SYMPHONY HOME CARE SERVICES NO. 8, INC.
     SYMPHONY HOME CARE SERVICES NO. 9, INC.
     SYMPHONY HOME CARE SERVICES NO. 10, INC.
     SYMPHONY HOME CARE SERVICES NO. 11, INC.
     SYMPHONY HOME CARE SERVICES NO. 12, INC.
     SYMPHONY HOME CARE SERVICES NO. 13, INC.
     SYMPHONY HOME CARE SERVICES NO. 14, INC.






                                        6

     SYMPHONY HOME CARE SERVICES NO. 15, INC.
     SYMPHONY HOME CARE SERVICES NO. 16, INC.
     SYMPHONY HOME CARE SERVICES NO. 17, INC.
     SYMPHONY HOME CARE SERVICES NO. 18, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- CALIFORNIA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- LOUISIANA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- OKLAHOMA, INC.
     SYMPHONY HOME CARE SERVICES NO. 18- TEXAS. INC.
     SYMPHONY HOME CARE SERVICES NO. 19, INC.
     SYMPHONY HOME CARE SERVICES NO. 100, INC.
     SYMPHONY HOME CARE SERVICES NO. 101, INC.
     SYMPHONY HOME CARE SERVICES NO. 102, INC.
     SYMPHONY HOME CARE SERVICES NO. 103, INC.
     SYMPHONY HOME CARE SERVICES NO. 104, INC.
     SYMPHONY HOME CARE SERVICES NO. 105, INC.
     SYMPHONY HOME CARE SERVICES NO. 106, INC.
     SYMPHONY HOME CARE SERVICES NO. 107, INC.
     SYMPHONY HOME CARE SERVICES NO. 108, INC.
     SYMPHONY HOME CARE SERVICES NO. 109, INC.
     SYMPHONY HOME CARE SERVICES NO. 110, INC.
     SYMPHONY HOME CARE SERVICES NO. 113, INC.
     SYMPHONY HOME CARE SERVICES NO. 114, INC.
     SYMPHONY HOME CARE SERVICES NO. 115, INC.
     SYMPHONY HOME CARE SERVICES NO. 116, INC.
     SYMPHONY HOME CARE SERVICES NO. 117, INC.
     SYMPHONY HOME CARE SERVICES NO. 118, INC.
     SYMPHONY HOME CARE SERVICES NO. 119, INC.
     SYMPHONY HOME CARE SERVICES NO. 120, INC.
     SYMPHONY HOME CARE SERVICES NO. 121, INC.
     SYMPHONY HOME CARE SERVICES NO. 122, INC.
     SYMPHONY REHABILITATION SERVICES, INC.
     SYMPHONY REHABILITATION SERVICES NO. 1, INC.
     SYMPHONY REHABILITATION SERVICES NO. 2, INC.
     SYMPHONY REHABILITATION SERVICES NO. 3, INC.
     SYMPHONY REHABILITATION SERVICES NO. 4, INC.
     SYMPHONY RESPIRATORY SERVICES, INC.
     TEXAS LPC, INC.
     





                                        7

     THE BESTON CORPORATION
     WEST COAST CAMBRIDGE, INC.
     WOODRIDGE CONVALESCENT CENTER, INC.


     By: /s/ 
        -------------------------------------
        Name:
        Title:
             of Each Guarantor or of the
             General Partner of such Guarantor