MANOR CARE INC/NEW
SC 13D/A, 1998-05-06
SKILLED NURSING CARE FACILITIES
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                                  UNITED STATES
                       SECURITIES AND EXCHANGE COMMISSION
                             Washington, D.C. 20549

                                  SCHEDULE 13D
                    Under the Securities Exchange Act of 1934

                               (Amendment No. 4)*

                        Vitalink Pharmacy Services, Inc.
- --------------------------------------------------------------------------------
                                (Name of Issuer)

                     Common Stock, par value $.01 per share
- --------------------------------------------------------------------------------
                         (Title of Class of Securities)

                                    92846E104
- --------------------------------------------------------------------------------
                                 (CUSIP Number)

         James H. Rempe, Esq.                      Copy to:
         Senior Vice President,
             General Counsel & Secretary           W. Leslie Duffy, Esq.
         Manor Care, Inc.                          Cahill Gordon & Reindel
         11555 Darnestown Road                     80 Pine Street
         Gaithersburg, Maryland 20878              New York, New York 10005
         (301) 979-4000                            (212) 701-3000
- --------------------------------------------------------------------------------
       (Name, Address and Telephone Number of Person Authorized to Receive
                          Notices and Communications)

                                 April 26, 1998
- --------------------------------------------------------------------------------
                     (Date of Event which Requires Filing of this Statement)

If the filing person has previously  filed a statement on Schedule 13G to report
the  acquisition  which is the subject of this  Schedule 13D, and is filing this
schedule because of Sections 240.13d-1(e),  240.13d-1(f) or 240.13d-1(g),  check
the following box / /.

Note:  Schedules  filed in paper format shall include a signed original and five
copies of the schedule,  including all exhibits.  See Section  240.13d-7(b)  for
other parties to whom copies are to be sent.

*The  remainder of this cover page shall be filled out for a reporting  person's
initial  filing on this form with respect to the subject to the subject class of
securities,  and for any subsequent amendment containing information which would
alter disclosures provided in a prior cover page.

The information required on the remainder of this cover page shall not be deemed
to be "filed" for the purpose of Section 18 of the  Securities  Exchange  Act of
1934 ("Act") or otherwise  subject to the liabilities of that section of the Act
but  shall be  subject  to all other  provisions  of the Act  (however,  see the
Notes).


                               Page 1 of 5 pages
                         Exhibit Index begins on Page 5

<PAGE>



                                  SCHEDULE 13D

- --------------------------------------------------------------------------------

CUSIP No. 92846E104               Page 2  of 5 Pages

- --------------------------------------------------------------------------------

1     NAME OF REPORTING PERSON
      I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON (ENTITIES ONLY)

      Manor Care, Inc.                                IRS No. 52-1200376
- --------------------------------------------------------------------------------

2     CHECK THE APPROXIMATE BOX IF A MEMBER OF A GROUP*    (a) / /
                                                           (b) / /

- --------------------------------------------------------------------------------

3     SEC USE ONLY

- --------------------------------------------------------------------------------

4     SOURCE OF FUNDS*

      PF, WC, BK
- --------------------------------------------------------------------------------

5     CHECK IF DISCLOSURE OF LEGAL PROCEEDINGS IS REQUIRED                     
      PURSUANT TO ITEMS 2(d) or 2(e)                              / /

- --------------------------------------------------------------------------------

6     CITIZENSHIP OR PLACE OF ORGANIZATION

      Delaware
- --------------------------------------------------------------------------------


                         7         SOLE VOTING POWER
    NUMBER OF                      0
      SHARES           ---------------------------------------------------------
   BENEFICIALLY          8         SHARED VOTING POWER
     OWNED BY                      13,000,000
       EACH            ---------------------------------------------------------
    REPORTING
   PERSON WITH           9         SOLE DISPOSITIVE POWER
                                   0
                       ---------------------------------------------------------

                         10        SHARED DISPOSITIVE POWER
                                   13,000,000

- --------------------------------------------------------------------------------

11    AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON

- --------------------------------------------------------------------------------
      13,000,000
- --------------------------------------------------------------------------------

12    CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES
      CERTAIN SHARES*                                             / /

- --------------------------------------------------------------------------------

13    PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
      49.8%
- --------------------------------------------------------------------------------

14    TYPE OF REPORTING PERSON*
      HC, CO
- --------------------------------------------------------------------------------
                      *SEE INSTRUCTIONS BEFORE FILLING OUT!
          INCLUDE BOTH SIDES OF THE COVER PAGE, RESPONSES TO ITEMS 1-7
      (INCLUDING EXHIBITS) OF THE SCHEDULE, AND THE SIGNATURE ATTESTATION.

                               Page 2 of 5 Pages

<PAGE>

         This  Amendment  No. 4 to Schedule  13D is being filed to amend Items 4
and 6 of the Schedule 13D.


Item 4.  Purpose of Transaction

         Item 4 is hereby amended and restated as follows:

         On April  26,  1998,  Vitalink  Pharmacy  Services,  Inc.,  a  Delaware
corporation (the  "Company"),  entered into an Agreement and Plan of Merger (the
"Merger   Agreement")  with  Genesis  Health  Ventures,   Inc.,  a  Pennsylvania
corporation ("Genesis"), and The Acquisition Corporation, a Delaware corporation
and a wholly owned subsidiary of Genesis ("Acquisition  Corporation").  Pursuant
to the Merger  Agreement,  the Company will merge (the  "Merger")  with and into
Acquisition  Corporation and Acquisition Corporation will survive the Merger. In
accordance  with the Merger  Agreement,  holders of the common stock,  par value
$.01 per share (the "Common Stock"),  of the Company will receive for each share
of Common Stock held, at the election of the holder,  either cash  consideration
in the amount of $22.50 or 0.045  shares of  convertible  preferred  stock,  par
value $.01 per share, of Genesis.

Item 6.  Contracts,  Arrangements,  Understandings or Relationships with Respect
         to Securities of the Issuer

         Item 6 is hereby amended and restated as follows:

         In connection with the Merger  Agreement,  Manor Care, Inc., a Delaware
corporation  ("Manor Care"),  and ManorCare Health  Services,  Inc., a Delaware
corporation and a wholly owned subsidiary of Manor Care ("ManorCare Health" and,
together with Manor Care, the  "Stockholders"),  entered into a voting agreement
(the "Voting Agreement"),  dated as of April 26, 1998, with Genesis with respect
to the  13,000,000  shares of Common Stock held by them.  Pursuant to the Voting
Agreement,  the Stockholders agreed, among other things, to vote their shares of
Common Stock and granted the Company an  irrevocable  proxy to vote their shares
of Common Stock (a) in favor of the  adoption  and  approval of the Merger,  the
Merger  Agreement  and the  transactions  contemplated  thereby  and (b) against
certain  competing  transactions   described  in  such  Voting  Agreement.   The
Stockholders  also agreed not to sell or  otherwise  dispose of their  shares of
Common Stock,  tender any such shares  pursuant to a tender or exchange offer or
grant any person  other than the  Company a proxy to vote such  shares of Common
Stock.

Item 7.  Materials to Be Filed as Exhibits

         Exhibit 1  Voting Agreement dated April 26, 1998 among Genesis
                    Health Ventures, Inc., Manor Care, Inc. and ManorCare Health
                    Services, Inc.


                               Page 3 of 5 Pages
<PAGE>


                                    SIGNATURE

         After reasonable  inquiry and to the best of my knowledge and belief, I
certify that the information  set forth in this statement is true,  complete and
correct.

May 1, 1998                                    MANOR CARE, INC.



                                               By: /s/ James H. Rempe
                                                  ------------------------------
                                                  Name:  James H. Rempe
                                                  Title:   Senior Vice President



                               Page 4 of 5 Pages


<PAGE>


                                  EXHIBIT INDEX

Exhibit      Description
- -------      -----------

1            Voting Agreement dated April 26, 1998 among Genesis Health 
             Ventures, Inc., Manor Care, Inc. and ManorCare Health 
             Services, Inc.





                               Page 5 of 5 Pages

                                                                       EXHIBIT 1

                                VOTING AGREEMENT

                  VOTING   AGREEMENT,   dated  as  of  April  26,   1998   (this
"Agreement"),  among GENESIS HEALTH VENTURES,  INC., a Pennsylvania  corporation
("Purchaser"),  MANOR CARE,  INC., a Delaware  corporation and MANORCARE  HEALTH
SERVICES, INC., a Delaware corporation  (collectively,  the "Stockholders",  and
each, individually, a "Stockholder").

                  WHEREAS,   Purchaser   and  its  newly  formed   wholly  owned
subsidiary ("Newco") have entered into an Agreement and Plan of Merger, dated as
of the date hereof (the "Merger  Agreement"),  with Vitalink Pharmacy  Services,
Inc., a Delaware  corporation (the "Company"),  which Merger Agreement provides,
among other things,  that the Company will merge with and into Newco pursuant to
the merger contemplated by the Merger Agreement (the "Merger"); and

                  WHEREAS,  as of the date hereof,  the  Stockholders  own (both
beneficially  and of record) the number and class of shares of Common Stock, par
value $.01 per share, of the Company ("Company Common Stock") set forth opposite
their respective names on the signature pages of this Agreement; and

                  WHEREAS, as a condition to entering into the Merger Agreement,
Purchaser  requires the Stockholders to enter into this Agreement  governing the
voting and  disposition  of such  number of shares of Company  Common  Stock now
owned  by the  Stockholders  and so  indicated  on the  signature  pages of this
Agreement and which may hereafter be acquired by any of the Stockholders (all of
the shares of Company Common Stock, such shares, collectively, the "Shares").

                  NOW,  THEREFORE,  in  consideration  of the  foregoing and the
mutual covenants and agreements  contained  herein,  and intending to be legally
bound hereby, the parties hereto hereby agree as follows:

                  1.     Voting of Shares.  Each  Stockholder  shall,  until the
Termination Date (as hereinafter defined),  cause the Shares it owns to be voted
at any meeting of the  stockholders  of the Company or in any consent in lieu of
such a meeting (i) in favor of adoption and approval of the Merger Agreement and
the Merger and the terms thereof and each of the other actions  contemplated  by
the Merger  Agreement;  (ii) against any other  action or agreement  that would,
directly or indirectly,  result in (A) any extraordinary  corporate transaction,
such as a merger,  consolidation  or other  business  combination  involving the
Company or its subsidiaries;  (B) a sale, lease or transfer of a 


<PAGE>
                                      -2-


material   amount  of  assets  of  the   Company  or  its   subsidiaries   or  a
reorganization,   recapitalization   or   liquidation  of  the  Company  or  its
subsidiaries;  (C) an election of new members to the board of  directors  of the
Company, except where the vote is cast in favor of the nominees of a majority of
the  existing  directors  of the  Company;  or (D) any  transaction  that  could
reasonably be expected to materially  delay or postpone the  consummation of the
Merger or cause a  material  breach by the  Company  of any  covenant  under the
Merger Agreement and (iii) against any action,  agreement or transaction that is
intended or could  reasonably  be expected (A) to facilitate a person other than
the Purchaser in acquiring the Company or (B) to impede,  interfere with, delay,
postpone,  discourage or materially  adversely  affect the  consummation  of the
Merger  (any of the  foregoing  in clause  (ii) or clause  (iii),  a  "Competing
Transaction").

                  The Stockholders  shall elect to receive  Preferred Stock with
respect  to all of the  shares  of  Company  Common  Stock  owned by  them.  The
Stockholders shall not seek to assert any appraisal rights.

                  2.     Irrevocable  Proxy. Each Stockholder hereby irrevocably
appoints  Purchaser,  until the  Termination  Date,  as its  attorney  and proxy
pursuant to the  provisions of Section 212 of the Delaware  General  Corporation
Law with full  power of  substitution,  to vote and  otherwise  act (by  written
consent or  otherwise) in  accordance  with the  provisions of Section 1 of this
Agreement with respect to the Shares which each  Stockholder is entitled to vote
at any meeting of the stockholders of the Company (whether annual or special and
whether or to an adjourned or postponed meeting) or in respect of any consent in
lieu of any such  meeting  or  otherwise.  This proxy and power of  attorney  is
irrevocable and coupled with an interest in favor of Purchaser.  The Stockholder
will take such  further  action or  execute  such  other  instruments  as may be
reasonably  necessary to effectuate the intent of this proxy.  Each  Stockholder
hereby  revokes all other  proxies and powers of  attorney  with  respect to the
Shares  which it may have  heretofore  appointed or granted,  and no  subsequent
proxy or power of attorney  shall be given or written  consent  executed (and if
given or  executed,  shall not be  effective)  by the  Stockholder  with respect
thereto.

                  3.     Limitation on  Disposition  or  Encumbrance  of Shares.
Each  Stockholder  hereby  covenants and agrees that,  except as contemplated by
this Agreement,  the Stockholder shall not, and shall not offer or agree to, (i)
sell, transfer,  tender, assign,  hypothecate or otherwise dispose of, or create
or permit to exist any security interest,  lien, claim, pledge, op-

<PAGE>
                                      -3-


tion, right of first refusal, agreement,  limitation on the Stockholder's voting
rights, charge or other encumbrance of any nature whatsoever with respect to the
Shares, (ii) tender any shares of Company Common Stock pursuant to any tender or
exchange  offer,  or (iii)  grant any  person a proxy or other  right to vote or
direct the vote of any shares of Company Common Stock, except in order to comply
with Section 2; provided, however, that a Stockholder may transfer the Shares to
Mars,  to New ManorCare  Health  Services,  Inc., or to any of their  respective
wholly owned  subsidiaries if such transferee agrees to be bound by the terms of
this Agreement.

                  4.     No Solicitation.  (a) Each of the  Stockholders  agrees
that it shall not,  directly or indirectly,  (x) solicit,  initiate or knowingly
facilitate or encourage  (including by way of furnishing or disclosing nonpublic
information)  any  inquiries  or the  making  of any  offer or  proposal  by any
corporation,  partnership,  trust,  person  or other  entity  or group (a "Third
Party")  with  respect  to, or that could  reasonably  be expected to lead to, a
Competing Transaction or (y) negotiate,  explore or otherwise communicate in any
way with any Third  Party with  respect to any  Competing  Transaction  or enter
into, approve or recommend any agreement, arrangement or understanding requiring
it to  abandon,  terminate  or  fail  to  consummate  the  Merger  or any  other
transactions contemplated by this Agreement.

                  (b)    Each  of the  Stockholders  shall,  by  the  end of the
business day following  receipt  thereof (i) promptly  notify the other party of
receipt by it of any inquiries,  proposals or offers with respect to a Competing
Transaction or any request for nonpublic  information relating to the Company in
connection with a Competing Transaction or for access to the Company's or any of
its Subsidiaries'  properties,  books or records by any third party that informs
its Board of Directors that such third party is considering making, or has made,
a proposal or offer with  respect to a Competing  Transaction,  and  indicate in
reasonable  detail  the  identity  of  the  party  making  the  competing  offer
(including  the name of such  party)  and the terms and  conditions  of any such
proposal  or offer and (ii)  immediately  cease and cause to be  terminated  any
existing  activities,  discussions or  negotiations  with any parties  conducted
heretofore with respect to any of the foregoing,  and it will take the necessary
steps to inform such  individuals or entities of the  obligations  undertaken in
this Section 4.

                  5.     Legend on Certificates.  The certificate(s)  evidencing
the Shares shall, prior to any transfer of such certificates, be endorsed with a
restrictive legend substantially as follows:


<PAGE>

                                      -4-

         THE  SHARES  EVIDENCED  BY THIS  CERTIFICATE  ARE  SUBJECT  TO A VOTING
         AGREEMENT  DATED AS OF APRIL 26,  1998  BETWEEN THE  REGISTERED  HOLDER
         HEREOF AND GENESIS HEALTH VENTURES, INC., A COPY OF WHICH IS ON FILE AT
         THE PRINCIPAL OFFICE OF THE COMPANY. THE HOLDER OF THIS CERTIFICATE, BY
         ITS  ACCEPTANCE  HEREOF,  AGREES  TO BE BOUND BY ALL THE  TERMS OF SUCH
         AGREEMENT, AS THE SAME IS IN EFFECT FROM TIME TO TIME.

                  6.     Representations  and  Warranties  of the  Stockholders.
Each Stockholder hereby severally represents and warrants with respect to itself
and its ownership of the Shares to Purchaser as follows:

                  a.     Authority  Relative to this Agreement.  The Stockholder
has all necessary power and authority to execute and deliver this Agreement,  to
perform  its   obligations   hereunder  and  to  consummate   the   transactions
contemplated  hereby.  The  execution  and  delivery  of this  Agreement  by the
Stockholder  and  the  consummation  by  the  Stockholder  of  the  transactions
contemplated  hereby  have been duly and  validly  authorized  by all  necessary
corporate  action on the part of the  Stockholder.  This Agreement has been duly
and validly  executed and  delivered by the  Stockholder  and,  assuming the due
authorization,  execution and delivery by Purchaser,  constitutes a legal, valid
and binding obligation of the Stockholder,  enforceable  against the Stockholder
in accordance with its terms,  except that such enforceability may be limited by
bankruptcy,  insolvency,  reorganization,  moratorium,  fraudulent conveyance or
other similar laws affecting creditors' rights generally.

                  b.     Conflict.  The execution and delivery of this Agreement
by the  Stockholder  does not,  and the  performance  of this  Agreement  by the
Stockholder will not, (i) require any consent, approval, authorization or permit
of, or filing with (other than as required under the Securities  Exchange Act of
1934, as amended) or notification to any  governmental or regulatory  authority,
domestic  or  foreign,   (ii)  conflict  with  or  violate  the  Certificate  of
Incorporation,  By-laws or other  organizational  documents of the  Stockholder,
(iii) conflict with or violate any law,  rule,  regulation,  order,  judgment or
decree  applicable to the  Stockholder  or by which any property or asset of the
Stockholder  is bound,  or (iv) result in any breach of or  constitute a default
(or an event which with notice or lapse of time or both would  become a default)
under,  or give to others any right of termination,  amendment,  acceleration or
cancellation of, or result in the creation of a lien or other encumbrance of any
nature  whatsoever on any property or asset of the Stockholder  pursuant to, any
note, bond, mortgage,  indenture,  

<PAGE>


                                      -5-

contract,  agreement,  lease, license,  permit, franchise or other instrument or
obligation to which the  Stockholder  is a party or by which the  Stockholder or
any property or asset of the Stockholder is bound, in each case, except as would
not materially impair the ability of the Stockholder to perform hereunder.

                  c.     Title to the Shares. The shares of Company Common Stock
owned by the Stockholder as identified on the signature pages hereto are all the
securities  of the  Company  owned,  either of record  or  beneficially,  by the
Stockholder.  The Stockholder  owns all such shares of Company Common Stock free
and clear of all security interests,  liens, claims, pledges, options, rights of
first  refusal,  agreements,  limitations  on the  Stockholder's  voting rights,
charges and other encumbrances of any nature whatsoever, and, except pursuant to
this Agreement,  the  Stockholder has not appointed or granted any proxy,  which
appointment or grant is still effective, with respect to any of the Shares.

                  7.     Representations and Warranties of Purchaser.  Purchaser
hereby  represents  and  warrants to the  Stockholders  that  Purchaser  has all
necessary  power and  authority  to execute and deliver  this  Agreement  and to
perform its obligations  hereunder.  The execution,  delivery and performance of
this Agreement by Purchaser have been duly authorized by all necessary corporate
action  on the part of  Purchaser.  This  Agreement  has been  duly and  validly
executed  and  delivered  by  Purchaser  and,  assuming  the due  authorization,
execution  and  delivery by the  Stockholders,  constitutes  a legal,  valid and
binding obligation of Purchaser enforceable in accordance with its terms, except
that  such   enforceability   may  be   limited   by   bankruptcy,   insolvency,
reorganization,   moratorium,   fraudulent  conveyance  or  other  similar  laws
affecting creditors' rights generally.

                  8.     Certain Events. In the event of any stock split,  stock
dividend,  merger,  reorganization,  recapitalization  or  other  change  in the
capital  structure of the Company  affecting the Company  Common  Stock,  or the
acquisition  of additional  shares of Company  Common Stock by the  Stockholder,
this  Agreement and the  obligations  hereunder  shall attach to any  additional
shares of Company Common Stock or other voting  securities of the Company issued
to or  acquired  by the  Stockholder.  In  the  event  of a  stock  dividend  or
distribution,  or any  change  in  Company  Common  Stock by reason of any stock
dividend,  split-up,  recapitalization,  combination,  exchange of shares or the
like,  the term  "Shares"  shall be deemed to refer to and include the Shares as
well as all such stock dividends and  distributions and any shares into which or
for which any or all of the Shares may be changed or exchanged.
<PAGE>

                                      -6-

                  9.     Termination  of  Agreement.  For the  purposes  of this
Agreement,  "Termination  Date" shall mean the  earliest of (i) the date that is
twelve  months after the date of  termination  of the Merger  Agreement  for any
reason  (other than pursuant to Section  10.01(a) of the Merger  Agreement or by
the Company  pursuant to Section  10.01(i) of the Merger  Agreement)  if, at the
time of such termination,  an Acquisition  Transaction (as defined in the Merger
Agreement)  has been  commenced  or  communicated  to the  Company  or  publicly
proposed or disclosed (other than such an Acquisition Transaction which has been
permanently  abandoned  or  withdrawn  by the  other  party  thereto);  or  (ii)
immediately  upon termination of the Merger Agreement by the Company pursuant to
Section 10.01(i) of the Merger Agreement;  or (iii) immediately upon termination
of  the  Merger  Agreement  by  the  Purchaser  unless,  at  the  time  of  such
termination,  an Acquisition  Transaction  has been commenced or communicated to
the Company or publicly  proposed or disclosed  (other than such an  Acquisition
Transaction  which has not been permanently  abandoned or withdrawn by the other
party  thereto);  or (iv) on the date  that is three  months  after  the date of
termination  of the Merger  Agreement  by the Company  (other  than  pursuant to
Section  10.01(i)  of  the  Merger  Agreement)  unless,  at  the  time  of  such
termination,  an Acquisition  Transaction  has been commenced or communicated to
the Company or publicly  proposed or disclosed  (other than such an  Acquisition
Transaction  which has not been permanently  abandoned or withdrawn by the other
party thereto); or (v) the termination of this Agreement or the Merger Agreement
by the mutual written agreement of the parties hereto.

                  10.    Indemnification.  Each Stockholder agrees,  jointly and
severally,  to indemnify and hold harmless the  Purchaser,  its  directors,  its
officers who sign the Joint Proxy  Statement/Prospectus  of the  Purchaser,  and
each person,  if any, who  controls the  Purchaser  within the meaning of either
Section  15 of the  Securities  Act of 1933,  as  amended,  or Section 20 of the
Securities  Exchange  Act of 1934,  as  amended,  from and  against  any and all
losses,  claims,  damages and liabilities  (including,  without limitation,  the
legal fees and other expenses  incurred in connection  with any suit,  action or
proceeding  or any claim  asserted)  caused by any untrue  statement  or alleged
untrue   statement   of  a  material   fact   contained   in  the  Joint   Proxy
Statement/Prospectus  (as amended or  supplemented  if the Purchaser  shall have
furnished any amendments or supplements thereto) or any preliminary  prospectus,
or caused by any omission or alleged  omission to state  therein a material fact
required to be stated  therein or necessary to make the  statements  therein not
misleading,  but only with reference to information relating to such Stockholder
furnished by such Stockholder in writing expressly for use therein.


<PAGE>

                                      -7-

                  11.    Miscellaneous.

                  a.     Specific  Performance.  The parties  hereto  agree that
irreparable  damage would occur in the event any provision of this Agreement was
not performed in accordance  with the terms hereof and that the parties shall be
entitled to specific performance of the terms hereof without the requirement for
posting  of a bond,  in  addition  to any  other  remedy to which a party may be
entitled at law or in equity.  Entire Agreement.  This Agreement,  including the
documents and instruments referred to herein,  embodies the entire agreement and
understanding  of the parties hereto in respect of the subject matter  contained
herein and supersedes all prior agreements and understandings  among the parties
with  respect  thereto.  There  are no  representations,  promises,  warranties,
covenants or undertakings by any party,  other than those expressly set forth or
referred to herein and therein.

                  b.     Assignment;  Third Party Beneficiaries.  This Agreement
and all of the provisions  hereof shall be binding upon and inure to the benefit
of the parties hereto and their respective successors and permitted assigns, but
neither this Agreement nor any of the rights, interests or obligations hereunder
shall be assigned by any of the parties hereto without the prior written consent
of the other  parties.  This  Agreement  is not intended to confer any rights or
remedies hereunder upon any third party except as expressly provided herein.

                  c.     Amendment and Modification;  Waiver. This Agreement may
be amended,  modified or supplemented  only by written  agreement  signed by the
parties  hereto.  Any extension of time or waiver of any provision  hereof shall
only be valid if set forth in an  instrument  in writing  signed by the party or
parties  to be bound  thereby.  Any  waiver or  failure  to insist  upon  strict
compliance  with any  provision  hereof  shall not  operate  as a waiver  of, or
estoppel with respect to, any subsequent or other failure.

                  e.     Severability.  The validity or  unenforceability of any
provision of this Agreement shall not affect the validity or  enforceability  of
any other  provision  of this  Agreement,  which shall  remain in full force and
effect.

                  f.     Notices. All notices and other communications hereunder
shall be in writing and shall be delivered  personally,  by next-day  courier or
mailed by registered or certified mail (return receipt  requested),  first-class
postage prepaid, or sent by facsimile, to the parties at the addresses specified

<PAGE>
                                       -8-


below  (or at such  other  address  for a party as shall  be  specified  by like
notice;  provided  that notices of a change of address  shall be effective  only
upon  receipt  thereof).  Any such notice shall be effective  upon  receipt,  if
personally  delivered or  telecommunicated,  one day after delivery to a courier
for next-day  delivery,  or three days after  mailing,  if deposited in the U.S.
mail, first-class postage prepaid.

                  if to Purchaser:

                           Genesis Health Ventures, Inc.
                           148 West State Street
                           Kennett Square, Pennsylvania  19348
                           Attention:  Ira Gubernick
                           Telephone:  (610) 444-6350
                           Telecopy:   (610) 444-3365

                  if to any Stockholder:

                           Manor Care, Inc.
                           11555 Darnestown Road
                           Gaithersburg, Maryland  20878
                           Attention: James H. Rempe
                           Telephone:  (301) 979-4265
                           Telecopy:   (301) 979-4007

                  g.     Governing Law. THIS AGREEMENT SHALL BE GOVERNED BY, AND
CONSTRUED IN ACCORDANCE  WITH,  THE LAWS OF THE STATE OF DELAWARE  APPLICABLE TO
CONTRACTS  EXECUTED  IN AND TO BE  PERFORMED  IN THAT  STATE  WITHOUT  REGARD TO
PRINCIPLES OF CONFLICTS OF LAW.

                  h.     Headings.  The descriptive  headings  contained in this
Agreement are included for convenience of reference only and shall not affect in
any way the meaning or interpretation of this Agreement.

                  i.     Counterparts.  This Agreement may be executed in one or
more counterparts,  each of which shall be deemed to be an original,  but all of
which taken together shall constitute one and the same agreement.

                  j.     Time of the Essence. The parties hereto agree that time
shall be of the essence in the performance of all obligations hereunder.



<PAGE>

                                      -9-

                         VOTING AGREEMENT SIGNATURE PAGE
                         -------------------------------


                  IN WITNESS WHEREOF,  Purchaser and the Stockholders  have duly
executed this Agreement, as of the date first written above.

PURCHASER:
- ---------




By: /s/ Ira C. Gubernick
    --------------------------------------
         Name:  Ira C. Gubernick
         Title: General Counsel --
                Corporate and Secretary






                                                          NUMBER OF SHARES OF 
STOCKHOLDERS:                                             COMMON STOCK OWNED:
- ------------                                              ------------------ 


MANOR CARE, INC.                                                        0


/s/ James H. Rempe
    --------------------------------------
         Name:  James H. Rempe
         Title: 11555 Darnestown Road
                Gaithersburg, Maryland
                20878




MANORCARE HEALTH SERVICES, INC.                                13,000,000


/s/ James H. Rempe
    --------------------------------------
        Name:  James H. Rempe
        Title: 11555 Darnestown Road
               Gaithersburg, Maryland
               20878



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